Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, September 8, 2021

Official Report 976KB pdf

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Portfolio Question Time

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Health and Social Care

Good afternoon. I remind members that social distancing measures are in place in the chamber and across the Holyrood campus. I ask members to take care to observe the measures, including when entering and exiting the chamber. Please use the aisles and walkways only to access your seat and when moving about the chamber.

The first item of business is portfolio question time, and today’s portfolio is health and social care. I ask members who wish to ask a supplementary question to press their request-to-speak button or, if they are joining us remotely, to put an R in the chat function during the relevant question.

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NHS Highland (Staff Bullying)

To ask the Scottish Government whether it will provide an update on NHS Highland’s independent review into allegations of staff bullying in Argyll and Bute. (S6O-00099)

Many improvement actions have already been delivered in response to the independent review of culture in Argyll and Bute, which was recommended by John Sturrock QC in his review into cultural issues in NHS Highland. NHS Highland has reported that there has been significant discussion by the board and within the health and social care partnership to explore how they might work together to support staff from across health and social care who have experienced bullying.

The leadership team has held a number of staff engagement events to tell staff about the actions that have been taken and to listen to staff feedback. The actions include establishing an independent helpline for staff to discuss concerns; setting up an independent review of disciplinary, grievance, bullying and harassment procedures; rolling out the courageous conversations programme more widely; and setting up a monthly assurance panel to review hiring decisions and to build trust.

The Scottish Government continues to support NHS Highland as it takes actions in response to this report, the report by John Sturrock QC and its recent independent listening and hearing survey.

I am very grateful for the cabinet secretary’s update. He might be aware that, in the previous parliamentary session, there were calls to hold a debate on the findings of the Sturrock report. The First Minister said that she was broadly sympathetic to those calls. Will the cabinet secretary commit to holding a debate in Government time on that important issue, so that victims of bullying across the national health service, wherever they are in Scotland, feel that they are being listened to and not abandoned?

First and foremost, I thank Donald Cameron for raising the issue. Emma Roddick and Edward Mountain have also raised such issues, which are incredibly important, and the Government takes them seriously. I suspect that, despite all our political differences, we are united in believing that a zero-tolerance approach should be taken to bullying or harassment anywhere in the workplace, let alone in our NHS and social care.

A debate has not been ruled out, but Donald Cameron knows that we are in the midst of a global pandemic. He will have heard about the priorities in the programme for government yesterday. Those will be our immediate focus for parliamentary debates, but I do not rule out such a debate taking place in the future.

I note that the Conservative Party will hold an Opposition debate next week, so it can bring forward such a debate if it chooses to do so. If it does, I will respond on behalf of the Government.

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Mental Health

To ask the Scottish Government what importance it places on recognising and addressing the societal issues that contribute to poor mental health. (S6O-00100)

Poverty is the single biggest driver of poor mental health, which is why we continue to urge the United Kingdom Government to reverse its decision to cut the uplift to universal credit.

We know that the pandemic has exacerbated pre-existing structural inequality in our society and that the adverse impacts on mental health are felt disproportionately by disadvantaged groups. In our mental health transition and recovery plan, we have committed to making the mental health of those groups a priority.

We also know that other social determinants, including employment and debt, can impact on mental health and wellbeing. We are working with employers, trade unions and other organisations, including the Money and Pensions Service and Citizens Advice Scotland, to better understand and tackle those issues.

The Medical and Dental Defence Union of Scotland recently carried out a survey that showed that 47 per cent of its Scottish general practitioner members and 58 per cent of its dentist members reported higher levels of stress because of the pandemic. What measures have been put in place to support the mental health of all national health service staff?

Our health recovery plan, which we published on 25 August, outlines that the recovery of staff is intrinsic to our collective ambitions for renewing our NHS. The Government is providing £8 million this financial year to support the mental health and wellbeing of the health and social care workforce, which includes £2 million for targeted support for the primary care and social care workforces.

A range of national resources is available to support the mental health and wellbeing of those who work in health and social care. Those resources include the National Wellbeing Hub, which provides self-care and digital resources; the national wellbeing helpline, which provides a 24/7 service to those who require psychological support and can offer advice, signposting and onward referral to local services when required; coaching for wellbeing, which is a free-to-access digital coaching service; and the workforce specialist service. Additional capacity has also been put in place within boards to provide psychological therapies and interventions to support staff’s mental health.

There are a number of supplementary questions and I want to take all of them, so I will need brief questions and answers.

Yesterday, the Cabinet Secretary for Health and Social Care conceded that waiting times for child and adolescent mental health services are “unacceptable” and admitted that the targets were badly missed before the pandemic.

Make it a quick question, please, Mr Hoy.

We found out this week that CAMHS referral rates are now the highest on record, with one in every 100 children being referred for specialist care. Will the minister now outline what he intends to do to honour the Government’s commitment to increase the CAMHS workforce by 320 new staff?

Since the Government came to power, the CAMHS workforce has risen by some 80 per cent. We will continue to do our level best to reduce waiting times and to do what is required to improve services for those in need. It would be helpful, in all that matter, not to have the continued austerity agenda, so that we can employ more staff. I ask Mr Hoy and his Conservative colleagues to try to persuade the United Kingdom Government to reverse its austerity policies so that we can invest even more in our public services in Scotland.

The reality is that societal issues such as poverty have a major impact on children and adolescents. The waiting times for CAMHS in Fife are at an unacceptable level and are rising. Will the minister agree to meet me for a discussion of those issues and see what the Scottish Government can do to support NHS Fife to get those waiting times down?

As always, I am more than happy to meet Mr Rowley to discuss that issue or any other constructively. I recognise that there are difficulties in Fife. As members will know, I have spoken to a number of health boards about the actions that they need to take to improve services. We have given £29 million of additional support to bring CAMHS waiting lists down.

The minister listed many contributors to poor mental health, but I did not hear him mention the fact that we have enormously long lists or the contribution that that fact makes to the worsening of mental health in this country. It is no surprise that mental health does not improve if people have to wait up to two years to get treatment. Will the minister do something about that situation at last?

We have laid out what we will do in our action plans. The Government is determined to ensure that the additional resources that we have put in play are used effectively to do the best for the people of this country, particularly the young folk who are waiting for treatment.

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Cataract Surgery (Waiting Time)

To ask the Scottish Government what the average waiting time is for cataract surgery. (S6O-00101)

Public Health Scotland published the most recent stage of treatment data on 31 August. It shows that the median wait during the quarter ending 30 June 2021 for ophthalmology treatment was 52 days. Over half—54 per cent—of those who were waiting for ophthalmology treatment had been waiting for nine weeks or less. The Scottish Government does not hold sub-specialty information, which would cover cataract procedures.

We recognise that a backlog of care has emerged during the pandemic as a result of services being paused. However, cataract procedures have continued during this challenging time. To support that, the Scottish Government has made £1.75 million available to NHS Golden Jubilee to support additional cataract procedures this financial year.

Obviously, this all has the pandemic as a backdrop. I have been contacted by a constituent who has been advised by NHS Lanarkshire that she will have to wait for at least 70 weeks for cataract surgery unless she pays for private healthcare. My constituent’s eyesight is deteriorating rapidly and she is terrified that she will soon be unable to drive or perform her duties as a teacher. What support can the Government provide to NHS Lanarkshire to help it to reduce its waiting times for cataract surgery?

I share Gillian Mackay’s concerns. She has corresponded with me about them in general, but I ask her to provide specific details about her constituent—I will be more than happy for the case to be investigated. Like Gillian Mackay, I would also be nervous about somebody having to wait 70 weeks for a cataract operation.

We are giving additional funding to NHS Golden Jubilee, which is planning to deliver 12,000 cataract surgeries in core sessions during the current financial year. That is 4,000 more than the hospital delivered during the previous year. We know that there is a significant backlog across all hospital procedures, which is why we published our NHS recovery plan at the end of last month.

Annie Wells has a brief supplementary.

Across my own health board, with our heroic front-line staff under unprecedented pressure, we are seeing cancellations of elective surgery appointments, leaving thousands to wait in pain before they can get the surgery that they need. That is having a brutal knock-on effect on accident and emergency departments, this being the fourth week in a row in which waiting times have hit the worst level on record. What reassurances can be given to staff? When will a winter preparedness plan be published?

I am sorry; I did not catch the very end of the question. However, I say to Annie Wells that we are taking that significant challenge very seriously, as are the secretary of state in England and the health ministers in Wales and Northern Ireland. We are facing a collective challenge that has been significantly exacerbated by the effects of the pandemic.

Our recovery plan, which is backed by £1 billion of investment, goes into significant detail about how we will increase in-patient activity by 20 per cent and out-patient activity by 10 per cent during the current parliamentary session, and diagnostics significantly by more than 70,000 by 2022-23.

I am more than happy to meet Annie Wells to discuss those details, but health boards are making challenging decisions and we will continue to fund them and give them the investment that they need, while also taking care of the mental and physical wellbeing of our staff, because they are crucial in helping us to meet the targets in our recovery plan.

We have supplementaries to most of the rest of the questions. I want to get those supplementaries in, so I would appreciate brief questions—and brief answers, cabinet secretary.

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National Autistic Society (Meetings)

To ask the Scottish Government when it last met the National Autistic Society, in light of its reported concerns regarding support for families during the Covid-19 pandemic. (S6O-00102)

I fully recognise the incredible pressure that the pandemic has put on autistic children, their families and carers.

The Scottish Government meets the National Autistic Society regularly. Officials last met with the NAS on 23 August and I will meet the director of the NAS shortly.

The Scottish Government has provided significant additional funding to help meet those pressures, including £170,000 to national autism charities, £28.5 million for local carer support and a further £1.1 million last year to the voluntary sector short breaks fund. We also published our plan, “Learning/Intellectual Disability and Autism: “Towards Transformation”, in March.

The director of the National Autistic Society Scotland has warned that the pandemic has removed critical support for families, which has left carers and young people struggling. Home schooling was difficult for children with autism to adjust to, with statistics showing that 63 per cent of autistic young people missed attending school. In addition, figures from the Autism Centre for Education and Research revealed uncertainty around education, which caused high levels of stress and anxiety.

What progress has been made on the proposed learning disability, autism and neurodiversity bill? When will families and people with autism receive the help and support that they deserve?

Families will continue to receive support, some of which I have already outlined. I am sure that that issue will form part of the discussion that I have with the director of the NAS when we meet shortly.

As far as the bill and the proposed learning disability and autism commissioner are concerned, the Scottish Government will carry out the scoping work for all of that, including the commissioner’s remit and powers, very soon, and within the current parliamentary year. A commissioner will be appointed as soon as possible following the bill’s successful passage.

I know that there are very diverse views on how we should progress our work in this area, and I aim to talk to as many stakeholders as possible to ensure that we get the scoping work, and the proposed commissioner’s remit and powers, right.

Will the minister set out what action is being taken to support young children who are effective in masking or hiding their autism, which causes delays in their receiving a timely diagnosis in the early years of their education? Will he tell us specifically what action is being taken to support young girls, who are more likely to mask their symptoms? How will the Government adapt pre-pandemic plans to do more to work with the affected families to focus on identifying and supporting the children concerned?

I will write to Ms Hyslop, because a lot of work is being done in that area. Very briefly, new guidance that was commissioned by the Scottish Government and published by the national autism implementation team in May this year supports areas to develop local children’s neurodevelopmental pathways. We know that there are challenges in diagnosis, particularly with young females, who are able to mask the condition. We will do more to develop the guidance to get it absolutely right in that respect.

As I said, it is a complex area. I will write to Ms Hyslop, and any other member who requires that information, in some depth.

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Dental Practices (Covid-19 Support)

To ask the Scottish Government what support is available to dental practices to alleviate pressures specifically related to Covid-19. (S6O-00103)

The minister, Maree Todd, joins us remotely.

The Scottish Government is fully committed to supporting the national health service dental sector. That is why, from the beginning of the pandemic, we have put in place emergency support payments for national health service practices and dentists, including £33 million of additional funding per year.

We have also recently announced £7.5 million of funding for dentists to buy new equipment to help to reduce the impact of United Kingdom-wide Covid restrictions. That builds on the £5 million that we have already provided to the sector for ventilation improvements. NHS National Procurement continues to provide around £1.5 million of personal protective equipment per week free of charge to dental contractors who provide NHS care.

We expect those measures to increase the productivity of practices, thereby enabling them to see more patients within the current infection, prevention and control constraints.

Plean Street dental practice in my constituency has responsibility for 6,000 patients yet, because of the funding structures in place for Covid support, when one dentist left during the pandemic, the practice lost 25 per cent funding, despite patient numbers remaining the same. Balancing reduced staff and physical distancing while ensuring dental care for thousands of patients places increasing demand on practices.

Does the Scottish Government agree that that anomaly is unfair on practices in such situations? Will the Government commit to evaluating how the policy can be adapted to ensure that proportionate funding is maintained?

We are certainly interested in working with dental practices to ensure that they are financially sustainable in future. Our commitment to provide free dental care in the programme for government shows the absolute priority that we give to dental care for the population.

We have provided significant funding for contractors who provide NHS dental services. Dentists have received a top-up payment of 80 per cent of their average monthly earnings from 2019 to 2020. We increased that to 85 per cent from November 2020, and that remains in place.

I am more than happy to hear more details about the situation in his constituency that Bill Kidd raised. If he writes to me, I will certainly look into the situation and give him a fuller, more individual response.

With dental practices across Scotland currently operating at restricted capacity in line with Covid restrictions, there have been worrying reports that although NHS patients are having to wait months to see a dentist, those who can afford to go private are being seen within days. Is the minister not concerned about risking the development of a two-tier dental system in Scotland? What steps will be taken to ensure that NHS patients who cannot afford private dental care still receive the timely treatment that they need and to which they are entitled?

We are absolutely committed to NHS dental care, and to supporting and protecting NHS dental care for all patients in Scotland. By the end of this session of Parliament, everyone in Scotland will be able to access free NHS dental care.

Covid has particular challenges for the dental sector, because the majority of procedures involve aerosol generating procedures. We have put in place funding to support enhanced ventilation in NHS practices and funding for different types of hand-held instruments, which do not generate aerosols.

We are doing what we can within the constraints of the pandemic to increase capacity in NHS dental care. Our commitment to NHS dental care is absolutely and fundamentally strong.

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National Health Service (Operations Backlog)

To ask the Scottish Government what action it is taking to address the reported backlog of NHS operations. (S6O-00104)

We published our NHS recovery plan on 25 August. It outlines our ambitions for increasing NHS capacity by at least 10 per cent as quickly as possible in order to address the backlog and meet the on-going healthcare needs of people throughout the country. It is, of course, backed by £1 billion of additional Scottish Government investment.

For this year alone, we have made more than £80 million available to specifically support health boards to target the backlog of treatment and care. However, we need to remember that the pandemic is not over and that Covid-19 and other pressures will impact on the NHS for some time to come. Health boards’ elective activity is being monitored through daily and weekly returns to the Scottish Government, and support is being provided where it is required.

We have ambulances queuing out the door of accident and emergency departments and record waiting times, all of which is putting patients’ lives at risk. In my region, when constituents have reported a stroke or a heart attack, in one example, an ambulance—

We need a question, Ms Gosal.

In one example, an ambulance was called at 2.30 pm and came at 4.45 am the next morning. I contacted the cabinet secretary about that and I am still waiting for a response. It has been more than a month. I therefore ask the cabinet secretary how he will help patients like my constituents get the help and support they need from the paramedics who are desperate to deliver it.

First, I thank the Scottish Ambulance Service for the incredible work that it is doing when it is facing such significant pressures. The pandemic pressures have built up the demand that Pam Gosal and all of us are seeing in the constituencies and regions that we represent.

We have given the ambulance service specifically an additional £20 million. That has already been invested and we are now starting to see recruitment. Last week, there was additional recruitment of 60-odd paramedics and ambulance staff into the north and north-east of the country, and we will back that with £1 billion of additional investment, which will help to increase our capacity.

However, when it comes to providing that additional £1 billion to aid our recovery—which is, by the way, £400 million more than the Conservatives were looking to spend—we will not hammer the lowest paid in order to pay for it. We will make sure that that recovery and the additional investment that we bring forward do not hit those who have already been hit hardest by the pandemic.

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Rural Health Services (Support)

To ask the Scottish Government what plans it has to support rural health services following the end of the Covid-19 pandemic. (S6O-00105)

Our NHS recovery plan sets out key ambitions and actions to be developed and delivered now and over the next five years, including in rural areas. As I said, the recovery plan is backed by £1 billion of targeted investment.

The Scottish Government remains committed to the recommendations that are set out in Sir Lewis Ritchie’s “Shaping the Future Together: Report of the Remote and Rural General Practice Working Group”. We aim to enhance primary care across remote, rural and island communities by ensuring stability for rural general practitioner incomes alongside other measures that support innovative approaches to the use of information technology and physical infrastructure, as well as supporting recruitment and retention practices in rural areas.

Following the 2021 Scottish Parliament elections, the recommendation to create a centre for excellence for rural and remote medicine is now a Scottish Government manifesto commitment on which we will deliver in this parliamentary term.

Yesterday, it was revealed that more than 1,600 children have been waiting for over a year for mental health support. Alarmingly, in my constituency, nearly two thirds of young people seeking help have not been seen within the 18-week national health service target time. That is absolutely shameful—as, I am sure, the cabinet secretary will agree. They are a lost generation of vulnerable children and young people, particularly in the wake of the pandemic. Despite promises from the Scottish Government, services remain—

Question, Mr Carson.

When will the Government finally act and provide adequate and timely support for my constituents?

In answer to a previous question, my colleague Kevin Stewart outlined the 80 per cent increase in CAMHS staff under this Government; an increase in spending on mental health promised by this Government; £1 billion of additional spending in the recovery plan; and an increase of 320 in the number of CAMHS staff.

Where there are specific issues in rural areas, I am, of course, happy to work with the member to address those, but I give him an absolute and categorical assurance that mental health—particularly that of our children and young people—is a Government priority.

I earlier asked members to be brief in their questions and ministers to be equally brief in their responses. We have not seen any evidence of that, so I am going to have to consider how we go about trying to strim this back. We have three supplementaries on the next question alone, none of which I will be able to take.

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Old Aberdeen Medical Practice (General Practitioner Services)

To ask the Scottish Government what steps it is taking to ensure that patients and staff at Old Aberdeen medical practice are consulted on the future provision of its GP services. (S6O-00106)

Patient safety is absolutely paramount in any changes to service provision. Integration authorities are legally required to engage and consult staff and patients to ensure the best outcomes for local communities. Aberdeen City partnership has extensively engaged with staff on the proposed changes and has communicated their plans to patients, assuring them that they will continue to receive medical care at the practice.

Until recently, Old Aberdeen medical practice was publicly run and it served the community well. I have met campaigners who are angry about the way that it has been put out to tender, and the previous minister ignored requests to intervene. Will the cabinet secretary agree to meet the campaigners to hear their concerns?

I will, of course, consider that request. I would say that it is often members on the Labour benches who tell us that the Government interferes and intervenes too much when it comes to local decision making, and these are local decisions to be made by local integration authorities. Now the member is asking central Government to interfere in that decision making against the best judgment of the integration authority. However, if Ms Villalba writes to me, I will, of course, consider meeting her and campaigners about what I know is an important local issue.