Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, September 7, 2021

Official Report 932KB pdf

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Topical Question Time

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

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General Practitioner Appointments

To ask the Scottish Government whether it will provide an update on the use of face-to-face general practitioner appointments. (S6T-00139)

I take the opportunity to thank our hard-working GPs for all that they did before the pandemic and, crucially, for the good work that they have done during the pandemic.

Public Health Scotland is publishing guidance on distancing and infection control measures in health settings that will change the 2m rule to a 1m rule. That means that there will potentially be more space for patients in waiting rooms, where that is appropriate, while we continue to ensure that everyone is kept safe. In the light of that, joint national health service and Scottish Government guidance for general practices will be published later today. That is an important step in getting more in-person appointments in primary care.

Today’s guidance also makes it clear that there is no longer a need to triage every patient, although GPs and clinicians should continue to screen patients for Covid before seeing them face to face. The guidance contains resources to help practices to improve their communication with patients, as well as advice on access arrangements.

We face a postcode lottery in patients’ experience when they try to access their GP. Although patients are permitted to have face-to-face appointments with practice nurses and other health professionals, GP appointments have been limited to phone calls, which, in some cases, have no specific time for a call back. With the reports at the weekend of the new contract signed by NHS Scotland to expand such consultations, many patients are worried about access. We know that early diagnosis is crucial for many conditions, yet many patients are not able to access their GP. Does the cabinet secretary believe that Scottish patients have the right to see their GP face to face, and does today’s guidance give a date for when they can expect that?

Yes, I agree, where that is clinically appropriate. I am somewhat disappointed that Ms Webber did not take the opportunity, as I did, to thank our GPs for the hard work that they have done over the pandemic, because the situation is not due to a lack of hard work. Our GPs are working incredibly hard, as they have done over the past 18 months, but it is because of the appropriate and clinically advisable infection prevention and control measures that are in place that digital solutions such as the NHS Near Me video consultation platform have been used.

I agree with Ms Webber that patient choice is absolutely critical, and I suspect and hope that the guidance that is being published today will lead to an increase in the number of face-to-face appointments. The NHS Near Me video consultation digital platform has been well used—in excess of 1 million appointments have been held using NHS Near Me since the beginning of the pandemic. Nevertheless, I recognise—our recovery plan lays this out in black and white—that face-to-face appointments can help us with some of the acute pressures that we face in our hospitals. I would like to see more face-to-face appointments, as, I suspect, would everybody else in the chamber, and I hope that the guidance that we publish will help in that respect.

It gives no date, then. As I mentioned, accessing healthcare is a problem for many patients right now. With many unable to access their normal healthcare routes, such as going to their GPs, they are simply turning to our accident and emergency services. For the past four weeks in a row, we have seen the number of patients not being seen within four hours at A and E departments hit shocking new highs, and Scotland’s largest health board, NHS Greater Glasgow and Clyde, is now telling people not to turn up unless the situation is life threatening. What has been done to tackle those waiting times now, and, as we move into the critical winter period, what planning is under way to ensure that we do not see a future A and E winter crisis?

I say again that it is clear that we are under pressure. Every health service—across the world, I suspect, but certainly across the United Kingdom—is under pressure. Ms Webber is absolutely right in saying that A and E waiting time targets are not being met. That is, of course, deeply regrettable, but I cannot magic away the effects of the pandemic. Those effects are being felt right across the UK. This is no consolation to anybody who has had to wait for more than four hours, but our A and E service continues to perform better than any other A and E service across the entire UK.

We are taking immediate action, and £12 million has gone to health boards to help with the immediate pressures. I hope to see some response to the crisis that we are currently facing.

In terms of the autumn and winter pressure, I can give an absolute assurance to Ms Webber and any member in the chamber who wishes to have more detail about our autumn and winter planning, which started months ago, that we are very concerned about the winter because we suspect that we will see challenges around flu. We are already seeing challenges around RSV—respiratory syncytial virus—and the autumn and winter generally see more trips, slips and falls as well.

We are concerned, but we are already investing to make sure that our workforce continues to be not just at record high levels but the best paid in the entire UK.

I take the opportunity to thank our GPs and acknowledge the importance placed on high-quality care in general practice when GPs have time to nurture and maintain relationships of trust with patients.

According to a recent British Medical Association survey, one third of GPs are considering taking early retirement. In relation to the Government’s remobilisation plan, Dr Lewis Morrison, the chair of BMA Scotland, has said that the plan contains “worrying gaps”, including the “crucial omission” of any plan to retain current NHS staff.

The plan states that there will be 800 new GPs by 2026 or 2028, depending on which paragraph you read. Will the cabinet secretary clarify that target and outline what action will be taken during the current crisis to retain GPs and ensure that there is sufficient capacity for people to see their doctor?

Mr O’Kane raises some very important points, many of which I agree with. Retention is clearly going to be a key strategy as part of our NHS recovery plan.

The GP workforce is at the record level of 5,134 GPs, and we remain on track to meet our target of 800 additional GPs by 2027.

The cabinet secretary creates the impression that all these problems are new, but the problems in primary care were deep seated well before the pandemic started. A bit of recognition of the long-term problems would not go amiss.

I am concerned about continued physical distancing of 1m. It is welcome that it has moved from 2m to 1m, but even that distancing restricts the option of GPs seeing some patients in person even though that might be the best thing for them.

Will the cabinet secretary look again at the physical distancing rules in primary care and justify his thinking that it is appropriate to continue with them? It is not all about Covid any more; there are other issues. I am as cautious about Covid as any minister in the Government is, but I am deeply worried about the long-term and deep-seated problems that continue to exist in the NHS.

Many of the actions that we have taken were taken pre-pandemic, such as the increase in the level of GPs. There is now a record staffing level that we have invested in and funded. Equally, I say to the member—I know that he knows this, but it is worth reiterating—that the pandemic has been the biggest shock our NHS has ever suffered. It is going to take investment but also time. That is why our NHS recovery plan is ambitious but also realistic in its timeframes.

In terms of his ask, I will look again at physical distancing rules. However, I say to Willie Rennie—I know that he understands this—that we take advice from public health experts and clinicians. We challenge them robustly but, ultimately, it is important that we take that clinical advice. It is important that we take soundings from patients but it is also important that we listen to stakeholders such as the BMA and the Royal College of General Practitioners. Willie Rennie has asked me to look at the matter again, and I promise him that I will do that.

Clearly, restoring more face-to-face GP consultations as quickly and safely as possible is absolutely vital, but many people have welcomed the opportunity to use e-health and telehealth solutions such as NHS Near Me to contact their GP. Can the health secretary confirm that those new avenues will be maintained after the pandemic for those who choose to use them?

Yes, absolutely. Gillian Martin makes an important point. A number of surveys have shown that a significant majority of people prefer to have telephone appointments or video consultations. As I mentioned to the Health, Social Care and Sport Committee this morning, a couple of weeks ago I was able to phone my GP to get the ointment that I needed for an eczema flare-up. It was done without having to disrupt my work, as I was able to have the appointment between other calls, and that made life easier for me.

However, that is not the case for everybody. Clearly, many people in particular demographics would like face-to-face appointments. A hybrid mix of options—video consultations through NHS Near Me, telephone consultations and face-to-face appointments—is something that I am keen to maintain.

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ScotRail (Industrial Disputes)

To ask the Scottish Government what its response is to the on-going industrial disputes with ScotRail. (S6T-00127)

First, I want to reiterate the Government’s recognition of and appreciation for the contribution that all our rail workers made during the pandemic to keep rail services operating.

Only one dispute currently impacts ScotRail services, and that is on Sundays. As part of agreed working conditions, all rail staff who work on a Sunday receive an enhanced payment. The dispute concerns enhanced payments for working rest days. That arrangement, which was made between the National Union of Rail, Maritime and Transport Workers and ScotRail, provided an additional, time-limited enhancement for ticket examiners and conductors, largely in acknowledgment of the extra work that existing staff were undertaking while ScotRail recruited and trained additional staff to minimise the requirement to work on rest days. Now that there are 140 additional ticket examiners and conductors, the issue of excessive rest day working has been resolved. I understand why the unions and workers might want to make that additional allowance permanent, but it simply is not sustainable in the long term.

I know that one group of RMT members has now voted in favour of extending the current industrial action, but I encourage settlement of the dispute. Any cancellations as a result of industrial action have the potential to not only undermine the recovery of our rail services but impact on vital revenue streams from ticket sales.

Industrial relations on Scotland’s railways are at an all-time low. That is a damning indictment of Abellio’s treatment of the key workers who have kept Scotland moving and a damning indictment of this Government, which is leading Scotland into the 26th United Nations climate change conference of the parties—COP26—with growing unrest on the railways and the prospect of strikes bringing Glasgow to a halt. That is a national humiliation and a failure of leadership from the Government.

The minister must get a grip and do so now. Why has he not intervened to ensure a satisfactory resolution to six months of RMT action and overtime bans? Will he intervene to ensure that ScotRail’s dispute with engineers, who last week voted overwhelmingly for strike action, is resolved? Will the minister explain why industrial relations have nosedived in the final months of the Abellio contract and on his watch?

Negotiation is a matter for the transport operator and the trade unions. However, I have had discussions with Abellio and the trade unions and have encouraged every constructive effort to resolve the situation.

We cannot continue the level of funding that is now going into rail. Prior to the pandemic, Scotland was spending about £1.1 billion per year on its railway. That figure covered all aspects, including investment. Because of the money that we have had to put in due to the pandemic, that figure has risen to around £1.5 billion per year. That is simply not sustainable.

We have encouraged unions and management to come together constructively and to identify efficiencies on both sides that could be used to fund reasonable pay increases. I reiterate that point today.

Negotiation is a matter for the operator and the trade unions, but it is also a matter for the transport minister and the Scottish Government. Government and taxpayers are paying ScotRail for a seven-day-a-week service but getting six days at the moment, because ScotRail does not have the workforce to cope with an overtime ban. Workers’ terms and conditions are under attack, jobs and services are being cut, ScotRail will not rule out compulsory redundancies, key workers are not getting the fair deal that they deserve and nor are passengers, who cannot even get replacement bus services on a Sunday.

Abellio is making a mockery of the Government’s commitment to fair work, as are five Scottish National Party MSPs who have done nothing to resolve the dispute and who have shamefully blamed the disruption on Scottish workers exercising their rights, rather than on ScotRail’s intransigence.

Whose side is the Government on? Is it with the workers who are defending their jobs and conditions and defending services for passengers, or is it on the side of unreasonable bosses who, in the era of COP26, are wrecking our railways?

The Government is on the side of delivering a sustainable rail service for the future and protecting employees’ jobs, but it is time for everyone to act responsibly. It is time to recognise the challenges that we face on the railway and to find a way to build back from the pandemic in a manner that delivers a more sustainable and efficient service that is ready to meet future demand.

“Everyone” includes Labour. No politician can expect to be regarded as credible if they argue—as Labour members appear to have been doing in the past week—that we should continue subsidising a pre-pandemic pattern of rail service, regardless of affordability and usage, at a time when the public finances face extremely significant challenges, and that we meet the cost of pay claims without seeking to achieve that by delivering efficiencies.

We all aspire to having an efficient and sustainable rail service and we all have a responsibility to help the delivery of that service.

We have seen cuts to services, a dispute that has now passed 130 days, 90 per cent of Sunday services cancelled, engineers now threatening strike action and the looming threat of all that continuing while world leaders visit rat-infested, SNP-run Glasgow in November. All of that is happening on the transport minister’s watch. When will he take control and get it sorted?

That is a typically pejorative contribution from Mr Simpson. I agree that it is unacceptable to have no Sunday service for passengers. Behind all the rhetoric and behind the scenes, there are moves to try to resolve some of those disputes.

A meeting is taking place today with a trade union and Abellio, and I know that another is planned for later in the week. Every effort is being made within the constraints that I have highlighted to bring the matter to a conclusion.

It appears that we are now in a perfect storm, with COP26 and disputes and timetable changes that are rocking the confidence of workers and the travelling public, but next year ScotRail will pass into public sector ownership. What best practice from the public sector—in terms of industrial relations, fair work, patient negotiation and consultation—can be brought to the new franchise?

Mark Ruskell makes a very fair and reasonable point, and that is where we aspire to get to. [Interruption.] I hear groans from members on the Conservative benches, but his contribution is the most constructive one that we have heard this afternoon.

The model that we want to deliver is one that protects workers’ jobs, delivers fair wages and has negotiating protocols in place that allow the unions—rightly—to seek a reasonable pay increase for their members. All of that can be achieved with a reasonable and proportionate approach from all sides, and that is what we look to deliver.