Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, June 2, 2020

Official Report 934KB pdf

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Resuming National Health Services

Our next item of business is a debate on Covid-19 and the next steps for the national health service. I invite all members who wish to contribute to the debate to press their request-to-speak buttons, and I call the Cabinet Secretary for Health and Sport, Jeane Freeman, to open the debate.

14:37  

In March, in the face of the Covid pandemic, I placed our NHS on an emergency footing. Since then, NHS staff, in my opinion, have been nothing short of magnificent. I know that they have the thanks not only of everyone in the chamber, but of everyone across our nation.

I have asked a huge amount of the staff of our health service: I asked them to undertake the biggest restructuring of our NHS in the shortest possible time, and they delivered. Our cleaners, porters, ancillaries, students, administrators, nurses, call handlers, midwives—the list goes on—doctors, paramedics and others worked doggedly to ensure not only that Covid-19 patients were cared for, but that other urgent treatments could continue.

I will also never forget the work of our medical physicists in repurposing anaesthetic machines to operate as ventilators in the interim period.

In primary care, a nationwide network of Covid-19 hubs and assessment centres, with NHS 24 providing initial triage, was established within 10 days of being commissioned. That has ensured effective management of mild and moderate coronavirus cases in the community, and has kept general practices clear of Covid cases, as best we could, so that other patients could continue to be treated. About 95 per cent of patient consultations have been conducted through the NHS near me service or through phone calls. Through its designated helpline, NHS 24 continues to be the first port of call for any patient who has queries about Covid-19.

Because of the hard work of the men and women of the NHS, at no point to date in the outbreak has Scotland had insufficient acute or critical care capacity to deal with Covid-19 and emergency demand. I have asked a great deal of those people, and now we are about to ask them for more. We are now at the point where we must carefully and cautiously plan the running of our NHS so that it moves towards running as normally as possible, but as safely as possible, because the virus remains.

The latest estimates, based on modelling, tell us that the Covid-19 reproduction rate—the R rate—in Scotland is currently between 0.7 and 1. Those estimates also tell us that, in respect of prevalence, about 19,000 people in Scotland have Covid-19 infection. In simple terms, I note that if the R rate remains below 1, the overall prevalence will steadily decline. Conversely, if the R rate goes above 1, that means that the number of infections will increase. More infections means more hospitalisations, more intensive care unit usage and—to be blunt—more deaths.

I know that the sun shone last weekend and that we are all feeling a little more hopeful now that some restrictions have been eased, but—and it gives me no pleasure to say this—the epidemic is far from over. The gains that we have made are painfully fragile, and it would not take much for them to be overturned and for our progress to go into reverse.

It is clear that our recently launched test and protect programme will have a key role to play in helping to minimise incidence and the transmission rate. We continue to remind people that in order to make that programme work, anyone who has symptoms must isolate at home and book a test. Even so, there is very little headroom for change, so we will move forward cautiously. We must remember that there will be a two-week to three-week time lag before we see the full impact of easing of lockdown restrictions.

We will start to remobilise the NHS, but I have to make it clear that that will be no “flick of the switch” moment. Remobilising in circumstances in which the virus is still with us, and the impact of changes in restrictions, need to be carefully and continuously monitored. That is a complex undertaking in which many factors, some of which will change over time, must be balanced. That makes the exercise long-term, as well as complex.

Over the next 100 days, Scotland’s national health service will remain on an emergency footing and will have three core tasks: to move towards delivery of as many of its normal services as possible as safely as possible; to ensure that we have the capacity that is necessary to deal with the continuing presence of Covid-19; and to prepare the health and care services for the winter season, including replenishing stockpiles and readying services.

Part of moving towards delivery of services as normally as possible must be the recognition that, as we have asked so much from our staff, we need to ensure that they—as individuals and as teams—have recovery time, and that the improvements that we have seen in practical and other steps to support staff wellbeing are not only retained but are spread.

The remobilisation of our NHS is a whole-system exercise: health services matter as much in the community as they do in the acute setting. That is why we plan phased resumption of some general practice services that can be supported by an increase in digital consultations.

We are also rolling out in community pharmacies the NHS pharmacy first Scotland service, which includes consultations, and we are exploring what other care pharmacies can safely support that was previously undertaken by other parts of the NHS.

In addition to our having increased the care that emergency dental hubs can provide, our chief dental officer is working with dental teams to prepare for phased introduction of dental services over this month, and is ensuring—as every part of the health service will be ensuring—that plans are fully compliant with current Covid-19 guidance and are safe for patients and staff.

The NHS will continue to provide increased direct support to care homes, to ensure that the clinical advice and guidance is where it needs to be, and to build on the strong links that exist between primary care and that sector.

The cabinet secretary has mentioned returning to normal. I hope that we do not return to normal, because that would mean delayed discharges and growing waiting times. In order to avoid our going back to normal, will there be continued funding of all the places in care homes and social care places that the Government did not fund, which resulted in so many people being in stuck in hospitals?

I take Mr Findlay’s point; I do not want us just to return to normal, which is why the document that I have published talks not only about remobilising and recovering but about redesign. I will go on to talk a little about some of the significant changes in service and care delivery that we have seen and which we intend to retain.

The overall funding of our NHS has grown exponentially over the years of this and the previous SNP Government. That includes our support for social care. The social care landscape is mixed, and private providers and others have a direct responsibility for ensuring that the income that they receive is matched by quality in the care of their residents and, of course, their staff. As Mr Findlay knows, we had to step in to ensure that staff in our care homes were not penalised for having to stay at home if they had tested positive for Covid-19. We will continue to look at those matters.

“Re-mobilise, Recover, Re-design: The Framework for NHS Scotland” sets out the guiding principles that will underpin the work, how we will go about it and how we will make critical decisions guided by clinical prioritisation. The document sets the broad direction not only for remobilising the NHS in Scotland but, which is important, for recovery and redesign of services. The aim is to set out a clear and evidence-based methodology that promotes as much robust and informed decision making as possible, because we will not be able to restart everything at the same time.

Of course, the NHS does not exist in isolation. The on-going iterative development of the plans needs to be founded on a health and care whole-system approach. We will continue to involve important partners including the Royal College of Nursing Scotland, the British Medical Association, other unions, our partners in local authorities and integration joint boards, the third sector and clinical stakeholders including the royal colleges and the clinical networks.

The patient’s voice matters too, which is why I have asked our national clinical director to work with the Health and Social Care Alliance Scotland to find the right ways to make sure that we hear what matters to patients, and to make sure that we pay attention to that in all our planning. Collectively, those groups will feed into the framework for mobilisation recovery group, which I will chair.

The initial health board remobilisation plans that I have received take us to the end of July. As members will expect, the immediate priorities cover cancer, elective procedures, mental health, primary care and important quality of life and preventative care services including pain clinics, dental care and optometry, and they cover planning for the return of screening services.

In looking to how we can slowly and safely remobilise and recover, while preserving our capacity to deal with Covid-19 and our emergency resilience, I want to retain as much new and innovative practice as possible. Our NHS did not just gear up to meet the challenge of the pandemic; in many ways, it transformed itself. We have seen some remarkable developments in service delivery, with new and improved patient pathways and use of digital technology enabling more care to be delivered at home or in the community.

The rapid expansion of digital access to therapies has led to innovations in mental health services—for example, the virtual hub in NHS Grampian, which is accessed via self-referral, for the benefit of local staff and patients, including children. In its first six weeks, 250 people accessed that service. It is but one example: there are many more.

It might be that not all innovations will work in the new landscape, but many will and many have proved to be effective. Where new and innovative ways of working have shown themselves to be delivering high-quality safe care, we will work hard to hang on to them, while remembering always that what matters to patients is the quality of the care and of the connection between them and the individual who cares for them.

I am acutely aware that the rapid reconfiguration of our NHS has not been without cost to other patients. We all understand increasingly the cost to our health and wellbeing of dealing with the pandemic. It has brought worry, continuing pain and anxiety for many. Stopping large and important areas of healthcare was a decision that I would never have taken if I had felt that I had any other choice. I deeply regret the pain and the anguish that that has caused, but there was no choice. Lives were, and still are, at stake.

In responding to the challenge of Covid-19, we have asked a great deal of our NHS and care staff, of care workers across many sectors and of the public. All that they have sacrificed has got us to where we are today—cautiously optimistic that we can control the virus, slowly ease our way out of lockdown and begin to restart areas of healthcare that we had stopped.

However, I have to ask for more again—and more again—from all of us. I have to ask every single person to keep to the rules, please. “Stay at home” remains the core message. The reasons why people can leave home have been increased in a small way, but taking all the vital public health steps to prevent transmission of the virus is even more important now, because we can leave home more.

I know it is hard: I know that everyone feels that if they bend the rules just a wee bit, it will be fine. However, if we all bend the rules just a wee bit, the virus will seize that opportunity, the gains that we have made will be lost and the opportunity that we now have of giving more people the care that they need will disappear.

We are on the right course: we are ready to begin safely and cautiously remobilising and recovering our health service. Please help us to stay that course, and please help us to improve it too.

14:50  

I thank the many organisations that have provided useful briefings for today’s debate, including Chest, Heart & Stroke Scotland, the RCN, BMA Scotland and Scottish Health Action on Alcohol Problems.

Like the cabinet secretary, I begin by expressing my continued gratitude to all our health and social care workers for the incredible hard work that they have put in during the Covid-19 pandemic. Their contribution cannot and must not be forgotten.

This is an important debate. It has been clear for some time now that the NHS does not have the capacity that it requires to restart all the many postponed services and that many people over this period have been suffering pain at home.

For some weeks, Scottish Conservatives have been calling for ministers to set out a detailed and comprehensive NHS recovery plan, in order to restart our NHS services and allow our constituents to access them safely. Many health charities, organisations and members of the public have also been calling for that.

I note the cabinet secretary’s announcement on Sunday and the publication of the framework, but I fear that the framework falls short of the plan that we need and lacks a detailed timetable of when the services will be available.

I ask the cabinet secretary to consider a number of positive ideas that Opposition parties have suggested to ministers and to take them forward as we emerge from the Covid-19 outbreak. I will return to that point later.

The resumption of cancer screening and of all cancer treatments is a key area of concern—it was the main topic at the recent meeting of the cross-party group on cancer. Cancer Research UK has undertaken excellent work in analysing the impact that the crisis has had. It points out that a substantial number of early cancers will have been left undetected before screening programmes are reintroduced and that the number of people who were sent on urgent referral for further investigation or diagnostic tests for suspected cancer dropped by as much as 72 per cent during the early stages of the pandemic.

Cancer Research UK highlights that, despite national guidelines stating that urgent and essential cancer treatments must continue during the pandemic, they do not seem to have taken place consistently across Scotland. It sets out a number of positive recommendations, including the creation of safe spaces for cancer patients, in order to minimise Covid-19 exposure, and appropriate safety netting and management of people who are affected by the suspension of cancer screening programmes, to ensure that those people can be seamlessly reintegrated into the screening pathway in the months ahead.

Like many other health organisations, Cancer Research UK also backs the restarting of clinical trials once the environment is right for them to restart and continue safely. I welcome the suggestion that pain clinics might soon reopen as well, as chronic pain patients across Scotland have been desperate to see that happen.

I recently convened a meeting of the cross-party group on chronic pain, at which a number of patients expressed their serious concerns about the impact that lockdown had had on their health and their quality of life. Some patients described feeling totally abandoned; some who are dependent on infusions or injections were forced to manage their pain by travelling to England and paying for private treatment. The toll on patients’ mental health is the key thing that we heard about. Chronic pain patients not being able to access treatment has had a hugely significant impact on their mental wellbeing. MSPs on the cross-party group have written to the Cabinet Secretary for Health and Sport with details and have asked her to look into those issues. I look forward to a full response.

Mental health services are the one area that the cabinet secretary did not expand on but that I think is very important. It must be a priority to restart them urgently. Given the anticipated increase in the number of people who will try to access mental health services and support, including child and adolescent mental health services support, we need to hear from ministers how they plan to expand capacity so that waiting times—which were already unacceptably long before the pandemic—do not become even more excessive and so that vulnerable people can access services as quickly as possible.

I am sure that—as I have—members from across the chamber will have had representations from anxious constituents who are trying to access treatment for dental problems, which, while not urgent, might be an extremely painful and negative impact on their everyday life. I would be grateful if ministers could set out more details today of when we can expect key non-urgent dental treatments to begin again and how and when they envisage non-urgent aerosol generating procedures to be reintroduced, looking at best practice internationally.

BMA Scotland makes a number of important points in its briefing, not least about the need to ensure that all NHS and social care staff are fully protected and have access to appropriate and sufficient personal protective equipment. Given that the need for PPE is likely to increase as more services resume, we must be confident that our procurement policies ensure that we have enough going forward, so that staff can feel confident in their workplace.

In relation to staff wellbeing, I also agree with the BMA that any improvements made during this difficult period, such as the local introduction of wellbeing spaces as well as the removal of parking charges, must not be lost as we take steps towards normalising services. The RCN also rightly makes the point that all healthcare staff must have access to high-quality counselling and psychological support, which is an important point. We already know that significant numbers of our NHS professionals are reporting higher levels of stress, and we know the negative impact that the Covid outbreak has had on their mental wellbeing and that of their families. A huge concern for all healthcare professionals—and for all of us—in the post-outbreak period will be the increasing needs of NHS staff presenting with mental health concerns. We must start the work to provide the support that we know will be needed.

Cancer Research UK has rightly argued that the longer we run without the full range of cancer treatment services, the greater the likelihood is of seeing reduced patient experience of care and quality of life and of not meeting all our national cancer outcomes. That applies across all our health services and is why every effort must be made to restore services while ensuring that that is done safely and sustainably.

Today’s debate is about the future. Those who work in our health and social care services want to see a change after the pandemic is over. The Covid-19 public health emergency has demonstrated the outstanding commitment and dedication of our healthcare professionals. It is clear that NHS staff have wanted to see change for some time. The way in which NHS services are delivered and the way the NHS operates have fundamentally changed during the crisis. Out of every crisis can come an opportunity to change, and I know that NHS staff are determined that their hopes and aspirations for a different normal will be realised.

Prior to the Covid-19 outbreak, Scottish National Party ministers were failing to meet any of their own waiting times or health targets. There can be—I hope that there will be—an opportunity for a new cross-party consensus on the need to improve and secure the future success of our Scottish NHS.

More than a year ago, I led a debate in the Scottish Parliament in which I called for a review of support for NHS staff and a more holistic approach to providing that support. It is clear that the public across Scotland want to see our NHS and social care staff not just given our thanks but given our support in making their life-saving work safer and more rewarding. If there is one lesson that I hope we have all learned during this public health emergency, it is that, when we empower our healthcare professionals and allow them to take decisions, they will always step up and deliver care in the most difficult circumstances.

Scottish Conservatives will continue to work with patients, health charities and representative organisations to scrutinise the Scottish Government’s actions. We owe it to each and every one of those NHS staff and social care staff who have stepped up to care for our fellow Scots during the outbreak to stop and listen to what they have to say. We have an opportunity to come out of the crisis and build a health system that meets the increasing challenges of an ageing population as well as one that delivers the modern and preventative health-focused services that we all want to see and that will help to build the healthier, happier nation that we all want in the future.

I call Monica Lennon, to be followed by Alison Johnstone.

14:59  

Thank you, Presiding Officer. I am pleased to see that you have made a good recovery and that you are back in your rightful place.

On behalf of Scottish Labour, I thank all of Scotland’s healthcare staff for their service to our country during this awful pandemic. Covid-19 has crashed into our lives and made us all less certain about the future, but we can be certain that we will always need the national health service. If the NHS had not been created by Labour 72 years ago, we would be at the front of the line of people calling for its creation now, so that healthcare, free at the point of need, could be universally available.

There is no getting away from the fact that this global pandemic is presenting enormous challenges to healthcare systems around the world. That is why we welcome this debate on the Scottish Government’s document “Re-mobilise, Recover, Re-design: the framework for NHS Scotland”. It is an opportunity to address the challenges that our health and social care services face in the short, medium and long terms.

For the past 11 weeks, the NHS in Scotland has been on an emergency footing and we have seen what life is like when parts of the health service are in lockdown or simply not available to us. We understand why there had to be an immediate focus on freeing up capacity and planning for the worst-case scenario. The Scottish Government has never tried to sugar-coat its drastic decision; ministers and officials have always made it clear that the virus will cause direct and indirect harm.

Despite every effort being made to protect the NHS and save lives, Scotland’s deaths contribute to a tragic and devastating picture across the UK whereby our collective death rate is believed to be one of the highest in the world.

In Scotland, the high number of non-Covid excess deaths—around 915 since the middle of March—has prompted the Scottish Government and the chief medical officer, many times during the past few weeks, to ramp up the message that the NHS is still open. We all know constituents and others who have been worried about going to see their doctors about changes in their health such as lumps or unusual bleeding, so it is good that we have heard that message directly from the Government.

Even so, there has been a huge reduction in the number of urgent cancer referrals, which we know is because patients have been staying away. We see the same problem in accident and emergency units, where attendance has been historically low throughout the lockdown period.

Urgent treatment is supposed to continue, but all members know constituents who have been unable to access urgent medical treatment.

Earlier today, official figures confirmed that the number of planned operations was down by more than 80 per cent in April and that more than a third of the children and young people who are waiting to be seen by CAMHS have been waiting for longer than four and a half months. We know that we are storing up a backlog of health problems.

On the immediate priorities, Miles Briggs mentioned a couple of the briefings that members have received, and I think that all members have been speaking to the same stakeholders and organisations in recent weeks, so there might be some repetition of themes in the debate.

Let me begin by talking about cancer, which is the leading cause of death in Scotland. Before Covid-19, about 34,000 new cases of cancer were diagnosed in Scotland each year and, sadly, there were about 16,000 deaths from cancer each year. Cancer will not stop simply because of the pandemic.

I support Cancer Research UK’s campaign to secure safe spaces for cancer services, and I agree with the charity that the disruption to cancer testing and treatment could have a devastating impact on people’s survival. I am looking at all the briefings that are pinned up on the walls of my room, and I can see that these issues matter deeply to Macmillan Cancer Support and other cancer charities, which do fantastic work all year round.

A few weeks ago, the Parliament heard evidence from Professor Linda Bauld. She made it clear that staff stand ready to deliver the cancer screening programme again—I mentioned that to the Deputy First Minister when he appeared before the COVID-19 Committee. We need to factor in access to PPE, as well as testing and screening for patients. I would like to see more detail about how the Scottish Government will get staff ready and ensure that working environments are safe, because we need safe spaces in which to get life-saving cancer services up and running.

I agree that we need to make mental health a priority, as RCN Scotland helpfully sets out in its briefing for the debate. I agree with the RCN that the framework at this stage is a little light on detail, which is particularly true of mental health services. We have to work collectively to get that right.

The cabinet secretary will be aware that I wrote to her recently to get further clarity on mental health support for staff and a plan to address the risks and harms associated with post-traumatic stress disorder. I see that BMA Scotland—[Temporary loss of sound.]—per cent of doctors—[Temporary loss of sound.]—suffering from anxiety, depression, stress or burnout.

A real cross-party consensus is building, and there is a real willingness to support the Government’s efforts and the national collective effort, which we see through the cross-party groups that we are members of. However, rather than the cross-party groups being seen as things that sit outside Parliament and through which we come to the cabinet secretary with a list of problems and challenges, I think that we all want to see closer working so that the Opposition parties can work alongside the Government when those frameworks and plans are being worked up.

Miles Briggs is right to highlight the challenges that chronic pain patients face. Although those issues have—again—been problematic for years, we heard testimony from patients who have been feeling suicidal because they are completely isolated and shielded and are not in contact with anyone. Although they are unlikely to have the virus, they cannot get the infusions and injections that Miles Briggs referred to.

I pay tribute to the cross-party group on cancer. I am sure that my colleague Anas Sarwar will speak more about the work that he and Miles Briggs have been leading in relation to it—there is an appetite to work across party boundaries.

Scottish Labour is completely realistic. On recovery planning, we know that it is not possible to resume all NHS services overnight and that it will require weeks, if not months, of careful planning. We want to work with the Government on that. The cabinet secretary was right to say that the NHS does not exist in isolation and that it cannot work alone. I wholeheartedly agree, which is why I would like to see more certainty for charities such as Chest Heart & Stroke Scotland, which has a fantastic hospital at home programme. However, at the moment, it has financial support from the Government for up to a maximum of only three months. We need to know what support will be in place so that health charities, in particular, can plan for the longer term.

There is much to say, but there is no time left. I have mentioned the values that underpinned the national health service 72 years ago, but I have not had time in today’s debate to talk about the impact on older people and the fact that our care homes remain at the centre of this crisis. We need a national care service with consistency in standards, quality and access right across Scotland. Never again can we have a situation in which people are cleared out of hospitals, without proper testing and screening, and into care homes where health support is not available. I look forward to hearing more from the cabinet secretary about that.

We have to remember that health and care workers have also lost their lives or become unwell during the crisis. For their benefit, and for the benefit of all patients in Scotland, we all have to work to ensure that we learn lessons quickly and take questions or criticism in no way as a negative but as an opportunity to do better in the future.

15:09  

I, too, express my heartfelt gratitude to all those in the NHS who have worked, and who are working, so hard to keep us safe. We owe it to them to amplify voices in the health service and in care in this chamber.

Scotland’s health service has not been overwhelmed during the Covid-19 outbreak, which is down to the incredible efforts of all those working in health and care. However, that does not mean that it has not, at times, been overwhelming for those working in health and care in Scotland. Staff in those areas have been subject to extremely difficult conditions and they have undertaken their work at great personal risk—due, in part, to inadequate stockpiling of PPE.

A recent survey by the Royal College of Nursing revealed that 69 per cent of respondents had raised concerns about PPE, and 46 per cent, including those working in the most high-risk environments, reported that they had felt pressured to care for a patient without appropriate PPE. That has added to the stress and anxiety that staff are feeling when they are working during the pandemic.

Our health service faced staff shortages and huge challenges before the pandemic, and we have to bear in mind that there might be staff working in the NHS and in care services who will be affected by post-traumatic stress. There might be many staff whose mental health and wellbeing is being impacted, so we need to be clear that we are prepared to help them, that support is available and that they can access it easily. Staff also need a guarantee that, given the likelihood of a future pandemic, proper planning is taking place, that lessons are being learned and that shortages of PPE will not recur. We need to ensure that staff feel as safe as they possibly can when they go to work during and after the crisis.

Routine testing of those who work in the NHS and in care services is essential. As we discussed earlier today, it is still the case that too much testing capacity goes unused. On Saturday, the number of tests that were carried out fell to its lowest level in more than a month, with only one fifth of Scotland’s testing capacity being used. Significant concerns remain that infected healthcare workers who are pre-symptomatic, asymptomatic or suffering from mild symptoms might be spreading Covid-19. Using the capacity properly would help to reduce anxiety, better protect front-line staff, ensure that no one needs to isolate needlessly and encourage patients to engage with services.

We urgently need more information on the effects of Covid-19 on black and minority ethnic people. Public Health Scotland has published preliminary analysis that suggests that there has not been a higher level of coronavirus cases among Scotland’s black and minority ethnic communities than would have been expected, but the First Minister has acknowledged that the data is very limited. We need detailed analysis now, so that people fully appreciate the risks.

We cannot rely entirely on the efforts of our wonderful NHS workers to pull us through crisis after crisis. We owe them more than that. To reduce the strain on staff and to ensure the sustainability of the NHS, we have to focus more on prevention. In its 2018 paper, “The Role of the NHS in Prevention”, the Faculty of Public Health stated:

“The NHS remains first and foremost a treatment service”,

so we need a new approach to ensure that our NHS is in place for generations to come.

Tackling inequalities must be a key tenet of that approach. Multiple studies have shown that income is the most important social determinant of health. The Joseph Rowntree Foundation tells us that

“health improvement policies that rely only on initiatives that target specific risk factors or deliver single interventions are in danger of being insufficiently comprehensive to yield anything more than modest benefits.”

Food poverty, period poverty and fuel poverty all have the same root cause: a lack of sufficient and secure income. Therefore, we need to take a more holistic approach to health.

Implementing a universal basic income scheme to ensure that everyone has enough money to live on would help, and the impact of the Covid-19 outbreak has driven home the importance of such a policy. Too many people in this country are surviving on precarious incomes and living in insecure tenancies.

The third sector also has a key role to play in prevention and in improving health. Many people in the sector are warning that they face significant financial risks and that they will need support to survive the crisis. The support that has been provided to date has helped to set up digital or short-term Covid-19-specific projects, but more long-term support must be guaranteed, because social distancing will impact on their fundraising ability and on their shop income. The real challenges for the sector go well beyond the pandemic, just when services such as the NHS will need it most.

I am glad to see the resumption of suspended services, such as cancer services and some mental health support. Cancer Research UK, the British Heart Foundation and Chest Heart & Stroke Scotland have been contacting us all, and they cannot wait to be able to properly help those who need their help most.

Some measures that are taken to protect our NHS during the crisis can have a positive and lasting effect on how services are run, such as the delivery of digital consultations when appropriate. The role of pharmacists has also been highlighted during the pandemic. They have an important role to play in the delivery of community services, and I welcome the roll-out of the pharmacy first Scotland service in community pharmacies during phase 1. We need to fully use the expertise of those highly skilled professionals. An increased focus on community pharmacy as the first port of call for managing self-limiting illnesses and supporting self-management of long-term conditions is a positive step—it lessens the strain on our GPs and it lets pharmacists contribute more fully to the multidisciplinary team.

In closing, I will focus on our care service. As we know, 46 per cent of the Covid-19 deaths that have been registered by the National Records of Scotland have been in care homes. Such horrifying numbers emphasise that our care system must be reviewed as a matter of great urgency. We need a public care service that is akin to our NHS. I welcome the fact that the discussion has finally started, but those conversations must be sustained and not abandoned as they have been by successive Governments so many times before.

Fragmented delivery in a postcode lottery is not good enough. We owe it to our elderly people, many of whom have suffered immeasurably in the past few months, to rethink how we value them, to commit to properly look after all our older citizens and to repay them properly after a lifetime of contributing to society.

We need to place human rights at the heart of social care. The impact of austerity has seriously undermined efforts to embed human rights in the delivery of social care, and it has impacted on wider society’s resilience. We must build back better, and a properly resourced, well-staffed national health and care service can begin to right the wrong.

15:16  

I echo Alison Johnstone’s eloquent words about the need for a national care service, which is a view that is shared by my party. I also thank her for and echo her comments in praise of our hard-working NHS and social care key workers.

In the foothills of the emergency, this country was gripped by a fear that has not yet dissipated. In the space of a week, we went from public health messaging around bumping elbows, to the strictures of lockdown. I remember the sense of creeping anxiety in the Parliament building when all but members and a handful of parliamentary staff were asked to work from home. The place felt like a tomb; it felt as if every surface was crawling with virus. I do not remember a time in my life when I have felt more afraid.

The fear was replicated in our communities. By the time that lockdown came, people were already begging for it to be imposed. We had seen images coming out of Bergamo and Madrid, we were aware of the mobilisation of ice rinks as potential mortuaries, and we watched in shocked admiration as the NHS Louisa Jordan hospital was erected in just a matter of weeks. It was therefore wholly unsurprising when the Government postponed all non-urgent elective surgery in the first days of lockdown. I received not one single complaint or note of concern in my parliamentary inbox about that decision. People felt that the risk of going where Covid-19 was likely to be was too acute for them to take, so they did not take issue with the decision.

Members may recall that, near the start of the year, I brought the case of Margaret Simson to the attention of the Cabinet Secretary for Health and Sport. In 2018, Margaret Simson was injured during a colonoscopy and fitted with a temporary stoma bag while she was on a waiting list for corrective surgery. She waited and waited. By Christmas last year, the pre-op medication that she had been given to take home in preparation for the surgery had passed its use-by date, so she got in touch with me. I raised her case in the chamber, in the papers and with NHS Lothian until she was finally given a date for her surgery in the middle of April. When the Government cancelled all non-urgent operations, her number was the first that I called. I stressed to her that, given the inconvenience and suffering that she has already experienced, we could now easily make a case to the health board that her procedure was urgent. However, she was quite clear that she was not ready to take the risk. The fear of Covid-19 was too great for her to entertain the prospect of entering any part of the health service estate.

Margaret Simson is not alone. I have an immediate family member who is in need of an urgent hip revision, and who has spent the best part of 10 weeks on crutches and in abject pain, but is prepared to spend 10 more weeks like that if need be, rather than risk a hospital stay. There are such stories the country over, and they can be measured empirically in our health service statistics. In April, there was an 83 per cent reduction in surgical operations from the previous month. There have been as many as 16,000 fewer cancer referrals, and accident and emergency departments are deserted.

That reality is concerning on several levels. First, it suggests a tremendous level of human suffering in our communities that should otherwise be dealt with in primary care. It suggests a massive drop-off in health surveillance, with many diseases and conditions going undetected or not being detected early enough for something to be done about them. It suggests that our national response to Covid-19, as reasonable as it might be, will lead to a human cost and a loss of life beyond the lives that have been taken by the virus.

That final point is deeply troubling to us all. In the first 10 weeks of lockdown, the number of deaths in the home rose by 67 per cent, yet only 15 per cent of those were as a result of coronavirus. Those deaths must have been those of people who were in need of healthcare but who, like Margaret Simson and so many others, were too frightened to access it.

I echo the words of other members who have spoken in the chamber throughout the emergency: if people are unwell or if they experience signs such as abnormal bleeding, chest pains or a new lump, they must get help. They can be certain that they will be seen and that they will be seen safely.

I ask the cabinet secretary to focus her efforts on three key areas of the health sector as we revive parts of the NHS. First, I ask that she consider the full recommencement of all types of cancer screening programmes. We know that cancer referral and diagnosis have dropped off a cliff, and the long-term impact of missing an early diagnosis for patients and, ultimately, our health service cannot be overstated.

Secondly, the cabinet secretary’s Government must redouble its efforts on child and adolescent mental health services. At the outset of the crisis, many children had already waited for more than a year for treatment; in the intervening months, young people have experienced the disruption of their education, removal of freedom and loss of contact with peers and loved ones. Therefore, it is inevitable that more children and young people will need help and support through CAMHS, and they deserve better than to join one of the longest queues in the entire health service.

Finally, I ask the cabinet secretary to look at dentistry. Every member of this Parliament will have received emails from constituents in agony, parked on antibiotics and awaiting fillings, root canal work or other aerosol-generating procedures. I am sure that, like me, members have been contacted by dentists who are desperate to get back to work to help their patients. They are confident that they can do those procedures safely with the right kit.

This Parliament and this country will never be able to fully repay the debt that we owe our NHS. It has weathered the first of the Covid-19 storms; it has prevailed and done so admirably. It has shown itself to be capable of doing that and having capacity to spare. While we have a bit of breathing space and while our clinicians are coping, let us restart some of the normal day-to-day NHS provision, where it is safe to do so, so that we can alleviate some of the suffering in our communities.

15:22  

It is impossible to consider and debate the next steps for our national health service in isolation from social care and care homes. As acknowledged by the Government and others, the pandemic has demonstrated the crucial interdependence between the different parts of the health and social care system, and exposed and exacerbated health and social inequalities. Indeed, in the Cabinet Secretary for Health and Sport’s opening remarks, she states that a whole-system response continues to be required to combat Covid and that a whole-system approach to life beyond Covid is not just required but essential.

The new framework is titled, “Re-mobilise, Recover, Re-design: the framework for NHS Scotland”. I want to focus on the future, as it is the prospect of a better future that gives us all hope.

I know that I am not alone in having had much to reflect on, personally and politically, in the past few months. In short, I, too, would like a national care service that is on a par with our national health service. Let me be clear that I do not want care services to be run like hospitals, with councils or charities cut out of the loop. I want a refocus on not-for-profit care, a clear national plan and infrastructure that builds and supports local services around the everyday needs of people in their own homes or communities, with lines of accountability and redress that are as clear as crystal. I certainly want a dispassionate examination of the so-called mixed economy of care that has been with us since the National Health Service and Community Care Act 1990 came into force in 1993.

The pandemic has shone a light on serious concerns about some private care homes. Although I do not want to tar all private providers with the same brush, we need to be clear that profiteering at the expense of care cannot and must not be tolerated. My concern, given how some large private care providers operate, is that millions of pounds of public money is taken from the care sector into the financial sector, particularly when care homes are sold, with care home fees being extracted for profit, and in paying for the building time and again. We need to interrogate the ethics and fairness of the financial models that underpin care, and evaluate their impact on the wellbeing of residents.

Will the member take an intervention?

I hope that Mr Findlay will forgive me, but I will not, because I do not want to get overly emotional.

I have written to the Cabinet Secretary for Health and Sport, calling for an investigation into the differential impact of Covid-19 deaths in care homes in the public, private and third sectors. My reason for doing so is rooted in the Scottish Government’s statistics, most recently from 27 May.

To date, the percentage, by sector, of adult care homes that have had a suspected case of Covid, is: 38 per cent in the voluntary and not-for-profit sector; 57 per cent in the public sector; and 69 per cent in the private sector.

Scottish Government statistics also show that a higher proportion of larger adult care homes have suspected Covid-19 cases. Seventeen per cent of adult care homes with 10 beds or fewer have suspected Covid-19 cases; by contrast, 91 per cent of adult care homes with more than 60 beds have suspected Covid-19 cases. It is imperative that we examine which sector prefers large care homes, and why, as well as the need for transparency about the tragic loss of life in care homes, sector by sector.

There are also massive questions to be asked about the role, remit and powers that are afforded to registration and inspection services.

I recently wrote to the Care Inspectorate and to the nurse director for NHS Lothian, and am hoping for a productive response, about a constituent who has been diagnosed with coronavirus. His family are worried sick about the private care home’s ability to cope. They are asking—pleading—for nursing staff to go from the health sector to the care home sector. Nursing vacancies in the private sector are high, at around 50 per cent; that can be compared with about 15 per cent in the voluntary sector. A local funeral director has also, independently, raised concerns about the same home.

In response to the pandemic, the Government is working with the care sector as currently constructed. The cabinet secretary is right to point out that she has stepped in to the private sector to pick up the pieces over concerns about terms and conditions of employment, including death in service benefits, pay, and sickness benefits. She has also stepped in over the supply of PPE. It is significant that NHS nurse directors have assumed professional responsibility and accountability for infection prevention and control in all care homes. We cannot turn our backs on that. We can only go forward.

As we look to a new life beyond lockdown, there are fundamental questions to be asked, and answered, about how we can best care for our most vulnerable yet cherished citizens. I hope that we can start to do that constructively, and together, sooner rather than later.

15:29  

First, I would like to record my thanks to every NHS and care worker. Over the past ten weeks, you have done so much to look after the vulnerable in our society. I also thank all emergency and key workers, as well as the thousands of volunteers who are helping out in their communities. No amount of thanks could ever convey how grateful we are to each and every one of you; nonetheless, thank you.

It is an underestimate to say that the coronavirus has brought many changes to our daily lives, not least to our NHS, which has seen the largest reconfiguration of the service in its history. The NHS was put on an emergency footing in March, and with that came the cancellation of non-urgent elective surgery, and, a few weeks later, the suspension of screening services for breast and bowel cancer.

The health service needed to be ready for a surge of cases at the beginning of the pandemic, but it is now time for the Scottish Government to safely restart services for those who are suffering in silence, otherwise lives will be at risk.

A few weeks ago, Cancer Research UK warned that Scotland faces a significant cancer crisis due to the backlog of diagnoses and treatment. It said that the number of people being given an urgent referral for suspected cancer dropped by 72 per cent during the early stages of the pandemic, with about 2,000 urgent suspected cancer referrals not happening each week. Cancer Research UK has urged the Scottish Government to set out a strategy to return cancer services to pre-coronavirus levels.

A number of wider programmes will be vital as we move out of lockdown and look to restart the NHS, the first of which is test, trace and isolate. At the start of last month, we agreed that it is vital for the TTI strategy to be a success. It will be key in suppressing the virus, and, I hope, will put us on a path towards some sense of normality.

However, recent developments have shaken public trust in the previous contact tracing operations, and none more so than the failure to inform the public of a coronavirus outbreak at a Nike conference in Edinburgh in late February. We all know the details that have emerged in which numerous people who came into contact with conference delegates were not contacted by the tracing team. None of those cases is more worrying than that of the kilt cutter Gillian Russell, who had to take time off work with flu-like symptoms shortly after spending more than an hour fitting kilts for Nike conference delegates. Shockingly, Gillian Russell found out about the outbreak only through media reports. That cannot happen again.

We also find it disappointing that the figure of 2,000 additional contact tracers, who were promised for the strategy to work, is being played down. In the past week, we have seen varying numbers in relation to tracers, with claims that only 700 would be needed at the beginning. It is still unclear whether those that have been hired so far come from outside the NHS.

Everything must be done to ensure that test, trace and isolate is not only a success, but has the confidence of the public. Additionally, the success of the TTI strategy will depend on the testing element. The Scottish Government has announced that capacity is more than 15,000 tests a day, but, as we have heard, shockingly, only a third of that capacity is being used daily.

The Scottish Conservatives have repeatedly called for the Scottish Government to get testing capacity into the community, particularly for carers working with the most vulnerable groups. That testing will vastly improve the data, which will enable us to move out of lockdown and restart our NHS. As Government ministers have themselves said, there is no point in having capacity unless we use it.

I found it promising that one of the Scottish Government’s publications shows that hospital beds and intensive care unit capacity has not been breached, and that in all scenarios to August, the forecasting data shows that it will not be breached. The capacity is there; it is time to put it to use.

I have said that the NHS has rightly diverted time and resources to tackling the coronavirus. In such an unpreceded time, it was only right that steps were taken at the start of the crisis to make sure that the NHS was ready for a surge in coronavirus cases. Now it is time for the Scottish Government to safely restart screening and operations. As those next steps are taken, the safety of staff and patients must be at the forefront. The NHS did not fail us in this crisis; moving forward, we must not fail it.

I remind members that those who are contributing remotely are not able to take interventions. I am sure that, during the debate, other opportunities will arise for members to rebut any points that they wish to.

15:35  

I am grateful for the opportunity to speak in the debate. First and foremost, I want to say that our NHS is truly a wonderful thing and must be top of our priority list during these unprecedented times. I am sure that members across the chamber would agree that all our healthcare workers—from doctors and nurses to hospital porters, social carers and ambulance staff and all those who are involved in the NHS—have performed admirably under what I can only imagine will have been incredibly challenging circumstances.

In our popular culture, superheroes fly about, saving the universe, in big-budget movies in which the ancient mythology of heroes saving the weak and those in need has been repackaged for the 21st century. However, in these challenging times, I think that it has been proven that superheroes are alive and well, and are living and working among us in our communities right now. That is why, as we move forward, it is vital that we get things right to ensure that our NHS can operate at peak level as we transition out of lockdown and through the four phases of the new normal.

The Scottish Government’s main priorities have remained the same throughout this global pandemic: to save lives and protect the most vulnerable. That is why the core message that will be at the heart of the next steps for our NHS remains the same: stay at home and save lives. The difficult sacrifices that we are all making in our communities are working. However, our progress remains fragile. Although we have now entered phase 1 of the transition process, we should still stay at home as much as possible to ensure that the virus does not spike again and take us back to square 1.

It is important to acknowledge how hard such restrictions are for many people across the country, who are experiencing extreme loneliness and isolation while they are physically cut off from their families, friends, colleagues and loved ones. I am sure that, for many households, video-calling technology such as FaceTime or Microsoft Teams is a godsend right now. I, too, am feeling the strain of not being able to hug my grandchildren and interact with them face to face. As every single one of us will understand, continuing with such restrictions causes its own harms. The Scottish Government has said that it will not keep them in place for a moment longer than is necessary.

Throughout the lockdown, the NHS has been available for those who have needed it, as the NHS is open campaign headline has said. Rona Mackay recently told me about a constituent of hers who was diagnosed with bladder cancer five weeks ago, and who received surgery and treatment immediately. So far, everything has been good. That example shows us that our NHS has continued to function. I therefore encourage anyone with medical concerns to continue to contact their GP or NHS 24 or to attend hospital if their illness is immediate or life threatening.

As we move into a phased return to some semblance of normality, the Scottish Government has instructed health boards to resume, where it is safe to do so, those health services the absence of which has clearly had a detrimental impact on people’s lives. “Re-mobilise, Recover, Re-design: the framework for NHS Scotland”, which was published on Sunday, sets out the core principles that underpin how we can safely and gradually resume some of the services in our community and hospital settings that were paused at the onset of the crisis. The initial outline of which services could be prioritised in the next phase of the health board mobilisation includes cancer services; expansion of treatments for conditions other than cancer; urgent in-patient services; and out-patient therapies in which delay will increase the risk to patients, such as the management of macular degeneration, paediatrics and respiratory services. I think that we can all agree that the resumption of mental health support services will be extremely important, as many of us will no doubt have heard from our constituents, and that they should be made more widely available as time progresses. Care offered at emergency dental hubs will also expand while dentists prepare to reopen.

As with everything right now, it is important that the remobilisation happens in stages, with constant checking on the prevalence of the virus and the R number so as to keep Covid-19 under control. Health boards will introduce their plans while maintaining Covid-19 capacity and resilience and providing appropriate support for social care. Alongside reopening many health service areas, continued testing for Covid-19 is top of the agenda.

The approach to testing must make sure that we have saved as many lives as possible and that we have protected the most vulnerable, which is why the three current objectives for testing are to support the care of those who are most seriously ill; to support essential workers to get back to work; and to provide surveillance and information to tell us how the virus is spreading and allow us to manage the spread.

The Scottish Government has expanded testing eligibility and capacity considerably. Combined with the Glasgow Lighthouse lab, we are able to test 15,500 people per week. From 18 May, eligibility for testing was extended to any symptomatic member of the public across the United Kingdom, which I hope will allow us to more accurately record and trace where the virus is spreading throughout our communities.

However, we will have to be equally vigilant in these coming weeks. Although things have been hard, it is undeniable that we are experiencing and living in extraordinary times. I am immensely grateful that we live in a country where top-quality health and social care is universally available. Our NHS has held up under unbelievable strain and performed absolutely brilliantly. It will continue to do so but we must ensure that we continue to give it the support that it needs.

15:41  

The Covid-19 crisis has exacerbated the same two greatest challenges that have faced the health sector since devolution, namely health inequality and the broken care system. For George Adam to say that we have top-quality social care is a disgrace.

As we look to the future, we cannot repeat the mistakes of the past. Report after report after report has been written about these issues, yet the only thing that changes is that the health inequality gap widens and the social care crisis deepens. Covid-19, just like cancer, diabetes, and so many other diseases, disproportionately affects the poorest communities. There is a clear class issue here; the evidence is there for all to see—if someone is low paid and lives in a deprived community, they are twice as likely to be hospitalised and to die from Covid-19 as they would be if they came from a wealthier community. They are also much more likely to have been asked to work on the front line, keeping the health and social care service going, the transport system alive and the food supply chain functioning throughout the pandemic.

It is bus drivers, train guards, shopworkers, cleaners and care assistants who have helped to keep us safe, well and fed during the past nine weeks. Many of those people are in precarious employment and are paid at or just above the national minimum wage. They cannot afford to take time off, because they will go on to statutory sick pay or they will get the sack.

What are we going to do to address the fundamental health crisis that kills many more people each year than Covid-19 ever will in this country, namely poverty? Will we use the powers that we have and do everything that we can with them to end low pay, to give people security and rights at work, to end homelessness, to create full, stable and sustainable employment, to clean up the environment, to decriminalise addiction, to fund and staff the NHS, to address the mental health crisis and to democratise decision making?

Health inequality is the manifestation of economic inequality and, without redistributive, democratic structural change in the economy, we will never see those inequalities narrow. If we need new powers to do some of those things, let us seek to build cross-party agreement on how to get those new powers and how to secure them.

On social care, the dogs in the street know that the system is broken. It is a sector that is characterised by a recruitment crisis, low pay, exploitation and insecure work; a sector in which a company such as HC-One, with 56 care homes in Scotland, keeps its profits up on the back of the pay and conditions of its workers, paying zero corporation tax while being registered in the Cayman Islands. What the hell are we doing allowing such companies anywhere near the care of our loved ones?

The system needs to be knocked down and rebuilt from the ground up, with a system that is based on human rights, equality of access and high-quality care and in which social care is professionalised, with a career structure, training, and pay and conditions that recognise the value of the important work that is being done.

On 6 March, IJBs were told to reduce delayed discharge by 400; on 27 March, they were told to reduce it by another 500; and, on 5 May, they were told to go further and that discharges had to outstrip admissions. We know that many people were discharged from hospital untested and without a care assessment to care homes or to home care. In my view, that policy decision was a disaster that resulted in infections and, tragically, deaths. Many of those people were long-term delayed discharge cases—patients who were stuck in hospital and told that they could not be discharged because a care home place or package was not available for them.

The delayed discharge issue has gone on for two decades, which is the entire time of the Scottish Parliament, and successive Governments have failed to get a grip of it, but it was at record levels prior to the crisis and then, suddenly, as if by magic and overnight, thousands of care home and home care places appeared. Did we build all those new bedrooms in care homes? Of course we did not. Did we create all those new jobs and were people trained and disclosure checked overnight? Of course not. So how did the social care miracle happen? It was because all those places and home care slots existed all along—they were always there.

Of course, what was not there was the money to purchase them, and that was down to political choices of the Government, which took Tory budget cuts and doubled and sometimes trebled them before handing them on to local government and the IJBs. Delayed discharge has never been about places not being available; that was just the excuse that was given to families who were waiting for people to come out of hospital. It has always been about not funding the places. The most recently published care home survey proves that, as it shows that 37,200 places existed in Scotland but only 32,500 places were occupied, so almost 5,000 excess places existed in the system.

It gets worse, because we know that a care home place costs around a third of the cost of a hospital bed. That means that, in cutting social care and council budgets, the Scottish Government has cost the taxpayer millions of pounds by keeping our loved ones stuck in hospital. It was a deliberate policy choice. Because people have been stuck in hospital, more people have been stuck outside hospital on long and growing waiting lists and not getting in for the procedures that they need. If we are going to look at the future of the NHS, I suggest that we start with those two fundamental issues.

I will make one final point. Angela Constance spoke about small care homes, and I agree with her on that. However, the tragedy is that, when Bield Housing Association, which is a not-for-profit organisation, closed all its care homes in Scotland, the Government sat back and did nothing.

15:48  

Like many other members, I welcome the opportunity to contribute to the debate. The pandemic feels as though it has been with us for a long time and it has affected our daily lives in ways that most of us will never have experienced before and, I hope, will not experience again. Our focus in the past few months has been on suppressing the outbreak, and the vast majority of our NHS staff and resources have been deployed to care for Covid-19 patients. That has been absolutely necessary in order to help save lives.

As others have done, I put on record my thanks to and support for all our key workers who have come together to support people across our communities. Those workers have done a fantastic job and it has been heartening to see an outpouring of solidarity and compassion throughout our communities.

The Scottish Government’s framework for NHS Scotland mobilisation, which is called “Re-mobilise, Recover, Re-design”—it is quite a catchy title, actually—sets out what I would call cautious steps for opening up our health service to non-Covid patients. The framework gives a good indication of what we can expect from our NHS during the phased approach to lockdown. I want to take this opportunity to highlight some areas of concern that have been raised with me.

As members know, I am the convener of the cross-party group on older people, age and ageing, and I am eager to see how the framework will apply to such people. Many people, particularly older people and those who have been shielding, have reservations and anxiety about attending hospital for treatment. I welcome the cabinet secretary’s comment about looking at the current restrictions on people who are shielding, and I look forward to seeing what comes out of that. People who have been shielding have had hardly any contact with people outside. Many of them will be full of trepidation as they take their first steps to attend a hospital appointment. It would be helpful if the cabinet secretary could outline what reassurance or alternative steps the Government could put in place to ensure that those requiring medical treatment are fully supported.

I now jump from the older generations to our young generations to flag up concerns that have been raised with me and others about paediatrics. Although there have been concerns regarding the level of service pre-Covid, those concerns have been exacerbated by the pandemic and the pausing of community paediatrics. A professional paediatrician has said:

“To maintain social distancing, we can’t have the same footfall in our clinics. We are doing whatever we can by telephone and video consultation, but I cannot give a child a lifelong diagnosis of autism without seeing them face-to-face at least once. I need to examine them, and not miss signs of an alternative or additional diagnosis.”

Paediatricians are working very hard to disseminate their expertise and are working closely with health visitors and others to link families to good online information wherever possible, but they feel that that is not enough. They highlight that the knock-on effects on young people and their families and carers of not being able to access the services can be extremely damaging. The professionals give examples of how the situation can affect the lives of families. If a child has additional needs, it can result in eligibility for disability living allowance and carers allowance and can support an application for housing and, in some cases, support an appeal to the Home Office for leave to remain. Support is a huge area, but they are saying that, without their help, families cannot always access the support. We need to look at that issue.

It is clear that, in the face of this truly devastating pandemic, we need to reassess our priorities. Protecting and nurturing our public health and social care system must take precedence; I will not go into it, as others have already done so, but it must include care homes. As the cabinet secretary has said, care homes are mixed—we cannot continue with a system in which more than 74 per cent of care homes are privately owned. Much has been said about the issue, and I highlight that training and conditions vary tremendously. What every member has said about care homes is absolutely right; we have an opportunity to fully value care and change it for the future—we must use that opportunity.

Others have touched on dentistry, and I welcome the cabinet secretary’s comment. Like other members, I have been contacted by many constituents regarding dental services and by dental practices seeking support ranging from funding to the resumption of NHS-funded training for dental practitioners. The framework states there will be an expansion of services in the dental hubs, which I welcome. However, it would be helpful if, at this stage—I appreciate that we are taking every step as it comes in opening up services—further information could be provided on the resumption of both dental and orthodontic practices.

15:54  

Around the chamber and across the whole of the UK, we have seen an outpouring of support for the NHS and its staff during the pandemic. Many NHS employees and contractors, alongside key workers, have been at the front line of the crisis. While most of the public have been able to stay at home, NHS staff have put themselves in harm’s way to provide the help and care that people need.

Sadly, many have had to make sacrifices. They have lived with the added fear that they might bring the virus home to their loved ones. Some have isolated themselves from their families for safety reasons, with the result that they have been unable to see their children. Tragically, there are also those who have been among the victims of the outbreak.

In the fight against a viral pandemic, it is impossible to eliminate risk entirely, but the primary responsibility of Government and the public must be to help to manage and reduce that risk. We should remember that the response has been unprecedented. Millions have remained at home and the state has stepped in and directly supported hundreds of thousands of employees to stay away from work in Scotland alone. The nation has shut down in a way that is incomparable, even with wartime.

In my region, I have heard numerous stories of NHS staff working incredibly hard to tackle the effects of the virus, and I thank them for everything that they have done. There are, of course, questions over the extent of Government’s capacity to address the challenges that Covid presents. How much can we do in the face of an invisible threat? To what extent can we change our public services and our ways of working and living in such a short time? Although it is clear that there have been shortcomings, mis-steps and mistakes, huge logistical challenges have been overcome and things have been achieved that we might never have previously considered possible.

NHS staff have been central to those efforts, as have the civil service and public officials. In addition, the armed forces have been there to help in some of the most desperate situations, and our thanks go to all of them, too.

The core objective of reducing pressure on the NHS and maintaining its capacity is working, because the service has not been overwhelmed, but there are lessons to be learned. In that respect, we should look to social care, where some of the worst harm has been caused during the pandemic. Despite the integration of health and social care, Covid-19 has cast in a harsh light the fact that social care still remains the poorer neighbour of the NHS. I am not alone among members in having to pursue proper testing and the making available of resources to care homes in my region.

We should consider, with regret, the Scottish Government’s decision to move patients from hospitals to care homes in the early stages of the outbreak. Patients who had not been tested were moved into settings where people are often at their most vulnerable. I simply do not accept the argument that it is necessary to have hindsight to make the case that that should not have happened. We knew early on that, as with every similar virus, asymptomatic transmission was a risk. Although the guidance to isolate patients based on their showing symptoms was sensible, we knew that there was still a risk that symptoms might not at that point have manifested themselves or been properly identified. Despite the hard work of the sector, it was less equipped and less prepared to deal with those issues.

In many cases, our testing capacity has fallen short, despite its importance in limiting transmission. Too often, despite the health secretary’s claims, there appears to have been a lack of testing kits or a lack of access to such kits—in other words, there was testing capacity, but not testing availability. That must change if we are to make a success of the next stage of our response.

Contact tracing will be an increasingly important weapon in the NHS’s arsenal, and it is one that must be delivered effectively as infection levels in the community fall. Without a vaccine in place, it will be the main barrier to harmful future waves of the virus sweeping through our population.

In the Highlands and Islands, the potential exists for greater localisation of our response. In more isolated communities where infection rates have been low or almost non-existent, there is scope for different approaches to be taken, but contact tracing must be an essential part of the process. We can begin to look at other approaches; other members have mentioned the reopening of routine NHS dental services. The monitoring of responses will enable the public to return to a greater level of normality more quickly. I recognise that such processes are already getting into gear on a Scotland-wide level.

One legacy of the virus will, I hope, be greater use of telehealth to address the challenges that exist in delivering healthcare in remote and rural areas. As with schools, adaption has taken place by necessity in ways that have been discussed for years but never brought into the main stream.

However, we cannot overlook the negatives. For years, I have challenged ministers on the many issues with our NHS. For example, NHS Grampian has among the worst waiting time records in Scotland, and progress in addressing those has been painfully slow. Ministers must be able to recognise where the pandemic has set us back even further in managing those challenges. Even when the last new cases have passed, change in our NHS will be more urgent and vital than ever.

The threat of pandemics will always be with us, and the legacy of Covid-19 will linger on. That legacy will have a huge cost, in lives, in economic terms and in how we live, but we should also consider what it tells us about the delivery of health and social care in Scotland. The virus has undoubtedly exposed weaknesses in that provision. A more resilient national health service is in all our interests, and it is time that words about the value of social care were translated into action.

NHS staff and care givers have shown a huge willingness to help us all through this dark chapter in our history; there will come a time when we should repay that debt by creating a more effective and responsive public service to the benefit of every one of our citizens.

I call Emma Harper, who will be the last speaker in the open debate.

16:00  

I welcome the opportunity to speak in this debate, albeit remotely, and I welcome the publication of the Scottish Government’s “Re-mobilise, Recover, Re-design: the framework for NHS Scotland”.

As other speakers have done, I put on the record my personal thanks to the key workers in my region and across the country—our doctors, nurses, NHS staff, health and social care staff, cleaners, ambulance service, porters, police, fire service, delivery drivers and all those who provide essential services. They all do fabulous and hugely important work every day and they must be commended.

I also thank people across Scotland for their resilience in sticking with the lockdown restrictions and playing their crucial part in stopping the spread of Covid-19. Without people following the restrictions—and we know how hard it has been for everybody—we would not be where we are today in looking towards establishing a new normal in the near future.

Since the outbreak of Covid-19 in Scotland, our NHS has shown exemplary resilience. In a matter of weeks, our NHS boards managed to almost double their critical care capacity. Staff have been redeployed and upskilled and new training has been undertaken. I participated in nurse induction, expecting to be expedited to return to the front line as a nurse, but NHS Dumfries and Galloway has not required me to rejoin the workforce. That shows that, locally, the NHS has been very resilient and has not been overwhelmed.

That is hugely impressive, and the NHS boards, managers and staff deserve recognition for their outstanding efforts. However, as we move out of the first peak of Covid-19, we need to look at how our NHS will move into the future towards a new normal. I absolutely endorse Angela Constance’s very thoughtful contribution on care homes, because we know that health, the NHS and social care are completely intertwined.

The remobilise, recover, redesign framework for NHS Scotland is a great starting point. The document outlines three key aims that should be achieved over the next 100 days. It states that the Scottish health service must work on

“Moving to deliver as many of its normal services as possible, as safely as possible”,

“Ensuring we have the capacity that is necessary to deal with the continuing presence of Covid-19”

and

“Preparing the health and care services for the winter season, including replenishing stockpiles and readying services.”

Local mobilisation plans may need to include pre-procedure Covid-negative testing and a requirement for self-isolation prior to elective hip and knee replacements, for instance.

In addition, we need to make sure that people know that the NHS is open for all who need it. I encourage anyone who has medical concerns to contact their GP or NHS 24, and certainly to attend hospital if their illness is immediate or life-threatening.

While restoring normal services, we must not lose the gains that we have seen recently with the roll-out of new technologies and techniques. We have seen the rapid adoption of digital consultations, for example through the attend anywhere and near me systems. Many patients have been able to access multidisciplinary clinicians from the safety of their homes, which has reduced the need for physical attendance for appointments. That is the future—or should I say, “That is the new normal”—for Scottish NHS services.

That approach has been particularly effective in rural areas such as Dumfries and Galloway. It has allowed people to access appointments without making the 150-mile round trip from Stranraer to Dumfries. I welcome that, and it shows how adaptable our NHS and patients are.

I would like to touch on those in the shielding category, including folks with lung health conditions. Since the beginning of March, nobody in that category has left their home or been able to physically see their loved ones. Although that has been incredibly hard, there is no doubt that it is saving lives.

We are seeing that those in the shielding category south of the border are now being advised that they can go out, despite the medical and scientific evidence suggesting that it is still too early for that step to be taken. I am grateful that the cabinet secretary has reassured those who are shielding that they are not forgotten and I thank her for her response to my topical question earlier.

I have a final comment regarding the future and preparation for the winter and the next wave of Covid. We need to ensure that access to PPE continues in a seamless, Scottish, self-sustainable way. I am aware of the good work that the cabinet secretary and the minister, Ivan McKee, have implemented in tackling PPE challenges. We are self-sustaining with regard to visors and hand sanitiser, and the on-going work to achieve self-sustainability with regard to gowns and aprons is good work that I welcome. I look forward to it continuing in preparation for winter.

Last week, several of my MSP colleagues and I attended a Zoom meeting with EveryDoctor, which is a doctor-led campaign organisation. EveryDoctor told a very different story about PPE in NHS England. The two speakers were London doctors, and they were pretty angry at the UK Government’s handling of the pandemic, especially its failure to supply adequate PPE. They said that the Scottish Government and our NHS in Scotland is doing a much better job. EveryDoctor was lobbying MSPs who attended the meeting to help it to force the UK Government to do better.

I welcome the debate and I thank all key workers across Scotland. I encourage people to stick to the lockdown requirements as we move into the future and our new normal for our Scottish health services.

We move to closing speeches. We are well over time, so I ask everyone to please keep to time or below it, if possible. I call Anas Sarwar, who has up to six minutes.

16:07  

Like so many members have done, I start by thanking all our NHS and social care staff for their commitment before and during the crisis. It is no exaggeration to say that thousands of our fellow citizens have risked their lives in order to try to save lives throughout it. To every single one of them, and to all our front-line workers, I say a genuine thank you.

It is right that we applaud them and it is right that we thank them, but what is more important is what we do after we applaud. That means properly resourcing them, properly paying them and properly supporting them well beyond the end of the crisis.

I welcome the tone that has been adopted by the health secretary, and the fact that we have had this time to debate the next steps for the NHS. It is important to recognise that all was not well in our NHS before the Covid-19 crisis. Too many of our NHS staff were telling us that they were undervalued, overworked and underpaid. Too many patients were having to wait too long for vital treatment or were having their hospital operations cancelled. Too many staff were working far too many shifts, with not enough support.

Far too many people were waiting in hospital as a result of delayed discharge. To give a graphic example of that, the delayed discharge rate was the equivalent of every bed in the Queen Elizabeth university hospital being occupied every day for a year. That is how many days we were losing to delayed discharge in our national health service.

As we move out of what we hope has been the peak of the Covid-19 crisis and into the next phase for our NHS, we should acknowledge the challenges that we had before it, and think about how we will address them.

Many members have said that the NHS is still open. That our NHS is open for other forms of care is a really important message to get across to the public. I will touch more on that in a moment.

We should acknowledge that we are seeing many innovations in the NHS because of Covid-19. Many things that we were previously told were not possible and could not be done quickly—for example, online consultations and sharing of medical information with pharmacies—have been done very quickly. We have been told in the past that all those things were blockages, but they now happen very quickly. I hope that beyond the crisis we can maintain some of those developments and the innovative thinking that there has been throughout the crisis.

On the next phase, we need to ensure that we support all front-line workers with adequate amounts of PPE.

There is also still an issue with testing. I do not like it when Governments—whether UK or Scottish Governments—hide behind capacity and do not talk about actual testing figures. I do not want us to talk about capacity; I want us to talk about tests. It is right that we shout down Boris Johnson and Matt Hancock when they talk about capacity, but we should apply the same to the Scottish Government. It is unacceptable that we have the lowest testing rate of any of the four nations of the UK. If we are, as would be right, to make test, trace and isolate the way in which we get out of the crisis, we need to test more. We need to test, test, test.

As part of the approach, we should be implementing a test guarantee for any individual who wants a coronavirus test. We have the capacity, so we should guarantee that they will have a test within 24 hours and then get their result within 24 hours—24 hours to get a test, then 24 hours to get the result. We can implement that guarantee across Scotland.

I, too, am worried about unintended consequences. I have previously raised the issue in the chamber, and Miles Briggs raised it in his speech. I fear that there might be the unintended consequence of people losing their lives because of the response to Covid-19 rather than because of Covid-19 itself.

One example is our cancer services. I am worried because there have been 2,000 fewer referrals for early diagnosis; because people have not been able to access vital cancer treatment through the crisis; because lots of treatment will have been delayed; and because we have a too-slow phased approach to reopening our cancer services. Cancer remains Scotland’s biggest killer. If we are to confront Scotland’s biggest killer, we must restart cancer services as soon as possible—without delay.

Other members have mentioned dental services, but we will also have a mental health challenge. We will have a mental health pandemic after the Covid-19 pandemic because of the stress and strain of the Covid-19 pandemic and its consequences. How we address the mental health pandemic that is coming will be very important.

I realise that I am short of time, but I want to briefly mention some other issues. The cabinet secretary rightly outlined an NHS improvement plan. What stage is that plan at now, considering that we will have a much bigger treatment backlog?

There was previously a promise to amend the patients charter in terms of giving patients accurate times for how long they will wait for treatment. What communication is there with patients now?

We are still too slow in getting people access to their loved ones in acute care who might be in the final period of their lives. It is not right that in three weeks we will probably be able to be 2m from a stranger in a Primark store but not 2m from a loved one in a hospital. I appreciate that the cabinet secretary has said that that can be done now, but it can be done only in their final moments. I would much prefer the situation to be that a person who is in the final period of their life—perhaps their final weeks or months—can have access to their family members not just in their final minutes or hours. That is an important difference that we need to make.

I know that there is a longer debate to be had about care homes, but I will stop there. I look forward to hearing the cabinet secretary’s response.

Brian Whittle has up to seven minutes.

16:13  

Without a doubt, once the Covid-19 crisis is over, we will study its impact for years to come. There will be ruminations about who did what and when, what should have happened, and why we did not see the crisis coming. To use sporting parlance, I say that everybody wants to pick the team after the final whistle.

Jamie Halcro Johnston talked about the care sector, which has for too long been the poor relation of the health service. We need greater integration of health and social care. We have heard about the IJBs needing to be made to work for all partners equally, but the Health and Sport Committee’s investigations have shown that that is not the case.

We need more services close to where people live, and we need to put a stop to towns and villages losing their GP surgeries.

We need greater emphasis on public health and on tackling preventable illness. Miles Briggs touched on healthcare issues, specifically cancer, surrounding lockdown. I was also at the EveryDoctor briefing, at which the organisation said that it fears that the reduction in cancer screening might result in up to 18,000 more cancer deaths coming down the road.

Anas Sarwar discussed the mental health crisis that is inevitably coming our way.

The Scottish Government has asked for support from across the chamber. That is what it got. We can all appreciate that throughout the pandemic the majority of MSPs have put political tribalism aside. Parliament’s value cannot be underestimated at a time like this; it has a vital role as a source of scrutiny both of legislation and of decision making by ministers. It acts as filter of poor decisions and provides an incentive for improvement.

The way in which the Scottish Government has sought to undermine Parliament’s ability to scrutinise its actions is a concern to me, as I know it is for many members from across the chamber. [Interruption.] Inevitably, that causes suspicion among parliamentarians and the media.

The lack of transparency around the Nike conference outbreak is one example. I spoke to the father of one of the delegates who ended up in hospital with Covid-19. No one from the Scottish Government has spoken to that person. Nike warned the delegates that they should get tests. If no delegates, hotel staff or any group with which they interacted were contacted by tracers, who exactly does the Government claim were contacted?

There is a catastrophe in our care homes, to which 1,000 untested hospital patients were transferred in March, despite the scientific advisory group for emergencies’ repeated warnings that people without symptoms might spread the virus.

The Scottish Government has consistently tried to deflect. We heard today that the testing protocol suggests that lessons are not being learned. Did the Scottish Government hope that we would not ask questions or that we would not find out? Transparency is crucial if the Government wants to take Parliament with it. Mistakes were always going to be made—we accept that—but Parliament cannot accept deflection and avoidance of proper scrutiny.

Mistakes have, no doubt, been made. The world was not set up for this crisis. We should be judged on the lessons that we learn from the crisis and the steps that we take to prevent the next one. Covid-19 has highlighted some serious flaws.

I have no truck with Mr Whittle’s politics. Indeed, I hope that his counterparts at Westminster are asking the same questions, but he is absolutely right that when we talk about scrutiny, we are doing our job in Parliament. We have every right to find out what is going on. The more the Government party’s back benchers moan about it, the more I, for one, will be asking the difficult questions.

The outcome that we should all be focusing on is long-term and sustainable high-quality healthcare that is free at the point of need. To achieve that, we need a world-class environment for our world-class healthcare professionals to work within, and we need to make sure that they are properly remunerated and properly resourced.

In the next part of my speech, I will focus on an essential first step. I could speak about technology in education, given the need for online learning, and the recognition that in it there is a far from level playing field. Similarly, I could highlight the need for better use of technology in the justice and welfare systems, both of which have been under pressure throughout the Covid-19 pandemic.

For those portfolios and more, the Scottish Government has been content with a make-do approach. Decisions on investments have been based on whether it can get by with what it has. Let us face the fact that the Government does not have a great track record when it comes to developing technology platforms and software, so I understand the reluctance to adapt.

Covid-19 has highlighted that access to quality data is a huge problem. The Scottish Government’s inability to measure accurately the R number—the measurement of replication of the virus—results in no small part from failure to gather good-quality data.

Would Brian Whittle care to cite the evidence for his assertion that the chief medical officer’s advisory group and our analytical teams are unable to estimate the R number? They publish their evidence and show it to the public. Where is his?

It is quite simple. The R number has not changed for the past five weeks, which tells me that nothing has changed in the past five weeks. The reality is this—

It has changed!

It has not changed. The R number has been 0.7 to 0.9 for about five weeks. That is about data gathering. The cabinet secretary has to gather better data. The R number is major contributor in respect of how the virus is being tackled, but she is unable to tell us with any certainty what the number is or how accurate it is.

Everybody has a unique community health index number—a CHI number—that identifies them within the healthcare system. The Government should have been able to identify quickly and contact the most vulnerable people by looking at the data and automatically generating a letter, email or text. Instead, it took weeks to do so, and even then there were too many mistakes.

How we record an individual, what we record about them and how that data is accessed and used and, crucially, who owns that data are key. Health boards around the country use different systems that cannot speak to each other. That means that if data is recorded in Glasgow, it must be recorded again in Edinburgh if a patient needs the same treatment there. The same is often true for patients who move between primary and secondary care: their medication advice or rehabilitation protocols are not available at the push of a button to GPs, pharmacists or physiotherapists.

The speaking time I have left is short, so I will finish by saying that, to date, there has been a “That’ll do” philosophy. Our inability to utilise big data properly is not new, but the current crisis has brutally highlighted that failing. As we move forward to ensure the long-term sustainability of our NHS, and to support and enhance the working environment of our NHS staff, the adoption of technology is the first crucial step, and technology must be front and centre. Perhaps the question that we should ask is whether it should have taken a global pandemic for us to start to consider the challenges.

I call Jeane Freeman to respond to the debate, for up to 9 minutes.

16:21  

I thank all members for their contributions. I have made a careful note of them all, but I will not be able to mention many in this response.

Before I go on, let me say that I absolutely welcome scrutiny and that that is absolutely the job of Parliament. The fact that members might not like the answers that we give, or might not understand them, does not mean that we are not open to scrutiny. I am very pleased to offer Mr Whittle the opportunity to sit down with our chief analyst and have the R number explained to him again, so that Mr Whittle will not again impugn his professionalism.

I want to say an important thing in starting my summing up. Some of the tone of the debate has worried me a wee bit; it is a tone that implies that Covid-19 has gone away, that we are past the peak and the difficulty. Yes, the incidence of cases is reduced, but our headroom is limited. The NHS still needs to be ready to cope with the challenge of Covid-19.

That is why the plans that we have requested from boards for the initial 100 days require them to hold capacity for Covid-19. As we look at how to remobilise and restart our NHS, we need to keep a close eye on a number of factors, such as what happens to the incidence number; what happens to the R number; what the impact will be of the changes in transport that my colleague Mr Matheson will introduce; what the continued demand will be on our health service for the support that it offers the care sector, and for test and protect; and, overall, what will be needed to ensure that patients feel safe in returning.

All of those are demands on our NHS staff. I quote the briefing that I believe all members have received from Unison:

“Staff are tired, both emotionally and physically. We must not overwhelm them.”

That is the “recover” point. We must recognise that we cannot, on Friday, ask staff to do everything that they have done and then, on Monday, ask them to keep up the pace as they continue to do what they are doing as well as do all those extra things.

Ms Lennon is absolutely correct when she says that there will need to be months of careful planning. Those plans might also change as we go. I share the worry of members across the Parliament—I have done from the outset—about the health impacts of our having to stop NHS services in some areas. I also understand and know all too well the health impacts that Cancer Research UK and others have highlighted to us—and that we have highlighted—which are caused by the significant reductions in attendance at accident and emergency units and in the number of urgent referrals from our primary care colleagues.

The first set of plans cover only the period until the end of July. To get it right, we need to take our time and continue to keep a close eye on what is happening to the virus, and to engage with those important voices. The immediate priority will be to reinstate cancer care—including safely restarting screening, about which much has been said already—along with elective care, where it can be restarted, and cardiovascular work. Primary, dental, pharmacy and optometry care will also begin to pull their plans together and reintroduce services. That includes reintroducing mental health services for the general population and for young people, building on the extensive work that has been undertaken on the emotional wellbeing of health and social care staff, including coaching and trauma counselling. It all matters and it is all important.

As Mr Briggs said, it is also important that we have safe spaces for the treatment of patients and give consideration to the use of additional testing in healthcare settings. All of that is critical as we look at the social care requirements that have been argued for and the consideration that needs to be given to those. That is an immediate but also a long-term prospect for us.

In the coming weeks, we will set out details of the services that we will restart and in what way we will do that. The extent or the pace of some of that work will be influenced by local circumstances and by the need to allow our healthcare workforce to recover. Health ministers and I will ensure that Parliament is informed and has opportunities, in the future, to debate and engage in shaping how the health service emerges as the pandemic progresses.

It is really important that every single one of us understands that Covid-19 has not gone away. Yes, we have suppressed it—the population of Scotland has achieved that by all that it has done and all the sacrifices it has made—but the headroom is small. We need to continue to push hard the public message about staying at home and remembering the 2m distance, which will influence the way in which some of our health services will restart and how slowly they will do so. That public health message is critical not just to the health of the people of Scotland but to our opportunity to use whatever chance we have to begin to restart our NHS.

That concludes the debate on Covid-19 and next steps for the NHS. As we move to the next item of business, I remind members who are leaving the chamber to observe social distancing measures.