Official Report 1113KB pdf
The final item of business is a members’ business debate on motion S6M-19548, in the name of Finlay Carson, on the growing tide of on-going challenges facing rural communities. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes the reported ongoing challenges faced by rural communities, including those in Stranraer, Wigtownshire and across Dumfries and Galloway, in accessing timely and high-quality healthcare; believes that people in these areas often experience longer waits for GP appointments, hospital treatment and emergency services, compared with the national average; expresses particular concern about the reported current shortage of GPs in Wigtownshire, which is placing additional strain on practices and impacting patient care; acknowledges the additional pressures on NHS boards and staff in delivering care across large geographic areas; notes the view that every person, regardless of where they live, should have equal access to essential health services; further notes the calls on the Scottish Government to set out clear plans to tackle rural health inequalities, including measures to recruit and retain healthcare professionals, including what it sees as much-needed midwives and dentists, address GP shortages, improve ambulance response times and expand diagnostic and treatment capacity in Galloway Community Hospital and other community health hubs, and notes the calls for both an increased provision of community beds and step-down facilities to reduce delayed discharge and enable care closer to home, and for the Scottish Government to work with communities to ensure that future health policy reflects the needs of rural Scotland.
17:43
I thank all members from across the chamber who supported the motion. I will be clear: rural Scotland, including areas such as Stranraer and the Rhins in Dumfries and Galloway, has been let down, not by geography but by Government choices. Those choices have stripped away vital health and care services without ensuring that replacements were ready, and they have left families facing a worsening healthcare crisis.
For years, I have warned that the greatest threat to rural healthcare is not distance but a chronic failure to recruit and retain the workforce that is needed to deliver care. That failure lies squarely at the door of the Scottish National Party Government.
What is happening in Wigtownshire? General practitioner shortages are critical—just recently, the Mull of Galloway practice handed in its notice. Patients in Stranraer wait weeks for an appointment, if they can get one at all. When people cannot access primary care, conditions worsen and hospitals come under greater pressure.
Ambulance response times in the Rhins are longer than the national average, not just because of geography but because crews are stretched to breaking point. It is hard to recruit paramedics locally, and those who join the service face impossible workloads. At Galloway community hospital, diagnostic and treatment capacity is limited, and the birthing suite has gone, so some mothers now have to travel to Dumfries to give birth, fearing that their babies might arrive in the car. That is not progress; it is neglect.
Jason Jordan, who is the assistant general manager at Galloway community hospital, recently said:
“We have an outstanding team of staff working at the Galloway and every effort is being made to deliver a first class service.”
He is right—the staff are outstanding. However, there is still too much reliance on Dumfries and Galloway Royal infirmary, which is almost two hours away.
The consequences of poor planning are clear. Cottage hospitals have closed, but promised community hubs and step-down facilities have yet to materialise. The result is delayed discharge and bed blocking. I spoke to a constituent from Newton Stewart who should have been discharged but had nowhere to go, because the local cottage hospital had closed and there was no funding for home adaptations. He spent months stuck in an acute ward, blocking a bed that he knew someone else needed, and he felt guilty about it. That is what happens when services are dismantled before alternatives exist.
NHS Dumfries and Galloway faces a £58 million funding black hole. Integration joint boards are staring at cuts that make it impossible to invest in community care or recruit staff. Those cuts are not just numbers; they mean fewer services, longer waits and more worry for rural families. The Government promised 800 new GPs by 2027, but there is no sign of those GPs. Rural practices are struggling—vacancies remain unfilled and community pharmacies are under pressure to try to pick up the slack.
That is not workforce strategy; it is workforce crisis. However, the Government’s response is to produce more reports, more consultations and more talking shops. As Dr Gordon Baird from the Galloway community hospital action group said,
“You can’t fatten a pig by weighing it.”
Scotland does not need more reviews; it needs action.
I make it clear that none of those failures are the fault of our local NHS staff or ambulance crews, who are doing an incredible job under impossible circumstances, working long shifts and driving hundreds of miles to deliver care. They deserve praise, respect and support, not the constant pressure that is caused by poor planning and underfunding. They are heroes, but heroes cannot hold up a broken system for ever.
What needs to happen? The motion calls for a clear funded plan to tackle rural health inequities. That means recruitment and retention incentives, including housing support, relocation packages and career development for rural posts. If we want doctors, nurses, midwives and paramedics to come to rural Scotland, we need to make it attractive and sustainable.
We need to restore local capacity and ensure that no service is removed until a replacement is operational and staffed. There should be no more dismantling of maternity units, leaving women with few safe alternatives, and no more closing of cottage hospital beds without alternative step-down facilities being put in place. That means investing in community beds and step-down facilities, which would prevent delayed discharge. That is as much about patient dignity as it is about freeing up acute beds.
I acknowledge that there have been improvements to service provision at Galloway community hospital, which have been driven by the wonderful staff. However, we need to see evidence of expanded diagnostic and treatment capacity, with the workforce to deliver it. That would restore confidence among local people that they can access care close to home. We need to rural proof planning and staffing by recruiting and training paramedics locally and ensuring that resources match geography in order to improve ambulance response times.
As a Gallovidian through and through, and as a rural Conservative, I, along with my colleagues, have made a commitment. Tomorrow, voters in Stranraer and the Rhins will choose a new representative. Julie Currie, our Conservative candidate, brings NHS experience that will deliver on our Conservative commitment—
Mr Carson, I caution against electioneering in the chamber.
My apologies, Deputy Presiding Officer.
Scottish Conservatives believe in fairness and that where someone lives should never determine the quality of care that they receive. That is why Scottish Conservatives are calling for a rural health guarantee; equal access to essential services for every patient, regardless of their postcode; a workforce action plan that incentivises recruitment and trains staff in rural areas, not just empty promises; and investment in community-based care, because care that is delivered closer to home or in the home is better for patients and for the NHS.
The Government has had years to fix the system, but, instead, rural communities have been treated as an afterthought. They pay the same taxes as everyone else and deserve the same standard of care, but, right now, they are being asked to accept less—less access, less choice and less safety.
It is about equality versus equity. Rural communities are not asking for equality; they are demanding equity. Equality assumes that giving everyone the same resource will produce the same outcome, but that ignores the unique challenges that rural areas face, such as long travel times, a limited workforce and smaller hospitals. Equity means tailoring support so that rural patients have the same chances of getting timely and safe care as those in urban centres. That requires additional investment, flexible service models and a recognition that one-size-fits-all policies perpetuate disadvantage rather than solve it.
I say this clearly: rural Scotland will not be left behind; we will not accept the dismantling of local services without replacements being in place; and we will hold the Government to account until every patient, wherever they live, has equitable access to care.
I advise members that there is a lot of demand to speak in the debate. I am conscious that we have already been late in starting, so I will require members to stick to their speaking time allocations if I am to get everybody in.
I call Christine Grahame.
Deputy Presiding Officer, can I go after the next speaker? I am having technical difficulties with my Surface laptop.
I think that we can do that.
Thank you.
I call Douglas Ross, assuming that he is ready to go.
17:51
I am always happy to accommodate Christine Grahame in any way that I can.
I am delighted to contribute to the debate, which has been brought to the chamber by my friend and colleague Finlay Carson, who has ably articulated the problems in his constituency in the south of Scotland.
I will take us up to Moray, in the north-east of Scotland, and talk about some of the problems that we are experiencing there. I could highlight many issues in the debate, but I will focus on just two.
The first issue concerns the on-going campaign by the save our surgeries Burghead Hopeman group. I have raised this matter time and again in the chamber, and we have had meetings with the Cabinet Secretary for Health and Social Care and with the Minister for Public Health and Women’s Health. I am sorry that neither of them is in the chamber tonight, but I will relay the debate to them and highlight the issue again.
We have a proposal from a campaign group that is made up of people who want to see a difference in their community. They have been met with challenges—their local surgery has shut down and they have come up with an alternative, but they continue to come up against obstacles from the Scottish Government, Moray health and social care partnership and others. A proposal from the group is sitting with the Scottish Government, but it has had no response. I urge the Minister for Drug and Alcohol Policy and Sport, after the debate, to go back to her officials in the health department to get a response for the save our surgeries Burghead Hopeman group.
I have tried the same with the new chief executive of NHS Grampian. I raised the plight and the campaign of the save our surgeries group with her when I met her a couple of months ago, but I am still waiting for a response for the group from NHS Grampian. I urge the minister and NHS Grampian to engage constructively with SOS Burghead Hopeman, because it has plans that can improve local healthcare. Those plans are innovative and could make a real difference to those two communities, and I hope that they are taken seriously.
As ever, Mr Ross is speaking up for his rural constituents.
What do you think that viewers of the debate tonight should read into the fact that not one single SNP member supported the motion that brought the debate to the chamber and the fact that the debate is very sparsely attended by SNP and Labour members?
Always speak through the chair, Mr Hoy.
I think that it is very disappointing. I will listen closely to the speeches from SNP members when we hear them. However, I note that we have members’ business debates to try to get cross-party support. We do not always agree with every word in a motion, but I have supported SNP motions in order to allow a subject to be debated. I am grateful that Finlay Carson was able to get support in order to have this important topic debated in the chamber, but I think that, when people look around and see the vast number of empty seats in the middle and on the other side of the chamber, they will wonder why those MSPs are not here to raise constituency concerns about healthcare issues.
In my final minute, I will relay the details of a case that I have already articulated to the cabinet secretary—I have provided him with further information. The case highlights what we are facing in Moray. A father and husband had a heart attack on Saturday 1 November. He stayed in the accident and emergency department at Dr Gray’s hospital, where he was based for four days, in completely inappropriate conditions. He was transferred to Aberdeen Royal infirmary on Thursday 6 November. He was told that he needed an angiogram, but the Scottish Government has told NHS Grampian that it will not pay for angiograms to be performed at the weekend. I want to know why, in one of the biggest health boards in Scotland, we are not performing that important procedure at the weekend. He had to wait until the following Monday—he got his angiogram and was released on Tuesday 11 November, well over a week later. Why was that treatment and vital test delayed, and why was he then forced to find his own way home from Aberdeen to Moray?
The family has put forward a very sensible solution: that we have a shuttle bus between the ARI and Dr Gray’s, or back to Moray, so that people can use that type of facility to get to and from those two medical centres, rather than having to rely on the good will of friends and family. I think that it would make a real difference if the minister could take forward that solution.
I am not getting an indication from Ms Grahame that she is ready just yet, so I will call Craig Hoy and possibly come back to Christine Grahame after that.
17:56
I thank Finlay Carson for bringing this important debate to the chamber. Today, we are talking about one overarching issue: the SNP’s neglect of rural Scotland. It is a neglect that is based not on geography, history or economics but on one thing only: constitutional politics. For years, the SNP has systematically and cynically neglected the rural parts of Scotland that do not support independence. Areas such as Dumfries and Galloway, the Scottish Borders and Aberdeenshire have been forgotten about by a Government that values independence-supporting central belt areas and communities more than it values the communities that I represent.
The numbers speak for themselves. In March, Dumfries and Galloway councillors were forced to find £30 million in savings over three years, blaming what they described as an “unprecedented funding gap”. As has been made clear, NHS Dumfries and Galloway is currently trying to find £58 million in savings, otherwise it will be cutting front-line services. I say to the minister that there is no clearer case of the SNP’s neglect of rural areas than the challenges that Dumfries and Galloway Council currently faces. However, the chickens have come home to roost, for the council is now run by a minority SNP administration, which is having to clear up the mess that was created by SNP central Government.
That is the reality on the ground. Rural bus funding has been systematically cut, and the SNP council leader is now begging ministers for additional cash as lifeline supported services face the axe. Rural primary schools have been systematically underfunded, with the closure of some village schools, the loss of headteachers, who have been replaced by pool teachers, and the removal of additional support needs provision entirely from rural schools, which has forced children into larger town-based settings. That includes children in a village who have had to move schools less than three years after their own school was closed.
There is systematic defunding of core services. This year, Dumfries and Galloway’s SNP council is being forced, by the SNP Government, to consider removing funding entirely from the citizens advice bureaux network. That £1 million saving could result in the loss of £15 million in social and economic benefits that are delivered by the services that the citizens advice bureaux provide.
The cuts do not end there. Music tuition is at risk in Dumfriesshire schools, which means that only the privileged few whose parents can afford to pay a private tutor will be able to learn a musical instrument. There have been proposed closures of leisure centres, including Hillview leisure centre in Kelloholm, which will strike another blow to rural residents. It will mean the loss of a space where people can play sports, go to the gym and have community and social gatherings. That is a clear loss to a rural community, and it has been brought about by SNP neglect.
Today, I say to the SNP that enough is enough—it must call a halt to the chronic underfunding of rural public services, and it must stop diverting money elsewhere. The political motivation at the heart of Scotland’s resource allocation has to be brought to an end. Rural health services and rural councils must be properly funded—with a fair funding formula, not the pork-barrel politics of John Swinney’s SNP.
Roads such as the A75 and the A76 need urgent action. The state of disrepair on rural roads has reached crisis levels on the SNP’s watch. My constituents—often elderly ones—are sick and tired of the SNP Government ignoring rural parts of the south of Scotland. They are sick and tired of seeing their services suffer while the SNP pump primes the areas of Scotland where it is buying votes to deliver on its only priority. That kind of SNP pork-barrel politics has to end because, under John Swinney, it is independence at the expense of all else, particularly the rural residents and communities that I represent.
I see that Ms Grahame is still not ready, so I call Rhoda Grant.
18:00
I thank Finlay Carson for securing this important debate. His motion speaks about the impact of urban-based policies on Dumfries and Galloway, and that is reflected in my Highlands and Islands region, where we suffer very similar challenges—I am sure that any member who represents any part of rural Scotland would say the same.
This week, the Equalities, Human Rights and Civil Justice Committee took evidence from stakeholders from rural Scotland, who talked about access to services. They told us that car ownership is a necessity to enable people to access services, given the lack of public transport. Even where there is public transport, it can be unaffordable.
Accessing the health service is not free at the point of use, because the cost of getting there means that people cannot access the services that they need. Failure to attend can also mean that they come off a waiting list altogether. I was told by a constituent of a case in which an elderly resident could access hospital appointments only if they were made on her GP’s day off, so that her GP could drive her to the appointment. That is an absolutely crazy situation.
We were also told that, although running a car costs about £50 per week, which adds to the cost of living in rural Scotland, it is necessary for people to carry that cost because it is the only way that they are able to access services.
I probably do not need to speak again about mothers from Caithness having to drive to Inverness to give birth. That journey is equivalent to driving from Edinburgh to Newcastle. If people do not have a car, they have to take a train or even a bus, and the journey is much longer. I recently heard of a mother who, just a couple of days after delivering her baby by caesarean section, had to make a four-and-a-half-hour journey by train, on her own, carrying her newborn baby. I know that there are similar issues in Stranraer.
Housing was another theme that came across as a major issue when we heard from witnesses at the committee meeting. There is little or no affordable housing in rural Scotland for local people in order to allow them to stay in the areas in which they were brought up, so many are being forced to move away. Housing was also raised as an issue in relation to recruiting staff to provide essential services. People would apply for posts and some would even start work, only for them to find that they could not find a home, so they were forced to leave. Rural health and care services are left to depend on expensive agency staff and, in many cases, those services cannot run at all.
All of that leads people to leave, so the problems create a downward spiral of depopulation. Centralisation happens in all aspects of daily life in rural Scotland. We saw it with the centralisation of police and fire services, which have since retreated from those areas. Police stations have closed and retained fire stations are not staffed to a level that allows them to go to an emergency.
Those issues are replicated throughout all of rural Scotland. We need to find solutions that provide people in my region—and in Dumfries and Galloway and elsewhere in rural Scotland—with equitable access to services.
I call Sharon Dowey.
18:04
The challenges that my colleague Finlay Carson has laid out are moving and troubling, and illustrate the experience of an area that faces a number of problems through no fault of its own. However, those challenges will be painfully familiar to people in other parts of rural Scotland, too.
Further north, in Ayrshire, we can empathise with all those issues, and I am sure that colleagues across the chamber who represent other areas of the country will say the same. The bottom line is this: small towns and villages have been neglected by the SNP Government, and that has been the case for almost two decades now.
Few cases sum up the issue better than the fate of the Carrick Glen national treatment centre. That project was supposed to upgrade significantly the level of care for patients across Ayrshire and Arran and provide staff with a far better environment in which to work.
However, two years ago, it was decided to hit pause on the scheme, even though around £5 million had been spent on it. The building now sits lifeless, contributing nothing, and yet sucking out millions of pounds that could have been invested elsewhere.
It would have been better if the Scottish Government had come good on its pledge to complete the project—by now, the centre would be up and running, and serving the local community well.
However, the problems in NHS Ayrshire and Arran go much further than that. The organisation is tens of millions of pounds in debt and needs huge loans simply to break even. Scotland’s public sector watchdog said that the challenges facing NHS Ayrshire and Arran were “unprecedented” and that there did not seem to be any plan to get out of the situation.
The Scottish Government needs to ask itself how things have got that bad. NHS Ayrshire and Arran is not the only health board, nor indeed the only public sector organisation, that is facing dire financial challenges, as Rhoda Grant mentioned. It is difficult to see how things will get better, especially as parts of Ayrshire have the fastest-growing elderly population in the country, which will only place additional pressure on health and social care.
The SNP Government has promised the people of Ayrshire many things, but it has delivered few. I will give members a few facts on Ayrshire. Shockingly, more than 11,000 people in Ayrshire have been waiting more than a year for an out-patient appointment—that is the second-highest number in any health board. That includes almost 2,800 people who need general surgery. NHS Ayrshire and Arran also had the longest waits for an audiology appointment, with people waiting 62 weeks on average for an appointment and 115 weeks to actually get hearing aids fitted. People are waiting on average 26 weeks for orthopaedic treatment, with one in 10 waiting more than 72 weeks.
That is on top of the trouble that people have in accessing a dental appointment. The SNP promised to scrap dental charges for everyone, but it has failed to deliver, and now 40 per cent of people in the most deprived areas in Ayrshire have had no contact with a dentist in two years, and one in four primary 7 pupils are suffering from tooth decay.
Instead of focusing on things that could make people’s lives better, nationalist ministers have obsessed about independence to the cost of everything else. The evidence is on show in almost every debate that the Parliament has. Rural Scotland might be more remote, and might happen to be in less accessible places, but it is a vital part of the country, and it deserves as much attention as everywhere else.
I fully support the motion that Finlay Carson has lodged, and I hope that those SNP members who have turned up today take the messages from the debate back to their Government ministers, whose time for acting is fast running out.
I now call Christine Grahame.
18:08
I thank you, Deputy Presiding Officer, for allowing me to resolve my technical issue—so far, so good, but it is early days yet.
I congratulate the member on securing the debate, and I agree with him on the following points. There are huge pressures on the NHS at all levels across Scotland, with specific challenges in delivery in rural areas. In addition, the Covid-19 pandemic still has a residual impact on health and social care, and then there are the demographics, with an increasing number of elderly people—I am one myself, being 81—requiring healthcare.
The Borders has an ageing population, with the fifth-highest proportion of people aged 65 and over in Scotland, and a declining birth rate. If we add together the declining birth rate, young people leaving for towns and cities and older people retiring to the scenic Borders, we see that the ageing demographic can only increase, and there will therefore be more demand on health and social services.
That is the background, but NHS Borders is using innovative processes to tackle those demands. I do not congratulate NHS Borders willy-nilly—in this instance, the board deserves it. There is the hospital at home service, a Scottish Government initiative that has been piloted in the Borders that allows patients to be cared for—as it says on the tin—in their home. It is targeted mostly at older patients with suitable health conditions—with the patient’s consent, of course—and it has an overall 90 per cent-plus satisfaction rating.
We know that people prefer to be at home, if that is suitable, and that recovery is accelerated and their sense of wellbeing increases substantially if they are. It is no wonder—who would not prefer to be treated and supported at home by professionals, with family and friends in familiar surroundings, reunited with the cat and “Bargain Hunt” while lounging on the sofa?
As a result of its success, the region’s health board has been allocated £600,000 from a £3.6 million Government pot. Not only is recovery better, but hospital beds are freed up, as is staff time. The service tackles the spectre of delayed discharge. The virtual-ward model monitors patients in their house, with regular clinical follow-up and access to specialist advice.
In 2023-24, more than 14,000 older patients across Scotland used the service. A new report from Healthcare Improvement Scotland estimates that £14.9 million was saved in “traditional hospital admission costs”, with an estimated further £36.3 million saved in post-hospital care as a result of a reduction in re-admissions. That is more than £50 million in total.
In the Borders, the hospital at home service is currently limited to the central Borders. I have proposed to the cabinet secretary that it could be extended using community hospitals such as Hay Lodge hospital in Peebles. At present, some patients are already discharged to that hospital if it is suitable for them, often as an interim measure, following their discharge from the Borders general hospital, before they return home. With the hospital at home service, some patients could go straight home, which would, again, free up beds and staff, this time in Hay Lodge.
For completeness, I highlight the issue of accessing GP practices, which is, as members know, more complex. Most are private practices—businesses—that are contracted by the NHS to provide certain services, so GPs are not NHS employees. That is why there is such a divergence in how, for example, people can make an appointment.
Nonetheless, I conclude where I began: by broadly congratulating NHS Borders on modernising delivery. That includes its work in liaising with housing associations and reserving key workers’ houses; those key workers include staff in the health service, so that has encouraged recruitment to the Scottish Borders.
All those measures are tackling the delivery of healthcare across that extensive rural area, and I commend them—and commend NHS Borders—to members. I hope that those measures can be replicated, for example in my old hunting ground of Dumfries and Galloway.
18:12
I thank the member for bringing this really important members’ business debate to the chamber. In some ways, I am a little bit shocked. I had a speech prepared, but I am not going to go through my speech—I will speak for a shorter time.
I am my party’s spokesperson on rural issues, but what shocks me is that we are all having exactly the same problems. I was going to speak about exactly the same things that Finlay Carson, Sharon Dowey and members of the Labour Party have spoken about. I was going to speak, for example, about the fact that we have ambulances queuing outside Dr Gray’s hospital and Aberdeen royal infirmary for hours on end, with patients stuck in the back, because they cannot get inside.
I was going to talk about the fact that I have one constituent currently on my books who presented to their GP in May with what turned out to be breast cancer, and they are only now starting treatment. That is a young woman with a young family who has waited months and months for treatment. In my eyes, that is not acceptable.
I was going to talk about the lack of beds. Grampian has the least acute bed space in the whole of Scotland, and yet nothing is being done to correct that. I was going to talk about delays to people being able to leave hospital because we have shut down community hospitals.
I am obliged to the member for taking my intervention.
I am not aware of this—perhaps you can advise me. Does NHS Grampian operate the hospital at home model, which has made great progress in the Borders?
Through the chair.
I was on the IJB in Moray when the hospital at home model was being discussed, and I remember making the point at the time that the model works only if we have people in communities who can run it. We do not have those people, so we end up sending people home early from secondary care, who do not then get the support that they need. That puts more and more pressure on primary care, and then we all attack the GPs.
I should declare a slight interest here—this is not actually in my entry in the register of members’ interest, but I declare that my wife is a GP.
There are heartbreaking real-life consequences as a result of what we are currently facing in healthcare in rural Scotland. It is simply not good enough, and I cannot carry on coming to the chamber and making the same arguments over and over again and getting no answers from the Government. There are five SNP members in the chamber tonight. I am not attacking those who are in the room, but this is more than a members’ business debate—it is about the really serious, life-altering impacts of what is currently going on in rural Scotland. That must change, and that is my message.
18:14
I thank my friend and colleague Finlay Carson for securing the debate, which I have been listening to intently. I did not map out a speech—I thought that I would just listen to what everybody had to say—but I will draw members’ attention to an issue that happened with one of my constituents, which I think highlights exactly what we are talking about today.
An elderly constituent approached me after a change in policy in rural Lanarkshire. He must get a vitamin B injection every 12 weeks. Previously, that was done at his local GP surgery, which was a 10-minute walk from his home. Following the changes, my constituent—who is on the NHS waiting list for a double knee replacement, which affects his mobility—must now make an appointment with a GP to get his prescription, take the prescription to the pharmacy, then phone his closest community treatment and care service, which is in Larkhall, to make an appointment for the injection, and then take a three-hour round-trip journey on a bus that he reports does not run according to the timetable. What used to take a single appointment at his GP now takes him days.
When we asked NHS Lanarkshire what could be done to reduce the journey that my constituent must undertake in order to get a simple, routine injection, the advice was that he could join a self-administration pilot or select a closer treatment service. Neither option is patient centred or able to produce a good patient outcome in this case. The fact is that there are no closer treatment services that do injections, and he does not feel confident enough to self-administer.
I have listened to colleagues across the chamber, and particularly note what Douglas Ross said about the trauma that his constituent suffered. It strikes me that this issue is not just about poor patient outcomes, which is the most important thing, but is also about waste. What a waste all of this is in a system that is crying out for investment. When we talk about the need to clear out the waste and redistribute resources to the front line, the issues that have been raised today are exactly what we are talking about.
On the issues of health and how healthcare is delivered, I think that we should be looking at how we deliver the basic services to people across Scotland, no matter whether they live in rural or urban areas or on the islands, or what the demographics of that area are. People should be able to readily access their GPs, dentists, A and E departments, pharmacy services and—certainly—maternity services. However, the reality is that delivery in urban areas will be different from delivery in rural areas and on our islands. We have to take cognisance of that, because the reality is that that basic level of service has to apply across all our communities. Most people who live in a rural area will accept that they will have to travel for specialist treatment such as a knee or hip replacement. However, they should not have to accept that we do not get the very basics of healthcare right.
I am a big advocate of the adoption and development of technology, including artificial intelligence. That approach would positively affect rural areas and islands to a greater extent than urban areas. That is one of the major solutions.
We cannot just talk about health in isolation; we need to look at other services. Education is part of health, as is access to leisure services and the community participation that is associated with those facilities, which Craig Hoy talked about. Of course, in many ways, the problems that we face in relation to health are the same as those that we face in relation to those issues.
When I think of the south of Scotland, I can see that transport by rail and road are also part of the solution, because we are talking about creating communities that are sustainable and that offer good local services and give people opportunities to be part of those communities. Trying to apply urban solutions to rural areas and islands just will not work.
18:19
I, too, thank Finlay Carson for bringing today’s debate to the chamber, and I was pleased to support his motion. As we have heard, people in rural areas face unique challenges in accessing healthcare. I therefore welcome this debate and the opportunity to highlight the day-to-day realities of those who live in my rural South Scotland region.
Issues have been raised with me not only by my constituents who are patients, but by our hard-working NHS staff. Living in a rural community should not limit people’s access to basic healthcare, as Brian Whittle has mentioned, and there should also be ways of managing more specialist care. However, for many constituents and staff, it is frustrating that things do not run smoothly. Many people in those communities feel disconnected from their healthcare, as services seem to move further and further away, and many of my constituents have told me that they feel a sense of doom, because they cannot see any improvement in rural healthcare.
Last year, we debated the Health, Social Care and Sport Committee’s findings on remote and rural healthcare, which revealed profound inequalities in access to services and care. That is a really important issue. The report reinforced what has long been known, which is that those communities experience greater inequalities in accessing healthcare compared with those in our more urban and central areas. That is true across health services—including maternity services, which I will mention only briefly, as Scottish Labour highlighted the issue in the chamber just a few weeks ago.
Mothers in Wigtownshire, in my South Scotland region, do not have a dignified service, and it is important that we address that. I know that there are staffing pressures, but women are travelling 70 miles to receive care. Those mothers, their husbands, their partners, their family members and other campaigners say that they are extremely concerned about the difficulties that might arise during that process.
I also want to mention staff recruitment, retention and training, because it is a real concern that has been raised with me. I have asked the Government a number of times about its plans to expand the apprenticeship-type model for healthcare workers, as recommended by the nursing and midwifery task force, which offers a great opportunity to grow skills in our communities. I have talked to many people about that model, which would allow people in rural areas to train, work in and be committed to their local area, whether they live there because they want to or because they cannot, for whatever reason, move away. I have been talking about the issue for five years now, but it does not feel as if it has edged forward at all. Perhaps the minister could come back to it in her closing remarks.
Lastly, I would like to highlight the workforce problems in South Ayrshire. That region might not be what some would traditionally think of as rural or remote, but people in communities such as Girvan feel that things are just becoming worse and worse. In my discussions with constituents and staff at the local hospital, I hear that it is often difficult to recruit and retain staff. These challenges are real for both patients and staff.
The Government might point to on-going work, but the reality is that communities need action and tangible changes for them and their families. What communities need now is delivery, and that is what we would like to hear more about.
18:23
My colleague Finlay Carson’s motion is absolutely spot on, and I thank him for bringing the debate to the chamber. Under the SNP, taxpayers are paying more and getting less.
Last year, community hospitals in the Borders faced a challenge when NHS Borders proposed the closure of 92 beds across Kelso, Duns and Hawick in my constituency, and in Peebles in the neighbouring constituency. My constituents are aware of the difficulty of delivering healthcare in rural areas, and the potential bed closure sparked huge concern, with nearly 4,000 people signing a petition to protect the community hospitals.
I acknowledge that a review is under way, but NHS Borders faces a significant financial challenge. Last year, its opening deficit was £28.1 million, leading to the potential for cost savings to be required in front-line services. Those services are being impacted right across the board, and, furthermore, delayed discharges in the Borders are already among the worst in Scotland. The Scottish Government should—and does—have a duty to ensure sustainable access to vital treatment options provided by community hospitals, especially in rural areas, because they plug those gaps.
The rural inequalities do not stop there. The average waiting time for a laparoscopy procedure for endometriosis in NHS Borders is 53 days, while the longest wait time is 126 days.
I hope that the member will agree that the demographics in the Borders are extremely challenging, with an increasing elderly population that is living even longer and requiring even more healthcare and social care. That is a huge issue in areas such as the Borders.
Christine Grahame has made my point for me: we should not have inequality, simply because of a geographical difference between urban and rural communities. In fact, the Government should be supporting rural communities because of that difference.
I recently met Jenni Minto, the Minister for Public Health and Women’s Health, for an update on the much-lauded women’s health plan. The Scottish Government said that it would bring endometriosis waiting times down to less than 12 months by the end of this parliamentary session, but has it done so? No. People are still waiting eight and a half years. That means, if someone’s symptoms started today, they would not get a diagnosis until 2034.
I shared with the minister the traumatic story of my constituent, Samantha Hogg, who said that she had been waiting for a diagnosis since she was 12. She is now 25, and she was scared about the damage that the wait was causing. She was told that she would have to wait two years for a laparoscopy procedure at the BGH, and she was in so much pain that she went private.
It does not stop there. Concerns have been raised in the Borders about diagnoses for ADHD and autism and whether the health board still provides that service. In a recent case covered by the Border Telegraph, an anonymous patient reported that their doctor had said:
“You clearly are [ADHD], you meet the criteria but the Borders have withdrawn their adult services and no longer will diagnose or provide services for ADHD or ASD, so you would need to go private.”
There is a pattern here, and I could go on, but I do not have much time. I just believe that rural health boards must be supported and that the rurality that my constituents live in must be recognised, and I ask the SNP Government to consider the fact that its resource allocation formula is inadequate and insufficient.
The Scottish Government is not on track to recruit 800 GPs by 2027, and the overreliance on locums and outsourced workforce is costing millions. It is evident that rural communities are being left behind. They are being used as a dumping ground for renewables, with the SNP overturning 99.9 per cent of appeals, leaving communities completely ignored.
Rural crime is up, with essential machinery and equipment being stolen because the Scottish Government failed to replicate Westminster legislation. Bus funding has been cut, leaving villages such as Swinton and Leitholm unable to access key services. Banks have withdrawn from high streets. Post offices have closed, with the likes of St Abbs left without even a postbox. Broadband is patchy, creating a digital divide.
You need to close.
Let us think about the physical and mental impact of what is happening in rural areas, areas that only the Scottish Conservatives are standing up for.
18:28
I thank Finlay Carson for bringing this important debate to the chamber, and I thank all members for their contributions.
I wish to respond specifically to a number of contributions towards the end of my speech. I will also try to pick up on some of the issues as I go.
As the chamber is aware, I represent a rural area: Caithness, Sutherland and Ross. The motion rightly highlights the challenges faced by rural communities, including those in Stranraer, Wigtownshire and across Dumfries and Galloway, in accessing timely and high-quality healthcare.
The 2025-26 budget commits a record £21.7 billion to health and social care, including £139 million for rural infrastructure. That funding will improve primary care access, expand diagnostics at Galloway community hospital and boost GP recruitment and retention.
In addition, we have announced the largest-ever investment in GP services—£531 million over three years—to stabilise practices and strengthen access in rural areas. Our GP action plan includes measures to strengthen recruitment and retention in rural and island areas, such as through the rural fellowship, reviewing the golden hello scheme to ensure the right incentives for harder-to-fill posts, and refreshing the GP retain and sustain scheme, which opened to new entrants in August 2025.
We have expanded multidisciplinary teams in general practice. More than 5,000 whole-time equivalent staff were working in services such as physiotherapy, pharmacy and phlebotomy as at March 2025. We are also working with boards in areas such as Borders and Shetland to model the best practice for those teams.
On maternity services, we expect all NHS boards to deliver care as close to home as possible, while ensuring safety for mother and baby. On 29 October, we launched the Scottish maternity and neonatal task force, which is chaired by the Minister for Public Health and Women’s Health. Its role is to provide national leadership, set the scope for a comprehensive review and act on lessons from Healthcare Improvement Scotland’s inspections. Crucially, it will examine rural provision, including in Caithness in my constituency, and in Stranraer. I know that that is important for rural communities.
The Cabinet Secretary for Health and Social Care met service leaders and local groups in Stranraer last month, and my colleague Jenny Minto, the Minister for Public Health and Women’s Health, visited Caithness in July. In all those areas, boards have increased local services.
I appreciate that the minister and her colleagues have met groups across rural Scotland, but nothing has changed. There is still no maternity birthing suite in Stranraer, despite independent professionals suggesting that a midwife-led birthing suite is the way forward. That has to do with the lack of midwives. There is a desire to have births as close to home as possible, but your Government is simply not delivering that.
Speak through the chair.
I recognise the challenges that the local health board is facing with recruitment for midwifery. Home births that are supported by a midwife are available, and there has been a step forward in the increasing of local services, such as scanning and antenatal care, which reduces the need for long journeys during pregnancy. That is welcome progress. We are also implementing our best start recommendations on the continuity of carers, community hubs and the greater use of Near Me for remoter consultation. It is unfair to characterise that as no progress.
When families must travel for specialist or neonatal paediatric care, our young patients family fund helps to cover food, travel and accommodation costs.
Looking ahead, the service renewal framework sets out a long-term reform agenda. One major change is improving access to services and treatments in the community, including planning for the unique needs of rural and island communities. Alongside the population health framework, it prioritises improving access to treatment, shifting the balance of care closer to people’s homes and ensuring that resources deliver the greatest impact.
A key part of that is the new subnational planning approach, which brings decisions closer to regions to reflect local priorities and integrate health and social care. That will deliver consistent core services nationwide so that everyone receives high-quality care, flexibility for remote and rural needs, and fair resource allocation that accounts for geography, workforce and transport, not just population size. Those approaches already embed equity of access as a core principle. Our recent direction letter asks health boards to demonstrate how remote and rural services are protected.
Access to healthcare is not just a service, it is a fundamental right.
Does the minister think that it is right that patients in NHS Grampian—and perhaps elsewhere; I am unsure—cannot get an angiogram over the weekend, despite being told that they need it, because the Scottish Government will not pay for it? Does the minister defend her Government refusing to pay for angiograms over the weekend in NHS Grampian?
I am certainly more than happy for colleagues—it would probably be the Cabinet Secretary for Health and Social Care—to look into that issue and get back to Douglas Ross. I recognise the need to access angiograms promptly, and there is certainly a need for prompt diagnosis and access to path labs. I know that we have made progress on access to good healthcare for myocardial infarction.
Access to healthcare is not just a service—it is a fundamental right. However, the Scottish Human Rights Commission has shown that rural communities still face systemic barriers. That is why our reforms put human rights at the heart of health policy by embedding the PANEL principles of participation, accountability, non-discrimination, empowerment and legality, and aligning with the forthcoming human rights bill to guarantee fairness for every citizen, wherever they live. We will continue to expand diagnostic and treatment capacity at Galloway hospital and other hubs.
Will the minister take an intervention?
I am quite short of time.
I can give you the time back, minister.
That is fine.
We are talking about fairness. Last week, my dad went from Aberdeen all the way down to Glasgow to the Queen Elizabeth or the national treatment centre—whatever it is called—because he requires a cataract operation. He travelled for five hours to get down there, spent 15 minutes in an initial consultation and then spent another five hours going back. Where is the equality in that?
Brian Whittle talked about increasing digital access to healthcare. It sounds to me as though there was no need to put hands on Douglas Lumsden’s dad, so that should have been a Near Me consultation rather than a 10-hour round trip. Those are issues that we face all over Scotland.
There is no doubt, however, that the national treatment centre programme is delivering for everyone in Scotland. The national treatment centre in the Highlands is delivering beyond what was expected. People are saying to me just how amazing the experience is.
There is a model in the Borders called Near Me, which would in fact have dealt with Douglas Lumsden’s issue.
Ms Grahame, can we have your microphone? It might be tucked away.
Everything is on.
That would have dealt with the very serious issue that Douglas Lumsden raised. A patient can have a video call with their allocated consultant about an issue so they do not have had to make such a journey just for a consultation. That is operational in the Borders, using videos.
I am proud of the Near Me technology, which is now used all over the UK and in Ireland. It came into its own during the pandemic. It was developed in Caithness, in my constituency, because of the challenge of travelling down to the hospital and it is now well used all over the UK. It could do with being used more, in fact.
We are continuing to expand diagnostic and treatment capacity at Galloway community hospital and other hubs. We are improving ambulance response times by reducing hospital delays, enhancing triage and increasing safe treatment at home or in community settings.
The provision of community beds and step-down facilities has been increased to reduce delayed discharge. Dumfries and Galloway’s home first work is a great example of shifting care into local settings, as is the investment in hospital at home around the country, flow navigation centres and, as we have mentioned, Near Me. Work with communities to co-design services that reflect local needs is vitally important.
Will the minister take an intervention?
I have a number of issues to cover before I finish.
I am not sure that I can give you an awful lot more time back.
I have taken a good number of interventions. Let me wrap up with some of the specific points that were raised during the debate.
I say to Douglas Ross that I am more than happy to chase that response for the save our surgeries group. Sharon Dowey raised some issues about audiology, which is a recognised challenge in our healthcare service and we are working to improve that. The issues with dentistry were largely caused by Brexit and the pandemic. The south of Scotland was particularly dependent on European dentists but we have taken action to try to improve that situation and we are seeing the benefit.
I agree with Carol Mochan’s point about apprenticeship and local earn as you learn, which would also be helpful in my area. There has been some progress on that front, with nurses, including mental health nurses, training in situ, but we need to expand it to other professions. Being a fellow member of a regulated health profession, Carol Mochan will understand that the barriers to that do not all lie in the Government’s hands; there are barriers within the professions, but it is important that we continue to pursue that.
I assure Tim Eagle that NHS Grampian has hospital at home. There are 35 patients a day using that service at the moment, and there are plans for expansion to respiratory and other areas.
I am sorry that I have not managed to respond to everyone’s points. I want to finish the debate by saying a huge thank you to our health and social care workforce for their resilience and for their innovation. It is very clear that there is a lot of innovation across the country, including in rural areas. The debate has highlighted the challenges that are faced by communities in Stranraer, Wigtownshire and across Dumfries and Galloway.
We are acting on the motion’s calls, investing in GP recruitment and retention, expanding diagnostic capacity, improving ambulance response times and increasing the number of community beds. We will continue to work with local communities to ensure that future health policy reflects their needs. I invite members to support those reforms and to work collaboratively across the Parliament to ensure that we deliver equitable access to care for every person, wherever they live.
Meeting closed at 18:39.Air ais
Decision Time