Chamber and committees

Thank you, Presiding Officer. I wish that there had been as much clarity and scrutiny at stage 1. It shows that my colleagues can scrutinise when they need to do so.

From the Royal College of Nursing to Unison, and many more besides, stakeholders are clear that developments last summer have breached their trust and muddied the waters even more. The National Care Service (Scotland) Bill has been touted by the First Minister as the most ambitious reform of public services since the creation of the NHS, but it has been a masterclass from SNP ministers in how not to legislate, and it is a dog’s dinner. The party of the defunct Gender Recognition Reform (Scotland) Bill, the delayed deposit return scheme and the dormant Hate Crime and Public Order (Scotland) Act 2021 has struck again. This is not just about policy but about process, and that process is a sham.

Today, Gillian Mackay asked Emma Harper about self-directed support. That is just the kind of issue that needs to be ironed out in advance of the parliamentary passage of the bill. We are in the extraordinary position of being asked to agree to the general principles of a framework bill that has changed so significantly that we do not know what we are voting on. As Ivan McKee pointed out, it was yesterday—he did not say “only yesterday”, sadly—that a model was shared, which was a week after the committee finalised its report. If no one is alarmed, they should be. It is disrespectful to the parliamentary process.

I think that we all agree that the Health, Social Care and Sport Committee’s stage 1 report is well written. However, as Dr Sandesh Gulhane emphasised in his remarks, that SNP-Green majority committee has ultimately nodded the bill through with too many unanswered questions. I have outlined two examples. There may be caveats and conditions in the report that support that, but there are no consequences. That is not a threshold of scrutiny that the Scottish Conservatives can get behind.

On Monday, up to half of the north-east’s ambulance fleet—18 ambulances—were stuck outside Aberdeen royal infirmary. A paramedic told The Press and Journal that they are unable to help people who are most in need because they are repeatedly tied up. The situation is now so bad that earlier this month a shop worker in Dyce who was covered in blood after being attacked and left almost unconscious by robbers had to be driven to hospital by her employer because the ambulance service was too busy. What immediate action will the Scottish Government take to address the on-going crisis across the north-east?

The social care sector is deeply concerned that the bill is becoming a battleground. We cannot lose sight of those people who require care, nor of those people who work so hard to provide it. Ramming legislation through on a wing and a prayer will serve no one, especially the taxpayer, who keeps picking up the SNP’s legal bills when it eventually and inevitably goes wrong.

For those reasons, the Scottish Conservatives cannot vote for the general principles of the bill at decision time, and I urge other members to do the same.

The social care sector is deeply concerned that the bill is becoming a battleground. We cannot lose—

Thank you, Presiding Officer. I am pleased that Michelle Thomson said that that was a correct quote.

From the Royal College of Nursing to Unison, and many more besides—[Interruption.]

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.