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Meeting of the Parliament [Draft]

Meeting date: Tuesday, June 4, 2024


Health and Social Care

The Deputy Presiding Officer (Liam McArthur)

The next item of business is a debate on motion S6M-13466, in the name of Neil Gray, on a vision for health and social care in Scotland. I invite members who wish to participate in the debate to press their request-to-speak buttons now or as soon as possible.


The Cabinet Secretary for Health and Social Care (Neil Gray)

We have reached a critical point in our country’s health. We are seeing growing demand on our health and social care services, which needs to be addressed, alongside an improvement in service performance. The growing demand, which is based on our poor population health, reduces the wellbeing of Scotland and impacts on the sustainability of our services.

The Government is clear that the institution of the national health service in Scotland and the values that underpin its work are a matter of national pride. I also recognise the vital role of the social care system in supporting people to manage their health in their communities and to live well. The principles of a health service being for everyone, owned by the people and free at the point of delivery are sacrosanct. Any consideration of abandoning those fundamental values lies beyond a red line that we will not cross.

However, although those principles will not change, Scotland has changed. The NHS was established 76 years ago to address the health challenges of its time. Now, we live longer, medicines can do much more, technology has transformed the way that we live and our lifestyles have changed. The treatment of people in hospitals when they are ill is only a small part of modern healthcare.

Although the Government is making progress in addressing the challenges of waiting lists, our health and social care services are hard pressed to meet service demand. Today, in good faith, I seek to open a debate of openness on how we can reform and improve our health services and on how we can collectively deliver a transformed system that is fit for the health challenges that we face.

I am a pragmatist. We have a clear vision for the direction of reform, which we will shortly outline, and a programme of improvements that is already under way.

Pam Duncan-Glancy (Glasgow) (Lab)

One way in which the health service can be prevented from being overburdened is to introduce the audit of fracture liaison services, which the Government committed to in April 2023. Will the Government confirm whether it still intends to carry out and publish that audit? If so, when will it start?

Neil Gray

There are areas that we should develop in the details of the service delivery that we can achieve, such as the one that Pam Duncan-Glancy mentions. That is why I want the debate: so that we can take forward the ideas that we think can help on prevention, improve our population health and improve our public health measures.

I am willing to consider fresh ideas. I am here today asking the Parliament to consider how we can work together to seize the opportunity to reform health and social care for present and future generations. I have already outlined to my Cabinet colleagues an overarching vision that will guide our work. I believe that no one here could argue with a vision of a Scotland where people live longer, healthy and fulfilling lives.

That vision is supported by four key areas of work: improving population health; a focus on prevention and early intervention; providing quality services; and maximising access. All those areas are underpinned by giving due consideration to the people at the heart of those services.

In the short term, we must ensure that our services are delivered in the best way that we can within our current arrangements. In the medium term, we need to begin to transform how we work. We must keep our eyes on the horizon because, in the longer term, we also need to fundamentally change how we think about the delivery of health and care by driving investment in prevention and early intervention.

Our vision also reveals the complexity of the task that is before us. If we do not improve our nation’s general health, no service improvements, clinical strategies or refined operating models will be able to make us a healthier nation in the long run. That is why prevention is key. We want to shift the balance of care closer to people’s homes and drive a proactive approach of early intervention and prevention. That will be underpinned by the principles of accessibility, addressing health inequalities, maximising outcomes and promoting innovation, as well as value for money.

A lot has already been done in urgent and unscheduled care, working with the Scottish Ambulance Service, NHS 24 and through the creation of flow navigation centres, to manage demand. Our continued investment in hospital at home will help to increase the provision of acute care at home and ensure that patients receive personalised care.

We also need to look at the long-term reforms that will be required. We are developing a population health framework, taking a cross-Government and cross-sector approach to improving the key building blocks of health.

We must also recognise the vital role of social care and unpaid carers in supporting people to remain in their own homes for longer. That is a cross-Government preventative approach. We are supporting low-income households, delivering the Scottish child payment, delivering the “Best Start, Bright Futures” plan to tackle child poverty and expanding free school meals. We will continue minimum unit pricing and take radical action to reduce the harm that is caused by smoking.

I am also clear that, as a nation, we all need to take personal responsibility and do what we can to mind our own health by paying due attention to nutrition, our mental health and exercise, whatever form it may take.

Our service reforms must take a whole-system approach, including social care and the planned national care service. Primary care, which is the crucial bedrock of the NHS and the key to driving sustainable, effective and good value-for-money healthcare, has a well-established collaborative programme of reform and improvement already under way. Primary care reform is focused on seeing the right person at the right time in the right place and is key to realising a community-first approach. Improving access to primary care and shifting care to the community is and must be a key focus of reform. That includes our NHS dental payment reform, free universal NHS-funded eye examinations, our NHS pharmacy first service and signposting people who have common conditions to local pharmacies for advice and treatment.

To support general practice, we have significantly expanded the primary care multidisciplinary team workforce, with more than 4,700 staff working in services including physiotherapy, pharmacy and phlebotomy. We are supporting development of those teams through investment of £190 million in the primary care improvement fund this year, as well as continuing to support practice learning time.

There are on-going issues that we need to continue to address. People whose discharge from hospital is delayed are not receiving the best care that they need, and that can have significant consequences for them as well as for the entire system. We have already put in place the delayed discharge and hospital occupancy action plan to help to create the necessary capacity, but we still need to improve the flow of patients through our hospitals, and we will work closely with all stakeholders to achieve that.

In 2021, the independent review of adult social care showed the clear need for change and recommended the reform of social care in Scotland and the strengthening of national accountability for social care support. The National Care Service (Scotland) Bill, which will ensure greater transparency in the delivery of community health and social care, improve standards, strengthen the role of the workforce and provide better support for unpaid carers, is the biggest public sector reform since devolution.

We will put people at the heart of reform, ending the inconsistencies in care provision across Scotland, ensuring that those who need it have access to consistently high-quality care and support and embedding fair work principles for our workforce.

Reform is also taking place within our mental health services, which we will continue investing in. We will shortly publish the delivery plan for the new mental health and capacity reform programme, which will be the first important step in making sure that the law, our policies and our practices will ensure that anyone who requires support is treated fairly and with dignity. That is just one aspect of our work to improve mental health support at all levels and we will continue working closely with the Convention of Scottish Local Authorities, health boards and other partners to implement the delivery plans that we published last year.

Our valued healthcare workforce is a key part of our vision for reform. In addition to the on-going implementation of agenda for change, we are working with the British Medical Association on reform of junior doctors’ contracts and have launched a ministerial task force on nursing and midwifery, with a remit that covers attraction, education and training, retention and staff wellbeing.

Finlay Carson (Galloway and West Dumfries) (Con)

Last week, we heard from midwives about the struggles that they face during training. What consideration has been given to apprenticeships for midwives and other healthcare workers, which might help them to transition from one career and into supporting rural areas such as Dumfries and Galloway?

Neil Gray

Finlay Carson touches on the important issue of attraction and retention, which is being worked on by the nursing and midwifery task force. We need to see an expansion of routes into the profession and want to ensure that we do that equitably across Scotland, so that services in rural areas can be improved.

The Health and Care (Staffing) (Scotland) Act 2019 was the first comprehensive, multidisciplinary workforce planning legislation in Scotland and is the most comprehensive of its kind in the United Kingdom. We have recognised the vital role of the social care workforce with a pay uplift to £12 per hour for adult social care workers in commissioned services.

Alongside that support for workforce wellbeing, productivity and moving into service, our reforms can and must be accelerated and enriched by the transformative potential of scientific innovation. Last week, the Deputy First Minister and I co-chaired a round-table meeting on game-changing technologies. That event brought together key leaders from the life sciences industry, academia, the NHS and Government to discuss advances in science and technology that can transform lives and the implementation of services.

Medical research is moving faster than ever. New preventative technologies are supporting people to manage their own health better and to prevent and mitigate disease. Wearable devices are helping people to take ownership of their own health, while new diagnostic and screening methods can support the NHS in identifying and treating disease before symptoms appear.

There is huge potential in personalised and precision medicine, gene therapies and robotic surgery, so we will proceed with a new partnership between Government, the NHS, our academic institutions and the life sciences industry to focus on seizing the opportunities to empower patients, liberate clinicians, drive efficiencies and prevent ill health. I am pleased to announce today that five Scottish institutions—the universities of Aberdeen, Edinburgh, St Andrews and Strathclyde, along with Public Health Scotland—have each been awarded £1 million of funding, through the chief scientist’s office, to conduct major research programmes into population health in Scotland. The five programmes that have been awarded funding have the potential to make a significant impact.

I am aware that some in this chamber have already called for structural change, but the urgent focus of change must be on transforming services within the current structures and maximising our current assets. I will work to implement an NHS Scotland approach that will harness greater levels of collaboration in our health boards and partners, resulting in better value, quality and outcomes for patients and staff.

There will be Government-led national engagement. We must ensure that we are fully committed to the engagement that can inform our plans, which will take a person-centred approach, ensuring that we utilise our incredible workforce.

We have established a primary and community health steering group to bring together a range of health stakeholders and an expert reference group will be convened this autumn to provide independent input, advice and an additional independent and international perspective. A stakeholder advisory group will also bring together a cross section of professional associations, including COSLA, the Health and Social Care Alliance Scotland, regulators and others that are in service delivery. I look forward to hearing directly from them to translate the vision into delivery across the system. We will listen to all voices and, by the end of the year, I hope to have brought them to bear on the actions that we will take.

There is no more important issue to a nation than the health of its people. I am not looking to publish another strategy. Our work is already being guided by multiple plans—notably, the national clinical strategy of 2016. Our task now centres on listening and delivery.

I am pleased and privileged to open the debate, and I welcome all contributions.

I move,

That the Parliament recognises the urgent and critical need for health and social care reform within the context of an ageing population, persistent health inequalities and fiscal pressures, whilst ensuring that the founding principle that the NHS in Scotland remains in the hands of the public and is free at the point of use will not change; agrees that reform must focus on a more sustainable healthcare system, performance improvement, prevention, providing quality services and maximising access, with a foundation of due consideration for the people at the heart of Scotland’s health and social care services, including the workforce; recognises the importance of continuing to invest in mental health and GP services, including the investment of £190 million in 2024-25 for multi-disciplinary teams to support general practice and the new support for protected learning time in GP practices, and supports the Scottish Government’s commitment to a national engagement that will inform and inspire the reform programme.


Sandesh Gulhane (Glasgow) (Con)

I draw members’ attention to my entry in the register of members’ interests: I am a practising NHS general practitioner.

The future of our national health service is of the utmost importance to the people of Scotland and to the more than 180,000 serving NHS Scotland staff. In fact, healthcare professionals and patient groups have been calling for a national conversation on the NHS for years, and we know why.

As our population ages; as more people suffer from chronic diseases, from mobility issues and from poor mental health; as life expectancy in Scotland falls; and as arthritis and musculoskeletal problems affect one third of our population, this debate is long overdue. With Scots in our most deprived areas being twice as likely to die from cancer; with one in seven Scots on an NHS waiting list; with accident and emergency waiting targets unmet in four years; with cancer referral standards unmet in a decade; and with the number of whole-time equivalent GPs decreasing at a time when the number of registered patients is growing, this debate is long overdue.

Ideally, the debate should transcend politics. The Scottish Conservatives were prepared for this crucial conversation early in February, when we published our paper, “Modern, Efficient, Local”. Since then, the Scottish National Party Government has been conspicuously silent and has yet to bring a coherent vision to the table. The SNP is devoid of any substantive proposals. That is not just disappointing—it is a neglect of duty. Instead of stepping up to the plate, either by publishing a plan before the Opposition did or—at least—responding to our call for a national conversation, the Scottish Government chose to bide its time.

I appreciate that the Government was somewhat distracted by the forced change of health secretary. However, if the SNP spent more time and energy thinking about the NHS than about its own travails, a colleague’s bill for data roaming or its politics with the Greens, then maybe—just maybe—we could get serious about NHS reform.

So, here we are. In the midst of a heated general election campaign, the SNP has suddenly decided to bring this crucial debate to the chamber. However, the timing is no accident: it coincides with the SNP’s general election headline on the NHS. Despite the clear reservations of the two largest Opposition parties, the SNP has chosen to manipulate Scottish parliamentary time in order to serve its UK general electioneering purposes. That is an affront to every Scot who relies on the NHS and to every healthcare professional who dedicates their life to serving others.

This is not the time for crafty manoeuvres or underhand tactics. This is the time for honest, robust and urgent dialogue about how we ensure that the NHS can continue to provide world-class care.

Despite the SNP and its political chicanery, we come today armed with ideas and with a willingness to engage in constructive dialogue. Our vision is for an NHS in Scotland that is modern, efficient and local, and one that is accessible for all of our population—urban, rural and island.

Does the Conservative vision for healthcare include its remaining in public hands?

Sandesh Gulhane

It does, 100 per cent. As an NHS GP, I will always want the NHS to be free at the point of care. In fact, if you listen a little bit longer, you will hear some of our great ideas and, if you read “Modern, Efficient, Local”—

Speak through the chair.

Sandesh Gulhane

—which is our vision for the NHS, the member will be able to understand our 26-page policy document.

To achieve that, our country will need to truly embrace innovation and change—plus take the strain off our health service and its staff. In that way, we can maintain them and universal healthcare as we know it.

To start with, we want to strengthen primary care so that practices can handle the volume of demand and carry out the types of clinical interventions that can safely and practically be delivered in the community. That includes backing our community pharmacies, optometrists, audiology services, physiotherapists and link workers, all of whom have expertise that can support community-based care. That should have happened under the GP contract, but the SNP has, as with all things, broken its promise and failed to deliver. To achieve that, we would reprioritise resources. In plain speak, we would radically increase the percentage of the NHS budget that funds primary care.

Our vision of a modern and efficient health service also embraces innovation. We want to see clinicians, university researchers, data scientists, artificial intelligence technologists, Government and industry in lockstep to develop monitoring, diagnostics and advanced therapies. We need to use technology to predict problems, because if we can predict we can prevent—and so protect people. We must also deploy technology to reduce inefficiencies.

Neil Gray

I really want to focus on ideas on how we will move forward. I agree with Sandesh Gulhane’s suggestion on refocusing and prioritising some funding for prevention and primary care services. However, is not how we do that, at a time of constrained public finance, the conundrum that we are all facing? I would welcome Sandesh Gulhane’s suggestions about how, while there is continued spending restraint from the UK Government, we can ensure that we would not see acute services and the secondary care sector suffering as a result of that reprioritisation.

I can give you the time back for interventions, Dr Gulhane.

Sandesh Gulhane

What we seek is a reduction in demand for secondary care, which is far more expensive than the work that we would undertake in primary care. We also need to be cognisant of the fact that, over the 17 years of SNP Government, £17 billion-worth of Barnett consequentials have not been spent on the health service.

We would adopt more data science and artificial intelligence solutions in order to become more efficient at handling surgery schedules, managing staff rotas and ordering equipment and consumables. Adopting medical technology solutions at scale would help us to manage patient care better, shorten hospital stays, reduce hospital readmission rates, improve patient satisfaction and achieve better patient outcomes. In rural and island areas, that would include mobile screening services to take diagnostics such as lung screening to communities instead of expecting patients to travel long distances.

We could use AI to speed up reading of X-rays, computed tomography scans and magnetic resonance imaging scans. That would complement, not replace, doctors.

We would also ensure that NHS management support our clinical staff better. Workforce terms and conditions must work for those who are on the front line and their families. Good staff morale is vital to retaining great people and to making the NHS an attractive option for our bright school leavers.

We would also, subject to each medical school’s capacity, remove the false cap on the number of medical students at Scotland’s universities, thereby allowing a greater number of qualified Scots to become medics.

However, across our population, we really must take greater responsibility for our own health: our NHS cannot continue to act as a repair shop when things go wrong. We need a service that is far more focused on keeping us healthier for longer.

The Scottish Conservatives have brought solutions to the table before now. Almost three years ago, I proposed a solution for tackling long Covid, but that was ignored. The then health secretary went on to be First Minister, while the number of Scots who were suffering with that debilitating condition grew to over 180,000—10 per cent of them children. Let us not have a repeat of that inaction.

We are calling for a serious, focused and sincere national conversation about the NHS—one that is free from the taint of electoral scheming and is dedicated solely to finding sustainable solutions for the future.

I move amendment S6M-13466.2, to leave out from second “, including” to end and insert:

“; notes with concern that the Scottish Government has frozen all major NHS project investment for two years and that, for waiting lists to be cut, construction on these projects must resume immediately; further notes that the Scottish Government’s A&E target has not been met in almost four years and that its 62-day cancer referral standard has not been met in over a decade; notes with alarm that one in seven people in Scotland are now on an NHS waiting list, and that the Scottish Government has failed to meet its targets to end long waits for treatment; requests that the Scottish Government reconsider its plans for a National Care Service, which will only serve to take power away from local authorities, and will not address the underlying issues in social care; reminds the Scottish Government that, since it promised to end delayed discharge seven years ago, successive health secretaries have failed to do so, and emphasises that any reform of health and social care must address the issues listed above as a matter of urgency and incorporate modern, efficient and local solutions into the health service.”


Jackie Baillie (Dumbarton) (Lab)

I think that this debate has been misnamed. It is entitled “A Vision for Health and Social Care in Scotland”, but this SNP Government has not had any vision for health and social care for the past 17 years.

For those who do not believe me, here are the words of Audit Scotland from its damning report on the state of the NHS from earlier this year:

“There are a range of strategies, plans and policies in place ... but no overall vision. The absence of a shared national vision, and a clear strategy to deliver it, makes it more difficult for NHS boards to plan for change.”

There you have it.

Up to now, the SNP’s past two health secretaries have resisted the BMA’s repeated requests for a national conversation. Now that we are on to our third health secretary, I can only assume that the sudden change of heart is because the SNP is indeed bereft of ideas and needs some help.

I say as a matter of record that the Scottish Labour Party is happy to help, because we care too much about the NHS not to do so. However, I gently point out to the cabinet secretary that the BMA, the Royal College of Nursing, Unison, the GMB, all the royal colleges, the social care sector and even we politicians have been offering suggestions for years. Here is the rub: even when we make suggestions, the SNP is incapable of implementing them properly.

I cite the national care service as one such example. It was first proposed by Labour more than a decade ago and was rejected by the SNP; now, suddenly, it is the SNP’s big idea. The problem is that the SNP’s plans are all about structures, not raising quality or improving culture—which is essential. Not one penny is going on care just now, when 9,000 people are waiting to be assessed for care and existing care packages are savagely slashed right across the country.

There is no doubt in anyone’s mind about the scale of the crisis that is faced by the NHS in Scotland. It is profound. Hard-working staff across the health and social care sector are doing their very best to care for us, but they are burnt out and demoralised. Vacancy levels among nurses and doctors are higher than they should be; the use of agency staff to cover shifts in social care is increasing; and GPs are struggling to cope with increasing demand as the promised numbers of new GPs have failed to materialise.

We can all agree that the NHS and social care are nothing without the staff. We owe them a huge debt of gratitude, but we also owe them better workforce planning and an increase in training places. The Government needs to urgently review the process of workforce planning and, while it does so, it needs to make better efforts to retain existing staff. We are happy to make suggestions in that area.

Then there are the lack of access to mental health support, the rise in delayed discharge, the failure to meet cancer treatment targets and the ever-growing waiting lists for treatment. When we add in the £1.4 billion in cuts that the health boards and health and social care partnerships are making, the picture will get even worse. Indeed, when the SNP came to power, spending on health per head of population was 17 per cent higher than in England; now, it is only 3 per cent higher. The SNP has eroded spending over time, so it is little wonder that, on its watch, life expectancy has dropped.

Neil Gray

I am interested in the waiting time statistics that Jackie Baillie quotes in her amendment, because they are factually inaccurate. I am interested in understanding how she has arrived at the figure of 840,000 people on an NHS waiting list, because that is not borne out by the figures that have been demonstrated by Public Health Scotland. How has she arrived at those misleading and factually inaccurate statistics?

Jackie Baillie

First, those figures are neither misleading nor factually inaccurate. They were taken from data that has been published by Public Health Scotland.

I will now focus on waiting times, because those are the most obvious sign of SNP failure. The fact that 840,000 Scots are languishing on waiting lists for tests, diagnosis or treatment is shameful. That is one in six of the population. That is somebody that you know—a family member or a friend. It is a national scandal.

When Humza Yousaf was the health secretary, he announced targets to eradicate the longest waits—to reduce them to below two years for out-patients and in-patients by August and September 2022. Almost two years on, none of those targets has been met—not a single one. Instead of reducing, the number of people who are waiting is going up. There have been an extra 77,000 in the past year alone.

Part of the solution that was suggested by the SNP in 2015—and which Labour supported—was national treatment centres. However, they have been paused indefinitely in Ayrshire and Arran, Tayside, Grampian, Lothian and Lanarkshire. What will the SNP do instead? It is clear that the recovery plan is not working. Waiting times are going up and more people are waiting, so I recommend that the cabinet secretary tears it up and starts again.

Before closing, I will deal with comments that were made by Stephen Flynn. Suggesting that Labour wants to privatise the NHS is disgusting, dishonest, and frankly desperate, as he struggles to save his seat in the election. Perhaps he was not aware of the SNP’s record in government. The total number of private hospital admissions in Scotland in 2023 was 46,000, which is 11 per cent higher than the number in 2022 and 32 per cent higher than the number in 2019. There were more private admissions than in any previous year on record, and the majority were paid for by the SNP Government. Shockingly, self-pay admissions are up 8 per cent and are at their highest level since records began. It is the SNP that is presiding over a two-tier health service, and it is the SNP that has failed to get to grips with the crisis in our NHS.

The NHS is in crisis and the SNP has no idea how to turn it around. Not only is it time for new ideas, it is time for a new Government, because this one is incapable of making things work. In 1948, Labour created the NHS. In 1997, we rescued the NHS and on 5 July 2024—the 76th birthday of the NHS—we will rescue it again.

I move amendment S6M-13466.1, to insert at end:

“is concerned that 840,300 people in Scotland are on NHS waiting lists for tests and treatment, of which over 87,000 have waited more than a year; notes that more patients are forced to use the private sector, with the latest data showing that the number of privately paid for hospital admissions is 80% higher than before the COVID-19 pandemic, and calls on the Scottish Government to set out a plan for reducing waiting times.”


Gillian Mackay (Central Scotland) (Green)

I begin by extending my gratitude to the workers who make up our NHS—those who spend their lives making sure that we get the care we are entitled to when we need it. That includes every single worker who is involved in the running of our services, from nurses and GPs to cleaners, cooks and ambulance drivers. The same goes to the countless carers who keep our social care system afloat. I hope that that serves as a reminder that there is no NHS and no social care without those people, and that their tireless contributions must continue to be valued.

There is only so much that we can cover in the chamber today, and I acknowledge that this should be the start of a wider conversation. We need to be clear that the work to fundamentally reform and improve our services must come on different fronts and that each set of issues will require different timelines.

I also believe that we cannot have a candid conversation about reform without acknowledging the context in which our health and social care systems exist. We cannot ignore the injustice of Brexit and the impact that it has had on our workforce. It has gutted our services and our ability to retain talented individuals. The fiscal constraints that have been placed on us due to austerity from Westminster, the ripple effect from the pandemic, an ageing population and the high burden of non-communicable disease put the NHS in Scotland in a particularly fragile place. We have to acknowledge that that is the reality that we are operating in. However, that does not absolve the Government from its responsibilities. I brought those factors up to inform our dialogue and to have an open and frank conversation that is based on the reality that we face, because it is all too easy to ignore their collective burden.

Reform must focus on a more sustainable healthcare system through performance improvement, prevention, providing quality services and maximising access. The preservation of a publicly owned system that is free at the point of use is non-negotiable. We must not allow ourselves to be buoyed by a false narrative that privatising key aspects of our NHS would fix its difficulties. Scotland has fought hard against privatisation since devolution, and I urge the cabinet secretary to continue that fight. I was pleased to see that reflected in the motion.

We have to focus on prevention, reform and waiting times as targets to help to solve the issues that we currently face. First, I will focus on prevention. We cannot prevent all ill health from ever happening, but given that we recorded 53,000 deaths in 2021 that were attributed to non-communicable diseases, the nation should aspire to reduce preventable ill health to the lowest level possible. That would put a real value on health and ensure that everyone has a good, healthy life for as long as possible. That will reduce pressure on the NHS overall.

That is not a quick fix, and it will not necessarily show up quickly in statistics but, over time, the little bits that we can all do will take pressure off the NHS and improve many lives across the country. For example, yesterday, I attended the Walking Football Scotland and Chest Heart and Stroke Scotland tartan teapot trophy event at Heriot-Watt University, as did the Minister for Social Care, Mental Wellbeing and Sport. The number of people taking part in walking football is phenomenal, with around 90 teams due to play in its Scottish cup competition later this month. It has benefits for players’ physical health. Many people who play are older and have stopped playing five-a-side football for a variety of reasons. The different style of play helps to keep them active for longer when they might otherwise have given up sport. It also contributes to better mental wellbeing and prevents isolation. I was reliably informed yesterday that, if people wanted to, they could play walking football five days a week. The sport is hugely accessible for those who have retired and could become isolated. It is a lot harder to do than it looks, though. We need to ensure that such organisations and initiatives have the funding that they need to deliver services, because the reach of many of them is far beyond anything that we in the Parliament could design.

We also need to invest in GP services. Securing the future of our NHS and improving the health of the people of Scotland fundamentally depend on increasing the number of GPs. Short-term fixes where need is particularly acute must be complemented by long-term strategic planning from the Scottish Government to tackle the severe workforce crisis. We also need to see protected learning time being established for GPs and their teams. I am pleased to see that aspect being included in the Government’s motion, and I thank the cabinet secretary for our conversation about it. We all know that having too little time is a huge barrier in primary care. At the moment, learning and improving knowledge has to fit in with everything else that happens in a general practice surgery. I am sure that much of that learning happens in clinicians’ own time. Allowing time to update and share knowledge can only serve to provide better outcomes for patients.

We also need to ensure that the action that the Parliament takes to create a good food and drink environment will offer people a real choice in improving their health. As I have said on previous occasions, some actions that we need to take to achieve that will involve a whole-Government approach. As we know, poverty is a great barrier to good health, so establishing a universal basic income and putting more money in people’s pockets has to be part of that. However, taking action to encourage reformulation of products, ban disposable vapes, reduce smoking and tackle other health-harming products has to be part of the landscape, too.

We also need a public health levy to ensure that, at a time when funding for services is tight, we are ensuring that sellers of products that damage health contribute to the services that pick up the pieces. I was hugely pleased that, in this year’s budget, we secured a commitment to explore establishing such a levy. It is essential that work happens quickly on that. Given the current financial situation, and the acute need for public services, it would be negligent of any Government not to maximise the funding that comes into such services. Having such a levy would be a relatively easy way to do that.

There is so much work to do in individual specialisms in secondary care that will need to change quickly if we are to get waiting lists down. However, I believe that a fundamental part of the reform agenda for health must focus solidly on reducing ill health overall. I again extend my deepest gratitude to the tireless workers who drive our health and social care services. Without them, we have no NHS.

As someone who has played walking football, I would be concerned that doing so five days a week might put additional pressure on A and E services.


Alex Cole-Hamilton (Edinburgh Western) (LD)

I am pleased to speak in the debate on behalf of Scottish Liberal Democrats. I am grateful that the cabinet secretary offered to meet me. I know that, in advance of the debate, he also met other members to talk about building consensus, which I welcome. As I told him at our meeting, our NHS is still in crisis. He knows it; we know it; and the people working on the front line, whom Gillian Mackay rightly thanked, know it. Many members have spoken of it in the chamber on countless occasions. Under 17 years of SNP Government, the fundamentals of our health service have been steadily eroded. Those who work in the NHS, and those who rely on it, are suffering greatly as a result. We are asking far too much of our hard-working staff. They are all going above and beyond repeatedly, and have done so for years.

I must take issue with the cabinet secretary’s reference to the Health and Care (Staffing) (Scotland) Act 2019. Even tonight, across the NHS, in hospital wards and in every health board area in the country there will be shifts that are not staffed safely, where both clinicians and patients are unsafe. We have yet to live up to the full spirit and fundamentals of that act. Across the board, clinicians, nurses, patients and ancillary workers have all been let down.

Primary care is one example. Many Scots are old enough to remember a time when, if they needed their GP, they could book an appointment and be seen within a couple of days. That is almost a forgotten country. Now, routinely, people have to make dozens—or hundreds—of phone calls, just to speak to someone at their GP practice. Two weeks ago, I spoke to a woman in Caithness who had phoned her GP practice 200 times when the phone lines opened at 8.30, before finally being given an appointment in three weeks’ time.

That is happening not just in that part of Scotland—it is happening everywhere. I have even heard of people being told that they would have to wait two weeks to get an appointment for a baby. For a young parent, that is a terribly long time to wait.

Many times I have borrowed the words of Dr Andrew Buist, chair of the BMA’s Scottish GP committee, who said:

“We are often told GPs are the bedrock of the NHS—but ... the bedrock is crumbling, and it is patients”

who are suffering. Patients are suffering—hundreds of thousands of patients in Scotland are languishing on waiting lists for tests or for treatment. We have heard harrowing tales of people in pain, waiting for hours for an ambulance to arrive.

Just last month, at First Minister’s question time—as you will remember, Presiding Officer—I, along with Douglas Ross, raised the case of a woman who nearly died on the doorstep of Portree hospital, on Skye. All the doors were locked at the time that she was suffering from asphyxiation, and her boyfriend was throwing rocks at the windows to get in. That happened despite a report six years ago telling the SNP Government to keep that hospital open for 24/7 care.

What about the thousands of Scots, many of them children, who are suffering with mental ill health as part of the long shadow of lockdown? They are forced to join the longest queue for treatment in our national health service. The motion refers to

“the importance of continuing to invest in mental health ... services”.

I could almost laugh at that if it was not so desperate. In previous budget negotiations, my party secured £120 million extra for mental health, but the SNP has seen fit to cut, in real terms, spending on mental health by nearly £80 million. With our young people still struggling with the legacy of the lockdowns, any mental health practitioner in the country will tell you that the Government could not have picked a worse time to let that funding slip away.

Just today, mental health treatment targets were missed yet again. Scotland needs world-class mental health services, and the Scottish Liberal Democrats will fight to see them delivered. That is why we have set out plans to increase the amount of tax that is paid by social media giants and use that money to help to fund more mental health support in schools and to get more professionals closer to where people live.

That is based very much on the polluter pays principle. We know that the ecosystems that are created by social media are the environments in which people are suffering abuse and dealing with body image issues, and they are finding those environments increasingly difficult to escape. The people who create that ecosystem should pay.

The Government is out of ideas for patients and staff alike, so it is no wonder that it is finding it harder than ever to attract and retain new staff. We need experienced staff, now more than ever, if we are to bring down those waiting lists. However, rather than making the meaningful investment that our health service needs, the Government is relying on short-term fixes to plug the gaps, and is pursuing its plans for an unwanted ministerial takeover of social care. That is little more than a bureaucratic exercise, but it will cost billions of pounds and it will do nothing to address the fundamental issues in social care that are leading to delayed discharges in our hospitals and creating an interruption in flow throughout the NHS.

Scottish Liberal Democrats want staff to be fairly paid and fairly treated, with good working conditions. The Government can make progress by adopting our burnout prevention strategy and setting up an NHS staff assembly so that our doctors and nurses can put their voices and their expertise at the heart of the solution.

Patients need to know that they will be tested, diagnosed and treated in a timely fashion when they seek care from our health service, so as to have the best chance of recovery. That is all that they are asking for, and they are right to expect it. The competent management of our health service is perhaps the primary thing that we elect a Scottish Government to do—in fact, Neil Gray said as much in his closing remarks. The fact that some people have been forced to pay for private treatment to get well is emblematic of how bad things have become.

I am glad to see the Government making time in the chamber for a debate on health and social care. In truth, the subject has been given far too little time by the Government in recent months. I also welcome the sentiment that the health secretary expressed. However—and I hate to be pessimistic—we have heard it all before. Each of his many predecessors has promised much, but delivered little, and people are sick to the back teeth of being taken for granted. They need new hope and they need change. The health secretary, in his heart of hearts, must know that any new vision for health and social care in Scotland has to be one that does not involve his party.

We move to the open debate.


Jackie Dunbar (Aberdeen Donside) (SNP)

The NHS in Scotland—our publicly owned, publicly run, free-at-the-point-of-use national health service—is one of our country’s greatest assets. For more than seven decades, it has served Scotland through thick and thin, even in a pandemic, looking after folk from the cradle to the grave and aathin in atween.

In years to come, I look forward to being able to talk about it alongside the national care service that is being set up by the SNP Government. The establishment of a national care service is a huge undertaking, but it is just one part of the reforms that we need to consider in health and social care if we want to ensure that it is sustainable in the long term. That sits alongside targeted investments such as the £190 million in multidisciplinary teams to support GPs.

When it comes to health, the answer is not just to throw money at the private sector, or, as Wes Streeting has said that Labour will do, to throw the NHS to the private sector. I firmly believe that at the heart of all the issues that the NHS faces in every part of the UK is Westminster austerity and the £18 billion to £30 billion of cuts that are contained in Labour and Tory spending plans. That threatens the NHS’s future. When it comes to the future of the NHS in Scotland, it is in the best hands possible when it is in public hands, but how we decide to fund the NHS and our spending on a range of other policies that impact folk’s health is a difficult balancing act.

Whether or not we choose to admit it, the question of how much a life is worth runs through many of the decisions that are made in this place, and not just in healthcare. The answer probably varies depending on the policy area that money is being spent in. The nature of what our NHS does means that we can just about identify every life that it saves and every life that it could not save. There is even a measure used in approving treatments that comes as close as you will get to answering that question. It considers quality-adjusted life years when making the most difficult decisions about allocating resources. However, elsewhere in Government, it becomes much harder to pinpoint the individuals affected by those life-and-death decisions. For example, if we invest in improving road safety and road fatalities go down, we will never know who did not crash. Conversely, we know that poverty and poor air quality shorten lives, but would we see those listed on a death certificate?

Initiatives such as the Scottish child payment and low-emission zones may go on to play as much of a role in keeping folk healthy and tackling health inequalities as some parts of our NHS will. Scrapping the child cap would have a similar impact. That would not just give more bairns a better chance at life; it would likely mean that they go on to live longer and healthier lives, too.

I am not suggesting that reform of the NHS be that wide ranging, but as we consider reform, it is worth recognising the role that prevention can play and that not every intervention needs to involve a doctor. I know a lot of folk who view their GP as their only point of contact for everything. That is a reflection of the capabilities of those GPs and the esteem in which they are held. However, some will insist on seeing their GP even when nurses, physiotherapists or other medical professionals are better placed to help them. That multidisciplinary approach is the way forward, and it is starting to become more common and more accepted. It can also be built on.

One example of that good practice is the Grampian eye health network, which works well in my constituency, and which I think other health boards would do well to look at. It is an initiative that sends folk with eye difficulties to an optometrist in the first instance. That takes pressure off GPs and A and E departments, and it means that patients can get a much more appropriate diagnosis or referral from someone who specialises in looking after eyes and deals with them day in, day out.

Nobody is saying that our NHS is perfect. There is work that needs to be done, and there are improvements that can be made. The motion acknowledges that reform is needed, and it looks forward to how those improvements will be delivered. However, let me finish by talking up the state of the NHS in Scotland.

Under SNP Governments, NHS funding has more than doubled, to £19.5 billion this year. We have worked with trade unions to avoid a single day of strike action over pay. NHS staffing is at a record high, with 31,300 more doctors, nurses and other staff than there were in 2007. Compared with England, we have, per head of population, more doctors, more nurses and midwives, more hospital consultants, more GPs, more dentists and more NHS staff overall, and we are continuing to invest in training even more staff, with 880 more junior doctor training posts created since 2014.

The NHS will stay in safe hands and in public hands under this SNP Government.


Sue Webber (Lothian) (Con)

Our NHS is an incredible national asset—I do not think that anyone doubts that—but it continues to face growing challenges. The SNP’s consistent attempts to blame its NHS failures on the UK Government lack credibility; after all, it has full control over healthcare. However, here we are, with more than 840,000 Scottish people waiting on an NHS waiting list. In March 2024, almost a third of patients had to wait for more than four hours in A and E. Just 71.1 per cent of cancer patients are seen within 62 days. Since the SNP promised to increase the number of GPs by 800 by 2027, GP numbers have decreased by 42. Right now, there are more than 4,000 nursing vacancies in NHS Scotland. In 2023, NHS staff faced around 31 assaults a day.

I could go on, but we have heard those statistics many times before, and I am sure that we will hear them again in this debate.

The only way to bring down the waiting lists is to be more efficient with the resources that we have or to create more capacity to do more. Just imagine what we could do if we could do both.

Here is what I mean by being more efficient. I recently spoke to a surgeon who operates across two different hospitals. In one hospital, the theatre is staffed with tens of nurses and operating department practitioners, and they deal with two cases, or maybe three if they are lucky, on a list. In the other hospital, there are far fewer staff in each theatre, but on one list, they can deal with six to eight cases. Faster patient turnarounds and fewer delays between cases is more efficient. Imagine how we could bring down waiting lists if that was compounded with increased capacity.

It is blindingly obvious to me that the decision that the SNP Government took to stop all new capital investment in our NHS will be catastrophic. The SNP Scottish Government appears to favour short-term solutions that will have devastating long-term consequences for our NHS. As Jackie Baillie said, we were promised 11 new regional treatment centres that were intended to bring down the waiting lists. Now, the Scottish Government website mentions only four.

In addition to those treatment centres, dozens of NHS construction projects across Scotland have been stopped. Vital projects in Lothian have been postponed. Those include a new cancer centre, a new eye hospital and a national treatment centre in Livingston. A GP surgery in East Calder that is crying out for a new facility has been all but abandoned. That is before we talk about community hospitals in and around the area closing. With a growing population and diminishing resources, the new chief executive of NHS Lothian has a real challenge ahead of her.

Let us focus on preventative healthcare for a moment. Right now, for every £1 that we spend on our NHS, we spend just 2p on public health. Investing in prevention has substantial benefits in reducing patient demand and costs, as does early diagnosis and treatment. That keeps treatment costs down, it results in far better patient outcomes and it gets people back to work, with a far better quality of life. We need to greatly increase spending on public health interventions if we are to make prevention the overall strategy for our approach to healthcare. We all know about the success that the smoking ban had in the immediate aftermath of its introduction.

Arthritis and other musculoskeletal conditions affect a third of Scotland’s population—that is, 1.7 million of us. Just last week, figures were published that showed record NHS waiting times, with trauma and orthopaedic waits forming the single largest cohort: they make up a third of all waits.

I am one of those 1.7 million, and I am far too young to be getting new knees just yet, but I have been in chronic pain and on a significant level of medication to manage that pain. That medication is not free; it costs money. Yesterday, I went to the GP for the second injection in my knees, so I have now had them both done. Almost immediately after my hyaluronic acid injection, I experienced a significant reduction in pain, I have increased mobility, and I am not taking the medication any more, which will have many health benefits.

Here in Lothian, there are very long waits for such joint injections. I have been very fortunate to have a GP who can do them, and I want to give a thank-out to Dr Graeme Parry in Colinton surgery. I met a physio who told me how important a role physios can play for people with arthritic joints, yet the Chartered Society of Physiotherapy has highlighted a worsening workforce crisis in physiotherapy, with record high vacancy rates and one in five physiotherapists considering leaving the profession. It is a key profession for getting elderly patients who are stuck in hospital more mobile and able to function themselves, which would free up hospital beds and appointments and make space for other activities to take place.

For those who really want to talk about preventative spend, I want to speak about a rare and incurable genetic condition that affects spinal motor nerves, which is called spinal muscular atrophy or SMA. Unless it is caught early, it results in progressive muscle wasting and weakness. With approximately one in 16,000 British babies born with SMA, the case for adding it to the screening blood spot tests for all newborns is obvious to me. I notice that Mr Doris is in the chamber—I know that he, too, cares passionately about the condition. Yes, that test will cost money, as will the treatment, but the cost of round-the-clock care for someone with SMA is around £500,000 a year, so surely that fits both financially and philosophically with the principle of preventative medicine.

Bob Doris (Glasgow Maryhill and Springburn) (SNP)

I can update the member on progress in relation to SMA screening. I and representatives of people who are suffering from SMA had a very successful meeting with the Cabinet Secretary for Health and Social Care. We need to get more information, but we are very optimistic that progress will be made, and the Scottish Government has been very constructive in relation to the matter.

Sue Webber

I thank Mr Doris for that update.

Still on the subject of preventative action, on Friday I met a lady in Colinton called Shona Harrower. She wanted to tell me about a truly preventative approach from Norway.

“Amazeballs free sports equipment loan scheme for all under 25s with a residential address in Norway”,

she proclaimed.

“Rachel (my daughter) just sent me this awesome photo from Norway. An old school friend visited her, and they borrowed all the camping gear they needed from the (free) Bua shop to make memories like this”.

If a picture could tell a thousand words, that one certainly did. What is there not to like about tackling physical and mental health at the same time, and getting our young people involved in sport and nature?

The NHS in Scotland has been described as

“not sustainable in its present form”

by Professor Paul Gray, the former head of the NHS in Scotland. The SNP has driven the NHS into that crisis. It must adopt the Scottish Conservatives’ proposals from our “Modern, Efficient, Local” healthcare paper to secure the future of our NHS in Scotland.


Christine Grahame (Midlothian South, Tweeddale and Lauderdale) (SNP)

The Scottish Government, in choosing to invest more than £19.5 billion in health and social care in 2024-25, is giving our NHS a real-terms uplift in the face of UK Government austerity. I understand that NHS funding comprises almost 40 per cent of the Government’s budget. It has more than doubled under the present Government, and staffing is at a record high, as colleagues have said, with far more doctors and nurses per head in Scotland than in England. By working with the trade unions, the Government prevented a single day of strike action over pay in our health service, unlike elsewhere in the UK. We all know that Scotland has an increasing ageing population and, therefore, increasing demands on health and social care, and the fallout from Covid continues to add pressure to NHS services.

I now turn to the financial context, which Sandesh Gulhane and Jackie Baillie conveniently sidestepped. There is a perfect financial storm, which started with austerity under the Tories, following the 2008 bank crash, and continues to this day. There was Covid; Brexit, with its costs; the raging inflation, which peaked at 11 per cent, that was brought about by the disastrous Liz Truss budget, and the natural wage demands that followed as a consequence; and the energy inflation that resulted from Ukraine’s invasion by Russia, which was compounded by a failure of UK Governments to invest in home-grown energy over decades, having squandered North Sea oil revenues, unlike independent Norway.

Before we tackle reform, let us lay to rest some myths. A good place to start is to follow the money. If any UK Government makes public sector cuts, because of Barnett consequentials, we suffer, too. That is significant when I refer to Labour’s plans, should it come to power. For example, if more health is delivered through the private sector, public funding decreases in England, so funding that is devolved to Scotland decreases when the Scottish Government is determined to keep the NHS in public hands.

Will the member take an intervention?

[Made a request to intervene.]

Yes, I will take an intervention.

I call Sue Webber.

Sue Webber

The spending is not ring fenced. If the NHS in England chooses to contract a private provider to provide a service, the money still comes to Scotland as a consequence. It is not allocated in the manner that the member is saying that it is.

Christine Grahame

I say with respect to the member that she had better check how the money is allocated to Scotland.

Labour’s shadow health secretary has admitted that, when it comes to NHS funding, Westminster is damaging Scotland’s NHS because of the Westminster austerity that we have suffered for 14 years. Rachel Reeves, the shadow chancellor, has indicated that the Labour Party, if it is elected to office, will not increase income tax, national insurance, corporation tax or VAT, and that it has accepted very strict borrowing limits within very strict fiscal and tax rules, and squeezed spending budgets. Does Labour have several money trees?

The Labour health spokesperson also said that the party wants

“the NHS to form partnerships with the private sector that goes beyond just hospitals”,

having previously admitted that he will be

“holding the door wide open”

to private interests in the NHS. To me, that is privatisation.

Private healthcare investors have also stated that the Labour Party would

“kick-start private sector investment much more proactively than the Tories were able to do.”

[Made a request to intervene.]

[Made a request to intervene.]

Will the member take an intervention?

I will take the member. Is she challenging those quotes?

Carol Mochan

Has the member considered some of the questions that have been put to the Scottish Government about its continued use of private beds in the Scottish system? We must think about what is happening in our system and be realistic about that.

Christine Grahame

I asked the member whether she was challenging the quotes, which have been used in the Labour Party’s election campaigning. She did not challenge them, so I adhere to them.

In Labour-run Wales, when the draft budget was published, the Minister for Finance, Rebecca Evans, said:

“After 13 years of austerity, a botched Brexit deal, and the ongoing cost-of-living crisis, this is the toughest financial situation Wales has faced since the start of devolution. Our funding settlement, which comes largely from the UK government, is not enough to reflect the extreme pressures Wales faces.”

What is true for Wales is true for Scotland.

On top of that, Scotland is still living with the bruising legacy of Labour’s private finance initiative, which has landed us with a bill of £30 billion. That was handed down to taxpayers by Labour, which built in Scotland using a “build now, pay later” scheme. The SNP Government had to buy out, for example, the contract levying car parking charges at the Royal infirmary of Edinburgh because of the PFI contract.

Until we are independent and have control of all our resources, the stark truth is that the Westminster Government might change from Tory blue to a lighter Labour shade of blue, but that will be the only change.

In conclusion, I will again quote Labour’s shadow health secretary Wes Streeting, who is now one of my favourite people. He said:

“all roads lead back to Westminster”


“The NHS is in crisis and all decisions that are taken in Westminster don’t just affect England – but Wales, Scotland and Northern Ireland.”

That should be borne in mind when Labour’s proclamations of change mean Labour’s creeping NHS privatisation plans, with a predictable reduction in Scotland’s NHS budget. We will not even be able to firefight, let alone do preventative medicine and treatment, because no reform can cope with that.


Elena Whitham (Carrick, Cumnock and Doon Valley) (SNP)

I am passionate about early intervention and prevention across all systems that impact on our health and wellbeing, individually and collectively as a nation. I believed in that ethos before Dr Campbell Christie’s commission, and it has been the guiding principle for all that I have done in the past decade.

The Government’s motion puts early intervention and prevention and public service reform at its heart. We cannot deny the fact that the Scottish Government has increased the NHS workforce by nearly 25 per cent since 2006. We also cannot deny that, despite 14 years of austerity and inconsistent funding flowing from Westminster, the Scottish Government is, this year, providing a record £19.5 billion for health and social care budgets. However, we cannot fail to recognise that the entire health and social care system urgently needs to be reformed, because, despite record staffing levels and record funding, people in our communities are still dealing with health inequalities and access difficulties. That means that we need to engage in an open and honest national discussion about what we want and need from our health and social care system and how we will navigate the systems and culture changes that are urgently needed. That need has been exacerbated by Covid and Brexit.

Yesterday, I chaired a round-table discussion at Girvan community hospital that was attended by cross-party MSPs, local councillors, community organisations and statutory services. The meeting was brought about by the untimely death of a much-loved local man who passed away despite the heroic efforts of locals, including two off-duty paramedics who worked valiantly for 50 minutes before the ambulance that was drafted in from Kilmarnock arrived. With a lot of unease in the community about access to emergency care, a letter was sent to elected members and statutory services to bring the tragic loss to our attention.

In Girvan and the surrounding villages and hamlets of South Carrick, there is a resilient population that is used to working collectively to deal with the rurality of their lives. They have excellent community groups, including the Royal National Lifeboat Institution, a community fire station and community paramedics, and there are many defibrillators across the area. Neighbours look out for and look after one another, with the deep-held belief that, in their time of need, the state will look after them.

I cannot determine whether the man’s life would have been saved had an ambulance attended within the target time, but, if it had, the family and the community would have known that all had been done for him.

Yesterday’s round-table discussion was wide ranging and hard hitting. We all realise that there are profound equalities issues in rural areas when it comes to accessing health and social care services and, indeed, many other public services. There was an acceptance that an ambulance cannot sit in the South Carrick area in case there is a critical incident requiring its attendance across the rest of Ayrshire, but it remains the case that, when the Girvan ambulance is pulled away, that leaves a vast area without life-saving cover close at hand.

We discussed the innovation that has been undertaken by the locality partnership to bring as many NHS services to the Girvan area as possible within the community hospital and health centre. There was a discussion about the learning from successful area-based shared-working models, such as the one in place in Dalmellington in East Ayrshire and, more recently, the one in Dumfries and Galloway. Both of those models involve looking across all systems, including those relating to housing, access to social security, access to exercise, and healthy food and wellbeing via reductions in poverty and social isolation at all stages of life.

The community conversation yesterday is exactly the type of conversation that we need to have across Scotland. We need to move the discussions away from resting only with decision makers and put them firmly into our town halls and community centres. We need to ensure that community assets are recognised and utilised to maximum effect. We need to move the dial towards investing much more in early intervention and prevention to ensure that our children and their children are able to live long, happy and healthy lives.

I am concerned by the rhetoric in the current political debate, which seems to point to very little increased funding for our public services, including the NHS. It feels more like we will be short-changed, rather than any real change occurring.

If we want to truly create a health and social care service that will support an ageing population and deal with entrenched health inequalities, which were exacerbated by the Covid pandemic, with comorbidities increasing, all spheres of government need to recognise that resources must be made available to innovate and intervene early on. Without investment in early intervention and transformation that is supported by everyone, we will not achieve our collective goal of a robust and resilient health service that is there at the point of need for everyone.


Carol Mochan (South Scotland) (Lab)

It is welcome that this debate has been brought to the Parliament in Government time. Discussing the NHS and its future is of critical importance, and we must all work together to deliver an NHS that is fit for the 21st century. Having said that, we absolutely cannot ignore the context in which we have the debate, nor the challenges that our NHS faces in 2024. The SNP wants all parties to participate in the discussion about our health service’s future, which is welcome. However, for that to happen, the SNP must recognise its role in causing the seriously challenging position in which the NHS finds itself. Acknowledging one’s own mistakes is a key factor. Acknowledging the challenges resulting from Governments’ own approaches is a key factor.

I know that some SNP back benchers like to discuss the Labour Party, and I, too, enjoy discussing the future Labour Government. However, today’s Labour amendment rightly takes the opportunity to set out what is happening in Scotland. We now have one in seven Scots on waiting lists. I must ask the Government and its back benchers to realise what is happening in Scotland. I do not say that to have a go at the Government; I say it because, to go back to my earlier point, we need to acknowledge the challenges in some of the approaches that have been taken. There are 32 per cent more private hospital admissions compared with 2019, and spending overall per person has reduced.

The member at the back was extremely critical of spending, but we know that, in the early years of the SNP Government, John Swinney did not pass on consequentials from a Labour Government to the Scottish NHS.

Will the member take an intervention?

Will the member take an intervention?

I will give way to Mr Whitfield.

Martin Whitfield

The Barnett consequentials flow from expenditure in England in certain specific areas, where the same areas are devolved to Scotland. Where money is spent on the NHS in England—however it is spent—it will lead to a Barnett consequential coming to Scotland.

Yes, of course—understanding the system is really important.

I am happy to take an intervention from the member at the back.

Christine Grahame

I thank Carol Mochan for that new title, “the member at the back”—I am quite happy with it.

Carol Mochan is a good socialist, like me. Does she have concerns about the noises coming from Wes Streeting and Rachel Reeves with regard to public services and, in particular, privatisation steps in the English NHS, which will impact on Scotland?

Carol Mochan

The member knows that I love a good Government back bencher, and that I think that it is important for members to challenge their own front benches. However, the member must understand that the NHS will deliver better with a Labour Government—there is absolutely no doubt about that.

To get back to Scotland, we must acknowledge that having patients using the private sector—those who can afford to do so—is creating a two-tier system. Those who can pay can get treatment, and those who cannot are stuck in pain. We know that the Government books beds in the private sector. I say that to be honest about the issue so that we can talk about how we move away from it. A and E waiting times remain stubbornly high, and the SNP does not have a clear plan for how to bring them down. Those are long-term issues that have arisen and are becoming worse. If the Government truly wants to work with us, it needs to be honest about those issues. I therefore hope that it will support the Labour Party amendment so that we can work together.

I am conscious of time, so I will move on. I believe that the cabinet secretary wants to look to the future and that he honestly wants to work together with us on the issue. My view is that health inequalities, which are divisive in nature, are one of the greatest challenges that we face, and I know that the cabinet secretary accepts that point.

From the uptake of cervical screening services to deaths from alcohol and drugs, from childhood obesity to life expectancy, in Scotland, a person’s postcode still determines their health outcomes in 2024. It is an absolute disgrace. For far too many people, a high number of years of poor health followed by early death is a reality. That is a serious issue, and tinkering around the edges will not resolve it.

We need to bring health services to our most deprived and vulnerable communities. I hope that the cabinet secretary will work with us on that. We need to roll out screening at home in areas where uptake is low. We also must invest in alcohol and drug partnerships, and it is excellent to have the minister who has responsibility for that with us. I know that she, too, wants to make sure that we have those services on the ground so that we can challenge some of the issues that face our communities.

We have to invest in health outcomes for our children by extending access to free school meals to tackle hunger and improving opportunities to take up sport. We need to do that by properly supporting our councils. It is essential that we fund local government.

We need to work cross portfolio to make sure that those things can happen.

Will the member give way?

Carol Mochan

I am supposed to be winding up.

I am happy to talk about the matter again. I could talk about it all day. The key point is that, if we want to work together, we need to have some honesty.


Ruth Maguire (Cunninghame South) (SNP)

I understand that conversations about the better performance of Scotland’s NHS are not what people who are on a waiting list want to hear. I would never minimise the real pain and worry of patients and their families or the pressure and stress among staff that issues in our healthcare system cause. However, in a parliamentary debate, it is perfectly reasonable to point out some facts about investment that the Scottish Government is making and action that it is taking.

The SNP Scottish Government is choosing to invest more than £19.5 billion in health and social care, thereby giving our NHS a real-terms uplift in the face of UK Government austerity. That uplift exceeds the front-line Barnett consequentials and means that resource funding for health and social care has more than doubled since 2006-07, including £14.2 billion in investment for our NHS boards and additional investment of more than £500 million.

That said, there is an urgent and critical need for health and social care reform. We have to change the way that things are done. This morning, in the Health, Social Care and Sport Committee, we heard about the difference that research can make, so I welcome the cabinet secretary’s announcement in that regard. Reform must focus on creating a healthcare system that is sustainable, performance must improve and we have to get prevention right.

We have been talking about prevention for an awfully long time. We have to shift resources and get that right, provide quality services and maximise access. The inequality in access and outcomes that a large number of the communities that I represent still experience is wholly unacceptable. Any reform must have a foundation of due consideration for the people who are at the heart of the health and social care system—patients, their families and, of course, the workforce.

When I speak in debates about reform, I never lose sight of the human aspect. Health and social care is not an abstract topic to me. Living in the area that I represent, I have the same first-hand experience as many of my constituents do, as do my friends and family, some of whom are employees, too.

In the context of an ageing population, persistent health inequalities and fiscal pressures, delivering a high-quality, person-centred service is indisputably challenging. I do not think that anyone in the chamber would be so arrogant as to claim that they are clear on exactly how to do that—clear that they have all the answers. In that regard, a national conversation is welcome. Elena Whitham’s eloquent remarks about her experience with her community will provide rich learning for the Government.

One thing about which the SNP Government is very clear is that the answer to the challenges that we face is not privatisation. My Labour Party colleagues are rightly proud of their party’s role in forming the NHS, and they are also talking a lot about change at the moment. Notwithstanding Jackie Baillie’s remarks, however, Ayrshire residents should be warned that there is the potential for Labour to short change them when it comes to protecting the NHS. These words have been read out before, but they are worth repeating. Labour’s health spokesperson said last week that the party

“will go further than New Labour ever did”

and that Labour wants the NHS

“to form partnerships with the private sector that goes beyond just hospitals”,

having previously admitted that he will be—and I am quoting directly—

“holding the door wide open”

to private interests in the NHS. Private healthcare investors have also stated that the Labour Party would

“kick-start private sector investment much more proactively than the Tories were able to do”.

We will need consensus on exactly how to reform and improve things. My worry is that, after 14 years of Tory austerity, the growing Westminster consensus between the Tories and the Labour Party now seems far more interested in selling the NHS than in saving it.

The founding principles that the NHS in Scotland remains in the hands of the public and is free at the point of use will never change for the SNP. It is clear today that the threat comes from Westminster. That is why, in the first 100 days after the election, SNP MPs from Ayrshire, I hope, and across Scotland will propose a new law at Westminster to keep the NHS safely in public hands—a new SNP law that will bind the hands of any UK Government and ensure that the health service is fully protected as publicly owned, publicly operated and, with its services, publicly commissioned.

The SNP will stand by the founding principles of the NHS of keeping it free at the point of delivery and keeping our health service where it belongs—in public hands.


Gillian Mackay (Central Scotland) (Green)

We should all continue to call for additional efforts and initiatives to support the recruitment and retention of clinicians and other NHS staff. For example, the Royal College of Physicians of Edinburgh highlights that it would welcome a review of the NHS estate to ensure that medical staff have access to hot food during night shifts and adequate rest and changing facilities. We know that one of the biggest barriers to that is staff not being able to leave a ward to access such facilities in the first place, so we need to ensure that work on safe staffing is progressed at pace.

As a front door to the health service, a thriving general practice not only brings direct benefits to its patients but serves to protect the entire NHS. Without general practice, the rest of the health service would be overwhelmed and the NHS as we know it would simply not exist. There are obviously pressures on urgent care in many health boards. In the short term, we need to have enough staff and capacity to deal with what is coming through the door. In the medium and long terms, we need to help GP services to ensure that they can see people, to prevent them from turning up at accident and emergency unnecessarily. GP out-of-hours services should also be supported and strengthened as a vital piece of the urgent care landscape. There is a hugely dedicated team that takes on that role in addition to other responsibilities.

The entire system is interconnected and interdependent, but that should not provide us with excuses for not tackling the big issues or not having big conversations with service users, unions and stakeholders.

As Sandesh Gulhane rightly said, we need to look at alternative routes into medical careers, to take care of short-term and long-term workforce issues. However, we also need the UK Government to play its part. For example, if they are given indefinite leave to remain, international medical graduates could be part of the workforce for a long time to come.

Elena Whitham’s contribution prompted a thought that I do not think we have covered today. We have all set out national aspirations, but that assumes that all our health boards are facing the same challenges equally. We know that that is not the reality, so we need to tailor approaches to ensure that they have the support that they need.

We need to see change in the short term to build clinician and patient confidence, because, if they do not believe that things are going to get better, it will be an uphill battle to continue reform. We need to see a realistic timetable from the Government for how and when things will change, and we need to know that we are not going to see just another round of constant meetings and talking.

We must continue to prioritise a preventative approach, to alleviate the pressures on our NHS and enhance the general health of our population. To continue with a preventative approach means building on strong progress such as minimum unit pricing and work on banning disposable vapes.

Increasing the number of medical school places across Scotland would be an important step towards addressing workforce challenges, but those increases must be matched by an urgent expansion in training posts for all who require them, across all specialties and in all parts of Scotland. Failure to expand training opportunities can lead only to extreme frustration in the medical workforce and will undermine attempts to retain doctors in the NHS.

We must also listen to our junior doctors and new nurses to ensure that the training process is improved so that they do not burn out. They will be our clinicians for generations to come and their experiences must be taken into account, because some of those are not good. They do not get shifts when they should, or they miss major life events to ensure that people get the right care, and that is just the tip of the iceberg.

Like other members, I will touch on mental health. Mental health problems are strongly linked to health and social inequalities. Those living in the most deprived areas are three times more likely to end up in hospital due to mental health issues than those living in the least deprived areas. We need more and better general practice in all areas of profound socioeconomic deprivation, to reduce the ill health and mortality that those services can influence.

We must also look at the treatment mix in mental health to ensure that it reflects what the population actually needs. Very soon, many young people who have known only talking therapies in the support given by their schools will transition to adult services. We do not have that balance or that provision of cognitive behavioural therapy in adult services. That is one example of a long-term issue that we must look at now to ensure that services are fit for the time when more young people enter adult services.

The outcomes for a number of other conditions could, with investment, be radically improved. Closed loop diabetes kits undoubtedly have positive benefits for users and reduce potential complications. Thrombectomy can literally save the life of someone who has suffered a stroke, as well as preventing disablement and reducing NHS spending. At the moment, that is only a 9 to 5 service in many places, creating a lottery that depends on when a person has a stroke.

I will briefly address the amendments to today’s motion. Green members will abstain on both. The Conservative amendment would remove some good things that we added to the motion, and, although we support the majority of the Labour amendment, the number contained in it is so incorrect that we cannot support it.

Overall, I have been pretty disappointed by this debate. If we are to have a grown-up conversation, we must all give up our politically entrenched positions. There have been some good ideas, but people do not want a good idea that is wrapped in a party political broadcast. We must be better than that.

I thank all those who sent briefings ahead of the debate and look forward to the conversations that are clearly needed—and wanted—about what the NHS needs, so that it can deal with its current challenges and ensure that it is fit for the future.


Paul Sweeney (Glasgow) (Lab)

I am pleased to close this debate for Labour, because this was the party that led the National Health Service (Scotland) Act 1947 through Parliament and brought the service into being on 5 July, 76 years ago next month. That was a huge milestone, but the national health service was certainly not an immaculate conception. I do not know whether anyone has managed to see recent the National Theatre production “Nye”, which shows the hugely fraught process that involved a number of stakeholders and interest groups, which brought the NHS into being.

We should not be complacent about that mythology, but the heart of it is the principle of providing a service that is free at the point of need. There is certainly a consensus about that across this chamber and Labour will always defend that fundamental principle. However, I have found it to be rather ironic that today’s Government motion refers to a commitment to the NHS being

“free at the point of use”

when that Government has presided over the national health service for almost a quarter of its existence in Scotland and has, in the process, allowed a two-tier healthcare system to emerge because of gradual disinvestment.

For example, we can look at the period from 2007 to 2010, when the current First Minister was finance secretary. He failed to pass on Barnett consequentials from the UK Labour Government, which set in train a trajectory of constraint on NHS spending. NHS expenditure per capita was 17 per cent higher in Scotland than it was in England when the SNP Government came into power. Today, it is only 3 per cent higher. That gradual increase in constraint on NHS expenditure has had a ratcheting effect and has caused major problems for healthcare investment here in Scotland.

John Mason

I think that I pressed the wrong button. I apologise.

I thank Paul Sweeney for giving way. He says that there should have been more money for the NHS. Does that mean that he thinks that there should have been less for local government?

Paul Sweeney

I do not want to get into using the premise of national income accounting, but that is certainly not the zero-sum game that we are talking about. That is exactly the problem at the heart of the debate—the simplistic analysis that has led us to this position. We know that, when we cut local government spending, that back-loads on to the NHS. For example, cutting programmes in a community leads to greater morbidity and ill health in that community, which then loads on to A and E departments. It is a false accounting exercise.

What we should be focusing on is cost avoidance. Here is an example. We know that people are suffering serious disablement, pain and invalidity in the community, because we can see it in the evidence that 40 per cent of the knee and hip operations that were carried out in Scotland last year were paid for privately, and in the fact that the number of self-paid hospital admissions is up almost 80 per cent from pre-pandemic levels.

Although we have the shared idea that the health service in Scotland must be free, it is certainly not there at the point of need for many Scots. They are suffering in pain for a long time and are having to spend their life savings and to sell assets to fund their wellbeing. That is not sustainable, it is not acceptable and it defies the principles on which the NHS was established.

We have heard some extreme examples today. I was quite struck by Elena Whitham’s talk about ambulances. I have seen that in my casework. For example, a man came home from work to find his father on the floor having a stroke. He waited more than two hours for the ambulance. By the time it came and got his father to hospital, the doctor had to come and break the news that he had waited too long and therefore had a permanent disability.

Will Paul Sweeney take an intervention?

Paul Sweeney

No. I am sorry.

The man was wracked with guilt that his father might not, had he got him into the car and to the hospital, have suffered long-term disablement. Such things are what we see daily in our health service, which defies the principle on which it was built.

We will not take lectures from the Government on private medical care, which has driven our NHS into the ground. The cynical misrepresentation of discussion about collaboration with innovators and researchers in the private sector or in the universities is completely unacceptable, because it defies the history of the NHS.

Let us look at one example. In fact, one of the greatest achievements in the NHS was a public-private collaboration. In the 1970s, the record label EMI, which was pioneering with the Beatles at the time and earning lots of money through revenues that were generated by their record sales, ploughed money into research at its central research laboratories to develop what became the computed tomography, or CT, scanner. EMI partnered with the then Department for Health and Social Security, which invested £600,000 in the project. Godfrey Hounsfield, who was the chief scientist at EMI and worked in collaboration with the NHS, won the Nobel prize for that work. The CT scanner was built as a legacy of the NHS and a private-public partnership. That is what we are talking about when we refer to bringing in the innovations that we need to improve our healthcare system.

Sue Webber talked about productivity issues in our NHS. That is exactly the sort of thing that we can improve with collaboration and investment, as are operating theatres that are not operating at optimal efficiency, for example. There are medical technology companies in Scotland that have products that can improve the productivity of the NHS, but they are not even getting a look-in at bringing their technologies to bear in the NHS. Those technologies cannot be developed in-house, because they are pioneering, cutting-edge and discrete specialist technologies. Companies across Glasgow and elsewhere in Scotland are offering such opportunities to the NHS, but they are not being brought in. That is what we should be doing to improve our healthcare system.

For 17 years, the NHS budget has been under pressure. However, as has been mentioned, the budgets of local councils up and down the country have also been under pressure, which is leaving health and social care partnerships strapped for cash and unable to fulfil the care needs of the community.

People who work in the care sector are not paid nearly enough to sustain themselves, so they leave the profession, which creates vacancies that continue to back-load pressure on to the healthcare system. That is why we need a new deal for working people that will transform terms and conditions for care workers, including a clear path to £15 an hour pay for care workers.

We recognise the importance of carers and our healthcare staff across the professions. They deserve better.


Tess White (North East Scotland) (Con)

The NHS is an incredible national asset, but as we have heard repeatedly in the debate, it is on its knees.

For 17 years, the SNP Government has been the custodian of Scotland’s healthcare service, but it is out of ideas and out of time. Perhaps that explains SNP Westminster leader Stephen Flynn’s ludicrous intervention yesterday, which abdicated any responsibility for the state of Scotland’s fully devolved health service. It was shameful grievance-mongering but, sadly, that is something that we have come to expect from the SNP. Professor James Mitchell was spot-on when he said that the latest deflection from the SNP was “evasive” and “simplistic”, with “no serious engagement” with the “challenges” that the NHS faces.

In a new report this week, the Royal College of Nursing has laid bare some of the challenges. It found that more than a third of nurses have delivered care in settings such as hospital corridors, which has alarming implications for patient safety. The situation is so bad that the RCN has described it as a “national emergency”.

Dr Sandesh Gulhane said:

“the SNP has chosen to manipulate Scottish parliamentary time in order to serve its UK general electioneering purposes. That is an affront to every Scot who relies on the NHS and to every healthcare professional who dedicates their life to serving others.”

Wherever we look, whether in primary or secondary care, the situation is critical for Scotland’s NHS. Delayed discharges are up by 12 per cent on last year and there have been almost half a million fewer operations than there were in the pre-pandemic period. Consultant vacancies are up by more than 11 per cent in a year, and nursing vacancies remain stubbornly high.

Across every health board, the number of GP surgeries is down on the number a decade ago. Ambulances are stuck outside A and E departments—especially at Aberdeen royal infirmary in my region—for hours at a time. NHS services are increasingly being centralised to urban areas. Minor injuries units in rural communities are closing or restricting their hours, and some rural health boards cannot even recruit GPs.

What about the one in seven Scots who are languishing on NHS waiting lists for months, or even years, as their conditions deteriorate? What about the national treatment centres, including in NHS Grampian and NHS Tayside in my region, that were promised to relieve the pressures on the system, but have been put on ice? Worst of all, we know that people are dying unnecessarily: in A and E departments alone, there were as many as 2,000 excess deaths in 2023.

For too long, the SNP has presided over a process of managed decline in the NHS. Successive SNP health ministers have overpromised and underperformed. NHS staff and patients are paying the price, with intolerable workforce pressures, inadequate infrastructure and unbearably long waits for people who are in pain and discomfort. SNP members do not want to hear it, but it is they who are responsible for the NHS in Scotland and they who are making spending decisions and determining spending priorities.

The crisis will only get worse with an ageing population and growing demand on a healthcare system that simply does not have the capacity to respond. A national conversation on the future of the NHS is welcome but, ultimately, we need solutions. Today, the cabinet secretary talked about the transformation of services and having a national conversation. He used the word “reform” at least seven times—in fact, it was used so often that I stopped counting. Why have the previous health secretaries and the current cabinet secretary not been listening to key stakeholders such as the RCN, the Royal College of Midwives and the Royal College of Surgeons? The SNP Government has the feedback that it needs. It is action that is lacking.

Today, Humza Yousaf was here at the start of the debate, but I noticed that it did not take long for him to scarper out of the chamber—[Interruption.] Did SNP members hear that? He scarpered out of the chamber when he heard the current health secretary talk about reform being required.

Carol Mochan talked about the importance of honesty when having a conversation—but how can one have an honest conversation with the SNP Government when it deflects and denies? There was deflection when the cabinet secretary questioned the figure of 840,000 people on NHS waiting lists, which came out last Tuesday from Public Health Scotland.

[Made a request to intervene.]

Tess White

I will refer to SNP back bencher Christine Grahame in a minute.

There was denial when every SNP back bencher—I am coming to you, Christine Grahame—electioneered with anti-Westminster rhetoric. Even when one of our favourite SNP back benchers bangs on her grievance drum—

[Made a request to intervene.]

Tess White

I am sorry—I will not take an intervention. I have had enough banging on the drum, Presiding Officer.

This should be about fixing and future proofing—[Interruption.]

Let us hear the member.

The SNP does not want to hear what I have to say, but I would like to finish. [Interruption.]

Let us hear Ms White.

Tess White

The Scottish Conservatives have already delivered in that regard. We were the first of Scotland’s parties to contribute detailed and credible proposals to the conversation. As Dr Gulhane said, for all our population—urban, rural and island—we would take a modern, efficient and local approach to healthcare reform that would increase capacity and address demand. We would introduce a 24/7 digital health service, through a “My NHS Scotland” app.

The cabinet secretary says that primary care is the bedrock of our NHS, but I say to him that primary healthcare is on its knees. We would deliver 1,000 additional GPs, investment of 12 per cent of the NHS budget in GP clinics and a new national standard that would guarantee patients an appointment within a week. We would establish maximum waiting times across all major NHS metrics.

Our NHS has reached a crisis point—

Christine Grahame

On a point of order, Presiding Officer. I seek your guidance. Two members—Humza Yousaf and me—have been mentioned by Tess White in a rather disparaging manner. Is not it incumbent on her to let us intervene and respond?

It is for the member who is speaking to decide whether they accept an intervention.

I ask you to conclude.

Tess White

Thank you, Presiding Officer. That point has been made: it was not a point of order, as we hear constantly.

If Neil Gray is serious about reform, the SNP Government must step up, stop shirking responsibility and finally show some leadership.

I call Neil Gray to wind up the debate, for up to nine minutes.


Neil Gray

I thank members for the important discussion on the future of health and social care services. I say that at the outset to be constructive and collaborative and to seek consensus. There are some exceptions, which I will come to. I opened the debate with a genuine call for openness and collaboration. I intend to continue that approach as we take forward our reform agenda. I genuinely thank those who contributed today. I will touch on some of them in detail and will thank others if I have time at the end of my speech.

First, I want to temper Sandesh Gulhane’s cynicism about the timing of the debate, as it has been well trailed for quite some time since I came into post, and was proposed long before the election was called. Although I agree with him on putting more money into primary care and agree that, in the long run, that will realise health and financial improvements, we will not see those savings in the short term. I am therefore genuinely keen in the reform discussion to apply our cranial attention to how we do that without affecting current secondary care services.

Sandesh Gulhane was also wrong in his assertion about the Government’s funding of health and social care. The Treasury’s own figures—which also contradict the assertions of Carol Mochan and Paul Sweeney about the Government’s funding for the health service—show that, if health spending per head in Scotland had matched that of England, £15 billion less would have been put into the NHS in Scotland between 2006-07 and 2022-23.

As many others in the chamber did, Jackie Baillie set out the challenges, but she did not rise to the challenge of saying where we go from here. I will turn to her remarks in more detail shortly—in keeping with the theme of honesty that Carol Mochan asked for.

Gillian Mackay made two very helpful contributions, which rightly turned to the need to target prevention and invest in primary care.

Alex Cole-Hamilton’s assessment of the challenge in our health service is real, but he failed to live up to what I had anticipated from the chamber by not saying how we move forward. Sadly, like others, he failed to do that. Mental health funding is up under this Government and, contrary to Alex Cole-Hamilton’s perspective, CAMHS figures show progress and the best performance for many years after the doubling of the budget and the number of staff.

I will turn to other contributions, including those from Jackie Dunbar, Christine Grahame, Elena Whitham and Ruth Maguire, in more detail. They were helpful. I also hope to turn to Carol Mochan and Sue Webber’s contributions.

Today, I have outlined the Government’s vision for reform, and I have spoken about the actions that we are already taking to improve and reform our health and social care services. Our intention to reform health and social care is now well established.

That vision, which will drive the reform to enable people to live longer, healthier and more fulfilling lives, is underpinned by the four key areas—prevention, quality service provision, increased access and having people at its heart—and it is broad and deep. It spans population health interventions that will improve our general health through a person-centred approach to clinical and service operating models that will drive improvements across our health and social care services.

Will the member take an intervention?

Neil Gray

I will try to take interventions once I have made some progress.

Now is the time to drive forward the reform activity that will ensure that we deliver the vision. It has never been more urgent to do so, and it requires concentrated action across Government to maximise efforts across portfolios and society. Those portfolios will include education, housing, communities and transport, and the efforts will be impacted by income and economic opportunity as well as physical and mental health.

It is clear that we need to work not only across Government but across health boards, community planning, education, business and other health services. Our vision is focused on change and improvement in current NHS structures, maximising current assets and delivering a population-based approach to the planning of acute services that will transcend traditional boundaries.

Crucially, we will need to harness the potential of research-proven technologies and scientific innovations while also maintaining focus on the outcomes that matter to people. Rapid national adoption will be critical to ensure that health services in Scotland have sustainability, address health inequalities and deliver improved patient outcomes. All of us need to reset the relationship with our health and that of our nation. Taking collective responsibility for a healthier Scotland is the only truly sustainable way in which we can protect and improve our health services.

I must reiterate that I am not looking to publish a new strategy. My focus is firmly on delivery and on building on the foundations that have already been developed during the past decade or so, including the 2010 quality strategy, the 2016 national clinical strategy and the 2016 realistic medicine strategy, among others. To do that, we will work to implement an NHS Scotland approach to harness greater levels of collaboration between our health boards and partners, resulting in better value, better quality and better outcomes for patients and staff.

Will the member take an intervention?

Neil Gray

I will try to do so shortly, but I need to get through these remarks first.

Through all that change, we must not lose sight of the fundamental mission of healthcare, which is to address the needs of each and every person who needs to receive care from our health and social care services.

As I said to Opposition spokespeople when I outlined why I wished for this to be a debate rather than a statement, I did not want to move into this space this afternoon. I did not want a discussion on where we are, because we have ample opportunity to discuss that and we accept that there is a need for reform and improvement, as I set out in our motion. Instead, I wanted this debate to be about how we move forward. However, Jackie Baillie, Paul Sweeney and others have tested my resolve.

It is important that, if we quote figures, we do so accurately. The figures that are quoted in the Labour amendment are wrong and misleading. We can leave it to other people to judge for themselves why Labour would wish to provide misleading and inflated figures on waiting times in Scotland when it currently has record waiting times in Wales. There are not 840,000 people on NHS waiting lists—that is misleading, as many people will be waiting for more than one procedure or test. The Public Health Scotland report clearly says that figures for new out-patient appointments should not be added to in-patient figures. When that warning is in the same report from which Labour has surely taken the figures that are mentioned in its amendment—it will have had to read past that point to get to those figures—I wonder whether that would constitute Labour knowingly misleading not only the Parliament but the people of Scotland as to the figures that are before us. Labour cannot quote those figures without reading that warning first.

Of course, I accept that that still leaves too many people waiting, and too many outstanding appointments. On such issues, when we need to take people with us on the journey and process of reform, with difficult decisions to be made, we must ensure that we are accurate rather than scaremongering. When that fact is coupled with Labour’s current plan for the health service, which amounts to spending an extra £134 million in Scotland, it would barely cover a 1 per cent pay rise for NHS staff. Labour should try explaining that one to them. It is also less than the Tory consequentials that were received in year following the most recent budget. Therefore Labour’s plan is not a plan for change; it is a continued, short-changing of Scotland and its health services from, in this case, a Labour UK Government rather than a Tory UK Government. That is why the Scottish Government cannot support either amendment.

The thrust of the debate is so important. It is about having a serious dialogue on reform and improvement while accepting that too many people are waiting for too long, but setting out a plan to address the immediate challenge, coupled with improving our population’s health, investing in prevention and embracing the opportunity that arises from technology and innovation. That is what I genuinely hoped that the national conversation and engagement that includes colleagues from across the Parliament will deliver, and I look forward to embarking on that in a shared spirit of endeavour.

In my opening remarks, I said that I want to approach this task in the spirit of co-operation. This vital period of reform and improvement has to proceed on a truly national basis. After all, as the founder of the NHS, Aneurin Bevan, who has already been quoted in the debate, famously said,

“The NHS will last as long as there are folk left with faith to fight for it.”

I believe that there is broad consensus among members, with a deep and abiding faith in our health and social care services. I also believe that, collectively, we have the ability to fight and reform, and to improve those services to meet the challenges of today, tomorrow and the future. I thank members for their contributions to the debate. I look forward to working together to progress the vital task that is ahead of us.