Meeting of the Parliament

Meeting date: Tuesday, January 10, 2017

Official Report 865KB pdf

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Topical Question Time

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Hospital Deaths

Presiding Officer, I will start the year by being the biggest sook in the chamber and wishing you and everyone else here a happy new year.

To ask the Scottish Government what its response is to reports of an increase in the number of people dying in hospital while waiting to be discharged because their care package had yet to be finalised. (S5T-00307)

I thank all health and social care staff across Scotland for their hard work and their dedication to the care of our old and vulnerable people over the winter period.

I am, of course, saddened to hear of any patient dying while waiting to return home. No one should have to wait unnecessarily in hospital once they are fit for discharge. That is particularly important for people nearing the end of their life, as we know that most people would prefer to die at home, or in a homely setting. That is why we have committed in our “Health and Social Care Delivery Plan” to double the amount of palliative end-of-life provision in the community by 2021. That will help to ensure that those who are nearing end of life get the care that they need in the right place at the right time.

I am also committed to eradicating delays, which is why we recently announced an additional £107 million to support sustainability in the care sector. That brings the national health service contribution to enhancing social care to around £500 million a year. My officials have been in regular contact with the partnerships that are facing the most significant challenges and I am assured that they have seen a great deal of progress in the lead up to and over the festive period, ensuring that people got home and freeing up much-needed beds over winter.

I join the cabinet secretary in paying tribute to all our amazing NHS staff who go above and beyond to care for others.

Freedom of information requests from Scottish Labour have revealed that, since the cabinet secretary made the commitment to eradicate delayed discharges, at least 683 patients in Scotland have died in hospital as a delayed discharge. Actually, the figures are expected to be much higher, as some health boards were unable to reveal total figures. Official figures also show that the NHS loses around 45,000 bed days a month due to delayed discharge. The cabinet secretary has repeated today the promise to eradicate delayed discharges, but the reality is that that is yet another failure on her watch.

A delayed discharge is identified as a hospital in-patient who has been judged to be clinically ready to leave hospital and continues to occupy a bed beyond the ready-for-discharge date. Those patients may be ready to return home or to be transferred to a care home.

Given the clear pressures on social care, why does the cabinet secretary support a further cut of £327 million to local councils this year? That figure has been confirmed by the Scottish Parliament information centre. Why will she not commit instead to use the Parliament’s powers to stop the cuts?

Audit Scotland has highlighted the progress that has been made, with a 9 per cent year-on-year reduction in bed days associated with delays in 2015-16. Progress has been made but, as I have said before in the chamber, I am the first to say that more progress has to be made. That is why it is important that all partnerships make the tackling of delayed discharge a key priority and why a further £107 million is allocated to be transferred from the NHS to integration authorities in the draft budget for 2017-18. That is in addition to the £250 million transfer in 2016-17, which is now baselined. When the £100 million integrated care fund and the £30 million delayed discharge funding that the NHS is contributing are added to that, there is around £500 million a year to support social care. It is quite right to have those resources in an integrated system to help to tackle delays, and the approach is, of course, in direct contrast to the one that is taken elsewhere, where there have been cuts to social care budgets and fewer people are getting the help that they need.

If all partnerships in Scotland were performing at the rate of the top 25 per cent in tackling delays—many of those have got the number of delays over three days into single figures—we would be able to halve the number of delays straight away. The challenge is to work with partnerships, which my officials are doing, to ensure that all of them are doing the things that we know work to help to eradicate delays in the system.

The cabinet secretary says that she understands the seriousness of the figures and, indeed, the seriousness of delayed discharges, but the reality is that Audit Scotland has given a damning indictment of the state of the NHS under her watch. Although the rhetoric today is rich, it does not match the reality for many individuals who are struggling as a result of social care cuts in councils throughout the country.

An individual and their family who have been let down and failed are behind each statistic. Almost 700 patients have gone on to die in hospital as delayed discharges since the cabinet secretary promised to eradicate delayed discharges. They are people’s relatives and friends. People were told that they were clinically able to go home and were ready for discharge. They believed that they were going home, perhaps to spend their final weeks and months at home with their own family. Instead, they were trapped in hospital waiting for a care package, perhaps for weeks or months on end. They never went home at all; instead, they went on to lose their lives in hospital. Will the cabinet secretary apologise to all families that have been let down by a delayed discharge and make a commitment that she will fight to reverse the cuts to social care packages and budgets throughout the country?

Of course I recognise that behind each statistic is a person, which is why I said in my initial answer that I am saddened to hear of any patient dying while waiting to return home. No one should have to wait unnecessarily in hospital once they are fit for discharge, which is why we are putting half a billion pounds into tackling this issue. It is one of the highest priorities for this Government and for me as Cabinet Secretary for Health and Sport.

As I said, progress is being made. Ten of the 32 partnerships now have delayed discharges—that is, delays over three days—in single figures. What we need to see is the other 22 partnerships following suit. We know what works, and that is why, with the resources that have been given, we expect all partnerships to put in place the services that not only ensure that people can get out of hospital and home in a timely fashion but prevent people from going into hospital in the first place. Action is being taken and some progress is being made. The speed of that progress needs to increase, which is why we are putting in the resources that we are.

The cabinet secretary will also be aware that the most recently published figures show that delayed discharges cost the NHS £114 million in 2015-16, which approximates to a daily cost of £214. That is an utterly unacceptable loss of vital funding for our NHS. What will the cabinet secretary do to ensure that that loss to NHS funding is not repeated this year and beyond?

It is of course vital that all the resources in the NHS and indeed in our health and care partnerships are used to the best effect, which is why the resources that we have put in to tackle delayed discharge are also focused on ensuring that the bed capacity in our acute sector and indeed our community hospitals is used for those patients who require to be in those beds and not for patients who are ready for discharge. As I said in my previous answer, progress is being made and the £500 million that we have put in is beginning to make a difference, but we need to see more progress. I say to the member that that is in direct contrast to the situation in England, where for six consecutive years we have seen cuts to local authority budgets. Only this week, the Labour Party in England raised the same issue about Jeremy Hunt’s stewardship of the national health service there, where 26 per cent fewer people get the help that they need.

I reflect on the Red Cross’s description of the NHS as facing a “humanitarian crisis”. We may have our issues and our challenges here in Scotland, but the Red Cross in Scotland is not describing NHS Scotland in those terms. Our health and care staff do a tremendous job. The resources are in place and we know what works. I would have hoped that the Opposition would get behind them in their work over the festive period and beyond, rather than criticising, as it does from the sidelines.

The cabinet secretary is aware that physiotherapy is often part of care packages, particularly for the elderly. She will be aware that, in NHS Ayrshire and Arran, waiting times for physiotherapy are now extending from 42 to 48 weeks, following the alleged laying off of staff. A 48-week waiting time for physiotherapy is little short of scandalous. It is almost a year. What can the cabinet secretary do to reduce the waiting times for physiotherapy for everyone in Ayrshire?

John Scott makes an important point. In making sure that people can not only get home in a timely fashion but, in many cases, avoid hospital admission in the first place, the role of our allied health professionals, including physiotherapists, is vital. When I met physiotherapists recently, I heard at first hand about the important work that they are doing to keep people out of hospital and get them home in a timely fashion.

In taking forward the plans through the health and care partnerships, I am clear that the role of our physiotherapists is very important. As part of the work on our national workforce plan, which will play an important role in ensuring that we have the right professionals in the right place, we will consult professional bodies, including those that represent physiotherapists. I think that the workforce will need more physiotherapists, to do the very things that John Scott talked about. I will be happy to keep the member informed about the work that we take forward through the national workforce plan, particularly in relation to the growth of the physiotherapy workforce.

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“Equipping Scotland for the Future” (Response)

To ask the Scottish Government what its response is to the Institute for Public Policy Research Scotland report, “Equipping Scotland for the Future”. (S5T-00304)

The report highlights many of the challenges that are identified in our economic and labour market strategies, which were, in part, drivers of our decision to undertake the enterprise and skills agencies review that is going on in partnership with stakeholders and the relevant agencies.

A skilled workforce will be a key component of a more successful and inclusive economy in the years ahead. That is why our labour market strategy sets out how we will put fairness at the heart of our drive to boost the economy, create jobs and remove barriers to work. Our recently published “Developing the Young Workforce: Scotland’s Youth Employment Strategy—2nd Annual Report 2015/2016” sets out the improvements that are being made in tandem with employers across the education system. We continue to invest in our successful modern apprenticeship programme and we are on target to achieve 26,000 new starts in 2016-17, as part of our target of 30,000 new starts by the last year of the parliamentary session.

In our draft budget for 2017-18, we announced the establishment of a new £10 million workforce development fund to support the skills development of people who are already in work.

The minister will be aware that the IPPR report says that the youth employment rate in Scotland has been consistently higher than that in the United Kingdom and that youth unemployment in Scotland is at its lowest level since 2001. What factors does he think have contributed to that? How will the trend be sustained or improved on?

The Administration has made a concerted effort to focus on youth unemployment, which was a particular concern during the economic downturn. During that period, we were the first Government in the UK to establish a Minister for Youth Employment, which underlined our focus on the matter.

A range of initiatives that support improvements are in place, such as community jobs Scotland, which is delivered in tandem with the Scottish Council for Voluntary Organisations, and Scotland’s employer recruitment incentive. We increased the number of modern apprenticeships that are available. We will continue to develop such initiatives and to take forward the developing the young workforce agenda, which will help us to make progress towards reducing youth unemployment by 40 per cent from 2014 levels by 2021.

The Scottish Government is committed to growing our economy, with a focus on more jobs and fair work. I share that commitment. Will the minister say how he is making work fair in Scotland?

That is another important agenda for the Government. We support the work of the fair work convention. Fair work is woven through our labour market strategy, in which we say that we will provide funding for the convention to enable it to roll out its fair work framework.

The business pledge contains a number of fair work commitments, and 299 employers have signed up to it. There is also support for the living wage. The Administration pays at least the living wage to all our employees and we fund the Poverty Alliance to run the accreditation scheme, under which more than 700 employers are accredited living wage employers. That helps to explain why some 80 per cent of the workforce is paid at least the living wage, which is the highest rate in the four UK nations.

We have an equalities action plan, to increase numbers in the modern apprenticeship programme from groups that are underrepresented. There are other initiatives, such as the women returners scheme, which we funded Equate Scotland to take forward in the past year. We will continue to do all that we can to ensure that we have a fair work culture in Scotland.

As the minister will be aware, according to figures that were released just yesterday, Scotland’s unemployment rate is 5.3 per cent, which is above the rate of 4.8 per cent for the whole UK. Does he really think that such underperformance, after 10 years of the Scottish National Party Government, is acceptable for the Scottish economy?

Clearly, we want to see continued improvement. Mr Lockhart failed to note that the unemployment rate decreased in the past year. That is welcome, and we will continue to do all that we can to bring the rate down further.

A key point in the IPPR report is about technological change and automation, and some reports suggest that the jobs of as much as 30 to 40 per cent of the workforce could be made obsolete through automation. What is the Government’s estimate of the potential impact on Scotland and the timeframe for that impact? With particular regard to the skills regime, what is the Government’s strategy for dealing with the situation to ensure that people whose jobs become obsolete can find new work by reskilling?

I caution against talking about obsolescence at this stage, but I recognise the point that Mr Johnson makes. I refer back to the labour market strategy, in which we specifically recognise the potential impact of increased automation. Over the summer, I went out and saw many employers for which investment in technology has—contrary to expectations—led to an increase in employment. However, I recognise that there is the potential for the situation to go the other way. That is why we have set out the concern in our labour market strategy and why we will continue to focus on it.