Chamber and committees

I have been a carer myself. No one should underestimate the importance of our social care system for the physical, social and emotional wellbeing of society. However, as we have repeatedly heard this afternoon, social care is at breaking point under this SNP Government, and vulnerable people are on a precipice.

As Jeremy Balfour rightly says, social care cannot wait for a national care service; it is too important. In 12 years, one in four people will be over the age of 65, which means that more people living with complex health and care needs will be accessing a system that is already in crisis. From staffing levels to care home closures, there simply is not the capacity to meet growing demand.

Of course, reform is needed. The system cannot sustain itself like this, and there is consensus this afternoon around that point. However, how that change will be achieved is a separate and, clearly, contentious question. The Feeley review put forward a new approach. The Scottish Conservatives supported many of the report’s recommendations, but we do not agree with the top-down concept of centralising social care. We want to see urgent investment in the sector, to preserve local democratic accountability through a local care service and to avoid any unnecessary structural reforms.

In ordinary circumstances, it would simply be a matter of divergence of policy between political parties, but these are not ordinary circumstances—far from it. The stage 1 deadline for the National Care Service (Scotland) Bill has changed four times since the legislation was first introduced in June 2022. The implementation date has been kicked down the road by three years, from 2026 to 2029. Spiralling costs show that the Government is making it up as it goes along—with figures of £2.2 billion and, today, £345 million, not to mention the millions spent on the army of civil servants who are trying to keep the proposals afloat.

How can you cost something if you really do not know what that something is? The goalposts keep changing. As my colleague Liz Smith highlighted, no fewer than four parliamentary committees roundly criticised the first iteration of the framework bill. They pointed to serious issues about the lack of consultation and detail in the bill and significant concerns in relation to the costings. They said that the process set out in the bill is insufficient to allow for appropriate parliamentary scrutiny and that it

“risks setting a dangerous precedent, undermining the role of the parliament.”

Ruth Maguire today called it a “can be”. SNP MSP Michelle Thomson said in a meeting of the Finance and Public Administration Committee that she had “no confidence whatever” in the level of detail found in the NCS bill financial memorandum. SNP MSP Kenneth Gibson said that introducing the plans was

“a sledgehammer to crack a nut”

and

“a monumental risk”—[Official Report, Finance and Public Administration Committee, 25 October 2022; c 24.]

That is hardly a ringing endorsement from the SNP back benches—[Interruption.]

Last summer, a controversial backroom deal on shared accountability arrangements between the Scottish Government, COSLA and the NHS was supposed to provide greater clarity on the bill, according to the disgraced former health secretary, Michael Matheson.

Neil Gray has inherited an overflowing in-tray from the disgraced Michael Matheson, who missed no fewer than 72 NHS-related targets set by his Government while he was in charge of the health service. As we have heard, it looks likely that the SNP Government will miss another of its flagship targets—the target to recruit 800 GPs. In fact, the British Medical Association believes not only that Scotland is not on track to meet that commitment but that we are going backwards. That matters because primary care is the backbone of the NHS. The majority of patient contact occurs in primary care. Those services are being expected to take the pressure off other parts of the NHS that simply do not have the capacity to treat patients.

General practices are pivotal to the survival of the NHS but, under the SNP Government, patient numbers are up and GP numbers are down. Scotland lost 10 per cent of its GP surgeries between 2012 and 2022. General practice is chronically underfunded and underresourced, as we have heard. Rural communities have been hit particularly hard, because it is increasingly difficult to recruit and retain GPs, so some practices are under increased pressure to close. It is little surprise that one of Scotland’s top doctors has warned that general practice is dying a slow and lingering death.

As Neil Gray gets up to speed with his brief as the new health secretary, he would do well to read the Scottish Conservatives’ recent paper on health, in which we committed to raising the amount of NHS spending on GP services by 12 per cent and to recruiting an additional 1,000 GPs.

Dr Sandesh Gulhane shed light on the flopped plans of the past three health secretaries, against a backdrop of GPs suffering from low morale caused by unmanageable workloads. Sadly, earlier in the debate, we saw more deflection from the latest cabinet secretary, who, according to Keith Brown, is one of the strongest members of the SNP. Let us therefore see the cabinet secretary start to put in place workable solutions to the current crisis, rather than continuing to lay the blame elsewhere, as his colleagues do.

Dr Gulhane challenged the cabinet secretary and his colleagues over not passing on £17 billion in NHS consequentials and instead wasting that money on SNP-Green pet projects. Dr Gulhane is not precious about our policies. The cabinet secretary could swallow the pride that he talks about and consider our workable solutions, which would give him a head start. The cabinet secretary is frowning at me, so clearly he has not looked at our paper—perhaps we could send him a copy of it. If he were to consider those proposals, that would make a refreshing change from the deflection, the cracked record and the smoke and mirrors that Alex Cole-Hamilton mentioned in his opening speech.

In making his maiden speech, Tim Eagle asked the cabinet secretary to listen to those whom he serves. Cabinet secretary, please do something now, listen and show that you mean what you say about making general practice

“the heart of the healthcare system”,

to quote your words to you.

The Scottish Conservatives have a clear plan to deliver a modern, efficient and local NHS. The SNP cannot preside over the permanent crisis in our NHS any longer.

Shocking new figures that were released yesterday have revealed the scale of the crisis in Scottish dentistry. In December last year, the number of patients who were able to see an NHS dentist fell by an astonishing 38 per cent. Gillian Mackay talked about regular check-ups not happening since the pandemic and mainly because of the pandemic. Mr Sweeney said that he was fine during the pandemic and afterwards but has now been waiting for nine months to be seen. I have a constituent in Angus who is in complete despair and significant pain and who cannot find an NHS dentist. That has happened recently and it is happening now.

The number of NHS dental procedures fell by as much as 200,000. The cabinet secretary proudly states that his Government provides free dental care to the under-26s, but the sad reality is that they cannot find an NHS dentist to treat them. Eighty per cent of NHS dentists are no longer taking on new patients, and 83 per cent say that they will reduce their NHS numbers. Is it any wonder that people in Scotland are having to travel thousands of miles for dental treatment? As we have heard today from Willie Rennie, as well as the fact that we have ferries coming from Turkey, people are having to go to Turkey to have their teeth fixed. As Dr Sandesh Gulhane said, people are going to India, and refugees are going from Scotland back to war zones to have their teeth fixed.

Keith Brown said that Neil Gray is one of his most capable colleagues, and Neil Gray said that he recognises the challenges. The SNP Government has decimated NHS dentistry, and patients are paying the price. As Dr Gulhane said, the SNP is tinkering with the problem with an outdated drill-and-fill model.

Sue Webber talked about the fact that oral health is a good indicator of general health. We hear harrowing stories again and again of DIY dentistry, with people resorting to Amazon to purchase tools for self-treatment. [Interruption.] Those are not isolated incidents. According to the BDA, 83 per cent of dentist respondents to a recent survey—

Thank you, Presiding Officer. SNP members might not want to hear from the British Dental Association. For colleagues who were standing chatting to one another at the back of the chamber, I will repeat that, according to the British Dental Association, 83 per cent of dentist respondents to a recent survey reported treating patients who had performed some form of DIY dentistry since lockdown, such as using Super Glue to fix a crown or pliers to remove teeth. That is Dickensian dentistry. No one should have to pull out their own teeth or use glue to repair their dentures. It is disgraceful.

For so long—too long—the public have been told that prevention is better than cure, but 1.2 million people have not had a dental examination or dental treatment in five years. As Carol Mochan said, the SNP-Green Government blames everyone other than itself and has a track record of 17 years of managed decline. In our latest health paper, the Scottish Conservatives have committed to root-and-branch reform of the statement of remuneration so that dentistry is financially viable and delivers modern best practice that is focused on prevention. Neil Gray said that he is not complacent, but he must heed the warnings of the experts.

Good morning. My first question is for Becs Barker. You talked about the good example of Dundee City Council. More than a year ago, the committee visited Granite Care Consortium in Aberdeen and heard about some good practice there.

Obviously, Dundee and Aberdeen are cities, and your recommendations recognise that there are more issues in rural areas. Some submissions that we received highlighted that people who live in rural areas are particularly disadvantaged, especially in relation to option 3. Could you expand on your thoughts about geographical disparities?

Are such cases measured and monitored? You say that you do not know about them, so are they measured in your area?

Thank you. My second question is for Peter McDonnell. Submissions to the committee included an anecdote about waiting from one individual and I know of other examples of individuals waiting for years. In the example in the submission that we received, a person had been waiting for two years to have a care plan signed off by a social worker. What is an individual supposed to do about their care arrangements in the interim?

I am aware that the cabinet secretary has had to step in at the last minute to replace Michael Matheson, so she may not be aware of all the facts. The facts are that Scotland has experienced a 25 per cent increase in alcohol-related deaths in the past three years alone and that, in the past 10 years, the number of people accessing alcohol treatment services has gone down by 40 per cent. Is the cabinet secretary really trying to tell us—and with great pleasure—that a huge hike in drink pricing in a cost of living crisis is the best solution?

It is statistically significant: an increase of 31 to 440 is huge. We are looking at no change in male deaths since 2008, but the figure on female deaths is dramatic. You talk about modelling and speculative figures, but the data from National Records of Scotland does not support what you are saying. You have confirmed that you just do not know whether MUP affects female deaths, so I would just like to say that there is no answer. I invite Alison Douglas in.