Scottish Parliament, 18 January 2023

285 contributions from 58 members. The official report.

Covid-19 Recovery and Parliamentary Business

Liam McArthur (Liberal Democrat, Orkney Islands)

Good afternoon. The first item of business is portfolio question time. We start with questions on Covid-19 recovery and parliamentary business. I remind members that questions 1 and 3 are grouped together. I will take any supplementary questions on those after both have been answered. As ever, if anybody wishes to ask a supplementary question, I invite them to press their request-to-speak button during the relevant question.

Low-income Households (Improved Financial Security)

Claire Baker (Labour, Mid Scotland and Fife)

1. To ask the Scottish Government how it is measuring progress on its Covid recovery strategy commitment to improve financial security for low-income households. (S6O-01772)

John Swinney (Scottish National Party, Perthshire North)

The Scottish Government has identified a range of high-level indicators that will help to measure progress towards achieving the individual outcomes in the Covid recovery strategy. The majority of our outcome indicators are drawn from population surveys or large administrative data sets that report annually and which are more measurable than the outcomes themselves. We are working to identify additional intermediate indicators that report more frequently and can therefore identify and influence real-time trends.

Claire Baker (Labour, Mid Scotland and Fife)

In October 2021, the Covid recovery strategy set out a number of actions to address financial security for low-income households in the following 12 to 18 months, including the second benefit take-up strategy. The annual report that was published in October showed that take-up of the job start payment remains far too low at only 29 per cent, with that rate being attributed to low awareness of the benefit and a lack of clarity around eligibility. There are also concerns that people leaving school are unable to access that support. Will the cabinet secretary advise what action is under way to ensure that young people on low incomes who are moving into work directly from school or following a period of sustained unemployment are getting the support that they are entitled to?

John Swinney (Scottish National Party, Perthshire North)

I accept Claire Baker’s point that one of the challenges is to ensure that people fully utilise the benefits to which they are entitled at the moment in life that they are entitled to them. We take a number of steps—my colleague the Minister for Social Security and Local Government has set out some of that information to the Parliament previously—to raise awareness of individual benefits and maximise take-up. That is our intention, and it is our desire to ensure that that is the case. Awareness-raising measures will be taken, and we will obviously look very carefully at the effectiveness of those. The Government’s marketing strategies generally result in good engagement and participation, but I will look specifically at Claire Baker’s points to identify whether we need to take further action to raise awareness and boost participation.

Low-income Households (Support)

Marie McNair (Scottish National Party, Clydebank and Milngavie)

3. To ask the Scottish Government, in light of a new report by the Resolution Foundation stating that the average household will be £2,100 worse off by the end of next financial year, how ministers across Government are working to prioritise support for low-income households, as set out in its Covid Recovery Strategy. (S6O-01774)

John Swinney (Scottish National Party, Perthshire North)

The Scottish Government is prioritising funding to help household finances across Scotland. We are taking action to increase financial security for low-income households, and the emergency budget review confirmed a range of additional support in response to the cost crisis. That includes increasing the Scottish child payment to £25 per week, doubling the fuel and security fund to £20 million and providing local authorities with additional funding for discretionary housing payments. In total, the Scottish Government has allocated around £3 billion this financial year to contribute to mitigating the increased cost crisis. More than £1 billion of that support is available only in Scotland, with the remainder being more generous than that provided elsewhere in the United Kingdom.

Marie McNair (Scottish National Party, Clydebank and Milngavie)

I thank the Deputy First Minister for that answer and his long-standing recognition of the impact that the pandemic has had on low-income households. Rightly, the Covid recovery strategy has a focus on groups that are more likely to experience low income. One such group is families with three or more children, and it is correctly acknowledged that our Scottish child payment will be of assistance to such families. However, does the Deputy First Minister acknowledge that the UK Government’s two-child policy, with its abhorrent rape clause, hinders our efforts and shows that increased powers in social security are necessary to maximise the support that we give to those families?

John Swinney (Scottish National Party, Perthshire North)

Marie McNair is absolutely correct that the two-child limit can have significant and negative effects on household income, which is why the Scottish Government has not adopted that approach in relation to the Scottish child payment. Therefore, eligible families with more than two children are able to access the Scottish child payment.

We are taking measures that challenge and try to tackle the effect of measures taken by the UK Government that make our challenge even greater as we work to reduce child poverty in Scotland. Our measures are having a beneficial effect on child poverty levels in Scotland, and we will continue with that relentless focus to support families to boost their household incomes.

Paul Sweeney (Labour, Glasgow)

Following a Glasgow City Council decision last week on community grant funds, a number of organisations, some of which provide mental health support and access to food, are facing funding cuts or even closure. Given the bleak outlook for households, as highlighted by Marie McNair, will the Government ensure that organisations in Glasgow and elsewhere that provide such lifeline support will not be forced to pull out of communities or close when those communities face such hardship?

John Swinney (Scottish National Party, Perthshire North)

A range of organisations provide valuable and vital support to individuals in our communities, and the Government wants to maximise support to those organisations. I accept that all public organisations face significant financial challenges as they wrestle with the cost crisis, and I was candid about that to the Parliament when I set out the budget in December. However, if we all maintain a focus on supporting the people who are in greatest need, we can do as much as possible to address the financial hardship that those individuals face.

Legislation on Sex Buyers (Parliamentary Time)

Bill Kidd (Scottish National Party, Glasgow Anniesland)

2. To ask the Scottish Government whether the Minister for Parliamentary Business plans to propose the scheduling of time to consider legislation to end sex buyers’ legal impunity as part of the business for the current parliamentary year. (S6O-01773)

George Adam (Scottish National Party, Paisley)

Details of future legislation will be announced in the programme for government in the normal way. Our policy in relation to prostitution, which includes considerations around the purchase of sex, is currently being taken forward through a framework for Scotland, which will seek to challenge men’s demand for prostitution and support the people who are impacted.

Bill Kidd (Scottish National Party, Glasgow Anniesland)

Yesterday, the cross-party group on human trafficking heard from Valiant Richey, the Organization for Security and Co-operation in Europe’s special representative and co-ordinator for combating trafficking in human beings. Mr Richey emphasised that full criminalisation of the purchase of sex is by far the most effective legislative approach to tackling human trafficking for sexual exploitation.

Given that the unrelenting sexual exploitation of women and children continues and that we have power to effect real change in the matter, does the minister agree that that devolved matter should be treated with urgency in this parliamentary session and that space should be made for further parliamentary engagement?

George Adam (Scottish National Party, Paisley)

I agree with Bill Kidd that it is an extremely important issue. Last December, as part of the 16 days of activism to end violence against women and girls, the Parliament reaffirmed that there is no place for sexual exploitation in Scotland.

I am currently working with ministers to agree the upcoming legislative programme, and I assure Mr Kidd that the Parliament will continue to be kept informed by the lead minister as that work progresses.

Rhoda Grant (Labour, Highlands and Islands)

From last night’s cross-party group on human trafficking, it was clear that countries that do not hold sex buyers accountable for their abuse are attractive destinations for traffickers. We also heard from Mr Richey about the clear targeting of Ukrainian refugees by traffickers and exploiters for the sex industry, which makes the issue even more urgent.

I ask for clear timescales for when legislation to hold sex buyers to account will be introduced. In the meantime, what steps is the Scottish Government taking to protect Ukrainian refugees and other vulnerable groups?

George Adam (Scottish National Party, Paisley)

As I said to Mr Kidd, I understand how important the issue is, and how we move forward with it is extremely important. As I also mentioned, we are currently working towards the legislative programme for year 3. Discussions are going on with other ministers with regard to that. I will ensure that the questions that have been asked are brought up when I have my bilateral meeting with ministers for the relevant portfolio.

The Deputy Presiding Officer

Question 4 is from Natalie Don, who joins us remotely.

Covid-19 Recovery Strategy (Inflation)

Natalie Don (Scottish National Party, Renfrewshire North and West)

4. To ask the Scottish Government what assessment it has made of the impact that rising inflation could have on its ability to deliver on the priority outcomes set out in the Covid recovery strategy. (S6O-01775)

John Swinney (Scottish National Party, Perthshire North)

The financial situation, including high levels of inflation, is particularly challenging, given the absence of fiscal powers to compensate for those factors. The Scottish Government has prioritised spending that supports the people who need it most, guided in part by the principles of the Covid recovery strategy. Last year’s emergency budget review and the 2023-24 budget provide funding that helps families, backs business and protects the delivery of public services. The Scottish Government is committed to making progress towards the shared Covid recovery strategy outcomes in partnership with local government and other partners and will continue to prioritise spending that is targeted to support the people who are in most need.

Natalie Don (Scottish National Party, Renfrewshire North and West)

One of the key priorities in the recovery strategy is financial security for low-income households. This morning, it was announced that inflation is still at an eye-watering 10.5 per cent, which is five times higher than the Chancellor of the Exchequer’s target. The price of basic food items, such as milk and cheese, has increased by up to 46 per cent.

Does the Deputy First Minister agree that our ability to deliver on the Covid recovery outcomes is being made much more difficult by the Tories’ economic incompetence?

John Swinney (Scottish National Party, Perthshire North)

In the budget statement in December, I was explicit with the Parliament on the scale of the challenge that is posed by the economic turbulence that has been experienced since the start of the war in Ukraine, which has been exacerbated by the twin effects of Brexit and the aftermath of the ludicrous mini-budget in early September.

The very high level of inflation that we currently face in our economy, along with the fact that there is even more acute pressure on low-income households because the price of many of the foodstuffs on which those households depend has increased disproportionately and by more than the headline rate of inflation, are issues of significant challenge. That is why the Government has prioritised the increase in the Scottish child payment to the extent that it has. It is also why I announced an uprating of the benefits that are under our control by 10.1 per cent. We want to do all that we can to address the difficult circumstances that low-income households face.

The Deputy Presiding Officer

Question 5 was not lodged.

Covid-19 Infection Rates (Recovery Strategy Review)

Katy (Labour, West Scotland)

6. To ask the Scottish Government whether it will review its Covid recovery strategy in light of rising Covid-19 infection rates. (S6O-01777)

John Swinney (Scottish National Party, Perthshire North)

The Covid recovery strategy focuses on reducing systemic inequalities and reforming public services. The Scottish Government remains committed to that work, so there are no plans to review the strategy.

The Scottish Government remains alert to the on-going threat that is posed by Covid-19. Public Health Scotland has worked in collaboration with the Scottish Government, local government and other partners to meet the commitment in “COVID-19: Scotland’s Strategic Framework Update” to develop and publish an outbreak management plan. We continue to utilise that, to apply careful judgment and to take all relevant factors into account to ensure that responses are appropriately targeted and the necessary resources are prioritised to deal with the effects of the rising Covid-19 infection rates.

Katy (Labour, West Scotland)

The Scottish Government’s ending of free testing last April has led to some of the poorest people in society being priced out of accessing lateral flow tests, which now cost an average of £9 for a pack of five. That decision is at odds with the Covid-19 recovery strategy’s aim of supporting low-income households.

Given the current high Covid rates, will the Scottish Government review its strategy and explore the feasibility of reintroducing free tests?

John Swinney (Scottish National Party, Perthshire North)

The Government has taken a range of measures to ensure that we have the available intelligence to support us in the management of the Covid-19 pandemic. Given that the rate is currently estimated to be approximately one in 25, we face a significant challenge. Such issues are regularly reviewed by the Cabinet and the ministerial group on health issues, which is chaired by the Cabinet Secretary for Health and Social Care, and in the resilience discussions that are chaired by the First Minister, which are taking place on a weekly basis.

I completely understand the point that Katy Clark puts to me, and I understand and accept its significance. However, in the absence of consequential funding from the United Kingdom Government to provide for the approach that she would like us to adopt, we would have to consider funding that approach from the existing resources that are available to the national health service in Scotland. As Katy Clark will know, we have taken significant decisions to boost the funding that is available to the health service by increasing tax for higher earners in the next financial year, but we would have to wrestle with the matter that she raises as part of the overall financing of our public services.

I will consider further the issue that Katy Clark puts to me, because it is a serious issue. I assure her that such questions will be regularly considered as part of the work of the management groups that I mentioned, which are looking at the effect of the pandemic on our public services.

Murdo Fraser (Conservative, Mid Scotland and Fife)

An important tool in tackling rising Covid infection rates is the booster vaccination programme that is currently being rolled out. I have been contacted by several constituents who are in the over-50 age group who have not received appointment letters for a booster vaccination. Although they are able to access drop-in vaccination centres, which are a welcome resource, having the prompt reminder of an appointment letter is often what encourages people to attend. Does the Deputy First Minister know how widespread that issue is? What more might be done to ensure that over-50s and those in other vulnerable groups are reminded of the need to get a booster?

John Swinney (Scottish National Party, Perthshire North)

I reassure Mr Fraser that the uptake rates are really quite high: they are in excess of 70 per cent of the eligible population. I have in my mind 77 per cent. I do not have the number in front of me, but I will have it tomorrow morning, when I am at the COVID-19 Recovery Committee, so I shall perhaps be able to give Mr Fraser a more definitive answer at that time.

The level of vaccination uptake is really quite high. We have taken an approach to awareness raising that is designed to maximise the participation in the programme—at this stage, there is a very high level of uptake—and we should continue to do that.

The drop-in facilities that are available are handy and convenient for people, but I will consider further the point that Mr Fraser puts to me about written communication, because it is in all our interests to have a highly vaccinated population.

Covid-19 Recovery (Cross-Government Planning)

Annabelle Ewing (Scottish National Party, Cowdenbeath)

7. To ask the Scottish Government whether it will provide an update on its longer-term, cross-Government plan for Covid-19 recovery. (S6O-01778)

John Swinney (Scottish National Party, Perthshire North)

The Covid recovery strategy contains more than 70 actions that will support people across Scotland, and particularly those most affected during the pandemic. It focuses on increasing financial security for low-income households, enhancing the wellbeing of children and young people, and creating good green jobs and fair work.

I co-chair the Covid recovery strategy programme board, alongside the president of the Convention of Scottish Local Authorities. Together with partners, we oversee recovery activity, and, at our meeting in September, attendees noted that the expectations of the Covid recovery strategy programme were being delivered. The board will meet again next week, and minutes are published on the Scottish Government website.

Annabelle Ewing (Scottish National Party, Cowdenbeath)

I note the 70 actions in the recovery strategy. On the important issue of Covid booster vaccination, can the Deputy First Minister advise what the current thinking is about a further programme of such booster vaccinations later this year and, indeed, in years to come?

John Swinney (Scottish National Party, Perthshire North)

Annabelle Ewing raises an important issue. As I rehearsed in my answer to Murdo Fraser, it is important to encourage uptake of the vaccination programme, and we are encouraged by the level of uptake that we are seeing. I would encourage anybody who is in the eligible population groups but who has not been vaccinated to take up the opportunity of that vaccination.

Our approach to vaccination is based on the clinical advice of the Joint Committee on Vaccination and Immunisation. I would expect the JCVI to consider the question that Annabelle Ewing puts to me about the provision of further booster vaccinations in 2023 or in later years and provide advice to the Government. Obviously, we stand ready to implement that advice.

I reiterate that, in the interim, the winter 2022 booster programme campaign remains open until the end of March. Appointments are still available, and I encourage anyone who is eligible and is yet to be vaccinated to come forward.

Government Business (Update)

Donald Cameron (Conservative, Highlands and Islands)

8. To ask the Scottish Government whether it will provide an update on what Government business it plans to bring forward for the current parliamentary year. (S6O-01779)

George Adam (Scottish National Party, Paisley)

Proposals for Government business in Parliament are agreed by the Scottish Cabinet, subject to consideration by the Parliamentary Bureau and, in turn, approval by the Parliament. As the year progresses and things move on, that will be the process.

Donald Cameron (Conservative, Highlands and Islands)

There are increasing concerns that the Scottish Parliament’s processes are inadequate when it comes to scrutiny of the Executive’s legislation. For that reason, I intend to introduce a member’s bill on parliamentary reform.

I take this opportunity to invite the Scottish Government to work constructively with me on that project. In the first instance, will the minister meet me so that we can discuss those issues together?

George Adam (Scottish National Party, Paisley)

Although I do not agree with some of the points that the member has made, I am quite happy to meet him to discuss things.

I will give some examples

of times when there seemed to be an idea that we do not get time to scrutinise legislation here. When we had the recent Gender Recognition Reform (Scotland) Bill, the Government listened to the relevant committee’s concerns and agreed to propose a deadline on the understanding that additional time would be agreed if an unexpectedly large number of amendments were lodged. On the National Care Service (Scotland) Bill, the Parliamentary Bureau agreed a longer stage 1 deadline following feedback from the committees. On the Hunting with Dogs (Scotland) Bill, the Rural Affairs, Islands and Natural Environment Committee recently requested that stage 2 be extended by one week—in effect, creating a stage 2.5—and we revised the deadline in order to do that.

I believe that, on the whole, we do work with those members in Opposition and with the committee system to ensure that there is scrutiny of the Scottish Government.

Beatrice Wishart (Liberal Democrat, Shetland Islands)

On the subject of fixed links, during the 2021 Scottish Parliament campaign, the First Minister told local media in Shetland that she was

“not just open to but actually quite enthusiastic about seeing if we could make the case for that”.

However, the Scottish Government has not scheduled a debate on the matter yet. Will the minister contemplate scheduling a debate on fixed links and tunnels so that the case can be made to help to reverse depopulation and save costs in the long term for internal ferry replacement?

George Adam (Scottish National Party, Paisley)

I take on board what Ms Wishart has said. My answer would normally be that the member should speak to her business manager, but I will make a special allowance in her case. I will bring the matter up with the bureau and will appeal to it myself.

The Deputy Presiding Officer

That concludes portfolio questions on Covid recovery and parliamentary business.

Finance and the Economy

The Deputy Presiding Officer

We move to the next portfolio, which is finance and the economy. I encourage members who wish to ask a supplementary to press their request-to-speak buttons during the relevant question. There is an awful lot of interest in this series of questions, so I make a plea for brevity in questions and responses.

Business Rates Relief (Hospitality Businesses)

Annie Wells (Conservative, Glasgow)

1. To ask the Scottish Government whether it will provide all hospitality businesses with 75 per cent business rates relief in 2023-24. (S6O-01780)

Tom Arthur (Scottish National Party, Renfrewshire South)

Having set out a strong non-domestic rates package in the draft budget, the Scottish Government has no current plans to introduce any further reliefs. As a result of that package, around half the properties in the retail, hospitality and leisure sectors in Scotland will already pay no rates in 2023-24 due to the most generous small business relief in the United Kingdom.

The budget statement also delivered the number 1 ask of the business community by freezing the poundage, delivering the lowest poundage in the UK for the fifth year in a row.

Annie Wells (Conservative, Glasgow)

Next year, hospitality businesses in Wales and in the south will receive 75 per cent business rates relief. However, Scottish hospitality businesses are getting no extra relief from the Scottish National Party. One hundred thousand Scottish businesses are being short-changed; they are missing out on more than £200 million of support.

How will our economy recover when Scottish businesses are worse off than companies in the rest of the UK?

Tom Arthur (Scottish National Party, Renfrewshire South)

As I outlined in my original answer to Ms Wells, we already provide the most generous package of rates relief for businesses anywhere in the UK, which includes freezing the poundage, making it the lowest rate for the fifth year in a row.

The reality is that we have to take decisions in the round when setting our budget, and any additional revenue to be supplied for rates relief would have to come from a corresponding decrease in another area of Government funding. If Ms Wells wishes to see a reduction in a particular area of funding in order to support non-domestic rates relief, I am happy to have that discussion.

The Deputy Presiding Officer

There are a number of supplementaries. I want to get them all in, but they will have to be brief, as will the responses.

Kenneth Gibson (Scottish National Party, Cunninghame North)

I welcome the decision to freeze the rates poundage, forgoing £308 million of income while ensuring that 100,000 businesses pay no rates at all. How much would it cost to provide 75 per cent rates relief for all hospitality businesses? Has Ms Wells or any other Tory MSP suggested from where in the Scottish budget those resources should be found or whether taxes should be increased to pay for such a relief?

Tom Arthur (Scottish National Party, Renfrewshire South)

It would cost an estimated £85 million to provide hospitality properties with 75 per cent non-domestic rates relief capped at £110,000 per business in 2023-24.

As I mentioned in my answer to Annie Wells, under our package of reliefs, which is worth an estimated £744 million, around half the properties in the retail, hospitality and leisure sectors will benefit from 100 per cent small business bonus scheme relief in 2023-23.

As I said, if any party wants to enhance the package of reliefs that is on offer in the budget, I would welcome hearing their alternative, fully funded proposals.

Daniel Johnson (Labour, Edinburgh Southern)

We know that retail businesses pay a fifth of non-domestic rates when they account for only 10 per cent of the economy. Short of a discount, does the minister agree that there is a case for rebalancing and recalibrating what sectors pay based on their economic contribution?

Tom Arthur (Scottish National Party, Renfrewshire South)

As the member is aware, the process of setting the rateable value is carried out independently by the Scottish assessors. However, the point that he touches on is one that I appreciate is a broader concern for members about how non-domestic rates operate, namely the lack of a correlation between the rateable value and the economic performance of a business. That prompts the question of fundamental non-domestic rates relief reform and non-domestic rates reform more generally.

This is a complex area, but I am happy to discuss it with members. My door is always open to any member who wishes to discuss such matters in more detail.

Beatrice Wishart (Liberal Democrat, Shetland Islands)

Hospitality businesses in Shetland were grateful for the support that was given to them during the Covid pandemic, but many now feel left behind. What more can the minister do to help island businesses through this difficult winter?

Tom Arthur (Scottish National Party, Renfrewshire South)

We provide a range of support through the relief packages that we provide via the non-domestic rates system, including rural rates relief. We have to take decisions in the round. The package of support that we provide on non-domestic rates, which applies Scotland-wide, is the most generous in the United Kingdom.

As I said in response to other members’ questions, if members have specific proposals for reform of non-domestic rates, I am happy to discuss them. If there are specific reliefs that they would like to see, I would welcome a conversation, but it has to come with fully funded and costed proposals.

Katy (Labour, West Scotland)

Unite the union’s get me home safely campaign calls on councils to make free safe transport home for late-night workers a requirement for new and extended alcohol licences, and some councils such as North Ayrshire Council and East Dunbartonshire Council have backed the campaign. Will the Scottish Government explore making the provision of safe transport home for late-night workers a condition of future support for hospitality businesses?

Tom Arthur (Scottish National Party, Renfrewshire South)

The issue of conditionality around rates relief has been raised in a number of different contexts. There are complexities to that, but I would be happy to discuss the issue with the member in more detail if she would like.

Oil and Gas Exploration

Sandesh Gulhane (Conservative, Glasgow)

2. I apologise for arriving during the session.

To ask the Scottish Government whether it has fully considered the economic consequences of its presumption against new oil and gas exploration, both to workers within the industry and to the wider Scottish economy as a whole. (S6O-01781)

Richard Lochhead (Scottish National Party, Moray)

The oil and gas sector and its highly skilled workforce have long been at the forefront of energy innovation and have an important role to play in Scotland’s energy transition. However, as we all know, the North Sea basin is mature, and production will inevitably decline.

The draft energy strategy and just transition plan draw on established industry data and independent work commissioned from consultants that analyses the energy and economic contributions of the North Sea and the wider oil and gas sector in Scotland, and includes production forecasts, the expected growth of Scotland’s low-carbon energy sectors and the impact of the energy transition on employment and the wider economy. As a responsible Government, we have set out a pathway to ensure a fair and just transition—any other approach would serve only to put jobs and our economy at risk.

Sandesh Gulhane (Conservative, Glasgow)

The oil and gas communities of the north-east of Scotland will be devastated at the disregard shown to them by the Scottish National Party Government. The sector is highly important to our economy, and even in our just transition away from fossil fuels, which is estimated to take 25 years or more, it will be a necessary component of our on-going energy infrastructure. Does the cabinet secretary accept that halting oil and gas production would increase our reliance on foreign imports of oil and gas and prop up questionable regimes, which would only amplify and relocate the greenhouse emissions that we seek to reduce as well as damage domestic job creation?

Richard Lochhead (Scottish National Party, Moray)

This question is about future exploration, not existing oil and gas production, as the member suggests. By 2035, production in the North Sea will be around a third of 1999 levels, and it will be less than 3 per cent of the 1990 peak by 2050. We have a duty, which the energy strategy fulfils by looking to the 2030s and 2040s and the need of future generations for energy and jobs, to look at what we can do to make sure that we meet our responsibilities as a country and do not focus only on today’s headlines.

Research from Robert Gordon University and other institutions estimates that the number of low-carbon jobs will rise from 19,000 in 2019 to 77,000 by 2050, which means that there will be an increase in energy-related jobs in north-east Scotland and elsewhere. As someone who represents a constituency with many oil and gas jobs in it, and who spends a lot of time in north-east Scotland because of my ministerial responsibilities, I am very familiar with the views of those in the oil and gas sector and with the fact that oil and gas majors are investing heavily in, and are very committed to, the energy transition.

The Scottish Tory party has to make up its mind: if it wants a transition, what does it want to transition to? We want to transition to clean energy for Scotland and to tackle climate change.

The Deputy Presiding Officer

Answers need to be slightly briefer.

Audrey Nicoll (Scottish National Party, Aberdeen South and North Kincardine)

During last week’s Prime Minister’s questions, Rishi Sunak committed to supporting the north-east energy sector. Does the minister agree that the Prime Minister should put his money where his mouth is by matching the Scottish Government’s £500 million just transition fund, and that he should stop delaying investment into the Acorn carbon capture and storage project, which has been left completely in the lurch?

Richard Lochhead (Scottish National Party, Moray)

Those were very good points. The United Kingdom Government—which has extracted more than £300 billion from the North Sea

—should match the Scottish Government’s £500 million for the north-east of Scotland and Moray just transition fund. The previous question was about the economic assessment of our energy plans, and I would like to know what the UK Government’s economic assessment was that led to its refusal to take forward the Acorn project, which would create up to 20,000 new jobs in Scotland, many of which would be in north-east Scotland.

Brexit (Impact on Economy)

Fiona Hyslop (Scottish National Party, Linlithgow)

3. To ask the Scottish Government what the continuing impact of Brexit is on Scotland’s key economic sectors. (S6O-01782)

Ivan McKee (Scottish National Party, Glasgow Provan)

It is now clear that Brexit is holding back our public services and scarring our economy. Leaving the European Union has made it harder to recruit doctors and nurses for our national health service, for example. The latest research by the Nuffield Trust shows that, without Brexit, the United Kingdom would have had 4,000 more specialist doctors from the EU.

Meanwhile, the exports of some Scottish industries have plummeted due to Brexit trade barriers. Just look at fruit and vegetables, where EU exports have been slashed by one half since 2019. That said, the Scottish Government will continue to support our businesses through our export growth plan, which will enable Scotland’s export performance to outpace the UK’s. Our international goods exports were up by 16.7 per cent in 2022 compared to the first nine months of 2019, while UK figures were up by only 2.4 per cent.

Fiona Hyslop (Scottish National Party, Linlithgow)

Does the minister agree that Brexit was never a one-off event and that it is having a continuous negative effect on our economy, with no apparent positives?

Businesses that export are more likely to pursue innovations, so, with Scottish exporters continuing to face growing challenges in trading with countries in the EU, the continuing effect of Brexit will also impact on innovations in our economy for the future. Does the minister agree that the longer Scottish businesses remain out of the EU, the more damage Brexit will bring to Scotland’s economy and that the only political route to the full benefit of trading in the single market—with the Labour party and the Liberal Democrats now embracing Brexit—is Scotland becoming an independent state and joining the EU?

Ivan McKee (Scottish National Party, Glasgow Provan)

As the member correctly identified, Scotland’s economy will continue to suffer while we remain outside the European single market because of a hard Brexit that we did not vote for. Only through the full powers of independence will Scotland replicate the success of comparable countries that are more prosperous, more productive and fairer than the UK.

Tay Cities Deal

Joe FitzPatrick (Scottish National Party, Dundee City West)

4. To ask the Scottish Government whether it will provide an update on any investment arising from the Tay cities deal. (S6O-01783)

John Swinney (Scottish National Party, Perthshire North)

The Tay cities region deal has had a successful first two years since it was signed, in December 2020, with more than £70 million of Government funding already having been received by regional partners. The partnership is currently preparing its latest annual report, which will outline the achievements to the end of September last year, and we anticipate that it will include the securing of over £120 million of investment into the region.

Joe FitzPatrick (Scottish National Party, Dundee City West)

The Tay cities deal is delivering vital support to the region’s economy in these challenging times by supporting skills development, providing training and job opportunities and driving additional investment into the area.

Can the cabinet secretary say more about investments in Dundee specifically and how those are helping to support local employment and drive innovation?

John Swinney (Scottish National Party, Perthshire North)

Dundee, which is in Mr FitzPatrick’s constituency, has benefited significantly from the Tay cities deal. The universities are benefiting, with £25 million from the Scottish Government going towards enhanced infrastructure for life sciences innovation at the University of Dundee as well as support for the refurbishment that led to the cyberQuarter development at Abertay University. That development opened in June last year and aims to support 150 businesses in the cyber security sector, which is absolutely vital given the developments in the global economy.

Not quite in Mr FitzPatrick’s constituency but at the other end of the city, the investment from the Scottish Government in the Michelin Scotland Innovation Parc is significant in supporting the development of new opportunities. If Mr FitzPatrick will forgive me, I will also mention the James Hutton Institute, in my constituency, which is close to the boundary with the city of Dundee. The developments there are welcome into the bargain.

Murdo Fraser (Conservative, Mid Scotland and Fife)

I agree with Mr FitzPatrick about the value of the Tay cities deal. In line with the rest of the developed world, we have seen substantial construction price inflation over the two years since the deal was signed.

When I visited the James Hutton Institute in December, it raised with me the issue of whether the funds that had been allocated in the deal would now cover the construction costs of the welcome major infrastructure build that the institute now has to commit to. Has the Scottish Government done any work on whether the funds that were allocated in 2020 will now be sufficient to meet those increased costs?

John Swinney (Scottish National Party, Perthshire North)

I raised that point in my budget statement to Parliament in December, because the issues that Mr Fraser correctly highlights will undoubtedly put pressure on these long-term projects.

Projects that, for example, had an estimated cost in the benign climate of 2020 are now in a significantly different position because of the effect of hyperinflation.

We hope that there will be reductions in inflation, but I have to say quite openly to Parliament that there will be challenges around uprating projects that have been affected by inflationary cost. It is a problem that we are wrestling with right across Government. We will do our level best to address that in the capital programme, to ensure that projects can be taken forward. However, there will be strains in city deals, which are long-term growth deals, because of the effect of inflation.

Willie Rennie (Liberal Democrat, North East Fife)

St Andrews university has delivered its part of the Tay cities deal at its new Eden campus in Guardbridge, and it is bursting with ideas about what to do next. It wants to crack on with the next phase of the deal. Has the minister had discussions with the United Kingdom Government about that next phase? If not, will he start such discussions?

John Swinney (Scottish National Party, Perthshire North)

We are certainly open to further discussions on these questions. I compliment the University of St Andrews on the development in Guardbridge. I drove past it the other week, on my way to St Andrews, and it is looking good. It is a significant enhancement of the area and a sustainable proposition.

We have not had discussions with the UK Government about a further round of city deals. On Friday, Mr McKee will be signing the islands deal in Liam McArthur’s constituency—I mention that because Liam McArthur is currently in the Presiding Officer’s chair. The islands deal is the latest of the deals involving the islands communities. However, we are happy to have further discussions with the UK Government on these questions.

The Deputy Presiding Officer

Mr McKee will be afforded a warm welcome when he arrives.

Financial Policy (Decision Making)

Michelle Thomson (Scottish National Party, Falkirk East)

5. To ask the Scottish Government how it takes the complexity of human behaviour into account during financial policy decision making. (S6O-01784)

Tom Arthur (Scottish National Party, Renfrewshire South)

The Scottish Government is aware of the risks

and benefits arising from behavioural responses to policy proposals, and we actively work with stakeholders such as HM Revenue and Customs to monitor and continually improve the evidence base, to help to inform policy development. The Scottish Fiscal Commission is responsible for producing independent forecasts of devolved tax and social security spending for the Scottish budget and for making judgments about the scale of any behavioural responses and their fiscal implications in those forecasts.

Michelle Thomson (Scottish National Party, Falkirk East)

The minister will be aware that the Finance and Public Administration Committee has launched an inquiry into approaches to decision making in the Government. One key aspect is fully understanding how to assess risk. Does the Scottish Government have an established approach to the disaggregation of risk? If so, can the minister outline its principles?

Tom Arthur (Scottish National Party, Renfrewshire South)

I recognise and welcome the committee’s work in that particular area and, indeed, its continuing interest in the area when I appear before the committee. I am sure that the inquiry will make a valuable contribution to the subject, including in the area of risk management.

The Scottish Government has a robust risk management framework to support the identification, assessment, management and reporting of risks during the development and delivery of policy within each portfolio and across Government, which helps to promote best practice. The framework aligns to the principles of risk management as they are outlined in the Scottish public finance manual, which is publicly available.

Elizabeth Smith (Conservative, Mid Scotland and Fife)

At the same committee meeting, the minister said, in answer to a question from John Mason, that he understands the importance of the private rented sector for the mobility of the working population. What is the Scottish Government going to do to address the concerns of landlord associations and some local authorities that the proposed increase in the tax on the additional dwelling supplement, which comes at the same time as the rent freeze, will cause some landlords to exit the market, thereby threatening the supply of private rented accommodation, which is crucial to the economy, especially in rural areas?

The Deputy Presiding Officer

As briefly as possible, please, minister.

Tom Arthur (Scottish National Party, Renfrewshire South)

As I set out at some length during the committee meeting yesterday, we take decisions on fiscal policy in the round. The policy intention behind the additional dwelling supplement is clear: it is to provide support for first-time buyers, but it also has the clear objective of raising revenue.

On the specific point about local government, the issues there and the current lack of parity with registered social landlords are being considered through the ADS review. I will be in a position to update the Parliament on the outcome of that review soon.

Amazon (Gourock Site Closure)

Neil Bibby (Labour, West Scotland)

6. To ask the Scottish Government whether it will provide an update on its response to the announcement from Amazon that it is to close its Gourock site. (S6O-01785)

Ivan McKee (Scottish National Party, Glasgow Provan)

I spoke with Amazon last week but was very disappointed that there was no clarity on its rationale for the potential closure of its site in Gourock. I have since written to Amazon’s US headquarters to seek further clarification on those points and to seek a conversation with the people who are behind the company’s operational decision. I have had a response from Amazon in the United Kingdom and I am about to reply to it, because, to my mind, it did not go far enough with the information that it provided. It is vital that we access the detail in order to explore all viable options and to seek an alternative outcome to its decision to close the site. During the meeting, I urged Amazon to engage with local trade unions and, at my request, the company has agreed to engage with the Inverclyde task force in order to better understand the potential impact that the planned closure will have on the local economy.

Neil Bibby (Labour, West Scotland)

I thank the minister for his answer and his recent updates. To support the workforce, I hope that he will continue to urge Amazon to think again and that he will seriously explore options with the company to relocate locally if the current site is deemed unsuitable, working alongside the GMB and the council.

I know that the minister is a member of the Inverclyde socio-economic task force and that he understands the long-standing challenges that that community faces. However, already this year, 300 jobs look set to go at Amazon. Ports on the Clyde have lost out on freeport status to the east and north, which has undermined their competitiveness, and Inverclyde Council faces a £6 million black hole in its budget, raising the prospect of more job losses. Given all of that, does the minister share my concern that the Inverclyde economy is being undermined? What action will the Government take to support the local economy and to ensure that the area gets a fair deal?

Ivan McKee (Scottish National Party, Glasgow Provan)

We are focused on all parts of Scotland in making sure that we maximise our potential. As the member knows, I engage closely with members and others in Inverclyde, and I am looking forward to the next task force meeting on Monday next week, which I will be attending in person, where I will take forward discussions on how we can work together to make sure that the full potential of the economy in Inverclyde is maximised.

There is a range of support available, including city region deal projects and other projects that the Scottish Government supports and funds, for the development of the local economy.

Budget 2023-24

Jamie Halcro Johnston (Conservative, Highlands and Islands)

7. To ask the Scottish Government what its response is to the comments by the Scottish Chambers of Commerce regarding the budget 2023-24 that it represents “a clear disadvantage for Scotland’s businesses and workers”. (S6O-01786)

John Swinney (Scottish National Party, Perthshire North)

I do not agree with that assessment. In arriving at our income tax policy for 2023-24, we have sought to carefully balance the need to raise revenue with the impact on households, businesses and the wider economy at the current time. The majority of people in Scotland will still pay less income tax than they would if they lived elsewhere in the United Kingdom, and our income tax policy will enable us to make additional investment in the national health service by exceeding the health resource Barnett consequentials from the UK Government. In addition, Scotland offers the most comprehensive social contract in any part of the UK, making Scotland an attractive place in which to live, work, study and do business.

Jamie Halcro Johnston (Conservative, Highlands and Islands)

As I highlighted to the cabinet secretary at the Economy and Fair Work Committee this morning, the tourism and hospitality sectors are facing severe pressure at the moment, but the budget provides little comfort.

As Annie Wells suggested, businesses in the sector south of the border will receive a 75 per cent discount on their rates next year, while—despite receiving hundreds of millions of pounds of Barnett consequentials to deliver the same—the Scottish Government has chosen not to do that. The Scottish Beer and Pub Association says that that puts Scottish pubs at a “significant disadvantage”; the Scottish Hospitality Group said that the budget offered “nowhere near enough to see the sector through” and that “many small businesses won’t survive”; and the Scottish Tourism Alliance expressed the disappointment of its members and warned that 23 per cent of Scotland’s tourism businesses were in “survival mode”.

If the cabinet secretary will not offer the same arrangement to Scotland’s sector, will he at least lobby his ministerial colleagues to roll back some of the extra unnecessary regulatory burdens, such as the delayed short-term lets licensing and deposit return schemes, that it intends to push on this already struggling sector?

John Swinney (Scottish National Party, Perthshire North)

In a sense, Jamie Halcro Johnston answers his own question. The Government has already delayed the introduction of the short-term licensing scheme to provide more time for the sector to adjust to it.

Earlier in the session, in response to Annie Wells, the Minister for Public Finance, Planning and Community Wealth set out the fact that about half of the retail, tourism and hospitality businesses will benefit from 100 per cent rates relief because Scotland has a different small business bonus scheme from that which operates in the rest of the United Kingdom. Rather than just tell us that we should replicate what goes on in England, Jamie Halcro Johnston should think about the fact that, if we did so, lots of companies would have to start paying business rates, and he is not suggesting that that should happen.

Finally—this is the real point—according to the figures that Mr Arthur put on the record, Jamie Halcro Johnston is asking me to commit to spending another £78 million on business rates relief. If he wants me to spend that money on that, he has to have the honesty to come to Parliament and explain where the money is coming from. Already, his colleagues are opposing the tax changes that I have made, which is another £125 million or so that they have to find.

The Conservatives cannot come here and ask me to spend more money when they cannot tell me where the money is coming from.

The Deputy Presiding Officer

I am determined to get the final question in.

Glasgow Economy (Business Support)

Pam Duncan-Glancy (Labour, Glasgow)

8. To ask the Scottish Government what steps it will take to support businesses in key sectors of Glasgow’s economy. (S6O-01787)

Ivan McKee (Scottish National Party, Glasgow Provan)

The Scottish budget 2023-24 will deliver the lowest non-domestic rates poundage in the United Kingdom for the fifth year in a row and maintains a package of reliefs worth an estimated £744 million, which will benefit many Glasgow businesses.

In addition, Scotland’s industry leadership groups have played an important part in developing sectoral recovery plans. The ILG chairs’ round table facilitates cross-industry conversations and actions, focusing on areas of greatest strategic importance for industry, and many of those sectors are represented across Glasgow’s wide and diverse economy.

Scottish Enterprise has invested £25 million in the Glasgow city innovation district as a founding member of Clyde Gateway urban regeneration company.

Pam Duncan-Glancy (Labour, Glasgow)

One sector that has not been mentioned is Glasgow’s black cab sector.

Black cab drivers in Glasgow have been given until June this year to meet low-emission zone targets. Most cannot afford £61,000 for a new car that would comply with the requirements, and, on Friday, the Energy Saving Trust said that there was no money left for grants to retrofit vehicles, and it stopped accepting applications as of yesterday.

Given that the deadline to meet low-emission zone standards is June, how on earth are those drivers expected to meet the requirements? Will the Scottish Government commit to providing more financial support and grants in order to prevent major job losses in the black cab trade in Glasgow?

The Deputy Presiding Officer

As briefly as possible, minister.

Ivan McKee (Scottish National Party, Glasgow Provan)

Since 2019, the Scottish Government has made £7.2 million available to support LEZ funding for small businesses, including taxi operators, and households. There is support available for retrofit of existing vehicles, and the Scottish Government is offering grant funding of up to 80 per cent of the associated capital costs, which is the most generous offer of its kind in the United Kingdom. This year has seen record numbers of taxis being retrofitted as a consequence of that.

Grant funding is available that provides more than £2,000 for any vehicle that is disposed of. That funding is available to microbusinesses, and taxi companies comprise the most applications for that in the past financial year.

Further, Glasgow City Council has a discretionary mechanism for eligible taxi operators to receive a temporary exemption to the LEZ beyond the enforcement date of June this year, which will give taxi operators additional time to comply.

I am happy to discuss any other points with the member and to raise those with Glasgow City Council.

The Deputy Presiding Officer

With apologies to the members whom I was not able to call for supplementary questions, I make the plea that the scripted responses from ministers need to be shorter in order to allow more supplementaries.

Before we move to the next item of business, there will be a brief pause to allow members on the front benches to change.

National Health Service and Social Care

Liam McArthur (Liberal Democrat, Orkney Islands)

The next item of business is a debate on motion S6M-07538, in the name of Jackie Baillie, on addressing the crisis in the national health service and social care. I invite members who wish to participate in the debate to press their request-to-speak button now or as soon as possible. We are pretty tight for time, so I urge members to stick to their allocated speaking time and accommodate interventions within that allocation.

Jackie Baillie (Labour, Dumbarton)

In opening the debate on the future of the NHS and social care in Scotland, I also want to talk about how we deal with the current crisis. However, I cannot help but note that it is only in Opposition time that we debate the NHS crisis. In Government, the Scottish National Party runs away from accountability.

Every day, lives are being put at risk due to the state of our health service; every day, staff are being asked to perform miracles under increasingly difficult conditions; and, every day, the situation further deteriorates.

At Christmas, the number of Scots who waited more than 12 hours at accident and emergency departments soared to its highest point on record—leaving almost 2,000 people a week stranded in waiting rooms for more than half a day. One in seven Scots is stuck on a waiting list, crucial cancer treatment targets are being badly missed and performance keeps falling to new lows. Delayed discharge has spiralled out of control, which has resulted in more than 1,900 beds being occupied every day by someone who is ready to be discharged but who is waiting for a care package that simply does not exist. The list of failures goes on and on.

Heroic NHS staff are exhausted and demoralised. It is right to thank them, but they do not simply want praise—they want action. The situation is so serious that Dr Iain Kennedy, the chair of the British Medical Association Scotland, has warned:

“There is no way that the NHS in Scotland can survive. In fact, many of my members are telling me that the NHS in Scotland has died already.”

That is a shocking observation from people who are on the front line. Our NHS has served the people of Scotland for decades, so the fact that the very existence of the NHS is now in danger is beyond belief.

For the past 15 years, the NHS in Scotland has been run by the SNP; it is entirely devolved. Cabinet secretary—that is on your watch. In the 600 days that you have been in office, you have performed worse than your predecessors, and things have got worse, not better. It is time that you took some responsibility for those serious failings.

The Deputy Presiding Officer

Please speak through the chair, Ms Baillie.

John Mason (Scottish National Party, Glasgow Shettleston)

Does Jackie Baillie accept that she is exaggerating somewhat? Some parts of the NHS are clearly struggling, but other parts are doing very well.

Jackie Baillie (Labour, Dumbarton)

I thank John Mason for his intervention, but he might like to note that I quoted the words of Dr Iain Kennedy, the chair of BMA Scotland. He is not exaggerating.

The SNP Government lacks the vision or political will to save our NHS. Last week, Anas Sarwar and I hosted an emergency round-table session to listen to front-line NHS staff. We heard directly from them about the impact that the crisis is having. They told us that it is causing them “moral injury”, because they feel unsupported in their work.

One front-line worker said that the conditions in which they were working meant

“no dignity, no respect, no safety for patients.”

They told us that this crisis in our NHS is not because of Covid, flu, Strep A or winter pressures; it is the result of 15 years of SNP failure.

Staff on the front line know best how to restore our NHS, how to save lives and how to modernise the system for the future, but the SNP Government is not interested in listening. The Government’s amendment to our motion says it all—excuse after excuse; it is not our fault—and provides no solutions. What a pitiful dereliction of duty.

Humza Yousaf (Scottish National Party, Glasgow Pollok)

Will Jackie Baillie listen to the head of the BMA’s general practitioners committee in Scotland? Dr Andrew Buist said that he

“was not at all convinced by”

Keir Starmer. Dr Buist went on to say:

“His ideas behind reforms seem very marginal and following on from Wes Streeting’s naive comments of GP reform I think further work is required by Labour.”

Is that not a demonstration that, on any subject but particularly health, Labour is completely out of ideas? Will

Jackie Baillie tell us who is wrong—the BMA or Scottish Labour?

Jackie Baillie (Labour, Dumbarton)

This is fascinating. This is the cabinet secretary who is presiding over the collapse of the NHS in Scotland, yet he wants to talk about the NHS in England. That is completely irresponsible and a complete dereliction of duty. [

Interruption

.]

The Deputy Presiding Officer

Ms Baillie, will you resume your seat for a second?

We are barely five minutes into the debate and we are already having accusations levelled through the use of “you” and not through the chair, and we have members on the front benches and back benches yelling at one another while somebody is on their feet speaking. I ask for a degree more decorum and respect in the debate, as emotions will be running high, and I ask that we conduct the debate in a respectful manner.

Ms Baillie, I will give you that time back.

Jackie Baillie (Labour, Dumbarton)

Thank you, Presiding Officer.

The SNP turns its back on Scotland’s front-line medics and nurses, while we are listening to their concerns and their ideas for rebuilding the NHS. They tell us that the crisis in the NHS cannot be resolved until we tackle the crisis in primary care and social care. Dr Andrew Buist said:

“Our primary care system is the foundation of the NHS in Scotland and desperately needs more, not less, investment. I genuinely fear for practices already struggling to keep pace with spiralling demand. The consequences for the communities deprived of their GP services—or having to cope with a brutally diminished service—are severe.”

What was the SNP’s response? It cut £5 million from GP budgets and £65 million from primary care. It presided over a cut in the number of whole-time equivalent GPs—numbers have gone down by 81 since 2017—at the same time as it promised more. That is a legacy of failure that is now driving up pressure and demand in the NHS.

However, that is not the only broken promise that is piling pressure on the NHS. Eight years ago, the SNP pledged to end the dangerous and costly practice of delayed discharge. It failed. Tackling delayed discharge is vital in supporting our NHS. As Dr Iain Kennedy has said:

“The key to unlocking the front door of our hospitals lies at the back door.”

He went on to say that the exit block

“is the real reason for many of the issues at the front door of our hospitals.”

The SNP failure to tackle delayed discharge is causing huge capacity issues for hospitals, with potentially deadly results. It is not the fault of the people occupying the beds; it is a failure in social care, due to a lack of investment over years. Until there is parity of esteem between health and social care, we will not end the problem. We must support a system that values health and social care equally, is rooted in the community and is about funding prevention and not just crisis. That means support for voluntary sector activities that sustain people in their communities. The Government’s approach of cutting budgets for such things is short-sighted and just plain wrong.

I turn to social care staff. In the chamber, we have all rehearsed the health vacancies numbers and the exodus of staff from the NHS: there are 6,400 nurse vacancies; there is a 14 per cent vacancy rate for consultants in some areas; and there are too few GPs to cope with demand. However, there is little said about the rising number of social care vacancies and the difficulty in recruiting and retaining staff. Of course, the Government does not bother to gather that data. If social care mattered, the staff would be counted. If social care mattered, the Government would pay the predominantly female staff a decent wage.

Time and time again, Labour has called for decent pay for Scotland’s care workers. In two successive budgets, we have called for a wage of £15 an hour. The Government should start immediately by providing £12 an hour and then negotiate a path to the rest.

However, time and time again, this SNP Government has voted with the Tories against Labour’s proposal. The Greens, who made promises about that in their manifesto, have quietly dropped their promise—the price of their ministerial Mondeos is being paid for by social care staff.

Although the SNP and Greens pay lip service to our care workers, they are happy for them to be paid less than supermarket staff. It is little wonder that we now face an exodus of staff.

Earlier today, I welcomed the social care sector, care workers and family carers to the Parliament for a round-table discussion. They could not have been clearer about the change that is needed.

We must not forget the enormous debt that we owe to family carers, who work day in, day out to care for their loved ones. By doing so, they relieve pressure on the NHS and the social care system.

However, they are being failed, too. Care packages have been slashed and respite care has been withdrawn. The SNP has failed to implement key recommendations of the Feeley review, including scrapping non-residential care charges. That alone would make such a difference to the cost of living for those who rely on social care, but the SNP dithers and delays.

There is no doubt that our NHS and social care system is in disarray. Lives are being lost and staff are exhausted. It does not get any more serious than this. No amount of shuffling the deck chairs will end the crisis.

However, the SNP could act now. Let us have a credible recovery plan that is not just about applying short-term sticking plasters but about applying a long-term approach that recognises the immense contribution of primary and social care.

To start, the Government needs to invest in primary care, reverse the planned cuts and put in place a credible workforce plan that will deliver more GPs and more staff.

In social care, the Government needs to scrap non-residential care charges—that could be done overnight—end delayed discharge and give social care workers a decent wage rise.

The SNP’s flagship national care service is in a great deal of trouble. There is a lack of vision, and it is more about structures than about changing culture. It will cost £1.3 billion, not a penny of which will go on providing direct care. The proposal is increasingly being rejected by stakeholders. Let us pause the National Care Service (Scotland) Bill, use the money to fund care packages now and take the time to get it right.

The NHS and social care are standing at the cliff edge of a catastrophe. The situation could not be graver. I do not believe that all hope is lost. Nye Bevan, the founder of the NHS, said that the system would continue to exist

“As long as there are folk left with the faith to fight for it.”

Scottish Labour is ready to fight for it; NHS staff are ready to fight for it; millions of Scots who owe the NHS their lives are ready to fight for it; and Scotland is ready to fight for it. Is this Government ready to fight for it?

If it is, the Government will back Labour’s motion today. That will send a message to thousands of NHS staff that all is not lost. It will send a message that this Parliament is united, across party lines, in defence of our NHS. It will also send a message to thousands of Scots on waiting lists not to give up hope.

I move,

That the Parliament is deeply concerned about the experiences of patients and staff across Scotland’s NHS; notes that in recent weeks A&E has recorded the worst ever performance against the 4-hour target, levels of delayed discharge have reached their highest ever and record numbers of people are waiting for appointments, tests and treatment; considers that this has not been caused by short-term problems, but is the result of 15 years of the Scottish Government failing to tackle systemic issues in Scotland’s health and social care system, and believes that, instead of sticking plaster solutions, Scotland needs an NHS Recovery Plan that is community care-led, focuses on preventative healthcare, properly values social care and delivers £15 per hour for social care staff, and has a fully-funded and sustainable workforce plan for health and care services so that Scotland’s NHS is fit for the 21st century.

Humza Yousaf (Scottish National Party, Glasgow Pollok)

I welcome the chance to respond to the motion on the pressures that the NHS and social care are facing. I remind Jackie Baillie and Scottish Labour that the first item of Government business in 2023 was my standing in this very chamber to give an update on those NHS pressures.

Jackie Baillie (Labour, Dumbarton)

I do not wish to be pedantic about it, but I believe that it was a statement that the Opposition had demanded that the cabinet secretary make.

Humza Yousaf (Scottish National Party, Glasgow Pollok)

It was not. This Government proactively offered that.

As I have outlined in recent weeks and months, including to the Parliament in that statement last week, this is by any objective measure the most challenging period that Scotland’s NHS has ever faced—and, I suspect, that NHS systems across the United Kingdom have ever faced. We recognise those unprecedented pressures and we put forward a series of actions, which were announced last October, to help our NHS and social care through this very challenging winter.

As I said, Scotland is not alone. Those challenges are being faced not just across the United Kingdom, but in health services around the world. We have encountered the perfect storm of pressures and it is impacting on our health and social care systems.

One of those impacts is noticeably lacking in the motion. There is not a single mention in the Labour motion of Covid-19, which is still exerting enormous pressure on our health service. Not for the first time in the current parliamentary session, Scottish Labour has brought to the chamber a debate about pressures in the health service and has failed to mention the word “pandemic”. To ignore the pandemic and its impacts is to ignore reality.

Alex Cole-Hamilton (Liberal Democrat, Edinburgh Western)

Will the cabinet secretary take an intervention?

Humza Yousaf (Scottish National Party, Glasgow Pollok)

I will shortly.

I am all for debate on our NHS, but the debate must be grounded in reality. Our entire health and social care system is still facing the continued impact of the pandemic, which is the biggest challenge that our NHS has faced in its 74-year existence. Indeed, the most recent statistics show that Covid is at its highest level since the summer. In the week ending 15 January, there were 1,100 patients in hospital with Covid-19. That represents a doubling of the number of patients since November.

The motion euphemistically refers to the global pandemic that has caused such loss and suffering around the world as a “short-term” problem. Covid is not and never will be a short-term problem. I say to members that they should try telling those who have lost a loved one to Covid this week or over the course of the past three years that Covid is a short-term problem, or telling those who are suffering from long Covid that the pandemic is a short-term problem. To describe Covid as a short-term problem is an insult to every person who has suffered or continues to suffer so badly as a result of this dreadful virus. If Labour had any decency, they would apologise for putting such an insensitive motion in front of Parliament today.

Alex Cole-Hamilton (Liberal Democrat, Edinburgh Western)

The cabinet secretary will be unsurprised by what I am about to say, because we have done this dance before. Of course there has been a global pandemic, and nobody can deny the impact that that has had on our health service. However, the problems were manifest in our health service and in social care well before anybody had heard of Wuhan, China.

The retired chief executive of NHS Scotland, Paul Gray, said that the pandemic only hastened the date of the crisis, which was always coming down the track.

Humza Yousaf (Scottish National Party, Glasgow Pollok)

As I said, members cannot airbrush the impacts that the pandemic has had on our NHS.

I pay tribute to the extraordinary efforts of our workforce across the entire NHS and social care systems. Our deep appreciation of our workforce is reflected in our commitment to having constructive industrial relations with the unions that represent the workers in our services. I am pleased to say that, due to that approach and the meaningful dialogue and positive engagement that I and the Government have had with our trade unions, Scotland is the only part of the UK that is not experiencing strike action by health staff this winter.

In Conservative-controlled England and Labour-controlled Wales, the respective Governments have singularly failed to engage meaningfully with their workforces. As a result, we see nurses taking strike action—regretfully, I do not doubt—today and tomorrow.

Michael Marra (Labour, North East Scotland)

What would the cabinet secretary say to the senior clinician who said to me last week,

“I am thinking of chucking it, to be honest. I actually do not know anyone who isn’t starting to think of chucking it. The NHS is finished.”

Does the cabinet secretary agree with his back benchers that such people are exaggerating?

Humza Yousaf (Scottish National Party, Glasgow Pollok)

I speak to clinicians every day of the week; in fact, I spoke to the Royal College of Emergency Medicine today. What I would say to the individual who spoke to Michael Marra is that we will reward them appropriately. That is why we are making the single biggest pay offer—a record pay offer, and one that has not been made in Wales or in England. We are going to make sure that they are rewarded and we will continue to invest in our workforce.

What have we done about some of the incredible pressures that our NHS is facing? The Scottish Government’s draft budget includes additional investment to increase the adult social care wage, and the creation of the national care service will provide a real opportunity for underpinning fair work in social care and delivering national sectoral bargaining for social care workers. However, no one should be in doubt about that: we are not waiting for the national care service to come to fruition to make those improvements in social care.

To address some of the demands in the system that we currently face—

Monica Lennon (Labour, Central Scotland)

Will the cabinet secretary take an intervention?

Humza Yousaf (Scottish National Party, Glasgow Pollok)

If the member does not mind, I want to make some progress. I have taken a few interventions.

I have announced £8 million to procure an additional 300 interim care home beds on top of the 600 that we are already using. I have also announced further plans to recruit additional staff for NHS 24, which is an incredible service, to help us to reduce some of the demand at the front door of acute services.

As health secretary, I retain the emergency powers and the ability to direct that are set out in the National Health Service (Scotland) Act 1978. I am well aware that a number of members have called for a national major incident to be declared or for the NHS to be put back on to an emergency footing. However, a blanket pause of elective procedures would be the wrong thing to have as there would be significant impacts on the health service and, crucially, on patients who are waiting. It is important that we allow NHS boards to make the necessary decisions at local level. Of course, I have provided guidance and will give support to NHS boards where possible.

Our strategy is unapologetic. We will invest in social care to try to help with the exit block, which we know is causing significant challenges at our busiest acute sites, and we will do our best to reduce demand at the front door. Our work on that is beginning to pay off. We see that attendance at the front doors of busy hospitals is lower than the pre-pandemic level. People are coming in sicker and with higher acuity—that comes across from clinicians on the front line day in and day out—but, if we deal with the front door and the exit block, we can make a difference and see that recovery. We have a relentless focus on that.

Monica Lennon (Labour, Central Scotland)

It is good to hear about the work that is intended to improve the situation, but the cabinet secretary knows as well as I do that, in Lanarkshire, we have had a code black situation for quite a long time now—hundreds of days—and we are not seeing that improvement. We talk about wellbeing and safety for patients and staff, but it is not fair work if people have to go to their work every day and work at the highest possible level of risk in the NHS. When will we see improvements in Lanarkshire? Is there any chance that we will de-escalate from code black any time soon?

The Deputy Presiding Officer

Please begin to conclude, cabinet secretary.

Humza Yousaf (Scottish National Party, Glasgow Pollok)

I absolutely think that we will see an improvement in Lanarkshire. I have spoken to the new chief executive, Jann Gardner, and I urge Monica Lennon to do so if she has not had the opportunity. I have been very impressed by the ideas that Jann Gardner has brought forward to try to make improvements in Lanarkshire. It is well worth Monica Lennon’s time to speak to the new chief executive.

I have no doubt that we still have challenging times ahead in our NHS, but I remain confident that, with the combined efforts of an incredible workforce and the will of the Government, as outlined in the amendment in my name, those challenges will be met and overcome.

I end where I started, by paying tribute to our brilliant NHS and social care staff, who provide exceptional care during the most challenging times. I offer them a promise that we will honour them not just by our warm words, but by our deeds.

I move amendment S6M-07538.2, to leave out from “is deeply” to end and insert:

“recognises the unprecedented pressure that NHS and care staff have faced over the winter and thanks them for all their efforts in caring for the people of Scotland at this challenging time; notes that these are challenges that are being faced across the UK and beyond; recognises that the triple impact of Brexit, the COVID-19 pandemic and the UK Government’s cost of living crisis has exacerbated the pressures faced by the health service; believes that freedom of movement within Europe would be beneficial to help addressing recruitment challenges, and that the only route to securing that is membership of the European Union; welcomes that constructive industrial relations in Scotland’s health service mean that Scotland is the only part of the UK not experiencing strike action from health staff this winter; notes the ongoing £1 billion NHS Recovery Plan, which is supporting new ways of delivering care that are creating additional capacity for inpatients, day case patients and outpatients, including investment to support the four National Treatment Centres (NTC) due to open over 2023; recognises that the expanded NTC network will provide additional capacity of eight additional orthopaedic theatres, an additional inpatient/day case ward, five endoscopy rooms and two general theatres, initially providing over 12,250 additional procedures, dependent on workforce; welcomes the Scottish Government’s draft Budget, which included additional investment to increase adult social care wages, and believes that, through the creation of the National Care Service, there is a real opportunity for underpinning fair work in social care and delivering national sectoral bargaining for social care workers.”

Sandesh Gulhane (Conservative, Glasgow)

Well, after that speech, it is clear that the cabinet secretary just does not get it. Under this health secretary, our NHS is on its knees and is facing a perpetual winter, with waiting times for A and E and cancer treatment at their worst-ever levels. That comes after years of savage SNP Government funding cuts to council budgets, and let us not forget the plans for a national care service, which would scrap local accountability and impose total ministerial control, with the cabinet secretary driving the bus.

Let us look at some of his key performance indicators for the past year. In November 2021, just 75 per cent of patients were seen in A and E within four hours, and we should remember that the target is 95 per cent. If we fast forward 12 months to November 2022, we find that the monthly figure dropped to 67 per cent, which was the worst month on record. More than 13,000 patients waited eight hours in an A and E department, which was twice as many as in the previous November, while the number of patients waiting more than half a day doubled to 5,000.

The situation is so bad that, in January last year, a patient waited more than three and a half days to be seen in A and E. Through freedom of information requests, we have discovered long waits even for people to be triaged in our A and E departments. Now, major hospitals across Scotland are so overwhelmed that they have paused non-urgent elective operations.

NHS Scotland is fantastic because it is full of fantastic hard-working and dedicated professionals. It is the cabinet secretary who is clearly underperforming and who is not providing an effective plan; rather, he has provided what can only be described as a flimsy recovery document.

What do all these numbers actually mean? Let me put it into context for everyone here and everyone who is watching at home, because these are real people. The cabinet secretary says that attendances are down. During the Christmas period, I saw an elderly patient who had significant central chest pain. Because of all the messaging around A and E and the concerns about long waits, she was too scared to go in and instead waited to see me the next morning, when I had to have her blue-lighted in to hospital. That lady has been failed by the system and by the SNP Government.

If the cabinet secretary would like further examples, I am more than happy to provide them. I have examples of children being unwell overnight while the parents were unable to get through to NHS 24; of patients having fallen and lying on the ground waiting for help; and of patients with injuries resorting to do-it-yourself measures. In the real world, where I am seeing patients, people are suffering.

In the winter time, it could be something as simple as slipping on the ice that necessitates your being seen in hospital—a Scottish hospital, which is why deflecting is simply not good enough.

What about patients with time-critical cancer referrals? Waiting times for cancer treatment are also the worst ever on record. In fact, it has been a decade since the SNP last met its target. Let us look closer at this health secretary’s stats. In the third quarter of 2022, just 74 per cent of patients started treatment within the official 62-day standard. We have shocking evidence of a patient who waited two years to start cancer treatment, and also of a six-month wait for breast cancer treatment, a seven-month wait for bowel cancer treatment, and a more than 16-month wait for prostate cancer treatment. That is for cancer.

What about children and mental health? The SNP has never met its target—never. We know that teenagers in Scotland who have been referred to child and adolescent mental health services with eating disorders, suspected attention deficit hyperactivity disorder or autism are being told to expect a two-year wait for a CAMHS appointment. Parents are being advised to go private, if they have savings, at a cost of around £1,500.

In August 2021—

Gillian Martin (Scottish National Party, Aberdeenshire East)

Will the member take an intervention?

Sandesh Gulhane (Conservative, Glasgow)

—the cabinet secretary committed to clearing waiting lists in both mental health and psychological therapies by March 2023. With more than 8,000 people waiting, that is unlikely.

Bob Doris (Scottish National Party, Glasgow Maryhill and Springburn)

Will the member give way on that point?

Sandesh Gulhane (Conservative, Glasgow)

I am afraid that I have no time. Scots either have to sit back—

Bob Doris (Scottish National Party, Glasgow Maryhill and Springburn)

Will the member give way on that point?

Sandesh Gulhane (Conservative, Glasgow)

I was very clear, and I think that members should maybe listen. Scots either have to sit back, shut up and wait, or dig deep and go private to get basic healthcare, relieve their pain—

Bob Doris (Scottish National Party, Glasgow Maryhill and Springburn)

Will the member take an intervention?

Sandesh Gulhane (Conservative, Glasgow)

—to allow them to function again. Presiding Officer, I have been very clear three times.

Annabelle Ewing (Scottish National Party, Cowdenbeath)

Yes, indeed. I think that the member has made it clear that he is not taking any interventions. Dr Gulhane.

Bob Doris (Scottish National Party, Glasgow Maryhill and Springburn)

That is noted, Presiding Officer—[

Inaudible

.]

The Deputy Presiding Officer

I think that we should just allow Dr Gulhane to resume his remarks.

Sandesh Gulhane (Conservative, Glasgow)

The SNP and the cabinet secretary will blame Covid, Strep A infections or the flu for the pressures on the NHS today, but the underlying problems that Scotland’s NHS faces are long in the making—long before Covid but during the SNP’s period in government. Failed workforce planning; cutting the number of student nurse places; failure to solve delayed discharges from hospital as promised in 2014—that all predates the pandemic, and we have been pressing the cabinet secretary month in, month out to plan and prepare for this winter. As he knows only too well, nursing vacancies are up 10 per cent this year. There are now 6,319 nursing vacancies in NHS Scotland. In the year to March 2022, more than 7,000 nurses left the NHS. That is one in nine nurses—the highest number of leavers on record.

Delayed discharge is at a record high, and do not get me started on primary care. A BMA survey found that 81 per cent of practices say that patient demand exceeds capacity. We are seeing practices collapse and general practitioners cutting hours or even leaving the profession due to workload pressures and burn-out. Patients are struggling to get the care that they need.

We have a cabinet secretary who is leading the charge to spend £1.6 billion on a national care service that stakeholders fear will result in hyper-bureaucracy, poorer service in remote areas and poor value for money.

The Deputy Presiding Officer

Dr Gulhane, you are over your time. May I ask you to conclude, please?

Sandesh Gulhane (Conservative, Glasgow)

It would be great if I was not interrupted so much.

We would like to see the Scottish Government introduce the kind of steps that we have recommended. Scotland’s NHS is in a perilous state.

I declare an interest as a practising NHS doctor.

I move amendment S6M-07538.1, to leave out from “, and believes” to end and insert:

“; recognises in evidence of this fact that the 62-day cancer treatment target has not been met in a decade, and that the Child and Adolescent Mental Health Services target has never been met since its introduction in 2014, and calls on the Scottish Government to take action by introducing new crisis maximum waiting times, increasing GP capacity by introducing a full electronic repeat prescription system, introducing an NHS care app to allow patients to see live hospital waiting times, introducing prehab for those awaiting treatment, and expanding rehabilitation and assessment in the community and home (ReACH) teams across all health boards to prevent older individuals from having to return to hospital.”

The Deputy Presiding Officer

Thank you, Dr Gulhane. I call Alex Cole-Hamilton, who has up to six minutes.

Alex Cole-Hamilton (Liberal Democrat, Edinburgh Western)

Thank you, Deputy Presiding Officer. I am very grateful to Jackie Baillie and the Labour Party for making their Opposition debate all about the crisis in our NHS. I rise to speak on that basis for the Liberal Democrats.

It is hard to remember a time when things were this hard and our NHS was engulfed in such a crisis. Indeed, every new set of health statistics reveals yet another unwelcome record. We have heard so much about that today—it is exhausting. To put it plainly, things have never been this bad. Not a day goes by when I do not receive an email, phone call or visit to my constituency office from someone who has been waiting months for a routine operation, weeks for an important diagnosis or days just to speak to somebody in their local GP surgery.

Every day, we hear more alarming reports from the front line of Scotland’s A and E departments. The huge impact on patients cannot and will not be overstated. We have heard from the Royal College of Emergency Medicine how the dysfunction in our NHS is measured out in human lives. It results in more than 40 preventable deaths each week. Perhaps we should stop for a moment and consider that number. Every one of them is a husband, wife, brother, sister, son or daughter who could have, should have and would have gone home but for the crisis in emergency care.

Just yesterday, I heard the heartbreaking story of an elderly patient who was forced to spend her final days on a trolley in the middle of a busy A and E department. Such accounts are, sadly, becoming familiar, but we cannot afford to become accustomed to them or desensitised to what is unfolding daily in Scotland’s NHS. The stakes are too high. People’s lives are literally on the line.

Neither can we afford to accept the toll on staff. They are on their knees. I saw it this week when I visited a medical practice in my constituency. It is a popular medical practice in a bustling part of our nation’s capital, but it has had an open vacancy for a partner for a year. It cannot hope to fill a locum vacancy when somebody goes on leave.

Doctors have spoken movingly about what they describe as the moral injury that they are suffering from being unable to provide the care that they would want to provide and that their patients desperately need. I know that members speak with one voice in saying that none of that is their fault. On the contrary, we owe the staff a huge debt of thanks for the incredible efforts that they go to and the fact that so many are sticking with it. We are blessed to have them and they deserve so much better.

I turn to the crisis that is engulfing mental healthcare in Scotland. Children and young people still face devastatingly long waits for treatment. Liberal Democrat research has revealed that, since mid 2019, the Government’s 18-week treatment time target has been breached by a cumulative 2.7 million days. The Government says that it will clear up those dreadful waiting lists by March, but they are getting worse by the day. The chances of the Government achieving that goal are, to be frank, vanishingly small.

Bob Doris (Scottish National Party, Glasgow Maryhill and Springburn)

I absolutely do not deny the pressures in mental health. However, I put on record the fact that recent correspondence that I had with NHS Greater Glasgow and Clyde shows that it is now on schedule to clear its CAMHS backlog by March this year.

There is some really good work, and some achievements are being secured in the NHS. I do not deny the existing pressures, but we should welcome the successes that exist and that are evident.

Alex Cole-Hamilton (Liberal Democrat, Edinburgh Western)

I am grateful to Bob Doris for that intervention. I salute the efforts of health boards that might be achieving the target, but it is not happening universally. I hope very much that we will achieve it. I certainly want the Government to succeed in it, but it is manifestly clear from the correspondence that I receive that, in Lothian, we are nowhere near clearing those waiting times by March.

The Government says that it will clear those targets by March, but they are getting worse every day and vulnerable young people are paying the price. In previous budget negotiations, my party secured £120 million extra for mental health, but the SNP and Greens have just cut it again by a staggering £38 million. Young people are suffering under the long shadow of lockdown—any specialist or schoolteacher in the country will tell you that. The Government could not have picked a worse time to cut that funding. Liberal Democrats led the way in getting the Parliament to declare a national mental health emergency. Now, the Government needs to step back and give that declaration the funding that it deserves.

In the face of multiple crises, it is natural to wish that someone, somewhere, in a position of power might be working with every breath in their body to make things better. That is what the Scottish people expect of the Parliament and what they hope for, but, sadly, they are faced with an SNP Government that is led by a First Minister who spent the weekend scheming about how best to break up the United Kingdom. She is more interested in which election should be made about her pet project than in ensuring that NHS staff are treated fairly and that patients are seen on time.

Let us get real: one person in six who could not get a doctor’s appointment last year conducted a medical procedure on themselves or got someone equally unqualified to do it. The waiting times for primary care are so bad that it made sense for a Ukrainian refugee to travel home to face the bombs and bullets of her home country rather than the queues of our Scottish NHS. That is the grim reality in Scotland in 2023 under the health secretary, the First Minister and the SNP-Green Administration, and no amount of plotting, scheming or wishing for a future nationalist utopia can hide that fact.

The cabinet secretary accuses others of being out of ideas. If he is open to them, let me offer some. Activate an immediate staff burn-out prevention plan that guarantees better pay and time off when people need it, as well as safe staffing levels. Replace the meaningless treatment time guarantee with real-time information for waits and operations. Reform the funding structure so that dentists can return to taking on NHS patients. Put more counsellors in schools and establish a single point of contact for those young people who are on CAMHS waiting lists. Stop the ministerial takeover of social care and invest the £1 billion that the Government intends to spend on it in services and staff. Finally—

The Deputy Presiding Officer

You are over your time, Mr Cole-Hamilton. You need to conclude.

Alex Cole-Hamilton (Liberal Democrat, Edinburgh Western)

—call a staff assembly that puts the expertise of front-line staff at the heart of solving the emergency. It is an emergency. Get to work, cabinet secretary.

The Deputy Presiding Officer

We move to the open debate. Speeches can be of up to six minutes.

Paul Sweeney (Labour, Glasgow)

I speak in support of the Labour motion

, because the crisis faced by our national health service impacts on every one of our constituents. As we have seen in recent weeks and months, the NHS’s continued decline is not only a matter of grave concern but a matter of deep regret. The national health service is Labour’s greatest-ever achievement, and I can assure everyone in Scotland that defending it against cuts, neglect and continued decline will always be a priority for our party.

Let us look at that continued decline. As has already been outlined very eloquently by my friend the member for Dumbarton, since the cabinet secretary has been in post, Scotland’s national health service has experienced the worst A and E waiting times on record, the highest-ever number of patients languishing on NHS waiting lists, the worst performance against cancer waiting time targets, the largest increase in levels of delayed discharge and the most vacancies ever recorded in the NHS workforce. That can only be described as a litany of failures—a litany of failures that has devastating human consequences for the people whom we are here to represent in this place and one that, frankly, should result in the health secretary resigning.

Gillian Martin (Scottish National Party, Aberdeenshire East)

I ask Paul Sweeney the same question that I wanted to ask Dr Gulhane, who would not take an intervention from me. A lot of GPs and clinicians at a senior level say that the current situation with their pensions is a problem, which means that they retire early. Would Paul Sweeney be supportive of moves to implement for doctors the same pension arrangement that High Court judges are given by the UK Government, to stop the drain?

Paul Sweeney (Labour, Glasgow)

I recognise the point that Gillian Martin makes, which I think is very important. When I was a member of the House of Commons, I raised that issue repeatedly in an effort to get the Treasury and HM Revenue and Customs to address the situation. I recognise that that is a cross-party effort. However, pensions are not the single factor that is driving vacancies in the national health service. There are many things that the cabinet secretary and his team could be doing to mitigate and to solve the problems in our NHS workforce. Young doctors and medics, in particular, are going to Australia in huge numbers, and that is not because of pensions.

It is extremely important to reference the human consequences of the failures that I listed. Statistics are released on a regular basis, and I fear that, at times, it is forgotten that behind every one of those statistics is a human being, who is often in tragic circumstances. I cannot be the only member whose inbox is regularly inundated by constituents detailing their harrowing experiences when they call on our NHS services. I make it clear that, in detailing those experiences, neither I nor those constituents are being critical of the staff who work on the front line, day and night, to keep our NHS afloat despite the incompetence of Government policy.

The content of those emails and pieces of correspondence ranges hugely, but one thing that binds every one of them together is that they paint a picture of a healthcare system that is crumbling and failing patients. In November, I was contacted by an ambulance driver who told me that, when he started his shift that morning at 7 am, his first patient had been waiting for an ambulance since midnight. He went on to detail horrendous cases, such as that of a toddler with complex medical needs who was having recurring seizures and had waited for more than five hours for an ambulance. When the crew arrived, the patient’s oxygen level was so low that their condition was deemed to be life-threatening.

In October, while on a constituency visit, I was approached by a constituent who told me a harrowing story about his father, who had suffered a stroke. Because of the delay in getting to A and E on time, because of ambulance shortages, he has been left permanently disabled. When the family asked the cardiologist how severe his stroke had been, they were informed that, if his relatives had got him in a car and brought him up to A and E instead of waiting for the ambulance to arrive within the appropriate timeframe, he would have been left without any permanent complications. Imagine the guilt of that tragedy and the lifelong complexities and burdens.

Just last week, I was contacted by a constituent whose mother-in-law was deemed medically fit to be released from hospital into a care setting in October. She was released on Friday 13 January and was charged £430 for the privilege of an ambulance transfer from the hospital in one health board to a care setting in another.

I could go on all day about the cases that have been brought to my office that show the state that our NHS is in. Every winter, we go through a crisis worse than that which came before. Every winter, we hear details of harrowing and devastating tragedies that could have been avoided. And, every winter, this Government comes to the chamber parroting excuse after excuse. It is not good enough. As much as I respect the cabinet secretary, on this occasion he is in over his head.

We have a workforce that is the best in the world, but it is exhausted and demoralised beyond precedent. The Labour Party has continually called for and argued for an integrated health and social care system, for an increase in social care workers’ pay to £15 an hour, and for a fully funded sustainable workforce plan to be the backbone of this Government’s plans. To date, we have been ignored, accused of scaremongering and, worst of all, accused of talking down the very national health service that this party created. Each of those accusations is not only a grotesque mischaracterisation of our position but a slap in the face for those of us who want nothing more than to see a national health service that is fit for the 21st century, that patients can rely on and that values and cherishes its workforce. On the basis of the current trajectory, under this Government it is unlikely that we will see any of those things any time soon.

Gillian Martin (Scottish National Party, Aberdeenshire East)

Every country in the UK has a health service that is under a great deal of pressure at the moment. It is always my hope that we come to the chamber open-minded about policy interventions that we can make, based on the advice of professionals who know what they are talking about and within the budget we have available to us. We must also take into account what patients need from our NHS and, with their expectations in mind, what level of tax they are prepared to pay so that Governments can meet those expectations.

That latter aspect can often be ignored. Warm words abound from politicians about our precious NHS, but how often do we really admit that, to maintain that magnificent thing, the benefits of which Scottish and wider UK citizens enjoy, we must collectively dig deeper into our pockets in terms of tax?

This is the UK conundrum. UK politicians in competition to be the next Government do not want to upset the upper and upper-middle classes and the powerful right-wing press—the kingmakers, as we know that they are—by taxing the better-off. Simultaneously, they want to maintain a façade of cherishing the NHS, even when their actions in government contradict that.

In Scotland, people voted for the SNP and the reforms that we outlined in our manifesto, our approach to public spending on health and our approach to tax—albeit within the limited powers we have in that regard. In my view, the full suite of tax and borrowing powers would give a Scottish Government of whichever stripe the means to protect over the long term the NHS that we want, especially in the face of the erosion of the national health service by successive UK Conservative Governments. In addition, I am sorry to say that the Labour health secretary in waiting, Wes Streeting—

Jackie Baillie (Labour, Dumbarton)

Will the member give way?

Gillian Martin (Scottish National Party, Aberdeenshire East)

I will finish this point. Diane Abbott said of Wes Streeting:

“Inch by inch Wes is trying to push for a privatised/insurance based NHS”.

On the Labour motion that is in front of us, I remain astonished that Opposition parties are not compelled to produce detailed budget plans for scrutiny. As it stands, the public cannot take Opposition proclamations and demands at their word. How might Scottish Labour’s demands for pay for carers be funded? We do not know.

Jackie Baillie (Labour, Dumbarton)

Will the member give way on that point?

Gillian Martin (Scottish National Party, Aberdeenshire East)

I would like to hear the answer to that.

Jackie Baillie (Labour, Dumbarton)

We have outlined over two successive budgets how we would pay for that. I point out to the member the £1.3 billion that the SNP is about to spend on a national care service that nobody believes in. It could use that to fund social care pay.

Gillian Martin (Scottish National Party, Aberdeenshire East)

Well, I have heard of back-of-the-envelope stuff—I cannot see the envelope on Jackie Baillie’s desk, but there we go.

From which other part of the public sector would the Opposition parties take money to put more into the NHS? Again, we do not know. Every week, the Conservatives complain in this chamber about the services that the Scottish NHS delivers, but they wanted the Scottish Government to replicate the tax cuts for the richest that Liz Truss put forward. Had we done so, how would we have maintained the current record spending that the SNP has put into the Scottish NHS? The simple answer is that we could not have.

The Tories in particular love when we compare the Scottish NHS with the service that they run south of the border. It is not just me who is pointing this out: when Sandesh Gulhane was interviewed on “Good Morning Scotland”, he was pressed on the point that if he was calling for the head of my friend and colleague Humza Yousaf over long waits in A and E, he should surely condemn his Conservative counterpart in England, where the waits are longer, the situation is far more precarious in terms of patients being left without care, and investment in the NHS is being stripped out by his colleagues. Let us not forget that the nurses are on strike there today as well.

I have massive sympathy for anyone with responsibility for the NHS wherever they are in the UK. Covid is still causing staff absences and increased admissions. As our health boards warned us, recruitment is suffering because of Brexit. We need better workforce planning, including targeted immigration and action on pensions, as I mentioned in my intervention to Paul Sweeney.

I have to say that I have a smidge of sympathy for Scottish Labour, too, which has been done no favours by its leadership in the past couple of weeks when it comes to health. Its members must have been horrified when Labour leader Keir Starmer played amateur doctor on television on Sunday—[

Interruption

.] Similarly, they must have been hiding behind the couch—

The Deputy Presiding Officer

Ms Martin.

Gillian Martin (Scottish National Party, Aberdeenshire East)

—when Wes Streeting—

The Deputy Presiding Officer

Ms Martin! Hello! Could you sit for a second? Could we please have less chit-chat from across the front benches, which is interfering with our ability to hear the member? Please resume, Ms Martin.

Gillian Martin (Scottish National Party, Aberdeenshire East)

Thank you very much, Presiding Officer.

Similarly, they must have been hiding behind the couch when Wes Streeting went to war with GPs, prompting Dr Philip Banfield, who is the UK BMA chair, to say that Mr Streeting

“does not understand general practice”

and that

“the Labour Party has a lot to do between now and the election”.

The Scottish NHS is under the same pressures but, my goodness, our cabinet secretary is working with the sector, negotiating to avoid strike action, providing extra care beds to ease pressures and listening to the professionals.

Across the chamber and across the health and care sector, we are united on one thing, and that is that a great many of the issues in A and E and wards have been caused by poor patient flow, both through and out of hospital. The social care system in its current state needs reform. The Scottish Government is working now to secure more places in care settings for those who are ready to leave hospital. However, radical structural reform is needed in the form of a national care service—a service that, I might add, has the support of Unison and many of the service users we have spoken to in our deliberations.

Alex Cole-Hamilton (Liberal Democrat, Edinburgh Western)

rose—

Paul O'Kane (Labour, West Scotland)

rose

—

The Deputy Presiding Officer

The member is just about to conclude.

Gillian Martin (Scottish National Party, Aberdeenshire East)

This is a chance for us all to come together with ideas on how we achieve that service and eradicate the major cause of the issue that is before us. Let us work together to shape the national care service and make it our whole Parliament’s defining achievement of the sixth session.

Sue Webber (Conservative, Lothian)

Our NHS is on its knees. Waiting times for A and E and cancer treatment are at their worst-ever levels, yet more parliamentary time was set aside last week to discuss independence than was spent on our failing health service. As Jackie Baillie stated, it is only in Opposition debate time that we get to discuss the issues in detail.

Today, as one in seven people languishes on a waiting list, I want to focus on waiting times. The real-time impact of pausing and restarting elective surgery is that we never really know the accuracy of median waiting times. All that patients are asking for is clear and accurate data on approximate waits.

Public health data as it is presented shows average waits of 19 weeks. However, that data uses the average median and does not count urgent cases. As Dr Gulhane mentioned, some health boards are not doing any elective surgeries, so it is impossible to deliver a four-week wait.

Patients get angry and distressed when they deal with moving medical goalposts. They have this unrealistic ideal of their waiting time, so they have increased phone contact with their GP and make more calls to hospital secretaries as they wonder where they are on the waiting list. All of that adds to the daily pressures that our front-line staff are facing.

Lauren Bennie, Scotland head of Versus Arthritis, said:

“People need clear and regular communication about when they can expect to receive surgery and what information and support is available while waiting. Many fear being forgotten or feel abandoned to manage their pain alone.”

Alex Cole-Hamilton (Liberal Democrat, Edinburgh Western)

Sue Webber has outlined eloquently the reality that many of our constituents face. They are given letters that say that their treatment will begin in 12 weeks when there is not a hope in hell that they will be seen within 50 weeks. People make life plans based on those letters; they agree to attend weddings overseas or put off holidays in the hope that they will be seen. We need to make sure that patients are seen in real time. Does the member agree?

Sue Webber (Conservative, Lothian)

Yes, I agree.

I will continue to quote Lauren Bennie, who said:

“The difference between a 33-week wait and a 19-week wait can be devastating for people”,

as Alex Cole-Hamilton just outlined, especially those

“with arthritis whose physical and mental health are worsening by the day, slowly eroding their independence. Edinburgh University researchers found that people’s quality of life significantly deteriorates after each six-month period of waiting.”

People with arthritis who are waiting for hip and knee replacements live with severe pain, struggle to move around and are often unable to work. In terms of healthcare economics, those operations are some of the most effective treatments that the NHS offers, so it is unacceptable that people face long waits or financial instability to access them.

We increasingly hear from people who feel that they have no choice but to use savings or borrow to pay for surgery privately. The financial hit is especially devastating when living costs are soaring. Before I get any interventions, yes, that risks widening health inequalities further and thus has to change.

We must remember that pain is crippling and debilitating. People have little or no confidence in any practical steps to reduce the impact of their pain on their daily life. Reliance on pain medication is very high, and a lot of self-management resources have been suspended due to the pandemic. Medication options, from prescription to over the counter, take a toll, too—from fatigue to nausea and, dare I say, constipation. They, too, impact on the ability to work and have a normal life. We call on the SNP Government to introduce prehab for people awaiting treatment, so that people can live well while waiting. Reliance on pain medication is very high and impacts the quality of many people’s lives.

The cabinet secretary told us that all would be well when he brandished his NHS recovery plan in August 2021. He then claimed that everything was under control when presenting the winter resilience plan in October. Now he has been forced to concede that everything is far from well.

Rather than work collaboratively with other politicians who have plenty to offer in what is undoubtedly a national emergency, on Tuesday of last week, Mr Yousaf was utterly dismissive of the Conservative NHS action plan, which was produced by someone who knows what they are talking about. The Scottish Conservative’s 14-point recovery plan includes streamlined specialist super Saturdays, the expansion of same-day operations and more off-peak scanning.

My colleague Dr Gulhane is a practising doctor and a former orthopaedic registrar. As he said, he spent the holiday touring practices to get a genuine feel for what is happening across the country. I have spent more than 25 years working with healthcare providers in Scotland, England and Northern Ireland.

The SNP has spent years hollowing out our local councils. With savage funding cuts on the horizon, its plans for a national care service would scrap local accountability and impose total ministerial control.

Kaukab Stewart (Scottish National Party, Glasgow Kelvin)

Will the member take an intervention?

The Deputy Presiding Officer

The member will be concluding shortly.

Sue Webber (Conservative, Lothian)

I am in my concluding remarks.

Last week in his statement, Mr Yousaf admitted that

“it is right for health boards to retain decision-making at local level so that they can determine how best to flex their services”.—[

Official Report

, 10 January 2023; c 37.]

Perhaps his Government should heed his own advice when it considers wasting £1.7 billion on ripping social care from local authorities.

Christine Grahame (Scottish National Party, Midlothian South, Tweeddale and Lauderdale)

I, too, put on record my gratitude to all who work across our NHS and care sector in whatever capacity.

I now address the Labour motion. It would have more heft if it at least mentioned, if only in passing, the devastating impact of Covid and the years to follow when the NHS throughout the UK and healthcare throughout Europe and the wider world dealt with a raging pandemic and adapted procedures in the face of the virus, which brought what I might term the usual provision of healthcare to a standstill.

The motion also does not recognise that it will take years for recovery. To this day, sanitation is high, mask protection continues and ambulances have to be sanitised after every patient. All that adds to delays, and Covid still stalks hospital corridors. Add to that the pressures of influenza—not mentioned by Labour—which can be very serious and, despite vaccination, is possibly proving more so to some groups of people, including me, because we have reduced resistance after years of wearing masks and sanitising our hands.

Then there is the welcome but extra pressure of the demographic shift, which also went unsaid in the Labour motion. We all live longer, which is a good thing, but age naturally brings additional demands on our health services and care sector. Wherever we look in the UK, the issues remain the same. Indeed, the situation is worse in Wales—where Labour is in government—than it is in England under the Conservatives. I do not say that with even a slight degree of satisfaction—not in the least—but do so simply to put today’s debate into context.

Also for context, I say that, in my 24 years as an MSP—during the Labour-Liberal Democrat coalition and to date—much of the attention has been on firefighting the increased demands on the NHS. Some good progress was made, and I welcome free personal care under the Labour-Liberal Democrats, and, of course, free prescriptions, free school meals for those in primary 1 to primary 5 and the child payment, all of which are interventions made under the SNP Government that are aimed at reducing NHS pressures. In England, it costs more than £9 per item prescribed, and therefore some people who live south of the border are rationing their medication to the endangerment of their lives let alone their health.

The problem is, as it always has been, how to move from the immediate demands, which are exacerbated as I have narrated, to a medium to long-term solution. I therefore welcome this suggestion by the British Medical Association:

“BMA Scotland is calling for a National Conversation with all stakeholders, to take a long-term approach to what we want and expect from our NHS. Only when we fully understand what we need and want from the NHS can proper consideration be given on how we resource it.

The National Conversation, commissioned by but independent of the Scottish Government, would act as a facilitator for a dialogue between the public, health and care stakeholders, Scottish Government and political parties; its purpose is to inform the reform, it must have practical outcomes that are part of a long-term vision for NHS Scotland.

Now is the time to seriously consider what the NHS provides within the resources we provide it with, and ask the difficult questions around what we as a society want from a National Health Service free at the point of need, what we can afford to deliver and how we deliver it. There are no easy answers.”

I agree.

Covid was a wake-up call for all of us to the growing needs of those who receive care at home or in care homes and the varying standard of that care; integrating health and social care; the standardisation of care provision; recruitment and retention; and the expanding use of pharmacies and allied health professional services so that the right treatment is provided at the right time by the right health professional. All of that is not easy, as the BMA stated.

Paul Sweeney (Labour, Glasgow)

Does the member agree with me that, although care is critical, resourcing it also essential? The disproportionate cuts that have been imposed by the Government on local government have only exacerbated the delayed discharge problem.

Christine Grahame (Scottish National Party, Midlothian South, Tweeddale and Lauderdale)

I will come on to resourcing.

During this thoughtful discussion, we should consider the following questions: what is the role of health boards? What should the relationship between GP practices and health board areas be? Should more GPs be directly employed by the NHS rather than in private practice? How much more can technology be used? What should the state provide in the care sector? What kind of workforce do we need and where do we get it when some options are closed because of Brexit? What will be required as our ageing population increases? How does our society afford expensive treatment and drugs? What price do we put on all that, and how do we fund it?

This is the only party-political thing that I will say: as a result of the disastrous and costly funding of public buildings, including in the NHS, using the private finance initiative under Labour, the cost each year to the Scottish Government in repayments to the private sector on NHS buildings alone runs at £250 million, which could have been better spent on services.

It is the job of the Opposition to hold the Government to account, but too often that is with press headlines in mind. Opposition members must offer solutions and, most importantly, credible funding sources from what is virtually a fixed budget, now reduced in value by £1.4 billion due to inflation.

I say to members in the chamber: less heat and more light, please. Turn down the volume on theatrical rhetoric; turn up thoughtful and responsible debate. That is what the Scottish public want.

Sarah Boyack (Labour, Lothian)

Our NHS is

in crisis, and we urgently need an NHS recovery plan, as Jackie Baillie has said. I agree that Covid has had a massive impact right across public life, including on the NHS, but we cannot pretend that the problems in our NHS are not long term and deep seated.

In Lothian, up until the first lockdown, the Scottish Government’s target to have 95 per cent of patients admitted, discharged or transferred for A and E treatment within four hours from arrival was last met in October 2017. This is an on-going challenge and we need to look at the issue of staff investment in terms of doctors and nurses and, critically, in terms of care staff, who will not be attracted to a profession where not only is the salary lower than many in other jobs but the job is significantly more stressful. It can often require people to pay for their own travel costs to support clients, and carers are not getting the career development opportunities that we should be giving them. That is why we need the national terms and conditions and decent career opportunities that Jackie Baillie talked about—not a bureaucratic, centralising organisation that will strip yet more investment from our cash-strapped local authorities, which are on the front line, trying to provide care for our communities.

When we look at NHS staff, we need to focus not just on this year’s pay negotiations, although those are critical to making sure that staff get a decent reward for their work. We also need to ask what more can be done to support staff retention. The pressures in the NHS in terms of understaffing and the stress that many staff are facing need to be addressed now.

The eye-watering length of time that people have to wait for treatment is not just affecting members of the public; it is also affecting those staff who cannot continue working for the NHS because they are waiting for an NHS operation or treatment.

When I recently met NHS Lothian staff members, it was heartbreaking to hear about their personal situations and to pick up on their anger about the use of agency staff when they would rather have full-time, permanent NHS staff doing that work. There are key challenges that we need to address.

I want to say something about the long-standing backlog of challenges. In NHS Lothian, a lot of our problems are due to systemic underfunding. The national resource allocation formula has not been delivering sufficient investment for years and, in Lothian, we have a growing population and we will continue to see more people needing support in the future. Our projected net population growth is 84 per cent of Scotland’s projected net growth. We need a discussion about that now, because we will get more young people, but we are already getting an ageing society, as Christine Grahame has just mentioned.

NHS Lothian needs that support now because, as I understand it from the helpful briefings that we get from the staff who are running those services, the services in Lothian are already at capacity. That is before that population increase, so we urgently need investment in staff to keep the services going. We also need new buildings, such as the eye pavilion, but there are other key investments that we need and which need to be factored into an NHS recovery plan to create the investment, to tackle the projections and to make sure that we can provide services now and that we have confidence for the future.

A particular issue that Jackie Baillie rightly finished on is the need to focus on preventative care, because access to our GPs and to community healthcare services is critical but, last year, our GPs saw significant cuts from the Scottish Government. That does not help because, in Lothian, we need capacity increased not just in our hospitals but in our communities.

Day after day, people phone my office who are struggling to get GP appointments and there are lengthy phone waits. They have to phone day after day, because there are simply not enough appointments available. That means that underlying health problems go untreated, which is a disaster for people as potentially dangerous symptoms do not get picked up. For example, symptoms of cancer do not get treated. As we know, swift treatments, with the fantastic services that we have in the NHS, can save people’s lives and give them different outcomes. That is why people are going to A and E, because they are desperate to get help when they need it, especially when they have experienced pain day after day and have waited weeks to get access to support.

We need more information. Last week’s briefing on the survival of cancers was impactful. Making sure that people get access to our GPs is critical; we can then get them access to operations and the treatment that they urgently need.

In his summing up, I want to hear from the cabinet secretary what action he is taking to prioritise additional investment in GP services across the country, particularly community access, with a focus on Lothian, not forgetting the current crisis in that region that is getting worse. Day after day, people are frustrated and upset; they are stuck in hospital waiting for operations that they urgently need. This week, someone approached me who needs to go to another health board for an operation. However, they are stuck in a bed in NHS Lothian, which is not what they want. They do not just want the operation; they also want not to be blocking someone else from getting access to their bed. People cannot go home, because the care that they need is not available, and there is not enough step-down care in care homes either. We urgently need action. Investment in preventative care is critical.

I would push back on the SNP members’ comments when they say, “We are not being party political.” The SNP has been in power for 15 years. The crisis in our NHS is of long standing and is due not only to a lack of investment but to a lack of correct priorities. Prevention is better than cure, but we are getting the opposite of that. We do not need social prescribing in three or four years’ time when we do not have the cultural organisations—

The Deputy Presiding Officer

Ms Boyack, you need to come to a close, please.

Sarah Boyack (Labour, Lothian)

We need action and

investment now.

Emma Roddick (Scottish National Party, Highlands and Islands)

It is an inescapable fact that the pandemic is, as it has been for healthcare systems across the world, the greatest challenge that our NHS has faced since it was created 75 years ago. I am not sure how Labour has managed to square the circle in its motion, in which it claims that the pressure on the NHS in Scotland is not caused by “short-term” issues, but also claims that those issues must be addressed by a recovery plan. There is, of course, an on-going recovery plan that has been funded with £1 billion, because our NHS needs to recover from what the Labour Party calls “short-term” issues.

Labour has its fingers in its ears, but the current issues that we are facing are enormous, so it is inevitable that there will be some effect on the NHS and its workers. Those issues include Brexit, which has seen us lose so many of our staff who no longer feel welcome in the UK, thanks to decisions that were made down south. They include the Covid pandemic, in which—even putting aside the current high number of cases—thousands of people who would otherwise have been well have been admitted to hospital, struck with long Covid, or otherwise made weaker as a result of catching the virus. They also include, of course, the Tory-made cost of living crisis, which is pushing people into poverty-related health issues and putting pressure such as I have never seen on budgets, thanks to overwhelming inflation.

Those issues have widespread and long-lasting effects that cannot be ignored, and they certainly cannot be separated from the significant pressure that exists, as Labour highlights, in the NHS.

Paul O'Kane (Labour, West Scotland)

Emma Roddick is seeking to outline a number of the challenges. However, does she accept that clinicians are saying that the current situation has been 15 years in the making, and that the issues that the member is relaying to the chamber are exacerbating a situation that was already extremely difficult because of decisions of the Scottish Government?

Emma Roddick (Scottish National Party, Highlands and Islands)

I am not sure which “clinicians” the member is referring to, but there is certainly work going on.

In looking at the Scottish Government’s amendment to the motion, I see no denial that there are problems within the NHS. I will come on to the difference between how those problems have been dealt with in Scotland and what has been done down south, because the context and issues that I have outlined exist in the rest of the UK, too, so what matters most is how the relevant Government chooses to react and how the issues are dealt with.

In Scotland, the SNP Government has eased delayed discharge by purchasing additional care beds and providing additional support to NHS 24. It has got round the table with unions and made the offer of a 7.5 per cent pay rise for agenda for change staff. We can compare that to what the UK Government has done, which is to disrespect unions and table legislation to prevent folk from going on strike.

Perhaps the different tack that is being taken in Scotland is why we have the best-performing A and E service in any of the four UK nations, and perhaps the fact that we have the best-paid staff in the UK and make the time to sit and talk and negotiate with them is a big part of why we are avoiding strike action here today, unlike other parts of the UK.

Perhaps Labour could look at the bigger picture and think about the contrast between the two systems that are on offer and the positive change that has been made here, and, rather than coming here and making claims about the NHS being on the point of total collapse, make actual costed and reasonable suggestions, and back us when we demand more freedom with the budget, which would allow us to make even more progress even more quickly.

Pam Duncan-Glancy (Labour, Glasgow)

Will the member take an intervention?

Emma Roddick (Scottish National Party, Highlands and Islands)

No—I am sorry.

I used to be a carer. My wee sister is still one—and a far better one. I would love to see more support for carers, and I know that the incredibly ambitious national care service will make the massive changes to their experience that are needed. Labour seems to be both demanding that we spend money that we do not have and complaining about the money that it is planned will be spent on the national care service. It wants us to spend more money, but not on that, even though the service is backed enormously by the public.

The increase in adult social care pay this year to £10.90 an hour is part of a 14.7 per cent increase in the past two years, and is the same as the Labour Government in Wales is offering. To offer more “overnight”, as Jackie Baillie asked for earlier, would require greater fiscal powers and/or the cutting of budgets elsewhere. Even increasing pay for care staff to £12 an hour would cost the Scottish Government hundreds of millions of pounds.

Jackie Baillie (Labour, Dumbarton)

We have been asking for that for some time now. It is not an overnight request.

Does the member agree that £10.90 represents only a 3.8 per cent pay rise during what is an incredible cost of living crisis, and that band 3 NHS workers have got significantly more. Does the member not think that they should get the same?

Emma Roddick (Scottish National Party, Highlands and Islands)

I was quoting Jackie Baillie’s earlier contribution when I used the word “overnight”. I do not think that anything that she has just said is in conflict with how I presented it.

It is a real shame that we lack access to the levers of power that are required to address the issue fairly, and that Labour—even after the Tories tanked the economy last year with their irresponsible UK governance—is still failing to back calls for greater power. We should not be tied to public spending decisions that are made by a Conservative Government in another country. We should be able to borrow where we see fit in order to react to events and fund our NHS properly, because the Government here in Scotland wants to protect the NHS. It does not want to let privatisation in and it is not focused on cost cutting more than on good public service.

We cannot keep relying on the promises of an irresponsible flip-flopping Government elsewhere, given that last year showed us that we cannot rely on its block grant figures from one month to the next. If we had employment powers here, we could defend workers against the attack that is being made on their rights through the introduction of the most restrictive anti-trade-union laws anywhere in Europe.

I wish that we could be debating today a greater vision from Labour—one that involves protecting and strengthening employment rights, rather than merely hearing that we should put more money in and do it quickly, without any indication of where in the fixed budget that money would be taken from.

The Scottish Government funds the NHS to a proportionally higher level than other Governments across the UK fund it; it will continue to do so, all the while keeping that public service in public hands, with public accountability.

Edward Mountain (Conservative, Highlands and Islands)

I start by thanking Labour for giving us the opportunity to discuss the national health service. I do not agree with everything in its motion, but I am grateful that it, like us, wants to concentrate on this subject, which is—dare I say it?—close to my heart and has become very personal to me over the past year.

Let us consider some of the problems that we are facing across Scotland, and let us turn the spotlight on the Highlands.

We know that, in December, across Scotland just more than 50 per cent of A and E patients were seen within a four-hour waiting time. That is the lowest figure ever recorded. The crisis in A and E has extended outside that department and on to the ambulance park. For the first time in the Highlands, we have seen ambulances that are carrying patients who are in need of treatment waiting outside hospitals. Furthermore, some ambulances have been deployed with only one member of the crew in them. The First Minister admitted that there were about 1,400 instances of single-crewed ambulances being deployed.

Humza Yousaf (Scottish National Party, Glasgow Pollok)

Obviously, we do not want any instances of single-crewed ambulances, but will Edward Mountain accept the Scottish Ambulance Service figure that well over 90 per cent of ambulance call-outs are double crewed? Although it should not happen, single crewing happens in a minority of call-outs. The overwhelming majority of call-outs are double crewed.

Edward Mountain (Conservative, Highlands and Islands)

I absolutely accept that point, but if the cabinet secretary was stuck on the A9 in a car, and a single-crewed ambulance turned up to collect him, I bet that he would wish that there were two people in that ambulance, so that he could not only be treated but taken to the hospital.

Let us look at other issues, such as the pre-hospital immediate care and trauma—PICT—team, which was going to be disbanded. That was a group of doctors who were working seven days a week, on the ground, to deliver care outside the hospitals. They were the only ones who were capable of dealing with patients who were stuck in ambulances on the forecourt because, according to convention, A and E doctors do not go out to ambulances. The PICT team doctors could go out, but it looked as though the team was going to be cut.

What about the other people whom we really want to see—our GPs? There has been a big fall in the number of GPs and an increase in demands on them. Miles Mack, who is one of the GPs in the Highlands, has warned about the challenges of recruiting GPs across the Highlands. It is really difficult. I know of at least three GP practices in the Highlands that have only one GP. What happens when that GP is sick? The other day, I met a constituent who has waited 12 weeks for a telephone appointment. They said to me that they are desperate for the telephone appointment because they want to get on another waiting list. They told me—these are their exact words—that they felt that

“it would be easier to get a face-to-face appointment with the Pope”

than it would be to get one with their GP. We should not be in that situation.

Let us look at Caithness. In 2016, there were 250 births in Caithness general hospital. The cabinet secretary’s Government centralised the maternity service so that, apart from very few, all births now take place in Raigmore hospital. Last year, 180 births took place in Inverness and only 10 in Caithness. Of those 180 births, more than half were induced. Is that how we want to go forward? Is it down to the shortage of staff or the fact that we are not providing what we need?

If we look at the orthopaedic figures, we see that 2,569 patients are waiting for orthopaedic surgery. Research from Aberdeen suggests that those patients might have to wait seven years for treatment. That will not be solved by the national treatment centre, which the cabinet secretary mentions in his motion and is delivering two years late and over budget. It is still not fully staffed—20 per cent of staff are still to be found. He said that, when the centre is working at full capacity, it will deal with approximately 2,000 cases a year. We have that many cases in the Highlands, but that is a national treatment centre. We should never forget that the national treatment centre will deal only with the easy orthopaedic cases—not with the difficult ones that have been waiting for four years and whose hips and joints are damaged because they have waited so long.

Therefore, the national treatment centre is not all that it promises to be. According to the figures that I have worked out, 868 patients will have to travel outwith the Highlands, either to Aberdeen or the Golden Jubilee hospital, in order to get the treatment that they need. Of those, 184 patients have been waiting in excess of three years. That is the state that we are in, and it is completely unacceptable.

The Presiding Officer will be tight with my time, so let us look very briefly at another area. There are more than 700 children on the waiting list for neurological development assessment. The maximum waiting time for treatment is meant to be 36 weeks, but that is just in the cabinet secretary’s mind—the staff estimate that it will take two years. Unacceptable pressure is being placed on them by mismanagement. I think that that is unacceptable and will, without doubt, result in bullying, because people are being set unrealistic targets that they cannot achieve.

I believe that this Government has a lot to answer for when it comes to the state of our national health service, which I am really proud of and passionate about protecting.

Cabinet secretary, I have said to your two predecessors—

The Deputy Presiding Officer

Mr Mountain, you need to conclude.

Edward Mountain (Conservative, Highlands and Islands)

I told Shona Robison and Jeane Freeman that it was time for them to go if we wanted to protect the health service, and I say the same to you. Your time is up, cabinet secretary—you have failed us and you are a disgrace.

The Deputy Presiding Officer

I remind members that they should address remarks through the chair. References to “you” are, in fact, references to me. I am sure that that is not what the member was trying to say.

John Mason (Scottish National Party, Glasgow Shettleston)

I will give a summary of my most recent personal—[

Interruption

.]

The Deputy Presiding Officer

Mr Mason, please sit down for a second.

Could we have less sedentary commentary from across the chamber? We need to hear the speaker who has the floor, and that is Mr Mason.

John Mason (Scottish National Party, Glasgow Shettleston)

Thank you. I will give a summary

of my most recent personal experience of the NHS. On Saturday afternoon, I went to visit my very elderly aunt in hospital, which happens to be in the Ayrshire and Arran health board area. I was there for only a short time, but the whole experience was welcoming, friendly and relaxed. Someone came and let me into the ward even before I had had the chance to press the buzzer, I was directed to my aunt’s ward, and a seat was brought beside her bed for me to sit in.

It was a lovely bright ward with lots of daylight, and it had just six patients in it. I could see the staff chatting to other visitors as well as to the six ladies who were staying there. When it was time for tea for the patients, the staff sought to interact with my aunt, helped her to drink it, went and got more milk when she said that it was too hot, and did all that I would have expected and hoped for, and in a warm, friendly and relaxed way. What a good advert for the NHS and, in this case, for Ayrshire and Arran.

No one is denying that A and E is facing challenges; no one is denying that elective surgery has been suspended in some cases; and no one is denying that GPs are under extreme pressure. However, let us not make sweeping and false declarations that the whole of the NHS is on its knees and that the whole of the NHS is broken—that is most certainly not the case. Many parts of the NHS are working extremely well and are fulfilling the roles that they were designed to do.

Paul O'Kane (Labour, West Scotland)

I note the member’s comment about sweeping generalisations and his previous comment during an intervention about exaggeration. Will he clarify whether he agrees with the clinicians who are saying that the NHS is struggling and suffering and is on its knees?

John Mason (Scottish National Party, Glasgow Shettleston)

I thought that I had been clear, but my point is that some parts of the NHS are clearly struggling and some parts are doing incredibly well. It is a mixture; it is not one picture.

I do not think that exaggeration and bringing up the most extreme individual cases serve Opposition politicians at all well. We will do ourselves and the country a better service if we discuss these challenges in a serious and sensible way, especially if we focus on what practical steps can be taken.

The Labour motion says that the crisis in parts of the NHS

“has not been caused by short-term problems”.

In fact, it has been caused by a number of things, both longer-term and shorter-term. In the short term, we have had Covid, which has been like a major injury or accident to our health system. When a person has a serious accident or operation, it can take them a long time to recover and fully regain their strength. In the same way, Covid was a major blow to all of our health systems, and it is taking all countries time to recover.

I fully accept that there are longer-term problems, including, for example, overall UK funding for the NHS. The UK is spending 39 per cent less per person on healthcare than Germany is, and 21 per cent less per person than France is. Those figures were highlighted in the

New Statesman

last week, and I understand that they are based on the Organisation for Economic Co-operation and Development figures.

That UK underspend on health is the result of Conservative and some Labour Administrations at Westminster peddling the idea that we can have high-quality public services while reducing the amount of tax that everyone pays. I am afraid that that is just not possible, so now the chickens have come home to roost. Lower taxes mean poorer health and other public services.

Health is devolved in Scotland, and we can vary income and other taxes to some extent in order to gain more funds for the NHS; however, we are constantly warned that we must not stray too far from UK tax rates in case every better-off person moves south, so we can only really vary health investment to a limited extent.

There is certainly no way that Scotland can make up the 21 per cent funding gap with France or the 39 per cent funding gap with Germany.

Jackie Baillie (Labour, Dumbarton)

Will the member take an intervention?

John Mason (Scottish National Party, Glasgow Shettleston)

I am sorry, but I have taken an intervention already and I do not think that I have time.

We are looking at a UK funding problem here, not a Scottish one—it is certainly not only, or even primarily, a Scottish problem.

Let us remember that, in recent years, Labour has repeatedly told us in budget discussions that we should be funding local government better. Broadly, that means giving the NHS less, because those are our two main areas of expenditure in Scotland. Therefore, Labour cannot have it both ways.

Jackie Baillie (Labour, Dumbarton)

Will the member take an intervention on that point?

John Mason (Scottish National Party, Glasgow Shettleston)

I am sorry, but I do not have time; I have one minute left and I have a huge number of important things to say.

Either we have been giving the NHS too much funding and local government too little in recent years, or we have been giving local government too much and the NHS too little.

We see in Labour’s motion the idea that we should focus more on preventative healthcare. Absolutely—I think that everyone here agrees that we should do that. However, the problem is that no one here has come up with a workable plan as to how we would do that in practice. Again, it is a question of choices and where we disinvest to find the funds to invest more in areas of prevention.

We have seen the tragedy of the air crash in Nepal this week. Members might know that I lived and worked in Nepal for three years. When I think of the health services in that country in comparison with what we have here in Scotland, it is like night and day.

We tend to forget how fortunate we are in comparison with most other countries in the world. If we want to maintain and improve that position, and the UK wants to match countries such as Germany and France, we must have a serious adult debate about what we want and how we will pay for it. That should not be just among ourselves as politicians; we must engage the wider population of Scotland. Do we want to be a low-tax country with a declining NHS, or are we prepared to pay more for the quality NHS that I want to see?

Gillian Mackay (Green, Central Scotland)

Before Christmas recess, we all noted in the chamber the strain that could be brought on the NHS over winter. Sadly, we are now seeing the reality of that played out in our hospitals across the country.

We need to tackle the current issues and ensure that we build in future resilience. We must plan services by anticipating demographic change. In addition, we must do the work now on preventative care and public health, to help people avoid becoming sick in the first place and to stay as well as possible if they have a health condition.

In the current period, the on-going work on recruitment and retention needs to gather pace to ensure that services are fully staffed and that patients are seen in a timely manner.

Some of that is undoubtedly about pay and I am pleased to see the progress that the cabinet secretary has made with unions. I hope that talks can be resolved in a way that is acceptable to all.

Paul O'Kane (Labour, West Scotland)

The member mentioned pay. We know that pay in the social care sector is an extremely important issue, as my colleague Jackie Baillie outlined. In the Green manifesto, the party was committed to paying £15 an hour for social care workers. Why did that disappear in the vaunted Bute house agreement?

Gillian Mackay (Green, Central Scotland)

That commitment has never disappeared from our work in government. [

Interruption

.] The difference between the Greens and Labour is that we are in government, working as hard as we can to push for uplifts, of which there have been several in the past year. [

Interruption

.]

While Labour continues to shout from the sidelines, we will continue to do the work in government.

As well as hearing about pay, I regularly hear about working conditions in meetings with unions and NHS workers. Some of the issues and pressures are health board and, sometimes, hospital specific; others indicate wider issues.

Many in the chamber will be aware of a story that broke in NHS Forth Valley in my region, where one nurse was left to support 37 patients on their own. The scale of that is, I hope, an extreme example.

The implementation of safe staffing legislation is essential to ensure patient and staff wellbeing. The cabinet secretary has previously set out to Parliament steps that were under way and I ask that whichever minister sums up gives an update on the situation.

To boost retention and ease pressure, recruitment is, as I said, essential. We need to allow staff the time to take breaks, to go home on time and to ensure that they do not have to take on extra shifts when they are already tired.

I hope that the UK Government will listen to the suggestion that I put to the cabinet secretary last week on fast tracking visas for international workers coming to the Scottish NHS. That could allow faster access and provide a more attractive option to those workers who were put off by Brexit.

Work in the Health, Social Care and Sport Committee has highlighted that people do not understand all the pathways that are available to them. We have to be explicit with patients as to what treatment options are available. Changing the way that people view their healthcare is not always a quick process, but we need to advertise all the different routes well.

At the moment, it is essential that the diversity of urgent care in particular is well understood. I hope that we can collectively support services such as GP out-of-hours services, which are staffed by passionate people who often have other commitments, too. With the strain that we are seeing across the health service, there is a real danger that we will rely on a dedicated few or risk seeing the service eroded.

I hope that in the future we can also see more digital offerings from NHS 24. Not everyone is comfortable speaking on the phone, and some cannot. Some people find waiting in long queues on the phone difficult—for example, if they have multiple caring responsibilities. A chat function might be more suitable for some, and I hope that that can be explored.

In the medium term, the treatment backlog that has resulted from the pandemic will continue to need to be addressed, even after the peak of winter pressure. Across the chamber, we are all aware that three health boards have taken the decision to pause elective surgeries, and I hope that that can be for as short a time as possible.

Many people have also seen their conditions progress more quickly because of restrictions and not being able to access services that had to be shut for public health reasons. We need to make sure that those who have had their operations or treatments postponed are well informed.

I hope that the capacity that has been brought in by national treatment centres can also help with waiting lists. I am always grateful for information from the cabinet secretary on progress and the details of that.

For the long term, we also have to consider what services will look like in the future and to plan for that now. There is a danger that, in the midst of increased pressure, we recruit to plug gaps without forward thought. Patients want to have more services delivered locally. We have seen a move towards that through the development of the hospital at home programme, and statistics show that more people want to die at home. Given our ageing population, that means that more palliative and end-of-life care is delivered in people’s homes instead of in hospital. That presents its own challenges for the primary care and social care workforces, where district nurses, social care workers and GPs are often on the front line. The need for recruitment across the health service now is clear, and we need to ensure that the mix is the right fit for what we would like to see from healthcare.

We should be making the move towards preventative health spending and keeping people well from the outset. That is not to say that all ill-health can be prevented—that would be too simplistic a viewpoint—but preventative spend saves time in hospital and saves costs at the acute end. I say to Mr Mason that it does pay for itself eventually. Preventative spend should also cover mental and physical health and be appropriate for whatever impairment or health condition a person already has. I recently met some amazing school nurses in Falkirk who are carrying out preventative work. I encourage everyone to speak to school nurses in their area.

I will end, as others have, by thanking all those across health and social care who have worked relentlessly, not just this winter but over the past number of years, to ensure that those who need care can get it.

David Torrance (Scottish National Party, Kirkcaldy)

The public health challenge that Scotland faces as a result of the global Covid-19 pandemic is unprecedented. Over the past two and a half years, the pandemic has had a significant impact on the health and wellbeing of individuals, families and entire communities across the country. That cannot be ignored. It increased the demand for social care services, shone a light on the health inequalities that exist across the population and changed the way that every person lives their life.

Covid recovery will take years—it is naive to think otherwise. The coronavirus pandemic has impacted our health both directly and indirectly. It has caused direct and tragic harm to people’s health, affected our broader way of living and our society, impacted on our economy and had a hugely damaging effect in terms of poverty and inequality. Our energies have been focused on how to adapt to the changing needs of our healthcare system. Although national and local government, NHS boards and other partners have worked tirelessly to address those problems, it would be delusional to suggest that the impact of the pandemic is not still a factor in the problems that our NHS faces.

I have said this before in this chamber, and I will say it again: although it suits Labour’s narrative to stand here and criticise Scotland’s NHS, it is not just in Scotland that healthcare staff and services are under strain.

The NHS in every part of the United Kingdom faces significant pressures. Although our performance can be improved upon, our accident and emergency departments continue to perform better than those in England, Wales and Northern Ireland.

Dr Gulhane mentioned the November figures. Scotland’s core A and E units were 9.2 percentage points better than those in England, where the Tories are in power, and 6.3 percentage points better than those in Wales, where Labour is in power. Despite what Labour would like us to believe, the reality is that the entire country is still reeling from the shockwaves of the pandemic.

Carol Mochan (Labour, South Scotland)

Will the member take an intervention?

David Torrance (Scottish National Party, Kirkcaldy)

I will not take any interventions from Labour Party members. They should listen to my comments on the legacy of their time in power, which is still affecting the NHS.

The cabinet secretary and the First Minister have set out the action that the Scottish Government is taking to improve A and E waiting times. The £50 million urgent and unscheduled care collaborative will help to implement a range of measures to drive down A and E waiting times. That will include offering alternatives to hospitals such as hospital at home, directing people to more appropriate urgent care settings and scheduling urgent appointments to avoid long waits in A and E. The £600 million health and care winter plan will support the recruitment of 1,000 additional staff. The Government is delivering £45 million for the Scottish Ambulance Service to support on-going recruitment and service development, and there is £124 million to assist health and social care partnerships to expand care-at-home capacity. Those measures do not sound like a lack of action to me.

In December, it was announced that the health and social care services would receive their highest-ever budget settlement in the next year. That is paving the way for sustainable public services in Scotland with a £19 billion package that helps to tackle the immediate pressures caused by the pandemic and the tough winter while supporting the delivery of health and care services that are fit for the future. Once again, that commitment does not seem to show that the Scottish Government is not fully aware of the importance of supporting our health service and its staff.

There is another pressure that health boards face—one that is inflicting a great deal of damage across the country—but somehow I do not think that we will hear about it from any of the Labour members today. Maybe that is because they have very short memories when it comes to public finance initiative and public-private partnership contracts. People in Scotland are still paying the price for Labour’s shameful PFI and PPP contracts for NHS buildings, with the Scottish Government paying more than £250 million every year for contracts that were agreed under previous Administrations. That is a staggering amount. Just imagine what that money could do to support our NHS services.

I have seen the effect of those damaging agreements locally at Victoria hospital, in my constituency. The hospital was built at a capital cost of £170 million but, by the end of the 31-year contract, NHS Fife will have had to pay £887 million for it. I will say that again for my Labour colleagues: the cost is £887 million for that hospital, which is a disgrace. Labour’s PFI legacy will long be remembered by the people of Fife and beyond. Labour’s ill-advised PFI deals have left the Scottish Government paying enormous sums that are above the odds for our hospitals and schools. That money would be much better spent on front-line healthcare than on paying the cost of Labour’s mismanagement.

The consequences of Mr Brown’s only-game-in-town public sector borrowing fiasco could almost be forgiven if lessons had been learned, but the Labour Party has learned absolutely nothing from its toxic legacy and wants to keep the door open to the Tories increasing private sector input in our precious NHS. It is really no surprise that the people of Scotland do not trust Labour any more than they trust the Tories. Rather than stand here and have an honest debate about Scotland’s NHS while acknowledging that these important issues are being faced by every health service across the UK, Labour members ignore the inconvenient facts that do not fit with their rhetoric and seek soundbites with which to attack the Scottish Government.

There are problems that must be tackled and challenges that require long-term solutions—no one denies that—but I, for one, am thankful that the Scottish Government is determined to continue to take real action to address the problems that are faced by our NHS and its staff and to alleviate the pressures that are being felt by our services. A whole-system approach is the right way forward as we progress through this critical period and look towards the future—a future in which health and care services ensure that everyone gets the care that they need, when and where they need it.

Roz McCall (Conservative, Mid Scotland and Fife)

I will come at the issue from a slightly different angle. I will never forget that it is thanks to our NHS that my husband is alive. The care and attention that he received were fantastic, and I will be eternally grateful to the surgeon and all the staff who worked to ensure that my husband could come home.

That is what everyone wants, isn’t it? People want to get on with their lives as best they can, safe in the knowledge that, when they need professional medical help, it will be there for them. They want the stress, strain, pain and trauma of the experience to be minimised and they want to know that they or their loved ones will be treated in a safe, speedy and sympathetic manner so that they can return to their lives as soon as is humanly possible. I know that my husband received that care, but I also know that we were lucky. I know it because I was told it. I was told it on four separate occasions, by four different medical professionals, for four different reasons.

First, the emergency services telephone operator told me that because we had an ambulance with us within 20 minutes instead of having to wait more than eight hours. The paramedics told me that because they had just finished a local call and had not gone anywhere else when the request came in. The emergency doctor told me that because the Covid lockdown meant that there were reduced numbers of patients in A and E. The psychologist who helped my husband over his depression told me that because a psychologist would not usually be assigned but was assigned because our family could not visit the hospital. That is not the case for many, who do not have luck on their side.

My husband was a grown man who was experiencing a mental health issue that was brought on by a stroke. Imagine being a child who is battling with a mental health issue such as living with anxiety. Imagine worry so deep that it consumes every moment and sleep is no release. Imagine being permanently vulnerable. Imagine worry so encompassing that it changes your physical state, with pain and nausea taking over. It is debilitating. Imagine having that day in, day out.

What are the chances of getting support? Young people are meant to be seen within 18 weeks of referral. Imagine being one of 28,000 people referred to CAMHS, a third of whom will not be seen. That is 8,988 children in Scotland right now who are not being seen within 18 weeks of referral. Now imagine being one of the 6,553 children who are refused CAMHS treatment and who find out that, having waited more than four months—it is more than a year in some cases—they have been rejected from the service, although their GP referred them, which in itself took months, and that, although they are years on, they are no further forward.

As Alex Cole-Hamilton stated, this Government has its own NHS recovery plan and set targets to clear CAMHS and psychological therapies waiting lists by March this year. That is in 10 weeks’ time, and, with 8,331 children and young people on the list waiting to start treatment at the end of September, I think that it is safe to say that that target will not be met.

The fact is that, when it comes to health, targets set by this Government are rarely met. The target of 90 per cent of children and young people starting treatment with CAHMS within 18 weeks of referral is not being met. The target of 95 per cent of A and E patients being seen within four hours is not being met. The target of 95 per cent of patients beginning cancer treatment within 62 days of referral is not being met. That worries me, because no-one is setting these targets for the Scottish Government—it is setting them for itself, and it seems that they are setting up the NHS to fail. The British Medical Association has highlighted that very point by stating that,

“for too long the debate on the health service has focussed on quick fixes, or short-term performance against waiting times targets that are widely accepted as completely unrealistic”.

Let us look at staffing issues. The fact is that NHS managers have been predicting a massive shortfall in staff. It has been on the cards for years. They all knew that this day would come. If we want an example, we do not need to look any further than when the First Minister was health secretary, which was at a far easier time—that is self-confessed—than we are in now. She was slated for sowing the seeds of a hiring crisis in the Scottish nursing sector through the controversial decision to slash the number of student nurses between 2007 and 2012, which has led to a decade-long staffing shortage. At the time, the Royal College of Nursing strongly criticised the move by the Scottish Government to slash the number of training places for nurses and midwives by nearly 300 back in 2012-13. Announcing the cut to student nursing places in 2012, Ms Sturgeon said that the reduction was a “sensible way forward” to minimise the risk of oversupply—so that aged well.

Again, the BMA highlights that and asks us to take

“serious steps to make working as a doctor an appealing career choice”.

That is needed because

“there is less GPs capacity available to care for the people of Scotland than at any point since 2009”.