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Chamber and committees

Meeting date: Wednesday, May 10, 2017

Meeting of the Parliament 10 May 2017

Agenda: Portfolio Question Time, National Health Service Pay, Business Motion, Parliamentary Bureau Motion, Decision Time, International Nurses Day


National Health Service Pay

The next item of business is a debate on motion S5M-05479, in the name of Anas Sarwar, on scrapping the national health service pay cap.


Today, the Scottish Parliament has the opportunity to unite in support of Scotland’s NHS staff. We should take that opportunity.

Every single day, our amazing NHS staff perform miracles. There is the caring, the examining, the diagnosing, the treating, the operating, the saving of lives and the delivering of newborns. There are also the aspects that are easily forgotten or not recorded as a statistic: giving advice, holding hands, shedding tears of grief and joy, comforting those who have lost loved ones—to put it simply, just being there and caring.

We all have our own personal stories of how the NHS has touched us. We all have family or friends who have worked for the greatest public institution in the United Kingdom. By coincidence, this debate takes place on the first birthday of my younger son. This time last year was the culmination of probably the biggest emotional rollercoaster that I have ever experienced, all within the space of a week. I welcomed the birth of my beautiful niece, only for her heart to stop the next day and, after days of battling, for us sadly to lose her. The next day, I was elected to this Parliament, and a few days later I welcomed the birth of my son—feeling partly joy and partly guilt because of the tragedy that my brother and sister-in-law were going through.

I can honestly say, with hand on heart, that if it had not been for the love and care of the neonatal nurses and midwives, my family and I could not have got through that week. So to all our NHS staff—the porters, the nurses, the midwives, the doctors, the consultants, the allied health professionals and all the rest—I say thank you, thank you for caring. We should never forget that what makes our NHS great is not the buildings, the medicines, the equipment or the treatments but the brilliant people who work for our NHS.

However, our thank yous are not enough. NHS staff should be respected and rewarded for the job that they do, too, because good will and dedication to the NHS and their patients go only so far. That is why the context of today’s debate is so important.

There is a record number of vacancies in all parts of Scotland’s NHS—for general practitioners, consultants, midwives, nurses and more. Let us take the last example of nursing vacancies. More than 2,500 nursing staff are missing from our hospitals across Scotland. Since 2011, the number of vacancies has increased from 660 to 2,500, which is a four-fold increase in only six years. Of those vacancies, the number going unfilled for more than three months has increased by 300 per cent and now sits at almost 750. Nursing staff report that they do not have the right number of colleagues to enable them to do the job properly.

The Royal College of Nursing’s centenary survey of its members in 2016 showed that staffing levels were their biggest concern and that they just do not feel that there are enough of them to care for their patients. Without the right number of nursing staff, patients simply do not get the care that they need—whether that is in hospital, at home or in a care setting. Nursing staff want to do their very best for patients, but their best efforts very often come up against the reality of pressures on the workforce. In short, we have too few nurses doing too much work for too little reward. They are underresourced, understaffed and under pressure—and they are clearly underpaid by the Scottish Government, which has the ability to do something about that and which needs to recognise the impact that its austerity is having on the recruitment, retention and morale of Scotland’s nurses.

I met some of Scotland’s nurses this morning. I want to give just two examples. Graham, who has been in the service for 32 years, told me that morale among staff was among the lowest that it had ever been. In his words,

“Good will only goes so far; good will does not pay the bills.”

Ellie, who is a trainee nurse, told me about staff having to step in to do bank shifts or roles that trainees should not be doing. Others told me about nurses having to take second jobs or even having to attend food banks. It is shameful that NHS staff should have to do that.

Let me set out what this Government’s policy of austerity means for Scotland’s nurses. The following is from independent analysis by the Scottish Parliament information centre. Pay at the starting point of band 5 has increased by 6 per cent over the period from April 2010 to April 2017. Over the same period, prices, as measured by the retail prices index, have increased by 22 per cent. That means that pay at the band 5 starting point has fallen by 13 per cent in real terms over the period. That is equivalent to a reduction of £3,400.

I asked SPICe about the figures that the member mentioned. The answer that it gave me was that a nurse who started on band 5 in April 2010 and progressed up one point per year would be on a salary of £29,033 as at April 2017, which is more than £3,000 more than the member suggests and represents a cash increase of 37 per cent and a real-terms increase of 12 per cent. Does the member recognise those figures?

We are talking about starting salaries, which do not take progression into account. As we are publishing the SPICe analysis, I am more than happy to say that.

What I do not understand is why Scottish National Party members are already jumping up to have an argument about numbers and bands when I have laid out the experiences of NHS members of staff in their own words. I do not think that they will appreciate—

On a point of order, Presiding Officer. With reference to Mr Sarwar, I ask what course of action a member who misleads Parliament during a debate, whether deliberately or otherwise, should take to correct the factual position at the earliest opportunity.

I think that all members know the rules of the Parliament. Mr Sarwar, continue, please.

Mr Doris should perhaps think about how his intervention and those of other SNP members reflect on NHS staff who will be watching the debate.

Is it any wonder that we have record numbers of vacancies, record levels of sickness absence and a vacancy crisis in Scotland’s NHS? While, on one hand, the Scottish Government is overseeing the vacancy crisis, on the other hand it is paying out hundreds of millions of pounds to private nursing agencies. Audit Scotland confirmed that, in the past year across the NHS, £175 million has been spent on private agencies. That has happened at a time when, according to Audit Scotland,

“agency staff are likely to be more expensive than bank nurses, and also pose a greater potential risk to patient safety and the quality of care.”

It makes no sense for the cabinet secretary to be throwing money at private agencies or starving the NHS of cash to resolve the vacancy crisis.

The verdict of the Royal College of Nursing has been damning. Nursing leaders say:

“Budget savings achieved through pay restraint are being used to meet efficiency-saving targets for the NHS. The result is that NHS staff pay has fallen way behind the cost of living and many nursing staff are now struggling to survive on their pay packet.”

Worryingly, they say that that is negatively impacting on the quality of care that is being delivered to patients. That is what SNP members should be reflecting on. That is happening in Scotland in 2017. On the watch of an SNP Government and an SNP cabinet secretary, nurses in Scotland’s NHS are struggling to survive on their pay packet. I will repeat that: nurses in Scotland are struggling to survive on their pay packet.

The RCN’s most recent employment survey of its members found that almost one in three struggled to pay gas and electricity bills, one in seven had missed meals because of their financial difficulties, more than half reported that they were compelled to work extra hours to increase earnings, and one in three were working shifts at night and at weekends to help them to pay bills and meet everyday living expenses. The RCN’s careers service has experienced a marked increase in the number of calls from its members seeking advice on career options outside the nursing profession. They often cite pay restraint and the increasingly limited opportunities that exist for skilled and experienced nurses to make progress in their careers.

Would Mr Sarwar care to comment on the fact that the RCN’s employment survey is a survey of the RCN’s membership in the whole of the UK, not just its membership in Scotland?

I have already said that I met nurses in Scotland this morning, whose experience is the same as that of RCN members right across the UK. Pay restraint has had an impact in Scotland. I would expect Emma Harper, as someone who has been a nurse, to understand acutely the struggles and strains that are being faced by NHS staff across the country. I hope that, as a former member of a union and a qualified nurse, she will vote in favour of a pay increase for nurses.

It is not the Labour Party that is reporting such damning facts—they are being reported by nurses. Many nurses are taking second jobs, and some of them are using food banks to feed their families. That is happening in Scotland in 2017. I note that the Scottish Government’s amendment calls for an assessment of pay restraint. I say to the cabinet secretary that the RCN, Unison and others are already telling us what the consequences of pay restraint are. The only people who are responsible are the Scottish Government.

The Scottish Government has been in control of every aspect of Scotland’s NHS for a decade. The First Minister was in control of the health service and took decisions that we are now reaping the consequences of, such as the decision to cut the number of student nursing places. There was strong criticism of the decision by Nicola Sturgeon and the SNP Government to slash the number of training places for nurses and midwives by nearly 300 in 2012-13. How did Nicola Sturgeon react at the time? She said:

“A reduction in intake for the 2012 academic year is a sensible way forward.”

How she must regret those words today.

Today, the Parliament can unite and send a message to Scotland’s NHS staff. We can tell them loudly and clearly, “You are our most valuable asset. You make the difference. We recognise the importance of the work that you do. We respect you, and you will be rewarded.” Our motion is clear: we must scrap the pay cap and give the NHS staff the pay increase that they deserve. The alternative is to carry on with more austerity and more cuts. The choice is clear: to focus on a Labour motion that will give the NHS the pay rise that it deserves or to focus on the SNP’s obsession with running another independence referendum.

I move,

That the Parliament believes that the NHS pay cap should be scrapped and that NHS staff should be given a real terms pay rise.


I am happy to take part in the debate and to move the amendment in my name. As the health secretary, I have the good fortune to see regularly the excellent work that our health service staff do day in and day out. Those men and women provide care to every family in our country, and work to ensure that Scotland is as healthy as possible and that our health service is first class. I know that I am not alone in agreeing with Anas Sarwar on this: those staff not only have the thanks of my family but the thanks of us all.

I will focus my remarks mainly on the issue of pay, and I will return to workforce levels—we have record workforce levels, although we have record demands on our health service—and agency spend in my closing remarks.

The independent pay review body in the NHS can trace its origins back to the 1980s. It considers pay and then makes recommendations that advise all four UK countries on the uplifts that should be applied. As staff representatives have, we have valued the independent pay review process to date. In Scotland, we have made clear our view that ours are annual settlements; however, there continues to be a challenge to that process, as the UK Treasury has, in recent years, insisted that pay restraint of 1 per cent on uplifts will be maintained until at least 2020. In turn, the UK Government’s Department of Health has adopted that approach for England, supported by Labour-run Wales: the Welsh Government has agreed that it intends to apply the 1 per cent restriction until 2020. That is perhaps an example of Labour saying one thing during an election campaign and doing an entirely different thing when it is in government and has the power to pay nurses.

Can the cabinet secretary confirm that her own submission to the independent pay review body recommended continuing with the 1 per cent pay cap for Scotland’s NHS staff?

Our pay policy is made in the context of not just addressing the pay uplift but addressing low pay and preserving the policy of there being no compulsory redundancies. As the RCN has recognised, we are all bound by the Treasury, because the resources that the Treasury gives to the Department of Health dictate what we get in consequentials. I will come back to the issue of the independent pay review body in a second.

Another aspect in which our approach has differed from that which has been taken elsewhere is the fact that we have consistently applied the recommendations of the pay review body as well as taking additional action to help the lowest paid. As a result, we have seen in recent years a steady divergence, whereby agenda for change staff in Scotland are now better paid than their counterparts in England, Wales and Northern Ireland. We were the only country to apply the full recommendations of the pay review body in 2014, and we were the only country to even request recommendations in 2015. Our staff are now paid more than their colleagues who undertake the same duties in the other parts of the UK.

As the Government’s amendment notes, nurses at the first pay point of agenda for change band 5 are now paid £312 more than their counterparts in Wales and England. In fact, at every pay point within band 5, staff in Scotland are paid between 1 and 2 per cent more than their counterparts in Wales and England. A band 5 nurse who started on the first pay point in 2010 and has progressed annually within that band will have started on £21,176 and will have advanced to £29,034. On the basis of Labour’s own analysis, that represents a real-terms increase of more than 12 per cent—37 per cent in cash terms—over the period. As the unions recognise, it is not just about pay; it is also about pay progression. I will come back to that point.

We have, of course, been able to bring real job security: the Government, with Parliament’s support, has delivered our no compulsory redundancies policy since 2007. I know that NHS Scotland staff value that commitment highly. The situation compares favourably with, for example, the more than 20,000 compulsory redundancies in the NHS in England since 2010.

The difference between our approach and what happens elsewhere is even more pronounced when we look at the position of the lowest-paid workers in the NHS. By delivering the real living wage for a number of years, by ensuring additional uplifts for the lowest paid above those that the review body recommended, and by working in partnership with unions including Unison to provide upskilling for previously band 1 staff, we now have entry-level support staff in Scotland being paid more £1,100 more than their opposite numbers in the NHS in England. I know that those additional amounts can make a significant difference for the dedicated and hard-working NHS support staff who help to deliver healthcare to the people of Scotland.

It is clear that there are staff who have reached the top of their bands for whom inflationary pressures will have outpaced their uplifts. I know that although staff at the top of their bands are relatively better off than those in England and Wales, they face real challenges from those inflationary pressures.

The cabinet secretary has rightly highlighted that people who are at the top of their pay band will, with the pay cap, be worse off in real terms year on year. Will she also confirm that a nurse who starts today will be £3,400 worse off in real terms than a nurse who started in April 2010?

Nurses in Scotland are over £300 better off at the starting point of band 5 than they are anywhere else in these islands, including in Labour-run Wales. No one stays on point 1 of their band, of course. Labour seems to misunderstand, or not understand, how pay progression works. This is about pay and pay progression. Nurses who started at point 1 in 2010 are now £7,500 better off because they have worked through the scale.

The Scottish Government, the NHS employer side and the staff side work together at all levels to deliver the outstanding health service that we all use and rely on. We greatly value the insight and advice, and the sometimes necessary challenge that the NHS Scotland unions and staff bodies bring. I look forward to meeting the RCN, Unison and others to discuss pay over the next few weeks.

In fact, I met Unison health staff earlier today. A nurse told me that although pay, the pay increase and the percentage of the pay increase are important elements, pay progression, seniority pay and recognition for continuing professional development and training are equally important, which was interesting. All those issues are equally important, and I will address them in my meeting with the unions. I am talking not about a promise of jam tomorrow from a party that has no prospect of winning the general election, but about real action in the here and now and working with the unions in partnership to address the issues.

Our constructive approach to partnership working was also evident during the recent negotiations effectively to do away with the lowest band 1 level in NHS Scotland and to move the staff on to better pay and more rewarding roles. Again, I am talking not about promises of something tomorrow, but about something that is being done today. Partnership with staff is always the best way to resolve issues.

I confirm that I have written to the staff-side representatives to arrange to meet and jointly to commission work to develop an evidence base that will help us to assess the impact of pay restraint and which can be used in the next round of submissions to the independent NHS pay review bodies.

Will the cabinet secretary take an intervention?

No—I am in my last minute.

In conclusion, we believe that there can continue to be value in the independent pay review process, but we are willing to explore alternative approaches, if that is in the best interests of NHS staff. We should bear in mind that many unions wanted the independent pay review process. I have made it clear to the unions on many occasions that if they are now saying that they think that it has run its course and that they want to engage with me on considering a different set of pay negotiation structures—perhaps Scottish pay negotiation structures—my door is open to that, but it has to be with staff-side agreement. I will put on the table for discussion with the unions in the NHS whether they want to maintain the independent pay review body process or to move forward in a different way. We will move forward, working in partnership with NHS staff, to deliver Scottish solutions that work for the benefit of all of our hard-working NHS staff.

I move amendment S5M-05479.3, to leave out from “believes” to end and insert:

“notes that the NHS Independent Pay Review body helps determine NHS pay on a UK-wide basis, and that the Scottish Government has consistently implemented the body’s recommendations; further notes that, as a result of recommended pay uplifts being passed on in full in Scotland, unlike other parts of the UK, band 5 Agenda for Change staff members in Scotland will be up to £312 better paid than their counterparts in England and Wales; welcomes that, over and above the pay recommendations, due to Scottish Government action for the lowest paid, entry level NHS support staff in Scotland are paid more than £1,128 more than their counterparts in England; further welcomes that no compulsory redundancies, free nurse student tuition and nurse student bursaries are being retained in Scotland, but is concerned about the impact of their loss on the NHS in other parts of the UK; however, recognises that NHS staff in Scotland have faced real challenges as a result of inflation outpacing uplifts at the top of pay bands; believes that the best resolution will be found by the Scottish Government working in partnership with NHS staff representatives; therefore calls on the Scottish Government to seek agreement with the staff side, through their representatives and unions, to jointly commission work, developing an evidence base to assess the impact of pay restraint, using this evidence as part of the submission to the next pay round of the NHS Independent Pay Review body; remains concerned that Brexit is continuing to be a cause of uncertainty for staff from other parts of the EU working in the NHS, and believes that the rights of these committed staff should be guaranteed immediately, and that maintaining freedom of movement within the EU is vital to sustain the health service for the future.”


The debate is about the priorities and choices for our national health service. Do we want a strong NHS that is able to cope with rising demand, an ageing population and the pressures that are placed on its staff, or must we have an NHS that is unable to handle the heat, with plummeting staff morale, longer waiting times and longer waits for appointments? Nobody in Parliament would opt for the latter.

However, the record of the SNP Government will inevitably lead to the very issues that we want to avoid. This Government has been in power for more than 10 years and has had full control of the direction of the NHS during that time. What is its record? There are significant staff vacancies in nursing and midwifery, consultants and allied health professions. People are waiting well over the 18-week target for referral to treatment and there has been a failure to meet waiting time targets in accident and emergency, with targets being met in only seven out of 52 weeks last year.

Has Donald Cameron looked recently at the relative performance of our A and E departments compared to those in the Tory-run NHS in England? The difference is night and day. A quarter of NHS A and E departments in England were in crisis over the winter, which was not the case here. Will he please give due recognition to the hard-working efforts of our A and E staff, who have delivered the best performance in the UK?

We have been here many times before. The SNP Government runs the Scottish health service. It should concentrate on its record and not point the finger at other places.

Most pertinent to the debate is plummeting staff morale in the NHS; almost half of NHS staff feel that they are unable to do their jobs properly because they are overworked. That is a depressing record for an SNP Government that likes to trumpet regularly that the SNP is the only party that can deliver for the NHS. It is a record that I will come back to in a moment.

First, however, I will address Brexit, which appears in the Government’s amendment. I will deal with the matter head on, given its prominence in the media today and the fact that it was mentioned earlier in portfolio questions. It is difficult to estimate the number of NHS employees who are from non-UK European Union countries, but we know that they make up 5 to 10 per cent of NHS staff. Undoubtedly, Brexit presents a challenge in that regard; the UK Government has been very clear on that. One of the Government’s top priorities, as part of the Brexit negotiations, is to secure the rights of EU nationals to continue to live and work in the UK. However, I have said it before and I will say it again: the serious issues in NHS staffing in Scotland did not suddenly begin on 23 June 2016 when the UK voted to leave the EU. GP shortages existed long before then, so the SNP cannot use Brexit as cover for an existing workforce crisis.

Will the member take an intervention?

I want to carry on.

We are going to be 820-odd GPs short by 2021, many NHS staff are close to retirement and those who are left are overworked and under immense pressure. The NHS workforce in Scotland is in crisis due to nearly a decade of SNP mismanagement, so let us not hear the SNP Government blame Brexit for its own problems or use it as a reason not to take responsibility.

I turn to Labour’s motion. I have huge sympathy with the feelings and motivations behind the motion because we all want our NHS staff to be properly paid. However, at this point in time, the Conservatives cannot support an end to the pay cap, partly because there are tight budgets and multiple rising budgetary pressures. We believe that, for the time being, staff should continue to receive a 1 per cent pay rise and should be supported in other non-financial ways. If we are to secure the long-term future of the NHS, we should be ensuring that the short-staffing problems that pervade the health service are addressed as a matter of urgency.

Surely that extra support should not be food banks. Surely there has to be recognition that there is a direct correlation between staff vacancies, staff morale, patient outcomes and staff pay. Surely even the Tories can see that.

I accept that hard-working NHS staff deserve to be paid well because they do skilled and vital jobs. I welcome the Government’s commitment to ensure that all staff are paid the living wage. We acknowledge that the Scottish Government has passed on recommended pay increases and that staff in the NHS in Scotland are paid more than those in other UK countries.

However, as I said, the NHS is facing rising demands from an ageing population with complex health needs. Any decision to increase pay has to be taken in a wider context. Despite the pay cap, staff costs have still increased by 6.4 per cent in the past five years, and they make up nearly half of all NHS operating costs.

If we manage to reform the NHS in order to continue to deliver high-quality healthcare, and truly to shift the balance of care away from the acute services into the community, we would be able to invest what we save. Labour has come to the chamber today with an important issue, but it has made no mention of, or given any detail on, the cost of what it proposes.

There are huge vacancy rates in the NHS. We cannot get people to take up posts, yet Donald Cameron argues for a cap of 1 per cent. In this place, there are no vacancies and there are armies of people outside who would be desperate to take up our posts. There are no gaps here, yet Donald Cameron will agree to an increase in what will be paid to him and me that is higher than the increase that will be paid to nurses. Is that fair?

The point that I make to Mr Findlay is that he has given no details of how much it will cost. How is it going to be funded? UK Labour has estimated that every 1 per cent extra on pay will cost the NHS £350 million. However, other figures suggest that the cost could be higher. Labour may want to supply some figures—though perhaps not by consulting Diane Abbott, this time.

The Labour motion does not address one of the central issues that face our NHS, but we must address staffing levels. We know that staff morale is low, and we have seen time and again that low morale is down to the fact that there are across the NHS severe staff shortages that this SNP Government has completely failed to tackle.

Will the member give way?

No; I have taken several interventions and need to crack on.

We know that the most recent figures show that. We have cited the number of vacant consultant, nursing and midwifery posts. Time and again, the Government has ignored our warnings, and it has even ignored the warnings in the very consistent calls from professional bodies, including the Royal College of Nursing Scotland, that tell us that the situation cannot go on. The doctor who led the Scottish Government’s own cancer strategy, Dr Anna Gregor, has said that the NHS in Scotland is

“hurtling over a precipice with everyone pretending that it is going to be all right and it won’t be”.

We are warning the Scottish Government about recruitment and retention. Professional bodies are warning the Scottish Government and medical staff are warning the Scottish Government. The warnings have been coming for years. The question is this: when will the SNP listen? Do we want, under the SNP Government, another four year in which targets are missed? Do we want another four years of crippling pressures on existing staff because of vacancies? Can we deal with four more years of inaction from a Government that deludes itself into thinking that it is best placed to run the health service while ignoring the serious concerns of professional bodies and staff? The answer to all those questions is a resounding no.

I move amendment S5M-05479.2, to leave out from “the NHS pay cap” to end and insert:

“NHS staff deserve to be valued and supported; notes that the Scottish Government has let down NHS staff by failing to carry out long-term workforce planning; acknowledges that nearly half of the NHS workforce believes that there are not enough staff for them to do their job properly; believes that widespread short staffing is damaging for staff morale and patient safety; considers that recruitment and retention issues are in large part due to working conditions; calls for efficiencies to be made in areas such as spending on agency and locum staff, and notes concerns from groups such as the Royal College of Nursing over staffing levels in NHS Scotland.”


I am proud to be standing up in the chamber today to support our hard-working NHS staff and I will be proud to vote at decision time in favour of a wage rise for the workers who are the foundation of our health service.

The continuation of the unfair 1 per cent pay cap on earnings over £22,000 per year means that Scottish nurses will have received, on average, a pay cut of £3,400 under this SNP Government. The Royal College of Nursing in Scotland tells us that, since 2011, nursing staff have experienced a real-terms cut in earnings of between 9 and 14 per cent. That situation is, frankly, unsustainable. Nurses are the foundation of our health service, but they are failing to get the support and resources that they need from the SNP Government.

The facts are clear. Nursing staff are under pressure like never before; they are finding it more and more difficult to get adequate time to care for their patients; and, all the while, they are facing increasing financial difficulties. The RCN’s most recent employment survey of members found that 30 per cent have struggled to pay bills while more than half have been compelled to work extra and unsocial hours just to make ends meet.

Meanwhile, spending on agency and private nurses has soared under the SNP, and there is a vacancy crisis with unfilled nursing and midwifery posts. The number of long-term vacancies has rocketed since 2011, when the SNP formed a majority Government. Audit Scotland tells us that agency spend has rocketed in the same period, and it is now at £175 million. Perhaps that is an area of savings that the Tories could consider before they put questions to the Labour Party.

Nine out of 10 nurses tell us that they feel that their workload has got worse. In every aspect, NHS nurses are being overstretched and overworked. I brought that issue to the chamber recently in respect of multiple sclerosis nurses, particularly in NHS Lanarkshire but right across Scotland. They, like all our staff in the NHS, deserve a much better deal than they are getting from the SNP.

In recent years I have had reason to be in and around hospitals more than I would have liked. Two years ago this month, my father died in Hairmyres hospital in East Kilbride after a period of illness—he was only 60 years old and it broke my heart. A couple of days before he died, one of the nurses prepared me and my family for what was ahead. His name was Paul, and although I did not want to hear what he was telling me, I was so pleased to see him because he had cared for my dad and nursed him during a previous admission. He had cared for him with such compassion and attentiveness that I had not forgotten him, and I doubt that I ever will.

Then there is Katie—another nurse who looked after my dad and my family as we said our goodbyes. When I returned to Hairmyres hospital just two weeks ago, this time while I waited for my mum to be taken into surgery, Katie approached me in the waiting room. It was a lovely surprise to see her, but she gave me one of those hugs that smothers us in kindness when we are struggling to hold it together and leaves us fighting back tears.

In between those experiences, last year, I had to be referred to the breast clinic at Hairmyres hospital to have some cancer tests. I went alone and I was terrified and—again—emotional. The nursing staff were simply first class. They kept me calm as I waited in between different examinations in a very busy waiting room. I looked around me at the dozens of people all queuing at the desk. There were people with children, it was noisy and stressful, and I wondered how the staff managed.

I have been in the Scottish Parliament for the past year. When I come here and hear Scottish Government ministers and SNP back benchers accuse me and my Scottish Labour colleagues of rubbishing NHS staff, talking them down or playing politics, I feel sick to my stomach. When our MSPs come here to shine a light on the pressures that are facing our NHS, it is because we have nothing but admiration and respect for NHS staff. The nurses who the Parliament will celebrate later in a members’ business debate are our friends, neighbours and loved ones, too.

When the Scottish Government deflects criticism of its stewardship of our beloved NHS on to the very staff who are being stretched to breaking point, is that fair? I know that a couple of SNP members are nurses, so I ask them to think about where their loyalties lie when they press their voting buttons at 5 o’clock. How can someone who has been a nurse and served alongside NHS staff betray those staff this evening?

This might be slightly different, but how can Monica Lennon, as a councillor, defend the approach that South Lanarkshire Council took to the equal pay claims of thousands of women across the authority?

I am no longer a councillor, but it is ridiculous for a Government minister to bring into a debate something that has no bearing on it. Aileen Campbell knows fine well that I support equal pay for all workers. That intervention was pretty shameful.

Let us get back to the point. Aileen Campbell can smile, but we have heard that nurses are going to food banks. We had a debate in the Parliament last night about food poverty. The Government cannot sit there and say that it is someone else’s problem and turn away. Tonight we will see whether the SNP Government will vote with the Tory party to block a pay rise for nurses.

Will the member give way?

I am in my final seconds—thank you for your generosity, Presiding Officer.

The choice is clear. Tonight, MSPs can either support a pay rise for our NHS staff and state that they believe that the pay cap should be scrapped, or not. It is black and white. Labour members are clear that we stand on the side of working people. Other members should consider doing the same.


Before I start what I was going to say, I want to make it clear to members on the Labour benches and others that they do not have a monopoly on awareness of people having to deal with the health service. They are not the only people who have had people die in hospital or who care about the nurses and the doctors who treated them. The contributions from the Labour Party and the Conservatives have suggested that we do not care about the nurses or respect the hard work that they do, but of course we do because, like the people on those benches, everyone here will have lost somebody in the health service. I do not think that it is becoming of anyone to pretend that they have a monopoly on that.

The NHS is often described as the jewel in the crown of British society, and with some justification. Despite what the Labour Party says, however, it seems to me that, across the UK, it is the Scottish Government that recognises the NHS’s importance and prioritises its needs while trying to balance the ever-shrinking gift of our own money that is passed down via Tory austerity. The Scottish Government has consistently protected the front-line health budget at all costs, enabling our health service to be free at the point of need and, importantly, to remain publicly owned.

What would James Dornan ask the Scottish Government to do to stop nurses in our NHS in Scotland having to go to food banks?

Scottish nurses are better looked after than any other nurses across the UK. What the Labour Party fails to recognise at any time in any debate is that, although we work under the same financial restrictions as the rest of the UK does, we have decided to have no compulsory redundancies, to make sure that the lowest-paid nurses have a £400 bonus and to make sure that they have a 1 per cent increase in their wages, which other nurses across the UK do not get. No one should come here and tell us that Scottish nurses are badly paid in relation to nurses in the rest of the UK, because in Scotland we are doing everything that we can within the restrictions that we are under to ensure that Scottish nurses are looked after.

The NHS is under great pressure across the UK, but nowhere more so than in Wales. Under the devolved Labour Administration there, accident and emergency department waiting times are longer, ambulance response times are longer and patients wait longer for many routine treatments than they do anywhere else in the UK. Perhaps Mr Sarwar, who apparently has all the answers when it comes to running a national health service, could use some of his expertise to assist his colleagues in Wales.

I could list a load of figures to show how much money the NHS is receiving from the Scottish Government, but it is more important to consider the results of that investment across Scotland. Certain politicians often issue quotes criticising the new Queen Elizabeth university hospital but, in January, there was a peak in the number of women who received maternity care across Glasgow, primarily at the QE. Although numbers are high and patients were looked after at the best available facility, Scottish Labour seemed to see that as another opportunity to use the hospital as a stick to beat the Scottish Government with.

The reality is that the only damage that is being done by the Labour Party’s constant carping, apart from the damage that it is doing to its ever-dwindling political reputation, is the damage that is being done to the hard-working staff across the Queen Elizabeth and other hospitals. Monica Lennon talked about the SNP trying to deflect criticism. We do not try to do that. The fact is that the politicians who come here and criticise health service workers are not on these benches but on the Labour Party benches.

The recent BBC documentary “Scotland’s Superhospital” was fascinating. It showed only a fraction of the first-class work that that state-of-the-art hospital does for the people of Glasgow. I was a patient in that facility and can vouch for the care that is given there.

Another thing to note is that parking at that hospital is free. Why is that important? It is important because families use it. I know of one family with two chronically ill kids who have to attend the hospital, sometimes four or five times a week. If they had to pay parking charges, on top of the stress of having to go to the hospital in the first place, they would be in an awful state—it would make things much worse. Why is that an issue? Until the SNP Government came into power in 2007, the Labour Party made sure that such families had to pay for parking at hospitals. The Labour Party was quite clear that it was justifiable to make people pay for parking at hospitals.

I absolutely agree that the removal of parking charges was the right thing to do. What I do not agree with is removing parking charges and having no traffic management system at hospitals. At St John’s hospital in Livingston, parking is chaos. People who attend for chemotherapy and other treatments leave home an hour or an hour and a half early in order to drive round the car park for an hour trying to find somewhere to park. If we remove the payment system, there has to be a traffic management system. If Aldi can do it, surely the NHS can do it.

I remind members that, interesting though traffic, parking and parking charges are, the motion is not on that topic and neither are the amendments, so—

They are not, but—

Mr Dornan, do not talk over me. Sit down, please.

I am looking at the amendments and at the motion. Let us keep to them, please, and not drift into another area—

On a point of order, Presiding Officer.

Mr Findlay, please sit down.

It is on a point of order.

It had better be.

May I speak?

I am letting you speak. I am waiting to see whether it is a point of order.

The issue of parking is relevant because it relates to nurses’ pay. They have to pay for parking if—

That is not relevant to the amendments that are before me, nor is it relevant to the motion. I want us to get back to the motion that is at hand. Mr Dornan, please continue.

Presiding Officer, can you clarify for me how far away from the wording of the motion and the amendments—

I have made my ruling, Mr Dornan. I want you to get on with your speech. Do not challenge me, please.


Nurses and midwives are one of the most valuable resources that we have. The Scottish Government clearly recognises that, in order to sustain a high level of care, we must invest in the future of our nursing services, and that is why we are committed to free tuition and bursaries for people who are studying to be nurses.

Not only are we committed to the development of the workforce, but Scotland has worked hard to maintain its policy of no compulsory redundancies while in England there have been more than 20,000 redundancies since 2010. Scotland works under the same financial restrictions as the rest of the UK does, yet I have figures from the Royal College of Nursing that show that nurses here in Scotland are paid at a higher rate than their counterparts across the UK, which is just another way of showing how we value their service.

I know that there is an election coming up and people want to grab headlines with motions criticising the Government. However, in the case of a motion such as this one, I would ask how Scottish Labour would fund this extra pay. Would it scrap the policy of no compulsory redundancies? Would it scrap bursaries for the nurses? Would it take more money away from the other vital front-line services that it claims to want to protect?

Where, I ask my friends—I was going to say “on my left”; I mean the Conservatives—is the £350 million a week for the NHS that we were promised after Brexit, which we opposed, as did most of the Conservatives in the Parliament? Well, they did back then, before they were told that they no longer oppose it. It is almost like a cult over in the Conservatives’ part of the chamber, is it not?

On Friday, I had the good fortune to be at the count to see the SNP take control of Glasgow City Council from the Labour Party—this is relevant. What did I hear there? I heard Anas Sarwar telling a media company that it was a terrible day for the SNP and independence and that it was a strong showing for Labour. While Mr Sarwar continues to make fanciful and irrelevant contributions such as his contributions last Friday and today, the Scottish Government will keep to its promise to improve the NHS and support our hard-working and much-valued nurses.

Eight minutes!

Eight minutes!

I will have no comments from anybody about the length of time members have had for speeches. I intervened during the speech, as did Neil Findlay. I gave the member extra time because I made a ruling during his speech.


I first declare an interest, in that my daughter is a healthcare professional in the NHS.

I welcome the opportunity to speak in the debate and I thank Labour for raising this important issue in the chamber. I am sure that across the chamber, there will be complete agreement that our NHS staff—as with all our front-line public servants in the police, the fire service and so on—deserve to be paid appropriately for the work that they do and the care and attention that they give daily. The question remains, how is that to be achieved in a sustainable and consistent manner, beyond the political rhetoric and posturing?

In the last week, I have had the opportunity to witness healthcare on the front line, as I spent some time in accident and emergency. Members will be pleased to hear that I was seen well within the four-hour guideline. While waiting to be seen by the duty nurse, I was able to watch the nurses’ station and observe what was going on. There were harassed staff phoning through to the front desk to ask them to stop sending people through because there was no room; patients complaining that they had already been sitting for half an hour; and a nurse saying that she was fed up of leaving the hospital feeling guilty, even though she was well over her hours. It was 8 o’clock in the evening and she was due back in on the morning shift. I took the opportunity to speak to her, and what she wanted above all was to feel valued, for us to understand her role, to have the staff numbers and experience to cope with demand, and to have the flexibility in the duty roster to cope with the fluctuating demand.

On Monday night, I met a GP who was part of a practice that had taken the difficult decision to close a surgery in Fenwick and resign the rest of the practice in Crosshouse and Kilmaurs. NHS Ayrshire and Arran is currently looking for GPs to take over the practice and has had only one tentative enquiry since January this year. Five GPs could be taken out of the system in Kilmarnock and that is compounded by the fact that, within 18 months, a further six GPs in the same area are due for retirement. That is a potential loss of 11 GPs in Kilmarnock. As of two weeks ago, there were already 15 GP positions advertised and unfilled in Ayrshire. A recent presentation on primary care at Glasgow University made it obvious that that is far from an isolated problem. It is endemic across Scotland.

Does the member agree that, although there are difficulties in recruitment to general practice, today’s report by the Royal College of General Practitioners about the impact of Brexit on the workforce in Scotland is worrisome? I would say to his colleague, Donald Cameron, that it is particularly worrisome for those of us who represent rural areas, such as the Highlands and Islands, where up to one in four of the doctors is an EU national.

I will give you extra time, Mr Whittle, as that was a long intervention.

Thank you, Presiding Officer.

The problem is not just about recruiting staff from across the world. What about supporting and retaining our own home-grown GPs? The GP that I spoke to told me that she wrote to Shona Robison two weeks before resigning from the practice on 31 January, asking for help. The practice is still awaiting a reply.

Will the minister take an intervention?

No, I will not take an intervention, thank you.

It is all very well having the rhetoric, but it is action that applies here, and that is patently not the case with the Government.

When that GP joined the practice as a partner 10 years ago, it was the eighth practice that she had applied to. Now a GP can pretty much choose whatever practice they want to go to, and I was shocked to be told that the most dramatic change had happened in only the last three years.

As has been alluded to, the practices that suffer the most are the rural practices, as GPs migrate towards population centres. The people who suffer the most are the patients, who lose continuity of care; it is not just GPs that we are losing, but their years of experience in those communities and the relationships of trust that have been built up with patients over years of treatment.

Locums are increasingly being sought to fill gaps, and that gives rise to a major financial issue that must be addressed. Three years ago, they were paying a locum around £180 a day. Now, I am told, the practice that has just closed was having to pay £250 for a locum to cover just four hours. With the pressure that our GPs are under, coupled with the demand, it is no wonder that working as a locum is such an attractive proposition.

The issue, according to the GP that I mentioned and her colleagues, is not the money that they earn; it is being valued. It is about recognising that GPs are the gatekeepers and that they are healthcare professionals with long-term patient relationships built on years of working in a community. The plea from GPs is first to stabilise the current workforce as an immediate priority. The consequence of not addressing that right now, according to the GP I spoke to, is more people ending up in hospital. The consequence of that is that the next conversation that we will have will be about how to deal with the mess and fallout. It is as true for politicians as it is for GPs that the longer you leave a problem before treating it, the harder it is to deal with.

The reality is that, as GP numbers have fallen, hospital consultant numbers have risen. With falling front-line GP numbers, the number of patients ending up in hospital inevitably rises as they come through A and E. Those patients could and should be dealt with in local GP practices.

That brings me to the Labour motion. It is not just about levels of pay. An NHS that is sustainable for the long term must be the aim, and that, quite frankly, will require a radical overhaul of the way in which we view health and healthcare. It requires a culture change in how health professionals are viewed and treated both in this place and by the public more widely. The preventative healthcare agenda, where there are potentially billions to recoup and reinvest, has to be placed front and centre instead of being given the lip service that it currently is.

The jobs that healthcare professionals do must have more attractive and valued career paths. In the words of healthcare professionals, that is about more than just money. Choosing a career as a healthcare professional is not driven by financial reward; it is driven by a desire to care. What came across loud and clear in my recent conversations with healthcare professionals, way above all else, was concern for patients and what will happen to them if the NHS is not steered on to a more sustainable course, where the baseline is improved long-term health outcomes through sustained continuity of care.

If we are serious about recruiting into the health service to address demand and about rewarding our healthcare professionals appropriately, simply throwing more money at the problem is not the right course of action. We need to stop treating the symptoms of the systemic issues in the NHS and focus on dealing with those issues for the long term. Let us stop just trying to keep the show on the road and start thinking about how we build a sustainable future for our NHS.


We have heard comments from some Labour members about the Royal College of Nursing Scotland briefing, so I would like to quote from the briefing. It states:

“Pay awards for NHS staff have been constrained by the UK Government’s policy on public sector pay since 2011.”

It goes on:

“It should, however, be noted that the Scottish Government has implemented recommendations made by the PRB to date, even when the UK Government has not. This means that whilst terms and conditions remain broadly equivalent across all countries pay rates for each of the pay bands vary.”

That means that, in Scotland, there has been an increase and there is a higher level of pay across the bands here.

Will the member take an intervention?

I have just started. I will try to let the member in later.

Between 2010-11 and 2019-20, the Westminster Government will reduce Scotland’s fiscal departmental expenditure limit budget by 9.2 per cent in real terms. In spite of that, the Scottish Government has committed to continue to provide above-inflation increases to Scotland’s health budget. While in government, the SNP has protected the front-line health budget, increasing it by 40 per cent between 2006-07 and 2017-18. Health funding now stands at record levels. In 2017-18, health spending in Scotland will exceed £13 billion, with resource spending being over £3.6 billion more than when the Government took office in 2007. Figures from Her Majesty’s Treasury show that health spending per head in Scotland is 7.2 per cent higher than in England, which is the equivalent of an extra £152 per person.

There are challenges in the NHS, and nobody on the SNP benches would say that there are not. There will always be challenges in the NHS, irrespective of which party or parties are in power. That will be the case here, in England and in Wales, and we have heard examples of that in the debate. Nonetheless, it is clear that those figures highlight the importance that the Scottish Government places on the NHS in Scotland. The funding that goes in to our NHS and the focus on it to make it better and more responsive show that it is absolutely paramount. Members across the chamber really have to try to understand the level of funding that is going in.

As we have heard today and in previous debates, our NHS staff are resilient. They have a unique set of skills that they bring to their patients and to the multidisciplinary teams in which they operate. Our NHS staff are always there at times of crisis to treat, care for and reassure their patients. I have been very fortunate in that I have not had to call on NHS staff very often, and my family, too, has been very fortunate from that perspective. However, I deal regularly with constituents who have had challenges, and the one thing that comes back time and again is how valued our NHS staff are. I for one fully recognise and appreciate every single thing that our NHS staff do for the country, and I am sure that every single member of the Parliament does so.

The Scottish Government’s public sector pay policy sets out the 1 per cent maximum increase for those earning over £22,000 per annum. The continued real-terms reductions in public sector budgets for Scotland for 2017-18 flow from the UK Government spending round.

Members of the Tory Party have to recognise that their cuts are coming to this Parliament and this Government, and that that means that constraints in pay bills across all public sector organisations are still required.

It is recognised that maintaining employment and fair rates of pay in the public sector is crucial in ensuring that Scotland’s economy remains strong. The aim of the policy is to allow public bodies to provide a pay increase for all staff, with particular support for those on the lowest incomes, and for employers to take their own decisions about pay progression.

I will put that in the context of NHS England and NHS Scotland. This proposal to increase the pay of NHS staff beyond 1 per cent per annum is primarily a result of the fact that there are severe shortages of NHS staff, particularly nurses, in England. Speaking on BBC Radio 4’s “Today” programme, Jonathan Ashworth, the shadow health secretary, revealed that as a result of staff shortages in England, Labour would scrap the 1 per cent pay cap in place for all NHS staff and would reverse the end to bursaries and introduction of tuition fees for student nurses and midwives that are planned for August. Indeed, the latest Universities and Colleges Admissions Service figures have revealed the deep damage that Tory Government cuts are having on the nursing sector in England. Applications to English nursing courses are down 23 per cent this year, after the UK Government abolished bursaries that encouraged people to take up training.

It is no wonder that Donald Cameron did not want to talk about comparisons with England, given that there has been a 23 per cent reduction in applicants, tuition fees are being introduced and bursaries are being scrapped, and given the creeping privatisation of the NHS.

I am conscious of time, so I will conclude with this point. The SNP Government continues to value the work of the independent NHS pay review body, whose recommendations the Scottish Government applied again this year. The Scottish Government has been consistent in its efforts to offer the right support to nursing students. By keeping free tuition, protecting the bursary and creating the discretionary hardship fund it is supporting our NHS staff of the future, as well as the staff of today.


It is time for the pay cap to be scrapped. Years of pay restraint have eroded living standards for our NHS staff. We cannot deny the negative impact that that has on staff morale, or the effect that it has on staff retention. The NHS in Scotland already faces severe workforce shortages, with a retirement boom on the horizon, and many staff are looking back at years and years of real-terms pay cuts and wondering whether they can afford to keep on giving to the NHS. I will support the motion, because the Scottish Greens believe that we must restore the value of pay for our NHS staff, and indeed, for staff in our wider public sector.

The pay cap has a direct impact on our wider communities. The NHS employs more than 160,000 people in Scotland, the majority of whom are women. A below-inflation pay cap contributes to the gender pay gap and inhibits multiplier effects in our local communities and economies. Hospitals and health centres are vital anchors in our communities, and holding down pay has implications for them, particularly in our remote and rural regions.

The Scottish Government’s position is that it adheres to the NHS independent pay review body’s recommendations and passes on its pay uplifts in full. I am glad that that often results in better pay for NHS workers in Scotland, compared to their counterparts in England. Ensuring a minimum increase of £500 for staff who earn £22,000 or less is a positive measure, but it does not go far enough.

The independent pay review body’s most recent report is quite clear that Government sector pay policies set the context for its recommendations. On NHS pay in England, it says:

“We were told by the Health Departments ... that a 1 per cent pay award is funded”


“it is clear that a pay award higher than 1 per cent would require trade-offs in terms of service levels, investment decisions and potentially staff numbers, with associated implications for workload and pressures on staff and service delivery”.

If the independent pay review body is prepared only to make recommendations that are already in line with the Government’s spending plans and to set the expectation that NHS staff should bear the costs of “trade-offs” between pay and service delivery, I struggle to see where the independence lies.

The report also outlines the Department of Health’s view that

“public sector pay restraint played a key role”

in the Government’s intention to reduce the budget deficit. It seems clear to me that the report makes its recommendations in that fiscal context. It is not for nurses, midwives, and healthcare assistants to play “a key role” in reducing the budget deficit, and NHS pay should not be based on misguided economic austerity.

Even the NHS pay review body’s report acknowledges that, in 2017, inflation is outpacing forecasts and that we are

“approaching the point when the current pay policy will require”

change. Public sector workers did not cause the financial crisis and they should not be expected to shoulder that burden 10 years on, or to absorb the financial pressures on our NHS due to demographic change.

In view of the UK-wide pay review body’s overall approach, I would be inclined to support a Scottish system for pay review in the future. However, if professional bodies and trade unions take a strong view that pay recommendations should still be set on a UK-wide basis, it is vital that the Scottish Government plays a full part in that process. The pay review body’s report was blunt about the impact that postponing the draft budget had on the process: it delayed the submission of evidence from the Scottish Government, reduced the time that was available for scrutiny and inhibited the ability of other parties to respond to the Government’s position.

The Royal College of Nursing has told us that the pay cap has resulted in a 9 to 14 per cent drop in earnings for nursing staff since 2011, which grossly undervalues the care that nurses give, the long hours that they work and the pressures that they face. As we have heard, the Royal College of Nursing’s recent survey of members found that 30 per cent of them have struggled to pay gas and electricity bills and—staggeringly—that 14 per cent of them have missed meals because of financial difficulties.

Could the member—or other members in the chamber—provide me with information about how many of the respondents to that survey were based in Scotland?

I was speaking to nurses yesterday and I can confirm that the policy is having an impact on them. I spoke to an experienced nurse who has taken on a part-time job because she cannot make ends meet. Although I have heard that pay progression is still in place, which is to be welcomed, the fact of the matter is that someone could be paid less now than someone doing the same job in 2011. We have a problem here.

Nurses should not have to cope with financial pressure at home as well as pressure at work. The Royal College of Nursing is calling for a pay award of 2.6 per cent in line with the retail price index. That is right and fair.

It cannot be denied that economic inequalities are at the centre of health inequalities in this country. Someone does not have to be living in absolute poverty to suffer poor mental health due to debt. They can suffer stress because they have no work-life balance or because they keep taking on extra shifts to keep their head above water.

Financial factors have an incremental effect, leading to sickness and time off work. In turn, staff absence pushes up spending on agency staff, and NHS employees really feel the unfairness when they see how much is being spent on agency nurses and locum doctors. NHS employees might look to Denmark, where hospital nurses are paid around 16 per cent more than they are here in the UK, or Australia, where their pay would be more than 20 per cent better. Sadly, we know that many NHS employees do exactly that.

Our nurses do not go into the profession for the money and nor do our midwives, paramedics, public health professionals, physiotherapists or psychologists. However, they should not expect their dedication, professionalism and expertise to go unrewarded as their pay falls below inflation.

The Government’s amendment says that it will “jointly commission work” to develop

“an evidence base to assess the impact of pay restraint”.

We have a good idea about what the impact of pay restraint is. Our NHS staff know the impact and, in previous submissions to the pay review body, they have already made clear what it is. The Royal College of Nursing has polled its members on the action that should be taken on pay restraint, including the option to ballot for industrial action. That is how urgent the situation is. Restoring the value of NHS pay will have a positive impact on staff retention and professional development and, ultimately, on the standard of care that we all want to receive.


I congratulate the Labour Party on securing this important debate and I assure Labour members of the Liberal Democrats’ support tonight.

I have spent the first year of my term as the MSP for Edinburgh Western on one of the steepest learning curves of my life. It has been my great privilege to serve as my party’s health spokesperson throughout that time and, through my introduction to the many tiers and avenues of our health service, I have met some of the finest and most dedicated professionals in our society. In many cases and from an early age, those people answered an inner calling to meet the needs of the most vulnerable and infirm in our society, and they have done so without thought of reward. That is just as well, because few roles in the health service attract lavish financial recompense.

Pay in the NHS has never been world beating, but the cap that we are debating has meant a year-on-year real-terms decline in the take-home pay of hard-working staff across the health service. In the teeth of a hard Brexit and with the devaluation of the pound that comes with that, the value of those pay packets will diminish still further and with it the buying power of hundreds of thousands of employees. We ask much of those whom we look to for treatment and care and yet we offer little reward, and what we offer is diminishing by degrees.

I do not think that it is melodramatic to say that to continue as we have done, with no prospect of pay increases in real terms for our NHS or social care workers, represents an existential threat to the delivery of health and social care in our society. At its bedrock, the NHS and the social care system that underpins it are nothing without their staff.

The rhythms of our health service are constantly interrupted by the stuttering of staff shortages, inadequate workforce planning and attrition in our staff base. Underpinning all that is the need for fair and equitable pay to make a career in health or social care an attractive and viable life path choice again. We cannot expect the pressures on our hospitals or GP surgeries to abate while those facilities are hungry for a new staff cohort that is not coming through the ranks or is looking overseas for opportunities that offer greater financial incentives.

Adequate investment in our workforce is vital. It is the call that all members receive from stakeholders in every specialty in the sector, and it is in the Labour Party motion. At all too many junctures, the system is buckling under the weight of demand. That was evidenced in last September’s revelations from Audit Scotland that our health boards have missed all but one of the national targets that they are expected to meet.

Delays in accident and emergency offer the starkest insight into the chronic problem that we face in throughput in our health system. I was grateful to meet representatives from the Royal College of Emergency Medicine, who opened my eyes to the reality that underpins the massive delays beyond the four-hour target.

Accident and emergency waiting times act as a weather vane for the natural state of flow in the health service. They point not to a problem in capacity at accident and emergency, as people often expect, but instead to how easy it is in reality to clear patients out of accident and emergency and into the wider hospital. Put simply, such delays are caused by bed blocking, which in turn is caused by a profound shortage in social care capacity.

I have raised many times the case of George Ballantyne, my elderly constituent who had to endure 150 nights in Liberton hospital beyond the point at which he was declared fit to go home.

I am sorry, but I perhaps missed the congratulations from my colleague Alex Cole-Hamilton to the Scottish Government on its incredible performance in accident and emergency four-hour waiting times in the past few years compared with all the other UK countries. The target is indeed a canary in the mine for the health of the system.

I am delighted to congratulate Maree Todd on using neither the word “coalition” nor the word “Conservatives” in her intervention on me this time. She misses the point entirely, which is that we have a colossal problem with bed blocking in our hospitals.

The delay in Mr Ballantyne’s discharge was due entirely to the fact that a social care package was not available. No night-time check could be established and put into a programme for him because no staff were available. That delay cost NHS Scotland hundreds of thousands of pounds. When members on the Government benches ask me from where we should get the money to pay for such an uplift, I point them to Mr Ballantyne’s protracted stay in the most expensive hotel in Edinburgh. The cost of failure demand in his case is replicated across every health board in our country. If we were only to recalibrate the direction of expenditure, we could free up far more resource to offer more financial recompense at every level. It is precisely because we fail to invest in our social care workforce that such cases are so commonly raised in the chamber.

We expect carers to attend their charges for sometimes as little as 15 minutes a session because of carers’ travel times and to receive a salary that they could just as well find stacking shelves in a local supermarket. Local authorities state regularly that they commission social care on the ground of quality over cost, yet the reality of that split is felt most keenly by service users.

It is easy for members of Opposition parties to ask the moon of the Government and to write cheques that, were we in government, we could never hope to cash, but the solution to much of the staff crisis that bedevils our health service and much of our social care sector is blindingly simple. If we entice people back to the fold, invest in our workforce and give people a future of comfort and security, they will visit that back on the people in their care tenfold.

We have much to be proud of in the men and women who deliver care in this country. The least that we as public servants can do is ensure that they can do the job that they love with a measure of dignity and proper reward.

Before I call Richard Leonard, I ask Neil Findlay, Maree Todd and Emma Harper to press their request-to-speak buttons. There is a technical glitch that means that, if someone intervenes, their request-to-speak button goes off.


I refer members to my entry in the register of members’ interests and specifically to my membership of the GMB and Unite trade unions.

With today’s motion, Labour is showing people a way out of a failing economy in which working people are being made to pay the price of a crisis that they did not create. Wages, which were once rising gradually, are no longer increasing. Housing costs and even the price of food cannot be afforded and, for too many people, fuel poverty is going up, not down.

We have the poor, the working poor and the public service working poor—people whose wages have been held down year after year. Nurses have experienced a real-terms pay cut of 13 per cent since 2010, and other people who work in full-time jobs in our national health service are below the poverty line and are forced to claim benefits. All that has been done in our name.

It is not as though we are living beyond our means; rather, we are not equitably distributing our means. All the demands for sacrifice are aimed at working people who deliver our public services, while the idle rich are studiously ignored. The result is that in Scotland the richest 1 per cent have more personal wealth than the whole of the poorest 50 per cent put together.

There are other consequences, too. As Cheryl Gedling of the Public and Commercial Services Union told the Parliament’s Economy, Jobs and Fair Work Committee,

“as long as we continue to have pay freezes and pay restraint we will not eradicate the gender pay gap.”—[Official Report, Economy, Jobs and Fair Work Committee, 18 April 2017; c 22.]

In days gone by, incomes policy was part of a wider programme of action by Government, through a social contract to deliver a social wage, which included food price subsidies and rent subsidies, increases to the basic state pension and investment in our industrial base and our public services. What we have today is not a two-way social contract but a blunt, one-way fiat of austerity.

In its amendment, the SNP Government makes comparisons with England. I am sure that that will be a comfort to the midwives who work around the clock in Wishaw and to the nurses in the Forth Valley royal hospital in Larbert who are at the top of their pay band.

Would the member make the same speech to a Labour Party conference in Wales, where nurses are paid less than they are paid in Scotland?

The last time that I checked, I was in the Scottish Parliament, addressing an SNP Government.

What will the cabinet secretary say to the porters who toil long hours and work long weekends at Hairmyres hospital, to the on-call ambulance crews who are stationed across the country and to the hard-working cleaners at Monklands hospital, who get £8.50 an hour—the lowest-paid staff? I am sure that it will be a comfort to them to know that, if they were living in England, they would be even worse off and subject to even more restraint.

I am sure that, in light of their experience, those workers will greet with some cynicism the suggestion in the cabinet secretary’s amendment that the best resolution will be found in partnership working and the benevolence of the Scottish Government. When the NHS pay review body produced its recommendations, it said:

“The scale of efficiency savings that the NHS is required to make appears to be bigger in Scotland than in other parts of the UK, with the Scottish Government telling us that Health Boards will be expected to make 3 per cent efficiencies in 2017/18.”

I challenge the Government to support today’s motion to scrap the cap and allow for free and responsible collective bargaining.

Will the member give way?

No—I have given way already.

Let me turn to the Conservative amendment. We have on the statute book the Trade Union Act 2016, which is barely a year old. It is a Tory act, which I presume that the Tory members in this Parliament support. It singles out public service workers and puts, at the top of its list of such workers, health service workers—the very workers we are discussing. That is what is in the act that the Tories support.

The act demands a minimum turnout threshold of 50 per cent and a minimum majority threshold of 40 per cent of those eligible to vote in order for industrial action to be taken legally by health service workers. I am bound to say that, if the same rules had been applied to the local government elections last week as Tory MSPs and ministers now apply to NHS workers, not a single Tory councillor would have been elected anywhere in Scotland.

Will the member take an intervention?

The member is in his last minute.

Of course, the Tories want to stop trade unions having a political voice, too.

Finally, I remind Parliament of the principles of the NHS as set out by Aneurin Bevan, who said:

“Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skills can provide ... If the job is to be done, the State must accept financial responsibility.”

Those prophetic words of Nye Bevan are chosen carefully. They remind us that the foundation stone of the NHS is not medical machinery or pharmaceutical formulas but the skills and dedication of the people who work in the national health service. [Interruption.]

I finish by saying to the SNP that it is no good claiming to be on the side of the workers in the NHS when the SNP is not prepared to back them up and it is no good claiming to be investing in the NHS if the SNP is not investing in the people who deliver the NHS. I urge all members to look to their conscience, to accept financial responsibility—and moral responsibility as well—and to back the Labour motion.

I say to those on the front benches that, if they wish to intervene, they should do so properly and not heckle from the side.


The debate gives us an opportunity to highlight the different approaches to nurses’ pay that are adopted in each part of the UK. I welcome the Labour Party bringing the debate to Parliament in advance of international nurses day, which falls this Friday. The debate gives us a chance to compare and contrast how Administrations across the UK—the Scottish Government, the UK Government and the Welsh Government—treat the most valuable asset of our NHS, which is its staff.

Although a clear process is in place to determine nurses’ pay, whereby the independent NHS pay review body makes recommendations each year that cover all parts of the UK, the Governments’ approaches have differed. That tells us much that we need to know about the priorities, focus and commitment of each Administration and of the parties that run each one.

Although the Tory-led UK Government and the Labour-run Welsh Government have failed to implement in full the PRB’s recommendations, in contrast, the Scottish Government, run by the SNP, has stood by the body’s recommendations and implemented them in full. Labour talks the talk—while failing to meet the PRB’s recommendations where it has the power to do so—and the Tories look the other way, but the SNP has met its obligations to abide by the agreements that are in place and has funded nurses’ pay to the levels that the review body required.

The RCN understands that well, as it said in its briefing in advance of today’s debate. It states:

“the Scottish Government has implemented recommendations made by the PRB to date, even when the UK Government has not. This means pay rates for each of the pay bands vary. For example, the starting salary for a newly qualified nurse is £21,909 in England”,

the same in Wales,

“£21,693 in Northern Ireland and £22,218 in Scotland”.

A band 5 nurse in Scotland earns £300 more than their equivalent in England and in Wales.

It is a clear demonstration of their priorities that the Tories never stop talking about the top 10 per cent paying a bit more—they are higher-rate taxpayers who can afford it—while the Tories never mention NHS staff who benefit from a similar amount in higher pay in Scotland. Never mind the benefit from council tax being some £400 lower in Scotland than in the rest of the UK, which impacts on the majority of households. When it comes right down to it, the Tories’ priority—their target constituency—is laid bare for all to see. If someone is in the top 10 per cent, the Tories will argue tooth and nail for their interests; if a person happens to be an NHS worker who earns a fraction of that income, the Tories are not interested in even honouring the independent recommendations on their pay.

As well as honouring the PRB’s recommendations, the SNP Government has put in place measures to assist the lower paid in the profession. A flat-rate £400 uplift for those who earn £22,000 or less has been implemented in recognition of the particular pressures on low-paid staff.

The Scottish Government understands the importance of supporting those who are entering the profession and ensuring that nurses are trained for the future to support our growing health service. Nursing bursaries are still in place in Scotland, and nursing students pay no tuition fees. That is in stark contrast to elsewhere in the UK, where such policies have been scrapped. As a consequence, the number of applicants to nursing courses in England has plummeted by 23 per cent, which is 10 times worse than the situation in Scotland. It is no surprise that England is suffering from a 9 per cent nurse vacancy rate, which is more than double the rate in Scotland. That is a consequence of the different approaches that are being taken to the treatment of staff.

The Scottish Government also understands the need to provide stability and security for our NHS staff. In contrast to the situation south of the border, where there have been more than 20,000 compulsory redundancies over the past six years, NHS Scotland has continued with its policy of no compulsory redundancies.

The Scottish Government’s practices of higher remuneration also apply to other NHS workers. Entry-level NHS support staff in Scotland are paid £1,128 more per year than their English counterparts. Salaries of consultants in Scotland can be up to £2,000 higher than those of consultants elsewhere in the UK. Those measures are underpinned by the Scottish Government’s commitment to support our health service with £500 million of real-terms funding increases over the parliamentary session—that is £500 million more than the amount that Scottish Labour committed to in its 2016 manifesto.

Does the member agree that it is unacceptable—indeed, it is a scandal—for any nurse or other NHS staff member in Scotland to have to turn to a food bank? What action should we take, if we should not give them a pay rise?

If the member had been listening for the past five minutes, he would have understood what I just said. Nurses in Scotland are getting paid more than nurses in Labour-run Wales. What does Anas Sarwar have to say about that? I made the point that the Scottish Government has committed £500 million more to the health service than Scottish Labour did in the manifesto on which its candidates stood for election in 2016. That is against the backdrop of the 10-year real-terms 9.2 per cent departmental expenditure limit funding reduction that has been imposed on Scotland by the UK Government since 2010, when the Tories came into office.

It is not only in funding and support for its staff that NHS Scotland is outperforming its counterparts in England and in Labour-run Wales. A and E performance is significantly higher in Scotland than it is across the rest of the UK. The Scottish Government has also stood firm against the creeping privatisation of services in the rest of the UK, as a result of which 7 per cent of health service provision down south is now in private hands.

The contrast between how the SNP Scottish Government funds and runs the health service here and how the Tory UK Government and the Labour-run Welsh Government run their health services could not be clearer. When it comes to fulfilling our commitment to implement the recommendations on nurses’ pay, as on so many other aspects of running our NHS, it is the SNP Government that the people of Scotland can trust to have their interests at heart and to deliver for staff and patients alike.

We have no time at all in hand, so please stick strictly to the guidelines.


I thank Anas Sarwar for bringing forward this important debate. It has been an extremely interesting debate on a very significant matter, so I am delighted to contribute to it.

I join other members in paying tribute to those who work in the NHS and care for us on a daily basis. I would like to focus on securing the long-term future of the NHS in Scotland and how staff should be supported by improving the response to the short-staffing crisis.

In the 10 years for which the SNP has been in power in Scotland, the NHS has taken a turn for the worse, with a major staffing crisis. The Scottish Government has taken a short-term view on job vacancies in the NHS, much to the detriment of our NHS in Scotland. We no longer have the number of staff that we need to ensure that patients get the best treatment possible. The number of nursing vacancies, for example, has been on the rise. On 31 December 2016, there was a vacancy rate of 4.1 per cent in nursing and midwifery posts, rising from 3.6 per cent in 2015. Those vacancies are putting increasing levels of pressure on overstretched staff seeking to deliver high-quality services.

Will the member take an intervention?

Let me continue.

Similarly, there have been rises in the number of vacancies for GPs, consultants and mental health specialists. Every empty post puts further strain on already exhausted staff. As with nurses, there is undue stress on those who work in our health services, while the Scottish Government looks to solve the problem by sourcing locum doctors and nurses. The Scottish Government continues to look for temporary solutions instead of seeing the bigger picture—and it does so at the expense of the Scottish people.

In fact, due to that poor workforce planning, the use of agency nurses has increased by almost 50 per cent in one year. That has inevitably led to an increase in the cost of agency staff, which has increased sixfold in three years. In addition, the Scottish Government is spending nearly £0.25 billion on locum staff. That is completely unsustainable and will do nothing to solve the long-term issue of vacancies in the NHS. Although I recognise that there will always be a need for locum staff, we certainly should not be as reliant on that form of staffing as we are at present. What we are seeing is, in fact, a sticking-plaster approach by the Government.

Former MSP Dr Jean Turner, who is now the chief executive of the Scotland Patients Association, called for fewer locums and bank staff to be used and more NHS staff to be appointed. In 2015, she stated that

“Our health service is in a serious state, really serious, and if we want to have care when we are old, we have to look after it today.”

Furthermore, Royal College of Nursing Scotland associate director Ellen Hudson highlighted that

“we need to find new ways for health boards to focus on the long-term sustainability of services.”

We can tackle that serious issue only by filling vacant posts on a permanent basis.

The number of gaps in the NHS in Scotland is predicted to grow, as many staff are close to retirement age. The issue is particularly prominent among nurses and midwives, a fifth of whom are set to retire over the next decade. Indeed, in the next 10 years, 18.2 per cent of the workforce are planning to retire, which will have a significant impact on NHS staffing across Scotland and put even more strain on overburdened staff.

The Scottish Government needs to focus more on recruitment to ensure that we have a sustainable NHS workforce for the future. It is currently turning to retired GPs to fill staffing gaps, and there have been many cases of trusts and health boards in Scotland having to recruit from abroad due to the shortage of qualified staff. That is not the way to secure the future of our NHS.

It looks as though we are starting to see the impact of the cuts that Nicola Sturgeon made when she was the health secretary. Between 2009 and 2012, the number of training places for nurses and midwives was slashed by more than a fifth, and more than 2,000 nursing jobs were cut to help to balance the books. The Royal College of Nursing believes that those cuts are now hitting the NHS in Scotland as students from those years graduate and take up full-time jobs. The Royal College of Nursing has summarised the situation as follows:

“we warned that this was short-sighted and would lead to problems. We have increased demand for services and not enough nursing staff, with staff bearing the brunt of these pressures and health boards having to employ expensive agency staff to fill the gaps.”

Will the member take an intervention?

I am sorry, but I am in my last minute.

The SNP Government was warned about its actions at the time and now needs to take responsibility for ultimately bringing about the staffing shortages that we see today. We ask it to start planning the NHS workforce for the future and to ensure that we take measures to improve the sustainability of our NHS in Scotland.

I will support the Conservative amendment.


I thank Anas Sarwar for lodging the motion and for getting the Government to act. It is now going to act, but it would never have acted unless the motion had been lodged.

I declare an interest in the debate, as both my wife and my daughter work in the NHS—both very much at the lower end of the NHS pay scale. I also declare an interest as a member of Unite the union.

My wife’s and daughter’s colleagues throughout the NHS—the porters, clerks, domestics, kitchen staff, tradesmen and tradeswomen as well as the clinical support workers, nurses, physios, occupational therapists and the rest—have been subjected to years of austerity pay, with their salaries frozen or uplifts capped at no more than 1 per cent. There have been years of pay settlements below the rate of inflation while, at the same time, the cost of basic food items such as beef, fish and dairy products, the cost of transport and the costs of gas and electricity have all soared by well over 20 per cent. Moreover, the retail prices index is forecast to reach 3 per cent. That has all resulted in an effective pay cut of around £3,500 for a band 5 nurse, as members have said.

The reality of working in Scotland’s NHS is that we have a system that is under pressure like never before. Staff are run ragged, morale is low, vacancies are up and the system is creaking at the seams. All of that overwhelmingly and disproportionately impacts on women workers, who make up three quarters of our NHS staff. So much for addressing gender pay issues.

The Scottish Government will claim that staff spending increased by more than 7 per cent between 2011 and 2016. That may be true, but it was, of course, driven by increased spend on bank, agency and overtime payments to try to plug the staffing gap. Indeed, agency spend doubled over that period. Staff are working more hours via the staff bank and agencies to try to make up for lost pay.

Has Neil Findlay taken the same message to Wales, which spends considerably more on bank and agency staff than we do in Scotland?

There is more chance of me telling my Welsh colleagues some home truths than there is of SNP members telling Aileen Campbell some home truths, because they have to sign a statement to say that they cannot do that.

Audit Scotland has told us that agency staff cost more and pose a greater risk to patient safety and quality of care. On which planet is it sensible to pay nursing agencies £84,000 a year for one nurse for a year? However, that is the reality of what is happening.

All of that impacts on vacancy rates, of course. There are vacancy rates of 3.6 per cent for nursing and midwifery staff, 9 per cent for health visitors, 5 per cent for public health nurses, almost 5 per cent for GPs and 6.5 per cent for consultants. Across the NHS, there are similar vacancy rates; for example, on tradesmen and estates workers, it is difficult to recruit electricians and other craftsmen because pay has not kept up with industry rates.

NHS staff do not want to be patronised. They are heartily sick of the warm words about being angels and heroes. They want respect, a supportive management regime in the establishment that they work in, an employer that cares about their wellbeing, the tools to get on with the job that they enjoy and, crucially, the pay that recognises all of that.

In its UK-wide staff survey, Unison identified that two thirds of staff felt worse off in the previous 12 months, 34 per cent relied on overtime payments to pay their bills, half relied on financial support from family and friends, and 11 per cent had used a payday lender. What a state of affairs for our greatest public services and the staff who deliver the care that we need when we are sick and injured. Let us be clear: that is a major contributory factor to people choosing other careers.

I want people to join the NHS. I am proud that my daughter, who works as a weekend cleaner in St John’s hospital, will soon graduate as an occupational therapist and, I hope, secure a job in the NHS. However, increasing stress, a high number of vacancies and an unhealthy management culture combined with a decline in pay is not a recipe for addressing the shortages in and demands on the system. The cabinet secretary can and must act, otherwise the problems that we have witnessed will pile higher and higher.

I want all our public sector staff to be paid fairly. The pay cap has hit people in many areas, including local government, the police and the fire service, but the Government can act when it wants to. I publicly commend the Prison Officers Association for securing what was called a one-off £2,000 increase for prison officers in 2015. It seems that “one-off” has a flexible meaning for the Government, just as “once in a generation” has, as the deal has been repeated this year. As I said, I congratulate the POA, but what about other staff in the prison service and staff in local government? There is no £2,000 for them.

You must come to a close, please.

What about NHS staff? There is no £2,000 for them.

Public sector workers deliver the services that civilise our society. I support the call to end the pay cap, and I support Anas Sarwar’s motion.


I remind the chamber that I am a qualified pharmacist registered with the General Pharmaceutical Council.

I am pleased to have the opportunity to speak in the debate. As many members know, until my election as an MSP last year, I worked as a hospital pharmacist, in one of the many staff groups paid under agenda for change. Each year, the NHS pay review body made a recommendation on how much my salary should rise by, although several times in the past few years, it was a below-inflation settlement because I was at the top of my pay band. I therefore agree that it is incorrect to describe that as a rise.

The Scottish Government has honoured the review body advice every year—something that my colleagues in Scotland were very thankful for. My colleagues south of the border in England have not been so lucky, because in several years the Westminster Government did not pass on the increase.

Will the member take an intervention?


That situation has led to a marked difference in salaries between the two countries, with Scottish band 5 staff being paid up to £312 a year more than their English and Welsh counterparts. The difference is even more stark at the lower bands where, over and above the pay recommendations, Scottish Government action for the lowest-paid entry-level NHS support staff means that, in Scotland, they are paid £1,128 more a year than their counterparts in England. The reality in the UK today is that nurses, junior doctors and care workers in Scotland all get paid more than those in England.

Will the member take an intervention?


As members might expect, given my background, I believe that NHS staff should be paid more, but I wonder whether that is possible, given the budget cuts coming from Westminster.

Will the member take an intervention?


Along with many of my colleagues in the NHS, I know that the NHS in Scotland is relatively well protected by a Government that is committed to a publicly run service, free at the point of care. Of course, the austerity agenda, which was supported by the Tories and their Liberal Democrat coalition partners, has cut public spending, which has an impact on the Scottish Government’s budget by reducing the block grant.

Will the member take an intervention?


I am grateful to Maree Todd for finally taking an intervention.

Even given the ultra-loyalist prism through which she sees the Scottish Government, does Maree Todd not think that her description of her colleagues being grateful for the miserly increase that we have seen under the Scottish Government belies the statistics and the research from the Royal College of Nursing in this country?

As I have said before, I suspect that if the survey in question had been conducted on an individual country basis in the UK, we would have got very different results.

With regard to Mr Cole-Hamilton’s party’s coalition Government and the NHS, the lnstitute for Fiscal Studies has said:

“Spending growth under the coalition was the lowest five-year average since records began (though generous compared with the cuts to spending in other government departments over the same period).”

Given the constrained budget, the Scottish Government has to be congratulated on not only managing to increase pay in Scotland, but ensuring that there have been no compulsory redundancies and maintaining free nurse student tuition and nurse student bursaries. In addition, the Scottish Government has created the discretionary hardship fund. That has not happened in England, and the number of English applicants to nursing courses has plummeted by 23 per cent as a result, while the number of applicants has been substantially maintained in Scotland. That may be why the current nurse vacancy rate is 9 per cent in England in comparison with 4 per cent in Scotland, where wage increases have been more generous.

The increasing policy divergence between the NHS in Scotland and the NHS in England is making it much harder to sustain a UK-wide perspective of the NHS workforce. I have already mentioned some areas of divergence, but the Conservative Party amendment raises another: the level of spend on agency and locum staff. My Conservative colleagues will no doubt welcome the fact that NHS Scotland has a nationally co-ordinated programme for the effective management of all temporary staffing. The team involved is working to establish regional and national staff banks to allow boards access, when required, to a high-quality, flexible workforce of appropriately qualified, experienced and competent staff who all work on NHS contracts, providing better value for money than alternative methods of filling the gaps.

My Conservative colleagues will also no doubt be pleased to hear that NHS Scotland spends, proportionately, a third of what is spent in NHS England on medical and nursing agency staff.

There are other areas of divergence that we might consider. Scotland outperforms all other UK countries on the four-hour accident and emergency target. Scotland outperforms on delayed discharges, too: there has been an increase of 11 per cent in England because of a lack of investment in social care, but in Scotland the figure has decreased by 9 per cent because of the contrasting policy. Scotland has consistently spent more per person on health than England since at least 2009-10. Scotland has higher clinical staffing—[Interruption.]

The member is coming to a close.

Scotland has higher clinical staffing per capita than England. More doctors, more nurses and more midwives work in NHS Scotland thanks to the SNP Government’s sound management of the NHS.

You must come to a close.

I finish with a wee mention of this evening’s members’ business debate, which was secured by my colleague Emma Harper MSP, who is a nurse.

You must come to a close, please, Ms Todd.

Later this week, we celebrate international nurses day, and over many years of working in a hospital—

Ms Todd, you really must close.

I am finishing—this is my last sentence. I have worked with some awesome nurses. I am sure that they will be pleased—

Ms Todd, you have finished your contribution. Thank you.


I welcome the opportunity to speak in the debate and thank Labour for bringing the topic to the chamber today.

The challenge facing the NHS has been described as

“a perfect storm of funding, structure and culture.”

The Scottish Conservatives recently constructed a 15-point action plan highlighting a myriad of areas in which there is massive scope for improvement, even when the demand is rising with an ageing population. The action plan highlights a multifaceted problem that faces the NHS. Staffing is the key to managing its funding, and that is where huge cracks have begun to appear.

My mother was a district nurse, midwife and health visitor who gave decades of support to the NHS. Her drive to support patients in dignity from birth to death was exceptional and she gave her working life to caring in the community. I am very proud of that.

Wastage, overspending and delays continue to blight the NHS in its day-to-day operations, and that is one area where we can look for efficiencies in improvements that can yield savings. Funding for the NHS in Scotland was roughly flat in real terms in the years from 2008-09 and that has had a huge impact across the piece.

Despite moves towards integration, the NHS is still broadly based on a traditional model—it acknowledges that, and we see it—in which we have social care reliant on primary and secondary care.

I pay tribute to all the staff who play a vital role in the sector. Their dedication, enthusiasm and commitment know no bounds and our NHS staff are the envy of the world because of that.

However, staff feel disengaged from reforms and look at the workload bases; if they are not managed effectively and efficiently, they feel stressed and overworked. There are still far too many managers in our NHS, which creates unnecessary tiers of management. Those problems are all linked: pay, training and support are vital to ensure that staff feel valued in our NHS. If clinicians feel alienated from the management reforms that are taking place, the pressures that they face continue to grow. If staff feel engaged, they are effective and they see better ways of managing things, which in turn reduces pressures on the workforce and ensures better outcomes for our patients. All of that is exactly what we want to see in our NHS system, and I believe that that is happening the length and breadth of the country because of the dedication of the staff who work in our NHS.

We know that we are dealing with an ageing population and we understand the demographics that we face—the bedblocking and all the other aspects that we have to manage. At the end of the day, we have to manage the finances to ensure that the budgets work effectively and that individuals can work within those constraints.

The whole situation is complex, but that alone is not why we have to see the SNP spending millions of pounds on private health firms. In 2015-16 alone, 14 health boards spent £51.6 million on private operations because NHS hospitals could not cope with the demand.

Will the member take an intervention?

I want to make progress, because time is tight.

The Government is also spending millions of pounds on agency doctors and nurses, which has a huge knock-on effect. The SNP has been running the health service in Scotland for 10 years and staff morale is at its lowest ebb. The SNP is failing staff and letting them be left behind and left out. This Government has a track record of looking at what its staff are achieving but not making progress.

Will the member take an intervention?

I want to make progress.

We have to think about what we are doing in my region of Mid Scotland and Fife. Tayside, Fife and Forth Valley have all had issues with staffing levels, morale and targets set by the Government, many of which have been failed. Much of this is unsustainable if we are to ensure that we have a workforce that is fit for purpose.

New information technology systems are being introduced. The new NHS 24 IT system is 73 per cent over budget and more than four years overdue.

The SNP is not tackling the lack of staff in the system; it is adding to the issue and to the complexities that we face. Technological glitches have been reported by staff who are struggling to cope in many hospitals across Scotland. Low morale, staff vacancies, staff sickness rates and stress are compounding what is happening in our NHS.

The NHS requires certainty as it moves forward. The Scottish Conservatives have recommended that the NHS invests now in dramatic service change that will have a positive knock-on effect and ensure that we manage our finances. The Government must address national workforce planning; it cannot continue to sweep the matter under the carpet. That will go some way to making the changes that we require to revitalise our NHS. I pay tribute to the NHS staff, but I do not pay tribute to the Scottish Government, which has overseen this decline and decay for 10 years. I support the amendment in my colleague Donald Cameron’s name.


I have been looking forward to speaking in the debate. I thank Anas Sarwar for his opening comments about his family’s experience. I am sure that, as James Dornan noted, everyone in the chamber has direct experience of interaction with the NHS. I remind members that I am a nurse and a member of the Royal College of Nursing.

If there is one thing that we can agree on across the chamber, it is that nurses should be paid more. This evening, I will lead a members’ business debate celebrating international nurses day, because we should shout louder about the invaluable work that nurses do here in Scotland and internationally, often in difficult circumstances.

Of course that should be reflected in their pay and conditions. However, does the Labour Party ever ask itself why we cannot pay nurses as well as we would like in Scotland? I have some bad news for Labour members: when we do not fully control our own budget, we do not fully control the pay and conditions of NHS staff. I believe that that point has been made to them before.

The Scottish Government has managed to maintain record levels of investment in NHS Scotland while receiving cuts to the block grant. Funding constraints on the NHS are the direct result of Westminster’s austerity agenda.

We appear to control our budget enough to pay prison officers more. Why can that not apply to nurses?

We have to understand the whole process—it is not just about raising taxes—and look at all aspects of salaries and banding in the whole NHS.

In my experience as a nurse who has worked 33 years, the most recent 14 in the NHS, I see staff struggle with the workload every day. When I was a nurse educator, part of my duties involved supporting efficient working and recognising when people are under stress—as I am right now. I want to make sure that I get this on the record. I hear what has been said in the chamber, and my colleagues would love a pay rise, but how can we do that with the constraints that we are being put under by the constant austerity measures of the Tory Government?

I am sure that all of us in the chamber will welcome the fact that, although many people have expressed concern about staff satisfaction in the NHS, we have a high level of patient satisfaction, and many members of our nursing workforce are to be congratulated on that. Our patient experience survey shows that we have a record high of 90 per cent satisfaction among in-patients, and the Scottish social attitudes survey has recently recorded the highest rate of confidence in the NHS in the past 10 years.

I thank Maree Todd for that intervention.

In its briefing, the RCN states that pay awards for NHS staff have been constrained by the UK Government’s policy on the public sector since 2011. However, it should be noted that the Scottish Government has implemented recommendations that have been made by the pay review body to date. That means that, every year, as the pay review is processed, the Scottish Government takes on board those recommendations.

I appreciate the scrutiny of the Government’s policies. That is a role that all the Opposition parties—and back benchers such as me—have to play. However, it is also the role of the Opposition parties to come to the chamber ready with an approach that might support the NHS in a balanced, fair and level-headed manner.

The 1 per cent pay rise in Scotland is further supplemented by the Scottish Government’s measures for the lowest paid, such as the £400 flat-rate uplift for anyone earning £22,000 or less. In Scotland, entry-level NHS support staff get £1,128 more a year than their English counterparts do.

One of my colleagues was at a recruitment event and said that nurses are leaving NHS England and coming to Dumfries and Galloway to get better pay and better working conditions, because they see what is happening in NHS England. I welcome those nurses from England and say to them: come and work in Scotland, and we will look after you.

We move to the closing speeches.


I am pleased to close this debate on the NHS for the Scottish Conservatives. Since being elected, I have found it a pleasure to meet and learn from many people who work day in and day out in our health and social care services. Their commitment and work ethic is what drives them each day and, as a number of members have done, I thank them and pay tribute to their dedication to helping to care for our fellow Scots.

One message that I have heard from them directly is that the decline in the performance of our NHS in Scotland is not a recent development, because it started while the Labour Party was in charge of health in the Scottish Executive. Over the 10 years when Labour was in power, waiting times increased dramatically; drug-related deaths and methadone prescriptions skyrocketed; and Scotland had the highest prevalence of hospital superbugs in Europe. All of that sits alongside Labour’s hospital closure plans.

We all have personal stories to tell about how the NHS and those who work in it have helped us and given us love and support, and about the amazing nurses who work throughout our health service. However, what struck me in today’s debate was the fact that no Labour speaker wanted to justify what Labour does when it is in power, and certainly not with regard to the party’s record in Wales. Wales is the only part of the United Kingdom in which the Labour Party has been in consistent and unbroken control of the health service since 1997—more than two decades.

Will the member take an intervention?

No—I want Mr Findlay to listen to this.

Looking at the NHS in Wales, I think that it is little wonder that Labour MSPs do not want to discuss that record today. The Welsh Labour Party has not introduced the pay rise that Scottish Labour proposes. Their colleagues who are in power are not doing what Scottish Labour proposes. Waiting times in Wales are at their longest and patients are having to be sent to England—

Will the member give way?

No, thank you.

Patients are having to be sent to England for emergency treatment. That is Labour’s record in power in Wales. In fact, analysis shows that, on average, patients in Wales have to wait five weeks longer for treatment than patients in England do. Labour has imposed record-breaking budget cuts and presided over the poorest access to cancer treatments anywhere in the UK, downgrading hospitals across Wales.

It is a scandal that the Labour Government in Wales has not met its cancer waiting targets since 2008. Welsh Labour—

Mr Briggs—may I ask you to address what has happened in the debate this afternoon?

Thank you. That is Labour’s record on the NHS and it is certainly not one to be proud of.

Here in Scotland, we are still seeing the impact of Labour’s use of the private finance initiative, under which hospitals have been built at an expense of £7.8 billion to the taxpayer—hospitals such as the Royal infirmary of Edinburgh, which cost £180 million to build but will cost the taxpayer £1.6 billion by the end of 2034. I do not think that that is right.

James Dornan tried to make a point about the cost of NHS staff parking. That is a key issue in relation to the costs that staff are facing. It is a scandal that car parking charges are as high as they are in Edinburgh and I have been pleased to support the campaign at the Royal infirmary, alongside NHS staff, patients, visitors and the Edinburgh Evening News.

NHS Lothian and the private company running the car park at the Royal infirmary—

Excuse me, Mr Briggs. The other Deputy Presiding Officer made a ruling earlier about discussing car parking. I ask that you address the debate that has taken place and indeed the motion and amendments.

I think that it is an important point that we are all making that these costs impact on people’s lives. On living costs, many nurses have told me that the cost of travelling by car and parking at the hospital comes to a significant amount. Certainly when the parking charge increase was proposed—

Mr Briggs—I asked you to move on to address the motion and the amendments and indeed the debate that has taken place, taking due cognisance of what my colleague in the chair said earlier.

I will indeed, thank you.

Of course, we all agree that everybody in the NHS deserves to be respected and valued and to be able to work in a positive and safe environment—I am sorry to say that the Health and Sport Committee has heard that that is not always the case in the NHS, with NHS staff being bullied. Often, they do not feel that they are being listened to.

My colleague Donald Cameron has laid out the SNP’s failure to improve our health service over the past 10 years. Scotland’s NHS has declined on the SNP’s watch and major reforms are clearly required. The SNP has taken decisions on hospital closures and service redesign such as the closure of the Edinburgh cleft lip and palate surgery unit, against clear evidence. That has impacted on NHS staff.

As Brian Whittle set out, a radical culture change is required. Working for our NHS must become an attractive and valued career path again, especially in rural areas and in areas such as general practice, which is struggling to attract graduates. Staff shortages are widespread, with more than 2,500 vacant nursing and midwifery posts.

Spending on agency staff has increased dramatically and nearly a quarter of a billion pounds is being spent on locum staff in Scotland. Not only do we have an ageing population; we have an ageing NHS workforce. To return to the culture change that is needed within the NHS, unnecessary A and E visits are costing NHS Scotland at least £33 million a year. Only this week, the Health and Sport Committee learned about the triaging work that is being undertaken by NHS Greater Glasgow and Clyde to help to take the pressure off A and E units. I welcome such reforms, which can make a difference to the performance of our NHS and give NHS staff the professional responsibilities that they are desperate to have.

Our NHS should rightly be an institution to be proud of, rather than one that is constantly on the brink of crisis; it should be an organisation that values every member of staff—all those who care for us. Enabling our NHS workforce to do their jobs and to deliver high-quality care—

You must come to a close, please.

—is something that we must all work towards. Today’s debate has failed to say where the money will come from.

Mr Briggs, please come to a close.

Until Labour can answer these questions—

Mr Briggs, will you please sit down?

I remind members that, when I ask people to close their contribution, there is a reason for it. There are time constraints and I expect them to be complied with.


I want to start on a point of agreement that has come out of this afternoon’s debate. We all care about the NHS and the staff who work in it, and no party has a monopoly on that, so perhaps we can start from there. Anas Sarwar and Monica Lennon gave powerful and personal testimonies of the support that their own families have received from the NHS. Monica Lennon talked about the high level of care that her family had received, and we would expect nothing less. In recent months, my family has received the same level of care, and I want to thank each and every one of the nurses, healthcare workers and porters from the bottom of my heart, as I am sure other members have done.

I will address as many of the points that have been raised as I can. A number of members talked about the workforce. I have said time and time again in this chamber that I do not run away from the challenges in the health service. Although we have record levels of staffing, with 3,400 more whole-time equivalent nursing and midwifery staff compared with five years ago, the demands on the NHS continue to rise. Vacancy levels are too high, standing at 4.1 per cent in December of last year, and we are working hard with boards to address that.

Similarly, agency spend, which a number of members mentioned, is too high. That is why we have a national programme to reduce agency spend, but there is a context to that. Combined medical and nursing agency costs represent 2 per cent of the overall staffing spend, and agency nurses represent 0.4 per cent of the total nursing and midwifery staff in the NHS. That is too high, but we have to look at it in context, and it is still less than when we took power in 2007. Indeed, as many members have pointed out, we have maintained such things as the student nurse bursary, which has meant that there is still a high level of interest from people coming into nursing and midwifery courses compared with the situation south of the border, where the bursary has been removed and there has been a 23 per cent decrease in student nurse applications. That will store up a whole heap of trouble and difficulties for the NHS south of the border.

That has been one of the defining issues in this afternoon’s debate. I can tell all members that I have no difficulty with anyone, from wherever in the chamber, criticising my Government’s record in power. That is what members are here to do. However, it is a little disappointing that nowhere in Anas Sarwar’s speech or Monica Lennon’s speech, or in speeches from anybody else on the Labour benches, was there any recognition that pay rates are higher in Scotland, that the Scottish Government has taken action to address low pay, that we still have student nurse bursaries, or that we have a no compulsory redundancy policy.

I thought that all those things would have merited a mention in one of the Labour speeches, but there was no mention of any of that, which shows a complete lack of balance. I accept criticism, but occasionally it would be good to get recognition of some of the good things that the Scottish Government has brought in, to bring balance to the debate.

I recognise those things.

He never mentioned them.

I will do so now. We are pleased that those things have happened in Scotland. However, we also recognise that, in her own submission to the independent peer review body, the cabinet secretary submitted that we should have a 1 per cent pay cap for NHS staff this year.

The Scottish Government made a balanced submission on pay, progression, tackling low pay and many of the other things that nurses tell me are important—it is not just about pay; it is about all those other things, too. As many members have said, what the independent pay review body can do is constrained by the Treasury—in effect, all roads lead back to the Treasury. Alison Johnstone made an important point on that, and she leaves a choice for us. If we are part of the independent pay review body, we will have to implement its recommendation, because otherwise why are we part of it? If we want to have Scottish negotiating machinery, I am more than happy to talk to the unions and staff side about that. However, at the moment, they do not agree that that should be the direction of travel—some agree and some do not. We need to get agreement across all the unions and the staff side about that way forward. If that is the way that we want to go, I will support that.

I want to touch on something that Richard Lenin said. Lenin? That is maybe a Freudian slip—I mean Richard Leonard. [Laughter.] I see him looking very proud. He said something interesting that Labour will have to clarify, perhaps in the winding-up speech today. He seemed to indicate that Labour’s position on partnership working has changed and that it no longer supports that. I am paraphrasing, but in essence his point was that the unions should be free to negotiate outwith the partnership arrangements. Really? Does he no longer want employee directors to sit on boards with an equal voice at the table representing the staff side? Does he no longer want partnership forums to be absolutely at the heart of decision making in our NHS? The unions like partnership working because it delivers for them in a way that does not happen in the rest of these islands. I think that the unions would be very interested to hear Richard Leonard’s comments about partnership working, and perhaps Labour can clarify whether it indeed no longer supports that.

You must close, cabinet secretary.


I am sorry that I have not been able to come back on other members’ comments. However, we have the delivery plan, which is a comprehensive blueprint for the NHS, and we will get on with that. We will work with staff—

You must close, please.

I will address pay and all the other concerns that staff have raised—they are not just about pay—with the unions when I meet them in the next few weeks.


Next year, we will celebrate the 70th anniversary of Labour’s greatest achievement: our national health service. The founding principle that, no matter someone’s class, race, age or wealth, they should be entitled to quality healthcare, free at the point of use, is as precious today as it was when Nye Bevan established the NHS in 1948. However, nearly 70 years on, equally precious is the principle that, if we want high-quality healthcare, we need to value the staff who we entrust to deliver that care.

As Richard Leonard said, the foundation stone of the NHS is not medical equipment or pharmaceutical formulas but the skill and dedication of the people who work in the service. Today, Parliament has the opportunity to match that principle and those words with our actions. We have the opportunity to show that we are on the side of the nurses, doctors and allied healthcare staff who look after our loved ones as if they were their own.

Many members have rightly paid tribute to the commitment and dedication of our amazing NHS staff. We heard personal stories from Monica Lennon, Anas Sarwar and Shona Robison. However, we know that the best way that we can support and repay those staff, as Alex Cole-Hamilton said, is by providing them with adequate investment in the workforce. Those staff need decent pay and conditions, and they want adequate staffing levels. However, as speaker after speaker has rightly highlighted, we do not have adequate staffing levels. Instead, we have a recruitment and retention crisis across our NHS.

One in four of our GP practices reports a vacancy, and we have a ticking time bomb of GPs queuing up to retire. The Royal College of General Practitioners predicts that, by 2020, Scotland will have a GP shortfall of nearly 830, just to bring coverage per head of population back to the level that we had in 2009. The crisis is not just in GP numbers. There are more than 2,500 nursing and midwifery vacancies, which is four times higher than the 660 we had in 2011. Further, nearly 750 of those posts have been lying vacant for three months or more, which is a rise of 300 per cent since the SNP formed a majority Government in 2011.

The consequence of those high vacancy rates and of training posts going unfilled is an increase in the burden on existing staff, which adds to their already unsustainable workloads, yet the Scottish Government has continued to impose a pay policy that means that someone entering nursing today is worse off in real terms than someone entering nursing seven years ago. That is a real-terms cut in the value of a starting salary, which will make it more difficult to attract the new nurses, doctors and allied health professionals that we so badly need in our health service.

As Anas Sarwar outlined, the Scottish Parliament information centre’s independent analysis shows what that means for those staff. If nurses’ pay had not even increased in real terms but simply stayed in line with inflation over the past seven years, the band 5 starting point in April 2017 would have been £25,839. Instead, it was £22,440. [Interruption.]

There is far too much background noise going on. Could members please show some courtesy to Colin Smyth?

In other words, a nurse’s starting salary under this Government today is £3,400 less in real terms than a nurse’s starting salary was in April 2010. That is an undeniable fact, and it is disappointing that, having listened to some SNP speeches today, I can tell that SNP members are in denial over the impact that that has on recruitment. The SNP’s argument seems to be that it is fine, because the situation is a little bit better for agenda for change staff at pay bands 4 to 9 in Scotland than it is for staff in England. It is touching to hear SNP members who want to break up the UK and have nothing to do with the NHS in England, Wales or Northern Ireland suddenly shed crocodile tears for nurses in other parts of the UK. The irony was lost on SNP member after SNP member, who had more to say about England and Wales than he had to say about Scotland, even though the SNP wants to walk away from England and Wales.

If the height of the SNP’s aim is to be a little bit less uncaring than Tory health minister Philip Hammond, frankly it is time that it raised its ambitions. Its approach was surpassed only by Miles Briggs. We thought that he was trying to walk out of this Parliament by standing for Westminster, but it seems that he is actually making a bid for the Welsh Assembly.

The SNP says in its amendment that

“the best resolution will be found by the Scottish Government working in partnership with NHS staff representatives”.

It calls on the

“Scottish Government to seek agreement with the staff side, through their representatives and unions”—

Will the member give way on that point?

I have not finished that point, but I will give way.

Will Colin Smyth clarify Labour’s position on partnership working? Does Labour support it or not?

We support partnership working if we can deliver the pay rise that we want for all staff across the UK. That is what will be contained in the Labour Party’s election manifesto.

The SNP amendment talks about working with unions and representatives to jointly commission work and develop an evidence base

“to assess the impact of pay restraint, using this evidence as part of the submission to the next pay round of the NHS Independent Pay Review body”.

It is a bit rich of the Scottish Government to talk about joint submissions with staff to next year’s pay review body when its submission to this year’s pay review went against those staff and argued for a real-terms pay cut. As Alison Johnstone pointed out, the pay review body bases its recommendations on Government pay policy.

The reality is that there is already evidence in this year’s staff-side submission to show the impact of pay restraint. The 44-page submission to the NHS pay review body for 2017-18 states that

“Public sector pay restraint has ... clearly damaged both the finances and morale”

and that

“Unless action is taken now, minimum wage levels will overtake Agenda for Change pay points ... This can only be avoided by a significant pay increase”.

If that evidence is not enough for the Scottish Government, it should read, rather than try to rubbish, the Royal College of Nursing’s most recent employment survey of its members. It found that 30 per cent struggled to pay gas and electricity bills, 14 per cent missed meals because of financial difficulties, 53 per cent have been compelled to work extra hours to increase earnings and 32 per cent worked extra nights and weekend shifts just to meet everyday living expenses.

That corresponds with a year-on-year increase of 30 per cent in the number of RCN members having to seek specialist money advice from their union’s welfare service over the past five years. Many more are borrowing money or taking second jobs to meet essential costs such as childcare. Some are having to use food banks—yes, food banks—to feed their families. Maybe that is what Donald Cameron meant about supporting nurses in other ways, rather than giving them a pay rise. It is no wonder that nurses in Scotland are being balloted on industrial action to end the pay cap. Yes, nurses in Scotland—before any more SNP members try to pretend that it is not an issue for nurses here.

We do not need to wait until next year to see evidence of the impact of the pay cap, as it is there before our eyes, although the Scottish Government is ignoring it. The Scottish Government has the power to make different decisions, as it—rightly—did with regard to prison officers. It has the power to be more progressive than the Tories but, as usual, it has chosen not to use those powers and, therefore, not to support Scotland’s healthcare workforce.

The SNP amendment makes one valid point on the impact of Brexit. Scotland’s health and social care sector employs around 12,000 EU nationals and we know that parts of the sector would simply not function without their contribution. However, Teresa May and the Tory Government—shamefully—will not make a commitment to protect the status of each of those EU nationals. Despite the Tories’ anti-immigration rhetoric, the truth is that, in hospital, we are more likely to find a migrant caring for us than a migrant lying in the next bed.

Not content with misleading us with their false claims on the back of a big red bus that the NHS would receive an extra £350 million a week if we left the EU, the Tory hard Brexiteers are now using the EU nationals who work in our NHS like poker chips in their negotiations. That is sickening and wrong, and it needs to stop.

The staffing crisis that our NHS faces is with us right here and now, even before the hard Brexiteers have their way. The SNP amendment is full of warm words but, in its failure to address that crisis, it is as cold as the Tory amendment. Like the Tory amendment, it will not put a single penny in the pocket of nurses who are struggling to pay the bills and it will not contribute to the recruitment of a single new doctor.

We will have a clear choice when we come to vote. This Parliament can choose to be on the side of our NHS workforce and to say to the Scottish Government that it is time to scrap the cap, to give our hard-pressed NHS staff a well-deserved pay rise and to begin to tackle the recruitment and retention crisis; or we can choose to continue austerity and to say that nurses going to food banks is acceptable. Labour members know what side we are on—the side of the NHS.