Meeting of the Parliament

Meeting date: Wednesday, April 3, 2019

Official Report 1065KB pdf

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NHS and Social Care Staff (Workplace Support)

The next item of business is a debate on motion S5M-16702, in the name of Miles Briggs, on looking after those who look after us. I ask members who wish to speak in the debate to press their request-to-speak buttons.

14:42  

I open today’s debate by paying tribute to all those who work in our Scottish national health service and social care services. Every MSP, no matter what part of Scotland they represent, will have seen at first hand the dedication and commitment of our NHS staff in providing each and every one us and our families with the care that we need, in good times and in bad. Any organisation, at its heart, is its people, and the NHS is no different.

Sometimes in politics there are cases that make us stop and think that we need to do something collectively to bring about a change. One of the most shocking and tragic cases that has stayed with me during my time as Conservative health spokesman is that of 23-year-old junior doctor, Lauren Connelly. Lauren was killed after her car veered off the M8 motorway as she drove home after a 12-hour night shift at Inverclyde royal hospital in Greenock. At the time, Dr Connelly, from East Kilbride, was just seven weeks into her medical training. The case tragically highlighted the fears about the long working hours and fatigue that are faced by so many who work in our NHS. Staff frequently work exhausting 100-hour weeks, with shift patterns of 12 consecutive days.

I pay tribute to Lauren’s father, Brian Connelly, who, since the tragic death of his daughter, has campaigned tirelessly alongside the British Medical Association for the introduction of stricter limits on working hours. I spoke to Mr Connelly last night, when he told me of his wish for there to be greater public awareness of the hours that junior doctors work, the tiredness that that causes and the consequent risks, both to them and to patient care. He would welcome the support of all MSPs for his campaign to try to rectify those long-standing problems and improve the health and safety of junior doctors across our country. Mr Connelly is determined to see the First Minister’s 2017 pledge to implement a 48-hour working week delivered, and I hope that all parties will agree to attend a cross-party meeting that I am organising to help take that work forward.

People who work in our NHS are superheroes in many people’s eyes, but they are not superhuman. We need to understand the impact that the on-going NHS workforce crisis, which involves high vacancy rates in nursing, consultancy and mental health posts and high absence rates across the health service, is having on staff and staff morale.

As the British Medical Association says, there are simply not enough health professionals working across all professions in Scotland’s NHS today. Ninety-one per cent of doctors are working more than their allocated hours. The British Dental Association recently warned that 57 per cent of associate dentists are looking to retire from general dental practice. One in four general practitioner practices in Scotland has a vacancy and the Scottish NHS is short of 2,400 nurses and midwives.

After 12 years in charge of our Scottish NHS, Scottish National Party ministers need to accept that they have presided over a workforce crisis that is impacting on the wellbeing of NHS staff today. It is therefore little wonder that the Royal College of Nursing accused Nicola Sturgeon of

“a spectacular error of judgment”

when she cut the number of student nurses when she was health secretary, quadrupling the number of unfilled nursing posts and putting all NHS staff under pressure.

Perhaps more concerning is that the BMA also believes that official figures are continuing to underreport the actual extent of vacancies among the consultant workforce. BMA research that was published last year showed that the actual vacancy rate is likely to be running substantially higher than the official figures. Freedom of information data showed that the number of vacancies was in fact around double the level that was recorded by official statistics. That is a difference of around 375 whole-time equivalent vacancies, which means that, potentially, enough doctors to staff a large hospital are missing from our Scottish NHS today.

We need to understand the severe pressures that NHS staff are under and how that negatively impacts on their own health and wellbeing. Retention of staff has to become the number 1 priority for the Government and for the health services that we all want to perform well. That is why the Scottish Conservatives have secured today’s debate.

We need our NHS working environments to take into account the wellbeing and needs of those who work in them. Therefore, the Conservatives call on ministers today to review NHS and social care staff workplace support services in order to improve and promote wellbeing. We have a few ideas, and so will, I know, members across the chamber and, perhaps more important, groups outwith the Parliament—ideas about how we can move towards a more holistic approach to the wellbeing of our NHS staff.

One such idea is to have sleep pods and phone charging points in hospitals, where NHS night-shift staff can rest before they attempt long journeys home. Another idea is to offer NHS staff free parking—NHS staff in Dundee, Glasgow and Edinburgh continue to face unacceptable parking charges. Mental health support and financial advice should be provided to NHS staff. Salus, which is based in NHS Lanarkshire, is already offering such support to all NHS Lanarkshire staff, and I would like to see its services rolled out across the country. We could also provide free health checks at community pharmacies to help give NHS staff lots of additional holistic support services, such as weight management services.

It is important that there is a focus on NHS staff wellbeing. NHS Borders recently told the Health and Sport Committee that it has a “wellbeing Wednesday”, and we need to look at how we take forward such good practice across all our health boards.

As I said, parties across the chamber and, more important, representative bodies will have ideas about how we can achieve all of that. I hope that we can take those ideas forward.

I am somewhat disappointed with the cabinet secretary’s amendment to my motion. The debate should, and can, be about how Parliament can collectively do something to support and improve the working lives of people who work in our health and social care services. When the Cabinet Secretary for Health and Sport first took over the role, she said that her approach to the job would involve “mature reflection”. I do not think that, in trying to delete from the motion the mention of the “workforce crisis” that we have across our health service, the approach that she has taken today is productive.

Will the member take an intervention?

Yes, if it is brief.

Miles Briggs has quoted the BMA at length. BMA Scotland’s GPs have spoken of the potentially devastating effect that Brexit will have, not only on our health service, but on medicines. Does Miles Briggs agree?

I have been absolutely clear about the impact of and potential challenges from Brexit, but the workforce challenges that we face across our NHS did not start with Brexit; 12 years of an SNP Government has built up those challenges. SNP ministers and members need to understand that, after 12 years of being in charge of our NHS, the SNP has no one else to blame but itself.

I welcome the constructive Labour Party amendment, which we will support at decision time.

I hope that the debate provides an opportunity for us to focus on our NHS staff and what we can do to make their lives easier. It is time that we changed the approach that is taken, to look after those who look after us.

I move,

That the Parliament pays tribute to all those who work in the NHS and social care services for the care and treatment that they help to deliver for patients and families across Scotland; notes the ongoing NHS workforce crisis, which sees high vacancy rates in nursing, consulting and mental health posts, as well as high absence rates across the health service; understands the pressures that NHS and social care staff face and believes that there is a need to improve the holistic care and support provided to them in their workplaces, and calls on ministers to review NHS and social care staff workplace support services in order to improve and promote wellbeing and look after those who look after people in Scotland.

14:49  

I thank Miles Briggs for bringing his motion to Parliament today.

I am immensely proud of our health and social care staff. The quality of care and treatment provided by our staff, and the compassion and dedication that they show, are unparalleled, and we thank each and every one of them. Whatever their role, they contribute directly to our nation’s health and wellbeing, and to our society.

Of course I recognise the pressure that exists from the increasing demand on health and care services. The reasons for that are well rehearsed, but they include demographic challenges, increasingly complex care needs and advances in the care and treatment services that we are able to offer. I recognise that the pressures are felt by our staff, and that is why we have acted and will continue to act to support our workforce, increasing training numbers in nursing and midwifery, among medical undergraduates, for our medical postgraduate programme and for allied health professional pathways; promoting training pathways; supporting board recruitment and retention; promoting staff health and wellbeing; and increasing the employee voice.

Delivering sustainable services is not simply about supporting recruitment and retention. The health and wellbeing of our workforce is of fundamental importance, and that is why I am happy to support Monica Lennon’s amendment. We must keep listening to staff and learning from their experience, so I also welcome the proposal in Mr Briggs’s motion of a review of support, and I am happy to take that forward.

There is, however, a threat to our work to support our health and care services that cannot be ignored, and that is Brexit. Although I accept that some of the challenges that we face did not start with Brexit, we have had three years of waiting to see what will happen with Brexit, and we still do not know the answer. Since the inception of our health service, our health and care services have benefited from inward migration, and they have benefited, too, from our healthcare professionals working elsewhere and bringing their experience and knowledge back home to apply here. Free movement is vital for us to continue to attract dedicated professionals to help to deliver those services. It is simply wrong that our European Union health and social care staff should no longer feel welcome, and it is absolutely devastating that skilled colleagues who have built their lives here in Scotland should be planning to leave as a result. We will continue to advocate on their behalf and argue for a tailored immigration policy that meets Scotland’s needs and reflects our values.

We are taking comprehensive action to support increasing medical, nursing and midwifery trainees through the system, including bespoke support for specialty medical training and midwifery to promote both rural training and recruitment. We are maintaining free tuition fees and increasing the nursing and midwifery student bursary to £8,100 this year and £10,000 in 2020. A non-means tested bursary was scrapped in England by the United Kingdom Government. For the seventh successive year, we have increased the number of student midwifery and nursing places.

We have provided funding for adult social care workers to be paid the real living wage, benefiting up to 40,000 care workers.

I thank the cabinet secretary, who helpfully met me recently to discuss payment of the living wage to overnight care workers. Despite local authorities having the resources to do so, some of them have not passed that on in full, particularly for those who are employed in the third sector. What progress is being made to ensure that that payment starts at the very beginning of the new financial year?

I am grateful to Ms Baillie for raising that point. She has long championed the issue, as I have done. The intention to support 24-hour care wherever it is needed is really important—I know that we share that view. I met the Convention of Scottish Local Authorities yesterday to look specifically at the information that we have so far on where the payment is not being applied and to determine what further action we can take. I am not yet clear about all the local authorities that are not yet applying it; some of the data is not yet complete. However, as soon as we have the information, we and COSLA will, between ourselves, act with those individual authorities, and I will ensure that Ms Baillie and others are kept up to date.

Our NHS staffing levels are at a new record high—up by more than 13,000 whole-time equivalent staff under this Government. To support local recruitment efforts, we have provided record levels of investment, with resource and capital expenditure this year exceeding £14 billion for the first time.

Members will be well aware that, to facilitate workforce and workload planning, we have introduced the Health and Care (Staffing) (Scotland) Bill, which is the first multidisciplinary workload and workforce planning legislation in the United Kingdom. The bill recognises the fundamentally multidisciplinary nature of health and social care services. It is an important piece of legislation: it is important for workforce planning and for our staff. I look forward to continuing to work with members across the chamber to make sure that we get the legislation right for the whole health and social care system.

It is absolutely the case that the care, compassion and support that we ask our health and social care staff to give those who need them is care, compassion and support that they should receive themselves. I do not believe that we can have one without the other. Across our health boards, we have a number of wellbeing and mental health support initiatives for our staff, but challenges remain and I am always open to good, constructive ideas that we can try to introduce to improve that approach. In fact, I will meet the BMA later today to discuss further the work that we are undertaking in respect of junior doctors.

I remain absolutely committed to high-quality, sustainable health and social care. At the heart of that system is a healthy and cared-for workforce. We are working hard to deliver on that commitment, but there is more for us to do. I look forward to the debate.

I move amendment S5M-16702.3, to leave out from “notes” to “health service” and insert

“believes that this support for staff should include support in their initial training, and welcomes that in Scotland free tuition has been retained for nursing and midwifery students, and that their bursaries are increasing by £10,000 in 2020; notes the observations of the BMA that Brexit will have a ‘potentially devastating impact’ on the health and social care workforce, and agrees with the BMA that, for staff from the EU, ‘It is simply wrong that they should feel they no longer belong here or should be planning to leave as a result of Brexit’.”

14:56  

“Looking after those who look after us” is the title of today’s debate and I hope that it reminds us all that we should never take our health and social care staff for granted. I am grateful to Miles Briggs for securing the debate and to the BMA, the RCN and Enable Scotland for their helpful briefings.

I associate Scottish Labour members with Miles Briggs’s remarks about Dr Lauren Connelly, who will be sadly missed by her family and her colleagues. Lauren was from East Kilbride in the region that I represent, and I pay tribute to her father and the family who continue to campaign.

Eight years on since Lauren died, the latest General Medical Council survey found that nearly one in every four UK doctors in training said that they were burnt out because of their work. A recent BMA survey found that 91 per cent of doctors work more than their allotted hours. We know that the problem is not isolated to doctors but extends to all staff who are affected by the NHS’s workforce crisis. Social care staff are at risk, too. The social care sector is fragile and staff often experience poor working conditions, sometimes on zero-hour contracts, with low pay and demanding shift patterns.

Health and social care staff are being stretched to their limits, working more than their contracted hours at times. Staff who I have spoken to feel as though they are always on call. Ahead of the debate, I was keen to look into what support is available to staff. I was interested to hear from Unison that some NHS workplaces have implemented staff wellbeing initiatives, such as lunch time yoga—something that perhaps we could all benefit from. The Scottish Conservatives have called for provision for sleep facilities, so that staff can catch up on much-needed sleep before driving home. Those ideas are all worth exploring, and any measure that will protect staff and promote health and safety in the workplace needs to be encouraged.

However, Labour members are concerned about the working conditions that allow staff to become so exhausted and stressed in the first place. Until the Scottish Government accepts that there is a workforce crisis, it will never truly address the systemic problems that our health and social care services face. Scottish Labour research has found that between 2015-16 and 2017-18, 1 million days of NHS staff absence were caused by stress. I attended the annual review of NHS Lanarkshire today, where I raised my concerns about staff wellbeing, because staff absences and vacancy rates there are above the national average. Although any measures to support staff are welcome, we must ensure that the focus remains on the root causes of poor staff wellbeing, such as too much work and not enough staff.

Research from the BMA, the GMC, Unison and others tells us that factors that contribute to stress include workplace culture, bullying and harassment. If our health and social care staff are truly valued, that must be reflected in workplaces, but we have reason to be concerned that some workplaces are not the supportive environments that we expect them to be. This year alone, we have heard worrying cases about staff bullying and concerns about how whistleblowing is dealt with. Those issues are too important to shy away from.

I acknowledge that the health secretary has said that she will appoint whistleblowing champions to every health board, but that must happen as a matter of urgency, because every day that goes by that staff do not feel able to report their serious concerns, more staff will feel demoralised, while patient safety can be put at risk. The on-going issues at the Queen Elizabeth university hospital show how patient safety can be compromised when staff concerns about infection control and cleanliness are not acted upon.

We can support the Conservative motion, because it gives us all an opportunity to show our appreciation for staff and concern for their health and safety. However, we would suggest that more extensive action is required to tackle the root causes of the issues. That is why I am pleased to hear from the cabinet secretary and Miles Briggs that they can support the amendment in my name.

We have sympathy for much of what the Government is saying about the potentially devastating impact of Brexit on health and social care and the EU citizens who are valuable members of our workforce. However, I am a bit concerned about the Government amendment, because it takes out the line about the workforce crisis, which is a fact that we must face up to.

Scottish Labour will always support our health and social care staff to get the working conditions that they deserve and the work-life balance that they need.

I move amendment S5M-16702.1, to insert at end:

“, and considers that such a review must address the underlying issues that contribute to burnout, stress, long-term sickness and to staff leaving health and social care, such as staff shortages, workplace culture, bullying and harassment and poor work-life balance.”

I call Alison Johnstone. Four minutes, please, Ms Johnstone.

15:01  

I, too, thank all of those who look after all of us.

It is clear that workforce pressures are severely impacting the wellbeing of health and social care workers. That is the message that is coming from those on the front line. In May 2017, the Royal College of Nursing launched a survey of nursing and midwifery staff in the UK and received more than 3,300 responses from Scotland. The findings show clearly the impact that insufficient staffing has on staff wellbeing. More than half of respondents reported a shortfall in planned numbers of registered nursing staff on their most recent shift or day worked, with around two thirds having worked unplanned extra time. In addition, more than half of survey respondents said that care was compromised on their most recent shift. There is a clear correlation between those conditions and poor staff wellbeing. One respondent stated that

“when nursing staff are overstretched due to insufficient staffing, they often suffer the consequences personally. Not being able to stay hydrated, eat, or use the toilet impacts on their physical and emotional wellbeing.”

Conditions, therefore, are so poor that nurses are often unable to have their basic human needs met.

I acknowledge that the Scottish Government has taken positive steps to address workforce pressures, such as the new GP contract and the introduction of the Health and Care (Staffing) (Scotland) Bill, and has increased nursing and midwifery student bursaries for next year. However, the workforce will not increase overnight, and there is significant cause for concern around staff wellbeing during the interim period.

There are significant pressures around the implementation of the new GP contract. Last year, the Royal College of General Practitioners commissioned a survey of its members that found that 35 per cent of those surveyed had spent consultation time explaining to patients why they had been offered appointments with other healthcare professionals instead of with a GP. That not only places strain on GPs, who have insufficient 10-minute consultations to see patients with increasingly complex health conditions, but causes distress to patients. The same survey reported that 60 per cent of respondents were aware of patients who had become distressed, angry or confused when signposted by medical practice receptionists. Changes to services as a result of the GP contract—as welcome as they may be—must be urgently communicated to Scotland’s population to ease the concerns of patients and lessen the strain on practice staff.

There are substantial pressures in the social care sector, where 15 per cent of social care workers work unpaid overtime, and 11 per cent are on zero-hours contracts. There is a significant disparity between the value of care and the support that carers receive, and it is important that professional caring is valued and considered an attractive career. Social care workers do difficult and essential work in people’s homes, in care homes and in communities, but social care remains one of the lowest-paid sectors, which fuels the gender pay gap.

Enable Scotland has called for the extension of the Scottish living wage to cover every hour that is worked by social care staff, including, as Jackie Baillie highlighted, overnight sleepover support. However, that must be properly funded by commissioners and, as we have heard, not all of them are doing so.

In February, I urged the Scottish Government to put fair work at the heart of Scotland’s care sector by adopting in full the recommendations of the fair work convention’s review, “Fair Work in Scotland’s Social Care Sector 2019”. It reported:

“Frontline workers feel respected for the work they do by their colleagues ... and their employers, but they do not feel particularly valued by Scottish Government or the wider public.”

We have to change that. Equitable pay is important, but we need to ensure that social care workers feel respected and supported.

There are positive measures that we can take to address staff wellbeing by ensuring that workers in all sectors feel valued and are fairly paid, but it is key that when changes are implemented to ease workforce pressures, we must communicate them properly.

We cannot have a healthy workforce—

No, please—you must conclude. I was making the signal.

I call Alex Cole-Hamilton. It has to be four minutes, Mr Cole-Hamilton.

15:05  

I echo the thanks that other members have expressed to the Conservatives for securing time for this debate and to the workforce that looks after us.

On two occasions, healthcare workers have represented the bridge between normal life and oblivion for my family. In the first case, when my eldest son was born and was not breathing, he was revived after huge complications in theatre. Secondly, and much more recently, a whole team of clinicians stayed behind after their shift had ended to operate and remove a coin that my four-year-old daughter, Darcy, had swallowed. I owe those workers the lives of my children. I am sure that I am not alone and that many people in this chamber can tell similar personal stories.

The NHS is unique in the chamber, because it attracts great love and, at times, great derision. It is important to make a separation and put on record that, as an Opposition politician—I am sure that I speak for all Opposition politicians on this—I might sometimes attack Government policy or the governance of our health boards, but I would never attack the work of our front-line staff. They are heroes in our country.

The first thing that I say in tribute to the staff is that there are not enough of them. There is a workforce crisis and it is wrong of the Government to try to amend the Conservative motion and delete the word “crisis”. Since I and many of my colleagues were elected in 2016, there have been warning lights for a range of disciplines across the workforce planning dashboard.

The issue is no more profound for me and my party than in the area of mental health. We already know about the mental health waiting lists for children and young people, but mental health is an issue of great importance for people of all ages. For example, we were going to recruit 800 mental health workers, but in the two years since that policy was announced only 106 have been recruited. To put that in context, one in four appointments with a general practitioner is made because of an underlying mental health complaint. It is no wonder that GP morale is rock bottom; they are having to deal with things that would be better solved by mental health practitioners. I ask the Government to respond to our concerns about the slow uptake of those 800 positions.

Morale is extremely important, and that feeds into it, but there are many factors that lower staff morale in our front-line NHS, whether that is having to send patients a 12-week waiting time guarantee letter when staff know that there is no hope of meeting that guarantee, or closing wards to elective surgery because there are no receiving beds for in-patients in the wider hospital due to delayed discharge. A senior neurosurgeon came to one of my constituency surgeries to talk about how low morale was in his department because of the repeated closures of his ward due to the lack of in-patient beds.

We have also heard a thing or two about safety. Alison Johnstone is absolutely right to cite the concerns of nurses who say that patient care was compromised on their most recent shift. However, it is not just about patient care, as we must recognise that staff, too, have to be kept safe. That is why we have lodged amendments to the Health and Care (Staffing) (Scotland) Bill to recognise the pre-eminence and importance of our staff’s safety.

Our approach to whistleblowing matters hugely, because we need our staff to understand that they are being listened to and believed and that there will be corrective action and culture change. The national whistleblowing helpline is not a universally accepted or well-regarded service in our NHS; we can see that in the fact that clinicians will sometimes phone national newspapers about a problem before they will phone the national whistleblowing helpline, such is their concern.

We must also thank our social care workforce and those unpaid carers who look after their loved ones. We all owe them a huge debt of gratitude.

Thank you. I am sorry—time is tight in these short debates.

15:10  

I am delighted to speak in the debate. I refer members to my register of interests: I have a close family member who is an NHS healthcare professional.

As the Parliament knows, my big passion lies in the preventable health conditions agenda. The escalating cost of the treatment of preventable conditions to the NHS is unsustainable. We are not managing the sustainability of the NHS; rather, we are managing its demise. We know the conditions that we are talking about: chronic obstructive pulmonary disease, obesity, preventable cancers, musculoskeletal conditions, mental health, stroke and so on.

If we are to maintain the long-term future of our most precious public service as being free at the point of delivery, it is crucial that policy tackles that issue. In developing a strategy, we must ensure that we have a delivery mechanism; our NHS staff will be key to that delivery.

Last year, I wrote a paper about changing Scotland’s relationship with food, drink and physical activity. The first action point noted that, when we ask our healthcare professionals to look after us and deliver a healthier wellbeing message, our first step must be to look after the health of our healthcare professionals. In so many cases, our healthcare professionals work in an environment that leads them to be more unhealthy than the people to whom they are delivering the health message. We need an environment in which they are able to look after their own health and wellbeing, so that they can adopt the active healthy lifestyle that we ask them to recommend to others. That should be the foundation of any strategy.

On the face of it, some potential interventions are reasonably straightforward. We must ensure that every staff member has access to a hot meal during their shift and adequate break time in which to eat it. Some hospitals do not allow a fridge or microwave in their staff rooms, which leaves night-shift staff with a vending machine as their only option. With regard to Monica Lennon’s point about yoga classes, another example is allowing staff to utilise any on-site facility, such as gym equipment in the physio department, and giving them instruction and time to do so.

If we are asking our healthcare professionals to deliver a service that has a focus on getting the population to be more physically active and nutritionally aware, it is obvious that we need to afford them the very same opportunities. Without that step, the subsequent steps become problematic.

The quality of care in that environment, not to mention the health of the healthcare professionals could be greatly enhanced, resulting in a reduction in absenteeism for both physical and mental health issues. We believe that that would allow healthcare professionals to deliver the kind of preventative and acute care that they want to deliver.

For example, the cardiac physiotherapy department in Crosshouse hospital in NHS Ayrshire and Arran has been running an extended community rehabilitation programme that not only helps chest, heart and stroke sufferers, but welcomes people with other conditions, such as obesity and musculoskeletal conditions. The comorbidity exercise and education classes have been successful in reducing re-admissions to hospital and doctors’ appointments, and they have been instrumental in increasing the quality of life for those suffering with those conditions. Those are the innovative and creative solutions that our healthcare professionals can come up with if they are given the support, room and encouragement to apply their knowledge.

It is disappointing, therefore, to read the amendment from the cabinet secretary, who toes the SNP line of trying to blame Brexit for everything. There are staff shortages, and they were there long before Brexit. Will she consider the impact on the current staffing rates of Nicola Sturgeon cutting nursing and midwifery places in 2012? That was poor workforce planning.

There are multiple Scottish applications for every training place for nurses, midwives, physiotherapists and doctors at medical schools. The reason for the shortage—especially among Scottish applications—is that the Scottish Government has capped the number of places.

Will the member take an intervention?

I am at the end of my speech.

The member has six seconds left.

This is a serious health debate that is long overdue in the Parliament, but has been systematically avoided in Government debating time. Our NHS staff are the main driver to deliver a healthier Scotland. It is time that we looked after their health.

15:14  

I am pleased to speak in the debate to highlight the work that both the Scottish Government and health boards across Scotland are carrying out to ensure appropriate levels of staffing in our NHS.

I recognise that, across NHS boards in Scotland, there are challenges with the recruitment of health professionals, particularly GPs. I have recently learned that the NHS in England is short of 100,000 employees and 40,000 nurses, so if we are going to try to recruit people to Scotland we will not be getting them from England. We will have to get them from somewhere like Europe, which will also be a challenge.

Will the member take an intervention?

I will not, because we do not have a lot of time.

We cannot fix the health staffing issues immediately, but measures are being implemented by the Scottish Government to support that. One such project, which aims to support the recruitment of GPs to rural areas across Scotland, is the Scottish graduate entry to medicine programme. ScotGEM is a partnership between St Andrews and Dundee universities and NHS Scotland. It is a course oriented towards the current NHS Scotland workforce requirements, particularly in remote and rural areas, general practice and other medical specialties. While ScotGEM graduates will be entitled to enter any branch of medicine, the course and the selection of students are designed to attract those interested in a career in a rural area. In one area of the South of Scotland, five GP practices across Dumfries and Galloway are set to take part in the pilot. I look forward to seeing its outcomes.

The Scottish Government is committed to supporting our highly skilled health and social care workforce to deliver a resilient, efficient and high-quality healthcare service that is world renowned. It is already world renowned. As a member of the Health and Sport Committee, I have been involved in the safe staffing legislation as we take the Health and Care (Staffing) (Scotland) Bill forward. It is the first multidisciplinary workforce and workload planning legislation in the UK and it is now approaching stage 3. The effective application of that legislation will support the wider workforce planning process by enabling a rigorous, evidence-based approach to decision making on staffing that takes account of patients’ and users’ health and care needs.

I will pick up on a couple of points that other members have made. Prior to being elected to Parliament, I was an NHS employee for 9 years while the SNP Government was leading, and I felt positively supported in many ways. It is not the SNP’s fault that there are challenges around staffing; many issues contribute to that. The required evolution of processes to support all staff takes time. I absolutely agree with Miles Briggs, who highlighted various ideas and options for supporting staff. Monica Lennon brought that up too. I would have expanded on that further, but time will not allow.

At the end of Miles Briggs’s motion there is mention of a review and of promoting the wellbeing of, and looking after the people who care for us in Scotland—especially me when I have been in hospital in relation to my type 1 diabetes. Our goal is to support people while they are in work and to prevent sickness and absence. NHS Dumfries and Galloway has introduced that as well, and I encourage the Government to review current practices across health boards. We need to make sure that people across NHS Scotland are supported, because they are working really hard.

15:18  

Last year, we rightly celebrated 70 years of the NHS. This year, we need to look forward as well and consider what kind of health service we want and expect for the next generation. Some things are bound to change. People are living longer, which means there are new challenges for health and care as well as a different demographic balance.

New technologies are part of the way forward. This morning’s The Press and Journal highlighted the potential for GP consultations going online at Countesswells in Aberdeen, where internet speeds of one gigabyte per second will provide fast and secure connections. The same newspaper also highlighted the decline in the number of GP practices in Grampian. It is down by more than 10 per cent in the last ten years. GP practice numbers have also fallen in many other areas, from Lanarkshire to Orkney and the Western Isles.

The future delivery of care in communities will require not just enough GPs but also a whole range of other healthcare professionals, from pharmacists and physician associates to occupational therapists and advanced nurse practitioners. This is, therefore, a good time to consider what primary care will look like in the next thirty years, what staff and skills it will need and what support those staff will require. The Health and Sport Committee is doing just that, and I hope that many of our constituents who are listening to the debate will take the opportunity to go to the Scottish Parliament website to tell the committee their views.

Hospital care, too, faces real challenges right now, many of which are also fundamentally about staff. One thing that has changed very little since the inception of the national health service is the extent to which we depend on the dedication and commitment of healthcare staff. Monica Lennon and others mentioned issues that staff organisations such as the BMA and the RCN have raised. They tell very similar tales. Nurses in Scotland and across the NHS have described how often they have to cope with inadequate staffing levels and how often they have to do more than their planned shift to ensure that patients receive the care that they need. Doctors talk about going the extra mile to cover for ill or absent colleagues or long-term vacancies. Even though, through those actions, they keep the NHS afloat, they feel that they get little thanks for doing so.

All of that is bound to affect the quality of care. It also risks the kind of reputational damage that makes recruiting the next generation of healthcare professionals to the NHS all the harder. Whatever we call them, those are challenges that must be faced and addressed sooner rather than later; otherwise, we will risk exhausting the good will and commitment of the staff that are so important to the NHS.

We must acknowledge, too, the issues that the social care workforce faces. The Health and Care (Staffing) (Scotland) Bill, which Emma Harper mentioned, acknowledges the need for parity between health and social care as part of the process of health and care integration, but as we have heard, when it comes to pay and support for staff, social care is still the poor relation of the NHS. The Joseph Rowntree Foundation says that 15 per cent of the social care workforce live in poverty. Enable describes that situation as

“Scotland’s most vulnerable people being cared for by Scotland’s most vulnerable workforce.”

It is clear that that must change.

When we look to the future, we need to think about how to close the gap between the NHS and social care at the same time as addressing the staffing challenges within the NHS. We can create the high-quality integrated health and care sector that we all want and need only if we start by supporting those who work there, now and in the future, and making the sector an attractive place to work for the next generation.

15:22  

I thank Miles Briggs for bringing the debate to the chamber. Credit where credit is due, as I am sure all members will agree. Credit is also due to the SNP Government, which is committed to supporting our highly skilled health and social care workforce. We want to deliver a resilient, efficient and high-quality healthcare service, and, from what I see as I go about the various areas in my constituency, the Scottish healthcare system is recognised as being among the best in the world.

We talk about staff morale, and I make this point to Miles Briggs, in particular. Do you not think that the fact that you constantly say that there is a crisis in the health service has something to do with the morale of the people who work in the health service? I have been speaking to those people for a while, and they feel that, by using the word “crisis” as you do, you are using the health service as a political football. I will leave that there.

Will Sandra White give way?

No. I am sorry, but I do not have time.

If Conservative members spoke to healthcare professionals and listened to organisations such as the BMA, they would discover that that is what they say.

Will Sandra White give way?

I am sorry, but I do not have time.

Miles Briggs mentioned staffing, but we are looking at staffing in the NHS. As the cabinet secretary said, staffing is at a record level and it has increased by 13,600—some 10.7 per cent—under the SNP Government. That is a good thing, not a bad thing. It is time that we looked at some of the positives. I am not saying that our health service is perfect, but we ought to recognise the positives. In that context, it should be mentioned, in relation to what Monica Lennon’s amendment says, that the health and social care staff experience report found that 79 per cent of NHS staff feel that they are treated with dignity and respect.

Will the member give way?

I am sorry, but I have only two minutes left—not even that—and I want to come on to Brexit.

I mentioned the comments that the BMA has rightly made, but we also have the view of 24 health professionals in Scotland, who wrote an open letter to the UK Government in which they said:

“As doctors, nurses and healthcare professionals from Scotland, we see the damage that Brexit is already inflicting on our treasured National Health Service. Make no mistake about it. Brexit is costing us lives.”

That is what they said, not what I said, so let us look at what other people are saying about Brexit.

EU citizens make a fantastic and vital contribution to our economy. They drive population growth and they work in all sectors. The vast majority of EU citizens in Scotland—84 per cent—are of working age and, of those, 76.8 per cent are in employment. Because of what is happening with the Tory Government at Westminster, we will lose those people.

Will the member give way?

No, I cannot—I am sorry.

Those people are already leaving because they are absolutely terrified that they will not be able to stay in this country.

Lewis Macdonald’s speech was very interesting. [Interruption.] If the Tory members are quiet, they might hear some interesting facts and figures. Lewis Macdonald’s points about care homes and care staff were absolutely true. As Miles Briggs knows full well, when the Health and Sport Committee took evidence on the issue, we heard that people are leaving and that they are frightened. That is all down to the Tories, so please do not just talk about a crisis. You should take responsibility for what your Government at Westminster is doing to the health service in Scotland.

I remind members to use full names, even when in full flow.

15:26  

I record my personal thanks to NHS and social care staff, who work so hard to care for us. I can think of at least a handful of individuals who have helped my family so much during difficult times. It is not just about the act of providing healthcare and all the years of studying and hard work that go into that; we can all probably think of little acts of kindness that have touched us in some way at some point in our lives. That is why I hope that we can all get behind the motion. People who go into health and social care do so because they care about people and, for that reason alone, we should do all that we can to care for them.

The context of the debate is important. Our NHS is facing numerous staffing-related problems. The NHS workforce in Scotland is getting older, with the proportion of staff aged 50 and over increasing from 29 per cent to 39 per cent in the past 10 years alone. Absence rates due to sickness are at the highest level for a decade, which is in part due to rising workloads, and we are experiencing a recruitment crisis. For example, one in four GP practices currently has a vacancy, hospitals are short of nearly 2,500 nurses and midwives and 5.5 per cent of child and adolescent mental health services posts are vacant. It is no wonder that staff are struggling.

Even without considering the factors that the Government has control over, we know that the jobs are extremely demanding, both physically and mentally. We have heard some extremely sad stories—unfortunately, they are not difficult to find. As we have heard, not only are people’s lives put into danger because of extreme fatigue, as we saw with the young medic Lauren Connelly, who died while driving home after a night shift, but the roles take an extreme toll on mental health. Statistics that were released last year revealed that the number of staff who were absent due to stress, depression and anxiety rose by nearly 18 per cent between 2015-16 and 2017-18.

Today, we are advocating the creation of a working environment that provides holistic care and support to all NHS and social care staff. There are simple measures that would make a real difference. For example, as we have heard, parking is a real issue for many NHS staff, especially in Glasgow. In recent days, we have heard more about the on-going saga of parking at the Queen Elizabeth university hospital, where it has been reported that nurses have slept in their cars just to get a space. Late last year, nurses at the Glasgow royal infirmary launched a petition against the £20 charges being levelled at them just for the privilege of parking at their work.

A future Scottish Conservative Government would launch a widespread review of parking across all hospitals, for staff, patients and visitors. We would like there to be sleep pods in hospitals, so that staff could rest after their shifts, and we would like there to be health checks at community pharmacies, which would include blood pressure checks, weight management programmes and the option of free flu jabs.

Mental health support is vital, too. That is why we want every health board to have a facility where staff can get mental health support as well as financial advice.

Such simple measures could lay the foundations of a more supportive working environment.

The most valuable resource in our NHS is its people, so it is only right that workplace services are improved to promote the wellbeing of staff. The Scottish Conservatives are today calling for basic measures that will make a difference to people’s working lives. Only then can we say that we are truly looking after those who look after us.

I call Fulton MacGregor. After that, we will move to the closing speeches—I was about to say “opening speeches”; that would have shocked everyone.

15:30  

I thank Miles Briggs and the Conservatives for bringing this motion to the Parliament. I agree that our NHS and social care workers are one of the country’s most indispensable resources and that staff face considerable pressure in their careers and on a day-to-day basis.

The SNP Government is backing and strengthening our workforce so that it can deliver the efficient and high-quality service that it provides day in and day out.

It is only proper that, as the constituency MSP for Coatbridge and Chryston, I pay tribute to workers in health and social care services in my constituency—at Monklands hospital, in health centres and day services and in many other services.

In particular, I pay tribute to EU workers. I am not sure why Conservative members, who were keen to lodge a motion about the health of workers, are resisting mention of the impact of Brexit on EU workers, who are going through a torrid time just now. Having to work in such circumstances is impacting those workers’ health.

As the cabinet secretary said, the Health and Care (Staffing) (Scotland) Bill is the first multidisciplinary workload and workforce planning legislation in the UK. That shows that the SNP is taking the lead in supporting our healthcare professionals. Through our groundbreaking evidence-based approach to nursing and midwifery workload and workforce planning, the bill will provide assurance for staff and service users that appropriate staffing is in place, irrespective of the health or care setting.

This will—I apologise, Presiding Officer. I have lost my place.

We did not notice. [Laughter.]

Okay. I apologise for that.

In the remainder of my speech, I will focus on a local issue in my constituency. Recently, I was shocked and astounded to learn that the North Lanarkshire integration joint board had voted on a recommendation to close the dementia day service at East Stewart Gardens in Coatdyke. That fantastic local unit provides an invaluable and critical service to many vulnerable patients from across my constituency. To give members some context, let me explain that the day service does not just cater for individuals who live with dementia and their families. A local nursery attends weekly, to build relationships and bonds between the generations, which people find to be a valuable experience. Probably most concerning—and relevant to today’s debate—is the fact that I learned that staff, patients and their families were told of the proposal to close the service only days before the decision was due to be made. That has caused considerable distress for all concerned.

As soon as I found out about the proposal, I wrote to the board, urging it to reject the decision to close the centre and to undertake a full equality impact assessment before making further recommendations. Such decisions cannot be taken lightly, and it is unacceptable that not just service users but staff were notified only a matter of days before the decision. The news must have had a massive impact on people’s health.

I see that I am in my final minute—and I jumbled up my speech earlier.

The board went ahead and made the decision to close the service despite representations from people who were against the proposal. I give credit where it is due: the Conservative Party resisted the proposal, as did the SNP. However, the local Labour Party has seen it go through. The notice that was given placed stress on staff, and there was no engagement with the unions or with MSPs or councillors. That is not acceptable, and the issue absolutely relates to the subject of the motion.

I welcome the motion. As Sandra White said, we must all work together to deliver the best health and care services. There is further work for the Scottish Government to do—I have talked about some of the work that is being done and the cabinet secretary will talk more about that. Funding from the UK Government must be prioritised, too, and, at local authority level, councillors from all parties must put local politics to one side. In that way, we will get the best services, which are what our nation deserves.

15:34  

Fulton MacGregor is always a hard act to follow, but I will try my best.

We have had a short but useful debate. Members have reflected on how important the NHS has been to them and their families. I am glad to hear that Darcy, Alex Cole-Hamilton’s young daughter, is doing well. She got us all very worried and we followed her progress very closely on social media. In our hour of need we all have something in common: we all need to pick up the phone and call for an ambulance or get the doctor. That reminds us all that we are all human beings.

What also almost unites the Parliament is the reality of the workforce crisis. There has been a failure to plan effectively for our workforce needs. Lewis Macdonald, a Labour colleague—who was also wearing his convener hat—rightly looked to the future and spoke about the challenges, the next generation of the workforce and the role of technology. He also nicely plugged the Health and Sport Committee survey, which is on-going. The closing date is 30 April: I hope that all of us will encourage our constituents to take part and have their voices heard.

We know that when people feel that they are not being listened to—whether that is patients, people who require social care or the workforce—they do not feel valued. As I said earlier, today I attended NHS Lanarkshire’s annual review, at which there was a mixture of people, some of whom were genuinely appreciative and recognised the great work and innovation that is under way, and others who felt frustration that health and social care integration is not happening quickly enough. People are not knitting together.

The cabinet secretary often hears me talk about resourcing and my concerns about underinvestment across the health and social care spectrum. However, it is not always about the money. We need to make sure that we have the right culture, and we need strong leadership at the top in all of our health boards and all of our health and social care partnerships.

We have the best staff in the world, but sometimes they feel that they are not being listened to when they raise issues and have good ideas. When I speak to colleagues in Unison, for example, their concern is that although lots of people get up the ladder and do quite well in the NHS, the training and development does not always keep up with that, which sometimes results in poor management. I know that the cabinet secretary will recognise those issues, not only from her time chairing a health board but from her time in her current position as cabinet secretary.

I think that there are points on which we can all work together, and we have to continue to do that, because this is all far too important. We are doing the people of Scotland and our health and care staff a disservice if we deny the fact that we have a workforce crisis. Therefore, Labour will not support the amendment in the cabinet secretary’s name. However, there are shared sentiments across the chamber today and we should listen to colleagues such as Emma Harper, who is a valued member of the Health and Sport Committee. We need such people here. The fact that we have a Minister for Mental Health who was a mental health nurse is a positive attribute of the Parliament. At times, we will need to step out of our own comfort zones and our party positions to find way of working together.

At the beginning of the debate, Miles Briggs highlighted the tragedy of Dr Lauren Connelly. We cannot have any more tragedies of that kind. I have not yet had an answer from the Government on what we are going to do about the fact that in the years that I mentioned earlier, 1 million working days were lost in the NHS due to stress absence alone. Some of that will be caused by issues outwith the workplace—we get that; people do not come into work and switch off from their lives outside—but these are the big challenges that we face.

Looking at what we have agreed on in the debate, we can see that there is a lot that we can build on and develop for the future.

I call Jeane Freeman to close for the Scottish Government. Cabinet secretary, you have five minutes.

15:39  

I thank all the members who have contributed to the debate. It has been a helpful one, and it was helpful to me to hear the propositions that members have put forward.

I want to cover some of the points that have been raised. Mr Briggs was right to recognise Brian Connelly’s work in response to the tragic death of his daughter. In recognising that, I want to pay tribute in passing to our colleague Linda Fabiani, who has long championed that issue.

I want to advise members of where we have got to in this work. Shortly, I will be talking to the BMA about all of the issues. However, so far, we have got to a point at which no junior doctor is required to work more than seven days in a row; working seven nights in a row has been abolished; and, by August this year, a minimum 46-hour rest period will be implemented. Further, we are continuing to work with the expert group on a maximum working week of 48 hours with no averaging. We are taking steps in that direction because, of course, the issue is vitally important.

With regard to some of the issues that were discussed, I need to make the point that I know that the BMA and others have raised with the UK Government the recent changes to pensions and the impact that they are having on many members of our medical workforce, both consultants and GPs. A GP whom I met this morning at the new Gorbals health hub raised precisely that issue with me. It is a serious matter, and, along with colleagues in the BMA and others, we will continue to press the UK Government to consider the issue again, as, I am certain, there are unintended consequences at play. I hope that our colleagues on the Conservative benches will support us in doing that.

I thank Monica Lennon for raising again the point about the importance of culture in our workforce—she makes that point often, and is quite right to do so. Why do people enjoy their work? Partly because it is recognised and valued, partly because of how it is paid but also partly because of the culture in their workplace. It is important that people feel that their ideas and concerns and the issues that they raise are recognised and that there is no negative comeback when they talk about them. I will come back to the chamber after the Easter recess to report on the outcome of the independent Sturrock review, which is concerned with NHS Highland. In that context, I will also bring members up to date on where we are with regard to the national whistleblowing champion and on the issues to do with the board that Monica Lennon quite rightly spoke about.

I would like to make a point about project lift, which is a values-based leadership programme that operates across our health service. Values-based recruitment is an important part of that. Its aim is to address some of the issues that Monica Lennon raised around training and support as people take on additional responsibilities.

Alison Johnstone made an important point that I will follow up on about the urgent need for communication about the changes that the GP contract will bring to the patient’s experience. One year on, we can use some positive examples of situations in which GPs are able to offer appointments of at least 15 minutes and in which patients feel that they have seen the right person in relation to their concern or medical issue.

Alison Johnstone was right to talk about the value of social care staff and the importance of social care being seen as a career. That is one area of work in which we are busy. We are considering how people can continue to work in social care while building up some of the practical skill-based education modules that they need in order to pursue their career in the field. Of course, that needs to be done in partnership with our local authorities and the private and independent sector providers. I believe that all of them are supportive of the approach, but we need to work out how much more we can do. Not least among what we have to do is to make absolutely sure that the funding that we have passed to local authorities in relation to paying the real living wage for 24-hours care is actually used for that purpose. I am determined that we will do that.

On the point of whether we face a crisis or a challenge, I would say that there are challenges that we face, but my point is that calling the situation a crisis does not take us one step further forward in addressing some of the measures that we have to take. It does not help our staff in the health and social care workforce. I am not dodging the issues that we have to address—

Will the member take an intervention?

No, I cannot.

You said it was Brexit.

I say to Mr Whittle that I did not claim that Brexit was the sole reason for all of this, but I will not accept Scottish Conservatives pretending that Brexit has nothing to do with them and that it is not affecting our health and social care workforce.

Will the member take an intervention?

No, I am afraid that the cabinet secretary must conclude.

It is not helpful for members to use this issue to try to score political points rather than doing their research, finding out the facts about what we are doing and addressing this situation maturely.

I call Michelle Ballantyne. You have six minutes, Ms Ballantyne. I warn members that I intend to move swiftly on to the next debate so that we do not lose time.

15:44  

We call it “our NHS”. We use those words because every one of us is touched by it at some points in our life. Last year, the NHS celebrated its 70th birthday. In the words of Scotland’s chief medical officer,

“We are now moving into a new era of ‘realistic medicine’ in NHS Scotland—moving away from the current ‘doctor knows best’ culture to shared decision-making, with the patient and their healthcare professional”.

I welcome that change and think that it is the right move. However, it will bring challenges for staff. I spent 27 years working in the NHS, first as a nurse and then in management. I can tell the chamber that, in 27 years, we never stopped changing. I doubt very much that the NHS will ever stop changing, and that brings challenges.

The cabinet secretary argues about words—is it a “challenge” or a “crisis”? Well, it is always a challenge, but it becomes a crisis when the numbers start to escalate. Absences due to stress increased by nearly 20 per cent over the three years from 2015-16 to 2017-18. Is that not a bit of a crisis? One in four GP practices in Scotland has a vacancy. Is that not a bit of a crisis? There are more than 400 vacant consultant posts. Is that not a bit of a crisis? Hospitals are short of 2,400 nurses and midwives, according to the latest data that I have. Is that not a bit of a crisis? I agree that those are all challenges, too, but we have to use our words carefully. It is a crisis for the staff. It is a crisis every day that they come to work and there are shortages of staff on the wards. It is a crisis when they feel that they cannot deliver the standards of patient care that they want to. It is a crisis for social care staff when they find themselves with four people on a rota that requires 10. It is a crisis when the only applicants whom one can get for a social care job for a profoundly disabled person are people with no experience. That is a crisis.

I am not looking to undermine the NHS. I love the NHS. Like all the people here who talk about the NHS, of course I value and acknowledge the people who work in it. This debate is not about undermining people; it is about saying that we need to acknowledge the issues that we face—and that we need to acknowledge them together. We can argue about words, but the reality will stay the same.

The cabinet secretary described the problems that the NHS faces as “well rehearsed”. Well, we need to stop rehearsing them and come together to address them. She listed the improvements that the Government is taking forward, which we welcome. I acknowledge that a lot of them are good and need to be taken forward. However, she also indicated—several times—that she will listen and reflect. I hope that she will, because I have found while speaking to NHS staff recently that senior professionals in NHS Scotland are increasingly reluctant to speak out about their thoughts and experiences—because when they do, they are taken aside. That is not the kind of atmosphere that we need. People need to be free to write and talk constructively about what is going on around them.

A number of members including Monica Lennon and Alex Cole-Hamilton raised that issue and asked the cabinet secretary to bring forward her appointment of whistleblowing champions. The issue is not just about people who are low down in the NHS and who are finding difficulties with the management structure, but about senior people who have things to say but feel unable to say them. We must start to listen and work together on that.

Miles Briggs talked about the impacts of health staff being stressed, tired and overworked. The tragic death of Dr Lauren Connelly is a prime example of the horrific things that can happen. Although I therefore welcome the changes in relation to staffing that the Government is bringing forward, they do not go far enough and we need to keep looking at the issue. Brian Whittle stressed the importance of making sure that those who look after our health have someone to look after their health. We need to ensure that all staff in the health and social care profession get regular clinical supervision. I have noticed that that has started to slide. They need to be able to talk about where their mental health is and how they are coping with the pressures that they experience. We need to ensure that our staff are fighting fit and able to do the work that they need to do.

I understand why Emma Harper denies that the SNP has anything to do with what is going on with NHS staffing levels, but I remind her of what Miles Briggs pointed out. When Nicola Sturgeon was the health cabinet secretary and was making decisions about nursing places, she was warned that there would be a longer-term effect. It is therefore slightly hypocritical to step away from that and say that the decisions that were made in the past have no impact on the present.

We should not use the NHS as a political football. [Interruption.] Jeane Freeman can cough all she likes, but that is exactly what she does. To be perfectly honest, as somebody who spent a lot of time in the NHS, I would be quite happy if the Government had nothing to do with its running. That will never happen because of the money around it, but it should be run by the people who know best.

Will the member take an intervention?

I am in my final seconds. I have to sit down.

Indeed you are.

We need to focus on the issue. There is a crisis, and denying that does not solve the problem. We have to work together to solve the problem.

We will move swiftly on to the next debate, because I can see that people are in their front-bench places.