I am pleased to close this debate for Labour, because this was the party that led the National Health Service (Scotland) Act 1947 through Parliament and brought the service into being on 5 July, 76 years ago next month. That was a huge milestone, but the national health service was certainly not an immaculate conception. I do not know whether anyone has managed to see recent the National Theatre production “Nye”, which shows the hugely fraught process that involved a number of stakeholders and interest groups, which brought the NHS into being.

We should not be complacent about that mythology, but the heart of it is the principle of providing a service that is free at the point of need. There is certainly a consensus about that across this chamber and Labour will always defend that fundamental principle. However, I have found it to be rather ironic that today’s Government motion refers to a commitment to the NHS being

“free at the point of use”

when that Government has presided over the national health service for almost a quarter of its existence in Scotland and has, in the process, allowed a two-tier healthcare system to emerge because of gradual disinvestment.

For example, we can look at the period from 2007 to 2010, when the current First Minister was finance secretary. He failed to pass on Barnett consequentials from the UK Labour Government, which set in train a trajectory of constraint on NHS spending. NHS expenditure per capita was 17 per cent higher in Scotland than it was in England when the SNP Government came into power. Today, it is only 3 per cent higher. That gradual increase in constraint on NHS expenditure has had a ratcheting effect and has caused major problems for healthcare investment here in Scotland.

I do not want to get into using the premise of national income accounting, but that is certainly not the zero-sum game that we are talking about. That is exactly the problem at the heart of the debate—the simplistic analysis that has led us to this position. We know that, when we cut local government spending, that back-loads on to the NHS. For example, cutting programmes in a community leads to greater morbidity and ill health in that community, which then loads on to A and E departments. It is a false accounting exercise.

What we should be focusing on is cost avoidance. Here is an example. We know that people are suffering serious disablement, pain and invalidity in the community, because we can see it in the evidence that 40 per cent of the knee and hip operations that were carried out in Scotland last year were paid for privately, and in the fact that the number of self-paid hospital admissions is up almost 80 per cent from pre-pandemic levels.

Although we have the shared idea that the health service in Scotland must be free, it is certainly not there at the point of need for many Scots. They are suffering in pain for a long time and are having to spend their life savings and to sell assets to fund their wellbeing. That is not sustainable, it is not acceptable and it defies the principles on which the NHS was established.

We have heard some extreme examples today. I was quite struck by Elena Whitham’s talk about ambulances. I have seen that in my casework. For example, a man came home from work to find his father on the floor having a stroke. He waited more than two hours for the ambulance. By the time it came and got his father to hospital, the doctor had to come and break the news that he had waited too long and therefore had a permanent disability.

No. I am sorry.

The man was wracked with guilt that his father might not, had he got him into the car and to the hospital, have suffered long-term disablement. Such things are what we see daily in our health service, which defies the principle on which it was built.

We will not take lectures from the Government on private medical care, which has driven our NHS into the ground. The cynical misrepresentation of discussion about collaboration with innovators and researchers in the private sector or in the universities is completely unacceptable, because it defies the history of the NHS.

Let us look at one example. In fact, one of the greatest achievements in the NHS was a public-private collaboration. In the 1970s, the record label EMI, which was pioneering with the Beatles at the time and earning lots of money through revenues that were generated by their record sales, ploughed money into research at its central research laboratories to develop what became the computed tomography, or CT, scanner. EMI partnered with the then Department for Health and Social Security, which invested £600,000 in the project. Godfrey Hounsfield, who was the chief scientist at EMI and worked in collaboration with the NHS, won the Nobel prize for that work. The CT scanner was built as a legacy of the NHS and a private-public partnership. That is what we are talking about when we refer to bringing in the innovations that we need to improve our healthcare system.

Sue Webber talked about productivity issues in our NHS. That is exactly the sort of thing that we can improve with collaboration and investment, as are operating theatres that are not operating at optimal efficiency, for example. There are medical technology companies in Scotland that have products that can improve the productivity of the NHS, but they are not even getting a look-in at bringing their technologies to bear in the NHS. Those technologies cannot be developed in-house, because they are pioneering, cutting-edge and discrete specialist technologies. Companies across Glasgow and elsewhere in Scotland are offering such opportunities to the NHS, but they are not being brought in. That is what we should be doing to improve our healthcare system.

For 17 years, the NHS budget has been under pressure. However, as has been mentioned, the budgets of local councils up and down the country have also been under pressure, which is leaving health and social care partnerships strapped for cash and unable to fulfil the care needs of the community.

People who work in the care sector are not paid nearly enough to sustain themselves, so they leave the profession, which creates vacancies that continue to back-load pressure on to the healthcare system. That is why we need a new deal for working people that will transform terms and conditions for care workers, including a clear path to £15 an hour pay for care workers.

We recognise the importance of carers and our healthcare staff across the professions. They deserve better.

I thank Alex Rowley for his powerful remarks. As this country spends more than any other developed country on acute hospitals, and the least on preventative community care, those examples are striking. Is it as frustrating to Mr Rowley as it is to me that the Government seems to be incapable of capturing examples of best practice and making them the national standard?

If the First Minister agrees that there is, indeed, a climate emergency, why is the Government’s biggest capital project in Glasgow—rebuilding a 50-year-old motorway viaduct—now estimated at a staggering cost of more than £150 million, with no consultation with my constituents, while it cuts the city’s public transport budget to zero?

Waiting times in accident and emergency departments in Glasgow have been the worst on record this year. Twenty-nine A and E consultants at the Queen Elizabeth university hospital have written to the watchdog to raise serious patient safety concerns, and the Glasgow integration joint board is already proposing cuts, which would create backing up in A and E departments. Given all those pressures, will the cabinet secretary consider the option of extending the opening hours of the minor injuries units at Stobhill hospital and the New Victoria hospital in Glasgow to relieve the pressure on national health service A and E departments?

I am curious as to whether the funds that are raised through the levy will have to be spent in the given financial year or whether there could be scope for a sinking fund to enable larger capital investments to be made in a multiyear programme. Has that been given consideration?

The national shipbuilding strategy refresh was completed in March 2022. One of the key recommendations was to enhance the competitive position of financing for shipbuilding programmes. Although a home shipbuilding credit guarantee scheme has been introduced, there is still not a competitive product range on performance bonds and builders refund guarantees. Will the minister outline what the Scottish Government can do to promote greater competitiveness in shipbuilding financing in Scotland?

I have a practical suggestion. Glasgow City Council has almost £0.5 billion in lender option borrower option—LOBO—loans, which run at rates of about 7 to 9 per cent, which is far higher than the Public Works Loan Board rate. A similar debt renegotiation to that done by Newham London Borough Council could save Glasgow City Council £450 million, or £11 million per year. Could that be an option for the Scottish Government to help broker debt renegotiation, cancellation and amnesties across Scottish local government?

I put on record my thanks to the members and clerks of the Public Audit Committee for their work on this vital and timely report on adult mental health services. I also commend the many witnesses who gave evidence to the committee on this subject matter and contributed valuable insight on all aspects of the mental health landscape.

The committee’s report, and the Audit Scotland report “Adult mental health” before it, have left no doubt: mental health services are in crisis. A sharp increase in demand for support, in part due to the impact of the pandemic and the cost of living crisis, has added further pressure to an already strained service.

However, worsening mental health in the Scottish population is not the fault of the people and we cannot blame an increase in poor mental health alone for the pressure on services. Individuals often have little control over the circumstances that lead to them requiring support. Indeed, they have no control over national or global events such as recessions or pandemics, and we should welcome the fact that more people feel comfortable enough to speak up and seek help when they need it.

Although we know that demand is rising, concerningly, we know only part of the picture. As the committee report says, we need better-quality data to fully understand the scale of demand. At present, data is published on psychological therapies waiting times, but that is largely the only measure of how adult mental health services are performing. There is no measure of quality of care or of outcomes and, as the Audit Scotland report found, that does not amount to sufficient Government oversight over service performance.

We cannot debate the issues around mental health care without considering the workforce crisis in the NHS. Vacancies for mental health nurses have more than doubled between 2017 and 2023. The number of people choosing to study mental health nursing has failed to fill the number of funded places at Scotland’s universities in recent years. In addition, a quarter of consultant psychiatry posts were vacant at the start of this year, with boards spending almost £30 million on locums in 2022-23. Health services can exist and thrive only if we have the staff to deliver them, and urgent action is required from the Government to deliver a recruitment strategy that does not just attract people into mental health care but retains them.

Another concern that is raised in the committee’s report is the ambiguity on how to access support. Although there are local support options, patients and primary care services are not always aware of all the resources or services that are available in their area. With a cluttered landscape of NHS boards, health and social care partnerships, councils and the third sector all providing myriad services, we need to ensure that the suite of support options that are available is communicated simply and clearly.

We also know that, even with many forms of support being available, access to help varies across Scotland. The situation is particularly difficult for people from ethnic minority backgrounds, people in rural areas and people living in poverty. For example, people in the most deprived areas are three times more likely to end up in hospital for mental health issues. That preventable disparity should shame us all.

Both the committee report and the Audit Scotland report reference the Scottish Government’s commitment to ensure that every GP surgery has access to a mental health and wellbeing service by 2026. I think that, across the chamber, we are agreed that support via primary care is crucial. A Scottish Action for Mental Health survey found that six out of 10 people who had tried to access support through their GP or specialist service since 2021 faced challenges or impediments.

The Government’s progress on delivering on mental health and wellbeing services in primary care has been stagnant. That commitment was made in 2021, but in 2024 the services have yet to be fully established. The promise of a primary care and mental health and wellbeing services fund to support delivery never came to pass, despite the health and social care partnerships planning implementation for almost a year. The pledge to recruit an additional 1,000 mental health workers has not been met, either. I think that ministers will understand why we question how they can expect to be taken seriously on mental health policy when their actions since 2021 amount to a string of broken promises.

In the absence of a clear pathway for where to access help, and without the support via primary care that patients were promised, people who need support are not getting the early interventions that they require, and that is loading more cost into the system in the long run. In turn, people are reaching a crisis point, which is having an adverse impact on their health outcomes and on other services. As the committee noted, Police Scotland is now in effect “filling the gaps” in the mental health care system. The chief constable, Jo Farrell, estimated earlier this month that a mental health call comes in every three to four minutes. That is one of the many examples of why we need to shift from responding to crisis to a model of prevention, which enables people to access the support that they need, locally and when they need it, before the issue spirals into something more complicated.

The community link worker programme is proof of the power of community-based social prescribing as a prevention tool. Link workers play a crucial role in providing practical support to help people with their mental health, and it is regrettable that funding for those valuable roles is subject to the ambiguity of short-term annual funding awards. I welcomed the Scottish Government’s intervention to protect the roles of link workers in Glasgow last year, but a sustainable funding model for those roles and other support that is delivered by the third sector must be considered for the longer term.

I sincerely hope that the committee’s report acts as a catalyst for action from the Scottish Government. Regrettably, the mental health budget has been frozen and cut in-year for the past two consecutive years. The psychological therapies target has never been routinely met. The Government is not on track to meet its target of 10 per cent of NHS spend going to mental health. In fact, an £180 million budget shortfall has been estimated.