Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, June 7, 2022

Official Report 947KB pdf

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Topical Question Time

The next item of business is topical question time. In order to get in as many members as possible, I would be grateful for short and succinct questions and responses.

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Nursing (Staffing Levels)

To ask the Scottish Government what its response is to reports that less than a quarter of nursing shifts have enough staff. (S6T-00764)

Before I answer that question, I will say what a fantastic and incredibly powerful time for reflection that was. It was a great honour to be in the chamber to hear it.

I am, of course, concerned about any reports of understaffing in our national health service. The Government recognises the challenges that are associated with ensuring that the health service has the right number of staff in the right place at the right time. We also recognise that the demand pressures that are placed on our health service continue to be significantly exacerbated by the impacts of the pandemic.

The recently published “National Workforce Strategy for Health and Social Care in Scotland” sets out how we are working to deliver workforce recovery. That is on top of the 1,000 additional new healthcare support workers who have recently been recruited and the nearly 200 new international nurses who have been recruited, with more than 200 in the pipeline.

Tess White will be aware that NHS workforce statistics were published this morning. They show that NHS staffing levels continue to be at a record high, which includes increases in nursing and midwifery.

However, I am not complacent. I recognise that, notwithstanding our best efforts, the NHS continues to face significant demand pressures, so I welcome conversations on safe staffing. We will continue to have regular dialogue with the Royal College of Nursing and other staff-side unions on that important matter.

The findings of the Royal College of Nursing’s last-shift survey are shocking. Almost 70 per cent of staff in Scotland felt that safe and effective patient care was compromised on their last shift, due to insufficient staffing levels. That is significantly higher than the number anywhere else in the United Kingdom.

We have asked this question before without getting a clear answer, so let me try again. When will the Scottish Government provide a timeline for implementing the Health and Care (Staffing) (Scotland) Act 2019, which was passed unanimously by the Scottish Parliament three years ago?

I intend to publish a timetable for implementation of the safe staffing elements of the 2019 act very shortly—in fact, I hope to do so in the coming month.

I point out to Tess White that the RCN survey was a UK-wide survey. In relation to concerns that were raised by RCN members, the vast bulk of those members would have come from England. This is a UK-wide issue; there is no doubt that the effects of the global pandemic have been UK wide, but we have a good track record in Scotland of investing in our nurses. That is why we probably have more qualified nurses per 100,000 people than other parts of the UK have: we have 8.5 qualified nurses and midwives per 100,000, compared with 6.1 per 100,000 in England.

As I said, we will make sure that we continue to invest in our staff, and we will take forward the safe staffing element of 2019 act in a considered way, but at pace, as is its due.

The number of nursing and midwifery vacancies has increased by nearly 40 per cent in a year, with more than 6,200 vacancies currently open across NHS Scotland. I repeat: the vacancies are in NHS Scotland.

The shortfall in registered nurses has risen to a record high under the Scottish National Party Government, while in Scotland growth in nursing and midwifery is the slowest in the UK. The situation is so bad that the RCN has evidence that students are being enlisted to plug staffing gaps, which is a potential breach of the law.

Given that record shortfall, does the cabinet secretary agree with RCN Scotland that the SNP-Green Government’s plan to increase the workforce by just 1 per cent over the next five years is totally inadequate?

I will say two things. I will engage with the RCN later today—in fact, I am going to speak at its congress. Let me put some facts on the record. The number of qualified nurses and midwives has increased by 13.7 per cent since this Government came to power. Nursing and midwifery student funded places have doubled to a target intake in 2022-23 of 4,837. We have, of course, plans in our workforce strategy to ensure that we continue that growth; the 1 per cent to which Tess White is on top of that natural growth.

I am certainly not dismissing the very serious concerns that the RCN has raised, but I am very proud of our record on staffing. On vacancies, it would have been good for Tess White to have read today’s workforce statistics, because they show that nursing and midwifery vacancies have decreased since the previous quarter.

The cabinet secretary has already mentioned some of the steps that have been taken to build on the existing workforce—which are set out in the national workforce strategy—and he has mentioned the increase in staffing levels since 2007. What action is the Government taking to continue to attract more people into the profession? What support is given to people as they undertake their studies—in particular, in midwifery and nursing?

Compared with the rest of the UK, we have a very attractive offer for students studying in Scotland—particularly those who are studying nursing and midwifery. They will not pay tuition fees in Scotland, and there is additional support.

Gillian Martin’s first question, on recruitment and retention, is exceptionally important, especially for rural, island and remote parts of Scotland. Although we are, as I have said, increasing the number of student funded places in nursing and midwifery, we will, of course, recruit from the rest of the UK. International recruitment also has a key part to play in attracting people to remote, rural and island parts of Scotland. I have mentioned that we have recruited almost 200 registered nurses internationally, and that we have another 200 in the pipeline. I am working very closely with rural health boards to ensure that there is not just recruitment to the central belt, but that recruitment is evenly and widely distributed throughout Scotland.

The member survey by the RCN, coupled with new statistics today that show record nursing vacancies in Scotland, is shocking. Nurses are at breaking point, and there are reports of nursing staff walking off wards due to stress and the pressure that they are being put under. That comes after 15 years of the Government slashing bed numbers, failing to tackle delayed discharge and failing the nursing profession by cutting training places and presenting no meaningful workforce planning.

I put that issue to the Deputy First Minister at First Minister’s question time a few weeks ago. He said:

“we are working to ensure that we can address the issues that are of concern to members of the Royal College of Nursing.”—[Official Report, 26 May 2022; c 20.]

With yet more deeply concerning evidence, what exactly is the cabinet secretary doing to address those extremely serious issues, which threaten not only the wellbeing of staff but the safety of patients? Is not it time to offer nurses a proper pay award and decent terms and conditions?

I will address the RCN directly today; I will meet it tonight. I will hear from it and take questions, and I will, I hope, provide it with some reassurance in my answers. Regular dialogue with the RCN and the other trade unions will continue, just as it continues across Government, with other trade unions.

Paul O’Kane asked about record nursing vacancies. I do not know whether he heard my response to Tess White’s question. If he looks at today’s statistics, he will see that they show that vacancies have reduced since the previous quarter. We are therefore moving in the right direction. I fully accept that the number of vacancies is too high, but the number is absolutely moving in the right direction.

Paul O’Kane also mentioned our 15 years in government. I remind him that, in the 15 years since we took over from his party, the workforce in the NHS has gone up by 23.5 per cent, and we have increased whole-time equivalents by almost 30,000. Nurse numbers are up by 13.7 per cent, and medical and dental consultant numbers are up by almost 60 per cent. We have the best-paid staff in the entire UK, including Labour-run Wales.

We have a very strong record of investment in the NHS—a record by which I am proud to stand. However, members are, of course, absolutely right to raise those challenges, which have my full focus and attention.

The legislation that we pass in the chamber is not worth the paper that it is written on without implementation to back it up. Safe staffing is not just about headcount; it is also about the skills mix and experience. We are losing skills and experience to staff burnout. Will the cabinet secretary revisit the Liberal Democrats’ suggestion about an urgent burnout prevention strategy? Will he instruct today the creation of an NHS and social care staff assembly so that we can learn from the lived experience of staff on the front line?

I will consider seriously Alex Cole-Hamilton’s suggestion about a staff assembly. There are other ways in which we reach out to NHS staff, whom I meet regularly, but I will certainly take on consideration of his suggestion.

Alex Cole-Hamilton has previously referenced a burnout strategy, and I have often said to him that we are investing record amounts—£12 million over the last financial year—in staff wellbeing. I do not think that it requires another bit of paper, or that another document be drawn up. It requires action; we are taking action. However, if the member would like a broader discussion on wellbeing, rather than just asking us to devise a strategy, I would be more than happy to arrange time for that to happen.

I take Alex Cole-Hamilton’s and Tess White’s points about implementation of safe staffing legislation. That is why I am committed to publishing an implementation timetable very soon.

The RCN survey found that students and support staff are being asked to fill staffing gaps and to undertake the work of registered nurses. How will the Scottish Government work with health boards to ensure that all students and staff are aware of their rights, and that there are clear channels for them to raise concerns if they are being asked to fill in for nurses inappropriately?

Gillian Mackay’s message is important and I will reiterate it when I meet the RCN. If any member of staff, including from among our hardworking student nurses and student midwives, has any concerns, the environment in their health board, hospital or community setting should be such that it allows them to raise those concerns.

I met all the whistleblowing champions from all the health boards and the independent national whistleblowing officer for NHS Scotland, and we agreed action points, because we think that there is more that we can do with staff cohorts so that they know their rights in relation to whistleblowing. We can co-operate and ensure that students across the medical and clinical cohorts are part of that communication strategy.

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ScotRail (Abellio Contracts)

I refer members to my entry in the register of members’ interests. To ask the Scottish Government, in light of recent reports, whether it will provide further information regarding existing ScotRail contracts with Abellio. (S6T-00768)

As part of the transition to a publicly owned railway, it was necessary for Transport Scotland to undertake a review of all existing contracts. It was identified that four Abellio contracts would be required to continue with ScotRail Trains Ltd from 1 April this year, to ensure consistency of service for passengers and to facilitate a smooth transition.

The contracts that have been retained include those for the Abellio shared services centre for customer service calls and correspondence, payroll services and payment processing facilities; Abellio rail replacement for the provision of planned and unplanned replacement bus and taxi services; Advance Ventures for management of station tenancy and advertising management; and the bus link between Glasgow Central and Glasgow Queen Street stations.

The information in the media came from a freedom of information request. Can the cabinet secretary inform the Parliament how much money is involved in those contracts?

I cannot disclose the financials involved in the contracts because they are commercially sensitive. However, the member is right that public ownership of Scotland’s railways needs to mean exactly that. To that end, her question requires a level of context.

First, it was prudent to carry over a limited number of contracts, whether delivered by Abellio or other suppliers, to maintain ScotRail services from day 1 of public ownership and to give that continuity of service for passengers and staff alike. It is also pretty common practice across the United Kingdom and Welsh Governments in relation to handovers that have happened in the past.

Secondly, only four Abellio contracts out of the contracts with almost 200 suppliers remain in place. Three of those contracts have a one-year break point clause, which will allow for the consideration of competitive alternatives.

The approach that we have taken is pragmatic. That is particularly pertinent when we consider the fourth contract, which secures jobs at the ScotRail services centre in Glasgow.

I am grateful to the cabinet secretary for that answer. Perhaps she will reconsider some of the issues around confidentiality and write to me in detail on the contracts, given that we are talking about fare payers’ and taxpayers’ money.

I hope that the minister agrees that every penny of money that we put into our railways should go into the system, rather than leaking out of the public sector. Could she outline whether any rail replacement services are being provided by Abellio, given that we know that there are contracts relating to that, yet there is currently a lack of rail replacement services? Will she commit to looking at that commitment and the other Abellio contracts in order to bring them back in-house as soon as possible, as she has indicated? Will she give us a timescale in relation to that?

The member has covered a number of points. First, I make it clear that none of the contracts is a permanent feature of public ownership. Indeed, to that end, I have asked my officials at Transport Scotland to continuously review whether the contracts are delivering best value for money.

I am sympathetic to the principle behind the member’s point about the financial benefits leaking out of the public sector. However, we need to consider the continuity aspect. On 1 April, staff and passengers alike were experiencing levels of anxiety, and it was essential that there was a level of continuity. Furthermore, the contracts were reviewed at the point at which ScotRail came into public ownership on 1 April.

On the member’s ask, more broadly, as we move forward with public ownership, as she knows, I want our trade union partners, passengers and staff alike to have a vested stake in Scotland’s railways and what that vision will look like. That is why we have committed to a national conversation on rail.

The member asked a question about rail replacement buses. That links to one of the contracts. As she might be aware, ScotRail has confirmed that securing rail replacement transport is significantly more challenging at this time than it has been in the past. That relates to a decrease in the number of available bus and taxi drivers coinciding with a number of other challenges, not least the challenge that the bus industry faces in relation to the Covid pandemic. Some challenges have been compounded by the wider impacts of Brexit.

I am happy to take the general question about rail replacement bus services to ScotRail. The member will understand that, over the past couple of weeks, I have been making such representations. There is a challenge here for ScotRail—I recognise that. I am happy to write to the member with more detail on the timescales that are associated with any delivery of further bus replacement provision.

I think that we all accept that a transfer such as this into the public sector will happen over time. Will the minister clarify how many staff are involved in the contracts? Obviously, they will be a bit concerned about their future. Can she give them any reassurance, including that fair work principles and practices will apply to them in the future, irrespective of whether they are in-house staff or they work on contracts?

The move to ScotRail Trains Ltd has given stability for all ScotRail staff, and the Scottish Government remains absolutely committed to a policy of no compulsory redundancies.

The member asked about the number of jobs that are affected. The four contracts that are being retained have supported a number of jobs, with around 160 being secured for the next three years at the Abellio shared services centre in Glasgow. Both Scottish Rail Holdings Ltd and ScotRail Trains Ltd are required to comply with the 2015 Fair Work Convention, the “Fair Work Framework 2016” and the Scottish Government’s fair work first guidance. That requirement is set out in the framework agreement and grant agreement, which underpin the new arrangements that came into effect on 1 April.

It seems to me that we need full transparency here. The minister should be telling us what the contracts are worth and not hiding behind commercial sensitivity. While the minister is thinking about that, will she commit to telling us what the new chief executive and chief operating officer are being paid out of the public purse? We do not know that, either.

On his final point, the member is right—he does not yet know that information and he should know it; it should be in the public domain. I make it clear that information on those salaries will be published in the coming weeks—I have had an assurance from ScotRail on that.

In relation to the figures that are associated with the four Abellio contracts—members should remember that a number of other contracts are involved in the process—that is commercially sensitive information, which I am not able to disclose in the chamber today. However, I have undertaken to ask my officials in Transport Scotland to continuously review the contracts that are currently in place, to ensure best value to the taxpayer.