Chamber and committees

Do I have time to give way?

The bus partnerships may well be making progress, but I do not think that we are seeing good enough progress being made on bundling routes, fare capping, common livery or the critical control of the fare box. Does the minister recognise that those things can come only with activation of chapter 2 of the 2019 act and getting the act fully firing on all cylinders?

With the accessibility of NHS dentistry declining, oral health inequalities are widening and access to dental care, particularly for vulnerable groups such as children and young people, is crucial. What steps is the Government taking to support the recovery and future of oral health improvement programmes, such as the Labour legacy of Childsmile, caring for smiles and mouth matters?

To ask the Scottish Government, regarding its cross-government co-ordination on island connectivity, what discussions the rural affairs secretary has had with ministerial colleagues regarding any impact of the continued delay of vessels 801 and 802 on island communities. (S6O-02296)

The minister will be aware that the connectivity of Scotland’s island communities has been severely hampered by the continued delay to those vessels, which are more than £200 million over budget and five years behind schedule. That does not include the economic impact to those island communities.

What is the Government doing to ensure that Scotland’s shipbuilding industry, which should be a national asset to our island communities as well as to the whole country, is resilient and able to flourish in the future to supply a continuous shipbuilding programme for ferries? Right now, it seems that the Government is content to simply capitulate on a national shipbuilding strategy and award future contracts for Caledonian Maritime Assets Ltd to Turkey. He must surely recognise that that is not sustainable and that we must create a continued shipbuilding programme in Scotland.

I absolutely recognise that. It is a major issue and one that is not well understood. The call for extra data and understanding of that qualitative experience is essential in order for us to ensure that the system works as best it can.

There is not only the issue about facilities and the costs of running equipment—which can be quite energy intensive—particularly in a cost of living crisis; there is also the issue of the complex needs of individuals in the home setting. A very striking exhibition by a series of hospice care providers in Glasgow called “The Cost of Dying” was held at the University of Glasgow. It was quite harrowing to see some of the experiences of people who wanted to die at home—to have a good death—but were prevented from doing so because of the failure of their registered social landlords to make the necessary adaptations to their home, so they ended up languishing in hospital in their final days. That is not acceptable and we need to do much more to ensure that the rights of the patient are upheld. The member for Rutherglen also mentioned that the patient focus is essential.

Also, if someone cannot stay in their home, there may be a role for step-down services. The member for Galloway and West Dumfries mentioned cottage hospitals and how that kind of setting offers a potential opportunity for that, as does having more sheltered accommodation where there is a sort of semi-supervised activity. Certainly, some housing associations are exemplars in providing those facilities. Let us look at how we can build on that capability across Scotland to ensure that the hospital at home concept is better embedded—a need that was recognised by members across the chamber.

Hospital at home might not be as well known as ministers perhaps think it is. Some members certainly alluded to the fact that they were not aware of it prior to today, or have only recently become aware of it. While it is a relatively recent innovation, and one to be welcomed, we need to do more to disseminate the information about how it can function well. That view is often fed back to me, certainly. Particularly when it comes to palliative care, as well, people often do not know their rights and they are so stressed by the situation that they do not realise what they could have achieved for their relative or the person whose care is their responsibility until it was too late and they had already passed away. Therefore, we need to look at that.

We also we need to look at how we build resilience. Mr Doris mentioned the budget of £10.7 million since 2020, but that is set against the fact that, even in Glasgow, as the member will be aware, the integration joint board is facing £20 million of cuts in this financial year alone and has had to dip into its reserves to the tune of £17 million. That is a really shaky peg to be hanging the system on. We need to look at the underlying fragility of the integration joint boards and their ability to step it up, when we are looking at 200 jobs being lost from the IJB service providers in Glasgow alone. That is a major risk to the resilience of the hospital at home system.

We recognise the huge opportunity that presents itself, and that we have one of the most acute hospital-centric healthcare systems among the Organisation for Economic Co-operation and Development countries. We need to move the emphasis out of the hospitals and into the community. We need to look at putting serious resource into that. I would argue that the cabinet secretary has to recognise the need to ramp it up and be serious about it.

That was what my colleague Miss Mochan, a member for South Scotland, meant about the long-term plan. We really need that long-term vision for how the system will develop. We need stable budgeting and the ability for the IJBs to properly plan for the long term, to build those pathways for career development and training, and to increase staff wages, as well, because we are really having a problem with retention and morale. We have heard about the issues of hospices not being able to fully staff their beds. That is just a tip-of-the-iceberg situation; there are huge issues there.

There are also huge issues in the practicalities. Urban settings are one thing, but rural settings are another. A number of members across the chamber have mentioned the practical challenges of managing hospital at home when we are faced with such wide geographical constraints. That needs to be looked at and is something that is essential to be fed back. What will the system look like in a city? What will it look like in a rural setting? It is not a one-size-fits-all thing and it would be good if the minister highlighted some of the challenges faced in those different geographical environments.

There is a major issue about the opportunity to free up capacity. Ms Mackay, a member for Central Scotland, mentioned that the programme is a huge opportunity to free up bed space and reduce costs in the healthcare system but how do we ensure that it does not simply displace staff capacity from other parts of the healthcare system and, thus, accentuate the problems that we have across the entire healthcare ecosystem, as the member for Kirkcaldy mentioned?

Although we all support the programme, we must be cognisant of the major practical constraints that we face. It is essential that Scotland achieves the best possible healthcare system for us all, but we must be aware of the acute problems that we face and work through them in a collegiate and co-operative way.

We are happy to support the Government’s motion.

The recent health inequalities in Scotland report cited a 24-year gap in the time spent in good health between people living in the most and least deprived 10 per cent areas. The reality is that making healthier choices is a privilege for many people in Scotland. Does the minister accept that the Government must address the root cause of health inequalities to improve health outcomes?

I thank my colleague, the member for Dumbarton, who lodged the parliamentary question that uncovered the extent of orthopaedic waiting times in Scotland as reported in the press over the weekend. The Government is quick to point to the national treatment centre that opened in Fife back in March, but people are still languishing on orthopaedic waiting lists. Does the cabinet secretary accept that his predecessor failed to deliver an end to the two-year orthopaedic surgery waiting times and can he confirm how many orthopaedic surgeries have been carried out this year, so far, and say whether the new national treatment centre will meet its target?

It is a pleasure to close this debate on behalf of the Labour Party. There is broad consensus across the chamber on the benefits in principle of hospital at home. Certainly from personal experience, I know, as I am sure that many others do, that being in hospital is a rubbish experience. It is frustrating and deeply tedious, certainly for a younger person but, for an older person, it can also be potentially life threatening. We have heard of the potential impacts relating to frailty and acquiring an infection, which can potentially lead to a fatal spiral. Therefore, any measure that can move the emphasis of care away from acute settings and into home settings is to be commended. That is why we all broadly support the scheme.

However, the member for Glasgow Maryhill and Springburn made an important point about that when he asked how we ensure the resilience of the home setting. There is an emphasis on hospital, but how do we emphasise the resilience of the home setting?

There is much more work to be done in that space. Mr Doris mentioned, for example, how we need to ensure that adaptations are made to homes to make a sufficient facility available for people. We need to do much more to ensure that housing associations and registered social landlords are supported.

Labour supports the hospital at home initiative. We have already heard about the benefits of delivering healthcare external to hospitals and acute care settings, all of which are entirely valid and commendable. For a long time, we have been advocating an approach to healthcare that is based on prevention rather than reaction, and we have been arguing that reducing the pressure on hospitals and acute care settings is essential and will deliver better outcomes.

Everyone in the chamber is well aware of the benefits of early intervention. Equally, we are all aware of the consequences for hospitals and acute care settings when services that facilitate early intervention and prevention fail. Therefore, we support the principle of the hospital at home programme, and we will work with the Government to ensure that patients who are in a position to benefit from the programme are able to do so.

Throughout my time in this role, I have always done my best to be constructive, and I would like to continue that approach today. A cross-party approach to tackling the crisis in our national health service will be crucial. In the interests of co-operation, we will support the Government’s motion and the Conservatives’ amendment. In the interest of trying to make a success of the hospital at home programme, it is important that the Government acknowledges that turning it into a sticking plaster just will not suffice. If we are to make a success of the programme, we need to recognise that, in many ways, our NHS is in dire straits and that we must address the root causes of the problems that we face today.

Those problems are found across our national health service. One in seven people in Scotland is on an NHS waiting list. The social care policy programme is in tatters. More than 160,000 bed days have been lost as a result of delayed discharge in 2023 alone, and more than a million bed days have been lost as a result of delayed discharge since the current First Minister was appointed as health secretary. One in 10 general practices in Scotland no longer accepts new patients. The vacancy rate for registered nurses in district nursing is more than 11 per cent, and it is 12.5 per cent for registered nurses in community settings.

I take absolutely no pleasure in rhyming off that list of problems. I want nothing more than for each and every one of them to be resolved immediately for the benefit of patients who desperately rely on such services, because we all have skin in the game.

However, the reality is that those problems exist today, and the harsh truth is that, for as long as they do, the hospital at home programme will fail to live up to its full potential.

Of all the problems that exist, the most egregious is the workforce crisis that is engulfing the NHS and social care. As I outlined briefly, vacancies are at a record high. Given the multifaceted and multidisciplinary nature of the hospital at home programme, there is a distinct possibility that it will fail purely because of a workforce shortage. That is why our amendment sets out the need for a long-term funding settlement for the hospital at home programme. We will happily work with the Government on that, should it desire it.

Although the workforce crisis in our NHS may take some time to resolve, given the training lead times and issues around that, there is no excuse for the workforce crisis in social care. The backlog in delayed discharge is down in no small part to the lack of a social care plan. One of my primary concerns about the hospital at home programme is that it will be used to try to mask the crisis in delayed discharge.

We can see that playing out in adjacent services such as hospice care. Just a few weeks ago, I visited the Prince & Princess of Wales Hospice in Glasgow, where people highlighted the fact that one third of its beds are unusable due to the lack of specialist nursing staff.

Labour has therefore set out our plan to increase the pay of social care workers to £15 per hour, at a cost of approximately £150 million a year. We have also identified three areas of an opportunity-cost value of almost £300 million, from which that money could be found, which would ensure that we have a further economic multiplier effect in our wider economy, through the marginal propensity to consume. I call on the Government to back us in that commitment and to increase the social care pay to £15 an hour. That would go a long way to alleviating the pressure on hard-pressed social care staff and to resolving the workforce crisis in social care; and, fundamentally, it would ease the pressure on front-line services by reducing the level of delayed discharge that is clogging up the system.

The Labour party supports and commends the hospital at home programme. However, we are clear that there needs to be a realistic and pragmatic assessment about the extent to which it will be beneficial, given the crises that I have mentioned. Without a long-term funding settlement or a plan to fix the workforce crisis in our NHS, and without a long-term prospectus for the future of our social care sector, hospital at home risks becoming a mere sticking plaster—another initiative that is doomed to failure before it has gotten off the ground. That would be a real shame, because the need for such a programme to succeed is greater than ever—and, if done right, it has the potential to enable significant progress for public health in Scotland.

I move amendment S6M-09191.1, to insert at end:

“; notes that one in seven people in Scotland are on NHS waiting lists, delayed discharge remains too high, and thousands of NHS vacancies are unfilled; recognises that Hospital at Home requires sustained investment to bring hospital-standard care into the home using technology, in addition to retaining and recruiting the multi-disciplinary teams that are required; considers that Hospital at Home is being hindered by the Scottish Government’s failure to tackle the social care crisis, which is essential in helping people to live independently, and calls on the Scottish Ministers to deliver a long-term funding settlement for this programme, to take urgent action to deliver well-funded and locally available social care services by immediately uplifting social care pay to £12 per hour, with a plan to raise it to £15 per hour, and, as recommended in the Feeley Review, to remove non-residential care charges.”