Official Report 428KB pdf
14:04
NHS Ayrshire and Arran
To ask the Scottish Government whether it will provide an update on its decision to escalate NHS Ayrshire and Arran to stage 4 of the national improvement framework. (S6T-02902)
As notified to Parliament on Friday through a Government-initiated question, the decision was made by Government, following careful consideration of NHS Ayrshire and Arran’s position, for the board to be escalated to stage 4 of the NHS Scotland support and intervention framework, for finance, specifically with regard to financial sustainability; financial management and control; and financial governance and leadership.
The move to stage 4 provides NHS Ayrshire and Arran with support to improve financial sustainability. That will include a Scottish Government-led assurance board, chaired by a Scottish Government director, which will oversee progress and report to the chief operating officer and the director general to monitor improvements against key challenges.
I have a great deal of confidence in the interim chief executive, Gordon James, and his leadership team, and we will work closely with them over the coming months to return the health board to a sustainable financial footing.
One of the things that we may not consider when something like this happens is the impact on staff with regard to their morale and how the decision impacts their day-to-day work. I know that meetings have been held, but the staff are still no further forward in their understanding of the position. What more can the Scottish Government do to ensure that the staff are reassured?
I am very grateful to Mr Whittle for raising that point, which I understand; I place a lot of importance on that aspect. I recognise that, when there is the perception of negative implications of a board’s position, that has a substantial impact on staff, particularly with regard to the increased frustrations that may be brought to bear on them in their front-line service delivery. Mr Whittle’s recognition of that is welcome.
We have support in place for staff who are going through such processes. I have confidence that Gordon James is ensuring that he and his leadership team are visible and providing leadership locally, and that staff are getting the requisite support that they need at this time.
We knew that the decision was coming. The Scottish Government is very keen on telling us about its record investment in the health service and the record numbers of nurses, doctors and consultants, yet the outcomes continue to slide. We have 14 health boards, 32 councils and 30 integration joint boards, which are supposed to be there to deliver healthcare, and yet we continue to see a slide in our health service in this country.
When will the Scottish Government recognise the need for a joined-up, revolutionary approach to healthcare that will include the deployment of significant healthcare and a reduction in the number of people who come to the front door of our healthcare services?
Mr Whittle makes a fair point in that we have—as he said—provided record funding and record staffing levels in the national health service, but that is meeting with escalating demand. He is right, therefore, that we need to point to reform and improvement to ensure that we have a sustainable health service going forward. That is why I am pleased that he has engaged so constructively with the reform documents that we set out last year. The population health framework, the operational improvement plan and the service delivery framework are all geared towards ensuring that we optimise the resource and capacity in the system and that we reduce demand, led in particular by the population health framework, a great deal of which Mr Whittle and I agree on—for example, the opportunity to prevent ill health and its escalation, through physical activity. There are a number of aspects in train in that reform and improvement journey arising from strategies that the Government has already published and is determined to deliver on.
Can the cabinet secretary explain not only how the Government will fill the massive number of carer vacancies, as is required to end delayed discharge, but how it will better support existing staff who are working flat out to provide care to those who are stuck in hospitals?
I thank Carol Mochan for her question, which recognises that not everything that arrives at the door of the health service is driven by issues for which the health service has a responsibility. She points to social care as one element of the whole-system approach that needs to be taken. That is why we are working very closely with the Convention of Scottish Local Authorities and why we have made further investments in social care in the current budget.
We are taking steps in relation to our investments in social care pay, as well as other elements of the budget, such as terms and conditions and the ability for social care staff to come forward with collective bargaining arrangements in order to make improvements.
I say gently to Ms Mochan that these matters could be improved if we were also able to attract social care staff here. She will be aware of the 77 per cent reduction in health and care visas that have been offered and the obliteration of the care route for international workers to come and work in this country. We could be working closer together to encourage United Kingdom colleagues to allow international workers to come and work in the social care sector in Scotland.
Palliative Care
To ask the Scottish Government what its response is to new figures on unmet need for palliative care that were published by Marie Curie on 16 February, showing that almost one in three people in Scotland die with unmet palliative care needs. (S6T-02900)
I thank Marie Curie for that report and recognise its important work in advocating for the palliative care community.
The Scottish Government’s “Palliative Care Matters for All” strategy highlights the changes that are needed to improve the experiences of people of all ages with life-shortening conditions, and their families and carers. It is focused on supporting enhanced delivery of palliative care in communities across Scotland. Marie Curie was involved in developing the strategy with the Scottish Government, and I have asked my officials to meet Marie Curie to discuss the figures that are contained in the report.
Marie Curie said that, without action, the number of people dying in Scotland with unmet palliative care needs will continue to increase. I believe that, over the recent period, in relation to the Assisted Dying for Terminally Ill Adults (Scotland) Bill, most members in the chamber have received heartbreaking emails from constituents, telling us of their experiences when loved ones died without the right support in place. Does the minister accept that every individual who is in need of palliative care should be able to access it when they are dying?
Very simply, yes, I do accept that. That is why I was very proud to introduce the “Palliative Care Matters for All” framework in September last year. In my ministerial foreword, I noted that, in Scotland, we still struggle as a society to talk openly about serious illness and death. Societal taboos around dying and stigma or fears about the withdrawal of treatment can lead to the marginalisation of palliative care services for adults and children. That is why I am very pleased that Marie Curie has done this work and that Mr Rowley has raised it in the chamber.
I welcome the fact that the minister says that her officials are going to meet Marie Curie, because the organisation is very clear that the situation does not need to be this way and it is calling for legislation to enshrine in law a right to palliative care.
Does the minister agree that every person must have the right to dignity at the end of life and access to quality palliative care? Will the Government therefore support the introduction—at some point—of legislation that gives everyone the right in law to palliative care?
Just on Friday, I was having exactly this discussion with one of my constituents. It is really important for us to have these discussions, which is why I am very pleased that the Scottish Government has good conversations and dialogues with Marie Curie on palliative care.
I underline again that the Scottish Government and I want everyone in Scotland, regardless of age, diagnosis or location, to have access to timely, high-quality and person-centred palliative care. I was very thankful for the consultation that Marie Curie did on the right to palliative care, alongside our colleague Miles Briggs and others.
As I have said before, we have the “Palliative Care Matters for All” strategy and its five-year plan, and I want to see how that develops, alongside the discussions that we will continue to have with members in the chamber and with Marie Curie.
There is much interest in this question. Concise questions and responses are appreciated.
Given that I chair Scotland’s cross-party group on palliative care, and in the light of our ageing demographic, the level of unmet need in palliative care is not wholly surprising to me. Marie Curie has helped to push forward our debate on resourcing palliative care. We must identify and quantify the gap in provision as part of any strategy to fill that gap, and we need a baseline. Does the minister agree that our long-term strategy to address the palliative needs gap will require a long-term approach to uplifting resource in all aspects of palliative care, as well as encouraging innovation and service reform across all sectors?
I recognise the work that Mr Doris has done in this area. Outcome 3 of our “Palliative Care Matters for All” strategy notes that national and local leaders need to have relevant data to inform the planning and delivery of services, so I agree with his points.
The report by Marie Curie is a wake-up call for us all regarding unmet need. Does the minister recognise that, in the 2025-26 budget, there is currently a shortfall of £3.9 million in the amount that the sector asked for to be able to deliver parity in pay awards between national health service staff and hospice staff? What plans does the Government now have to make progress on a national funding framework ahead of the election?
In the stage 1 budget debate last week, it was noted that the Scottish Government has increased its funding for hospices specifically to cover the difference in pay compared with NHS staff. We have increased the budget to £9.4 million. I am pleased to have supported that increase and that it gained support from members across the Parliament.
During the stage 1 debate on the Assisted Dying for Terminally Ill Adults (Scotland) Bill, Liam McArthur said:
“Investing in improved quality of and access to palliative and hospice care… is imperative”—[Official Report, 13 May 2025; c 15.]
Given the stark reality that the Association for Palliative Medicine has set out, MSPs might question that rhetoric when voting at stage 3. Palliative care is not an available alternative for far too many people and, under the proposed law, an early death might be a choice that people feel compelled to make. Will the minister confirm whether any additional allocation was made in the Scottish spending review to strategically enhance the quality of and access to palliative care?
I have been clear, whenever I have answered questions about palliative care and assisted dying, that there are no either/or questions and that we need to ensure that investment is in place. As Mr Marra knows, funding is transferred from the Scottish Government to support health boards, which also provide a level of palliative care. As I have just indicated to Mr Briggs, we have increased the budget that will be available to hospices in the next financial year. I strongly feel that it is not an either/or question and that we must support people to live their best lives and to have the most dignified deaths that they can.
The lack of palliative care is keenly felt in rural areas, especially across the Highlands. Some people need to travel hundreds of miles to get palliative care and are often separated from their family. We heard on television the other night that the lack of palliative care might give those people no option but to opt for assisted dying. That is surely not the position that we want to be in.
I agree with Edward Mountain that that is definitely not the situation that we want to be in. I, too, represent a rural constituency, which has islands as well, so I keenly feel that point. I have just returned from Inverness, where I was pleased to see big advertising hoardings for Highland Hospice and also one of its vans driving around the city. That hospice is important. We must also remember that hospices are not simply buildings; they are also about the people who go out to communities to support families at an important time in their lives.
The minister might be aware of the stage 1 evidence that the Health, Social Care and Sport Committee heard from witnesses from Victoria and Queensland, which highlighted that improved investment in and access to palliative care followed the introduction of assisted dying laws in those states. That confirmed the conclusions of the House of Commons Health and Social Care Committee’s 2024 report, which found no evidence of a deterioration in access to palliative care in any of the jurisdictions in which assisted dying laws have been introduced.
Will she reinforce that it is not a case of either/or? We need to improve both access to palliative care and the choice and compassion that we offer to terminally ill Scots who desperately need it.
As Mr McArthur will know, the Scottish Government is neutral on the issue of assisted dying, and the vote on the bill is a matter of conscience.
I absolutely agree that it is not an either/or situation. We must ensure that we are providing everyone who lives in Scotland with the appropriate level of palliative care, if that is their choice.
I note the minister’s comments that this is not an either/or situation. However, Marie Curie’s research shows that 18,500 people die with unmet palliative care needs each year, and the Association for Palliative Medicine warns that 40 per cent of doctors might leave the speciality if assisted dying is introduced. Does the Government accept that losing those clinicians would widen the existing gap in end-of-life care? What assessment has the Government made of the impact on the workforce during the passage of the Assisted Dying for Terminally Ill Adults (Scotland) Bill through Parliament?
I am afraid that I cannot answer the second part of Roz McCall’s question. However, I can be clear that the staff in our hospitals whom I met when I launched “Palliative Care Matters for All”, and more widely, are absolutely focused on ensuring that they provide the best palliative care or end-of-life treatment. That is really important.
We, in this chamber, need to come together to work out the best way to support the strategy that the Scottish Government launched last year, which I am sure Ms McCall will have read, and the number of outcomes that are in it. That focuses very much on ensuring that we have the right outcomes for people and the right staff complement to support those families.
I listened very carefully to the answer that the minister gave to Alex Rowley’s last question, which was a repeat of Marie Curie’s request for a right to palliative care in law. Will the minister please respond to the question that Alex Rowley asked her? Does she support the right in principle and in practice? If she does, she will realise that the gap between what is described in the Marie Curie report needs to be filled pretty quickly.
In Scotland, everyone has a right to healthcare, including palliative care. The key information from the figures is that we must recognise as a society that we need to support people. That is why “Palliative Care Matters for All” is probably one of the most important documents that I have introduced in my role as Minister for Public Health and Women’s Health.
Peter Murrell (Trial Date)
To ask the Scottish Government whether anyone who works for the Scottish Government, including ministers, special advisers or civil servants, was involved in discussions concerning the postponement of the trial of Peter Murrell until after the Scottish Parliament election in May. (S6T-02896)
There have been no discussions. Scheduling of trials is a matter for the independent judiciary and the Scottish Courts and Tribunals Service.
My question was worded very specifically because we have almost 20 special advisers, almost 30 Government ministers and more than 9,000 civil servants in the Scottish Government. Given Graeme Dey’s categorical reassurance that none of those almost 10,000 individuals had any involvement or discussions at all, can he update Parliament on how he was able to assemble that information on almost 10,000 individuals in the past couple of days? If he has not done that, has he just come here to try to fob off the Parliament, which is a signal of this corrupt Government from a corrupt party of government?
I utterly refute the allegations in that commentary from Douglas Ross, which is typical of his approach to many subjects.
Let me be absolutely clear: this is a live court case, so I strongly suggest that all of us should be cautious about our comments in relation to it.
I reiterate that the scheduling of trials is a matter for the independent judiciary and the Scottish Courts and Tribunals Service. It is a matter entirely for the judge to determine the date for preliminary hearings and for trials. I reiterate that there have been no discussions of the nature that Mr Ross implied in his original question.
The minister is still avoiding saying it. Has he gone round almost 10,000 people in the past couple of days to check whether they had discussions about that or not? If he has not, he cannot possibly give that categorical response.
This comes down to transparency, because it stinks—it absolutely stinks—that an accusation that was first made before the 2021 Scottish Parliament election will now not come to court until after the 2026 Scottish Parliament election. Does the minister not even realise, or does he not simply accept, how bad that looks for his party, which is the party that is in government? Because of the delay and the postponement, the reporting restrictions cannot now be lifted until after the Holyrood election. Will he at least accept that his party benefits from that?
As a Scottish Government minister, I take very seriously my responsibilities and the need to respect the processes that cover our justice system. I am not going to be dragged into a to-ing and fro-ing, particularly under the terms that Mr Ross uses so typically. I want to make it absolutely clear that an independent process is followed in all these things, which is overseen by the Lord President. There have been no discussions of the type that Mr Ross suggests.
That concludes topical questions. I will allow a moment or two for front benches to organise themselves.
Air ais
Business Motion