Chamber and committees

Several respondents to the consultation on the bill noted that there is no provision for challenging or reviewing decisions that are made by doctors on whether someone’s illness meets the definition in the bill of terminal illness, whether they have capacity to make the decision or whether they have been coerced. The Edinburgh Napier University centre for mental health practice, policy and law research submitted that it was

“concerned at the lack of any accessible mechanism by which the decision of a doctor can be appealed or independently reviewed by the courts.”

Again, is that something that you considered? Now that the bill has been under some scrutiny, would you consider amending it in that regard?

Conversely, is it unreasonable for there not to be an appeal process for someone who has perhaps been denied access to assisted dying?

It sounds like what you propose in terms of that conscientious objection would be quite discrete. How do you counter what surveys of palliative care staff and staff who work in hospices say? According to those surveys, quite large numbers of staff have talked about leaving those services should your bill be passed.

One of the other areas that the committee has touched on is qualifications. I believe that the bill speaks about medical practitioners, although I might be misquoting slightly there. However, witnesses were clear that the level of qualification that would be required for doctors to be able to participate in assisted dying could encompass those at foundation year 2 level. When representatives of the Royal College of Psychiatrists were at committee, we asked about their level of confidence in such a junior doctor participating in those assessments of capacity and so on. They were quite resolute that they did not feel that such a junior doctor would have sufficient experience at that level of their training. Why have you chosen that particular term, which encompasses such junior doctors, and, should the bill be agreed to at stage 1, would you look to amend that provision?

I welcome the opportunity to contribute to the debate on behalf of the Health, Social Care and Sport Committee.

I thank the cabinet secretary, supporting officials, all the stakeholders who have engaged throughout the committee’s budget scrutiny process, and the committee clerks for supporting the committee in all its work.

As members will be aware, the health and social care portfolio is, again, a budget priority. Its budget is increasing by £2 billion in cash terms, which takes overall health and social care investment to £21 billion. The committee notes that that increase reflects the Government’s commitment to pass on health-related Barnett consequentials that were received as a result of the UK October budget, which amount to an additional £1.7 billion for Scotland in 2025-26.

It is anticipated that much of that funding will benefit national health service board budgets. Given the on-going challenges that health and social care services face, as highlighted in the committee’s pre-budget scrutiny, that additional funding is most welcome.

Similarly, the committee welcomes the planned £200 million investment to reduce waiting times and improve capacity, with the commitment that, by March 2026, nobody will wait longer than 12 months for a new out-patient appointment, or in-patient or day-case treatment.

The committee also welcomes the additional support for general practitioners to address pressures that are related to waiting times and lack of prevention, as well as expansion of the hospital at home service, which will, I hope, alleviate pressure on front-line acute services.

Throughout the budget scrutiny process, the committee has heard extensive evidence on the current state of health and social care services. It is no secret that health and social care staff are under immense pressure across the sector, particularly as our population ages and as a result of the recent spike in flu cases and subsequent hospital admissions. Therefore, additional funding in key areas will be necessary to mitigate those challenges.

However, I reiterate a core theme that has stood out throughout the budget scrutiny process and has, indeed, been echoed by my colleagues from the Finance and Public Administration Committee. Budget transparency through improving links between the budget and agreed outcomes is crucial in order to assess whether spending has been effective in the areas that it needs to be.

Despite increased investment, significant questions remain about the level of detail contained in budget documentation and the level of transparency around health spending. As highlighted by the Scottish Parliament information centre, previous responses to the committee from the Scottish Government acknowledge that

“it is important that there is a clear link between spending plans and commitments.”

The committee argues that that acknowledgement has yet to be reflected in the health and social care portfolio. Specifically, changes to the presentation of budget numbers this year mean that the 2024-25 baseline is now presented after the autumn budget revision. Given that substantial transfers and additions to other portfolios occur at the time of the ABR and that one could reasonably expect similar transfers in the future, that could have particular consequences for the planned increase in the health and social care budget and the extent of that increase in real terms.

As highlighted as part of the committee’s pre-budget scrutiny, which focused on the financial position of integration joint boards, in-year adjustments to the 2024-25 budget have meant that a growing number of IJBs are having to rely on funding reserves to bridge the funding gap. That is having a negative impact on the long-term sustainability of budgets. Given the challenges that the sector faces, I strongly encourage the Scottish Government to do more to ensure that service providers are given the utmost clarity regarding funding in a way that is conducive to long-term planning.

Similarly, the committee is disappointed that, despite calls to align the budget with the national performance framework, that has not been reflected in the presentation of the budget or accompanying documents. Although the committee notes that the Government has stated that it is working to align the budget with strategic priorities, it is the committee’s view that more must be done in that area. If the NPF is to be the Scottish Government’s “north star”, it is essential that it provides a clear overview of how specific budget allocations align with progress towards corresponding national outcomes. Without that, it is difficult to measure the effectiveness of spending on health and social care and the extent to which any additional funding is contributing positively to the overall health and wellbeing of people in Scotland.

Although it is almost impossible to cover everything in such a large portfolio during the debate, I conclude by reiterating that the increased funding packages and various commitments that are contained in the budget are most welcome. However, more must be done to measure and track the effectiveness of any additional spending and to ensure that the budget for health and social care is properly aligned with national outcomes and the NPF.

The committee looks forward to seeing further progress in those areas as we look forward to scrutinising next year’s budget. It is only by making such progress that we will ensure that we are making the best use of the Scottish budget to tackle the challenges that the health and social care sector faces and to improve health and wellbeing outcomes for all the people of Scotland.

Finally, I refer members to my entry in the register of members’ interests, as I have a bank nurse contract with NHS Greater Glasgow and Clyde.

My Rutherglen constituency is home to many talented musicians, actors and other creative sector professionals. Will the cabinet secretary outline what organisations in the South Lanarkshire Council area will benefit from the very welcome announcement of multiyear funding?

It is important that the Scottish Government hears directly from armed forces and veterans families to understand the issues that children and young people in such families face. What role can the Scottish armed forces education support group play? When did the group last meet?

Has the Scottish Government come to any decision or any conclusion about whether an oversight body should be convened to monitor the function of the legislation should the bill pass?

I appreciate that and the committee understands that you have set out the Government’s position.

Does the Government have an opinion on the proposed five-year review period of the legislation or the suggestion that the bill should include a sunset clause?

That was for doctors only. So, for the entirety of the healthcare staff who may be involved if the bill passes, the training costs could be anticipated to be greater.