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Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, May 24, 2022


Health and Social Care

The Deputy Presiding Officer (Liam McArthur)

I ask members who are leaving the chamber to do so as quickly and as quietly as possible.

The next item of business is a debate on motion S6M-04567, in the name of Kevin Stewart, on keeping care close to home and improving outcomes.


The Minister for Mental Wellbeing and Social Care (Kevin Stewart)

The Parliament will be well aware of the scale of challenge across our public services and the level of uncertainty that we have faced over the past two years. In that context, it gives me particular pride to reflect on the ways in which our front-line national health service and social care workforce, and all those working to support them, have stepped up and adapted to new ways of working during the most challenging of times.

I will take a few moments to set out some reflections on the health and social care response to Covid-19 and some of the lessons learned, which are supporting us to future proof our NHS and social care services to provide sustainable reform and better care for the people of Scotland.

We know that demand for health and care services is increasing and the Covid-19 pandemic has accelerated the need to make optimal use of our resources. Innovation and transformation are critical to enabling our NHS to achieve reforms in the delivery of care.

The impact of addressing the Covid-19 pandemic meant that many health and care services had to be suspended or reduced in scope and scale. That affected almost all aspects of NHS care. As a result, demand for our healthcare services has increased, which is impacting on the efficiency of our services—for example, attendances at our accident and emergency services have increased and are now above 95 per cent of pre-Covid average levels; the average length of stay in hospital is up by about one day on recent seasonal averages; planned care waiting times have significantly increased; and acute capacity levels are regularly at above 95 per cent. Those issues are compounded by other challenges such as infection prevention and control measures, workforce pressures and delayed discharge.

The challenge of Covid-19 compelled our public sector to empower services to be flexible and adaptable and to provide alternative pathways for people to access healthcare. Teams blurred organisational boundaries, with unprecedented levels of collaborative working between sectors. We must all now build on that momentum to transform how we deliver care and how our systems work together.

With NHS 24 as the key point of contact, we have through our redesign of urgent care programme provided wide-scale triage of people away from hospital services and towards virtual hubs, which are staffed by A and E teams and have been established to prevent unnecessary exposure to a hospital setting and to ensure the right care at the right time. When hospital attendance is required, that can be scheduled. We are now seeing a reduction of between 15 and 20 per cent in people who self-present.

NHS 24 has focused on ensuring that patients receive the correct advice immediately, without a requirement to be placed in a queue. That means that patients sometimes have to wait longer for their call to be answered, but more than 95 per cent of calls are closed first time, as patients get appropriate support and advice without any requirement to be placed in a queue for a call back.

The Scottish Ambulance Service continues to increase see-and-treat outcomes to ensure that patients receive the most appropriate care first time, which reduces demand on operational ambulances. As a result, 41 per cent of patients were managed in their homes or community settings last year. Through the advanced practitioner role, the SAS has provided vital virtual pre-assessment care, which positively impacts on reducing avoidable A and E attendances and safeguarding patients in the community.

We have significantly increased the options for people to access health and care services. That includes increasing the availability of digital support and therapies for mental health, the ability to monitor a condition from home or the ability to have a video consultation with a health or care professional.

A key area for keeping people at home is telecare, which supports 180,000 people in Scotland. The Digital Office for Scottish Local Government is leading on local government’s transition to digital, which will support a more joined-up and resilient service across our country.

During the pandemic, the use of Near Me video consultations rose from about 1,000 consultations per month to a peak of 90,000 per month. Our aim is to continue to provide safe, person-centred and sustainable care through video consulting, with public choice as a key priority. Just after Christmas, the health secretary announced a series of actions to increase virtual capacity. That is key to reducing demand on our hospitals and ensuring that there is enough capacity in the community to provide care closer to home. To manage on-going pressures on acute care as a result of the pandemic and to support recovery towards a sustainable future, we have focused on building virtual capacity since early in the new year.

That work focuses on four priority pathways, which I will discuss in a moment. In combination, those services have avoided or saved about 655 bed days per day. That is the equivalent of adding the acute care capacity of a large district general hospital to our existing bricks-and-mortar hospitals. Without those services, patients would have been admitted to hospital and/or experienced a longer length of stay, thereby adding to the already significant pressures and providing a poorer outcome for the patient.

Through that work, we have enhanced hospital at home services across Scotland over the past few months. We are already seeing that work, which is critical as we move into the recovery phase, making a significant impact.

The level of care that we are able to provide at home continues to evolve and grow, and we are now seeing the spread of services such as hospital at home. I have visited hospital at home services in Edinburgh, and the cabinet secretary recently visited the Forth Valley service, on its first birthday, and was extremely impressed with the care that it provides. At that visit, he announced that an additional £3.6 million was being made available this year to support further development. That takes our total investment in hospital at home to more than £8 million.

Those services enable people to receive treatments that would otherwise require admission to hospital, such as an intravenous drip or oxygen supply. They also provide access to hospital tests under the care of a consultant in people’s own home. Evidence shows that those benefiting from the service are more likely to avoid hospital or care home stays for up to six months after a period of acute illness. For older patients, the service means that they are able to stay at home longer without losing their independence, which has contributed to overall improvements in patient satisfaction.

Local management information that has been collected by Healthcare Improvement Scotland shows that, between September 2021 and February 2022, 4,500 people were treated by hospital at home services who would otherwise been admitted to hospital. That equates to about 26,700 bed days.

Acute exacerbations of chronic obstructive pulmonary disease—COPD—are the most common cause of admission to hospital in Scotland. The condition affects 120,000 people in Scotland, a figure that is predicted to increase by 33 per cent in the next 20 years. Ambulatory respiratory services support patients with COPD in the community. Once in place, services can be expanded to manage other chronic lung conditions. We have increased capacity for respiratory rapid response services and they are reducing the number of occupied bed days, the length of stays and readmission rates. Since mid-January, 21,000 bed days have been avoided, which is an average of about 176 beds a day.

We continue to work with NHS boards to upscale that service and to reduce the variability of what respiratory services are in place. The impact will grow as boards further develop their pathways, particularly in the community.

We have also enhanced out-patient parenteral antimicrobial therapy capacity, which is a multidisciplinary service that provides an alternative for hospital admission or supports early discharge for a variety of patients with infection usually requiring IV therapy. To date, 22,000 bed days have been avoided, which is the equivalent of up to 197 beds daily.

To ensure that we can respond to future waves of the pandemic and a potential resurgence of the virus, we have been working with partners to roll out nationally a Covid remote health monitoring pathway. More than 6,400 Covid remote monitoring patient packs have been provided to 10 territorial boards and the Scottish Ambulance Service, and another 6,000 packs will be distributed this month. We are also embedding the remote monitoring approach across other specialties such as respiratory and maternity.

Planning continues with a view to expanding virtual capacity and aiming to double the overall provision of acute care that is currently provided in a patient’s own home, creating greater on-site hospital capacity and resulting in better patient outcomes at lower cost.

We are progressing a range of other actions to support flow through the hospital and minimise delays for patients either being admitted or discharged, including the discharge without delay programme.

To support our ambition of providing more care in the community, we are committed to expanding our district nursing service, as set out in the national workforce plan, which was published in 2019, and providing the necessary funding to support that. We are investing £47 million from 2020 to 2025 to increase the workforce by 12 per cent; that will introduce a minimum of 375 additional nurses to the district nurse service. The service supports people to stay in their homes, avoiding the need for them to be admitted to hospital or a care home, and it can support early discharge from hospital.

Our health and social care services continue to face unprecedented pressures. We have a lot of work to do to help the system recover; deliver on our ambitions; ensure that the people of Scotland receive the highest standard of care as they deserve; reduce waiting times; and increase our workforce across the system. There is no doubt that we have a long way to go to address the full scale of the challenge in our health and social care services, but I am optimistic that, by working collaboratively, and with the continued commitment and dedication of NHS staff and those in the social care sector, we will not only recover but innovate and redesign to deliver lasting improvements for the future.

The Government and I will continue to update members in the chamber on progress.

I move,

That the Parliament thanks Scotland’s NHS and social care staff for going above and beyond during the COVID-19 pandemic; welcomes the focus on stabilising and recovering healthcare through investment and reform; notes the efforts to ensure that more patients receive high-quality person-centred care and treatment in the right place, at the right time; supports the focus on building and enhancing virtual capacity to support a sustainable future providing alternatives to hospital and improving patient experience; recognises the recent progress on the roll-out of hospital and home and community respiratory services, for example, and agrees with the commitment to upscale these services in the community, utilising technology and digital opportunities to support improvements.

I advise members that we are already tight for time, so I require colleagues to stick to their allocated speaking time, even if they take interventions.


Sandesh Gulhane (Glasgow) (Con)

If we are going to make a difference and deliver improvements, we need to reject complacency, but the Scottish National Party-Green Government has once again lodged a motion that is heavy on self-congratulation but hollow on real targets, real commitment and delivery.

We know why—across the board, the SNP’s record on delivering on its policies and promises is abysmal. If members want examples, here they are: ferries wildly overdue and over budget; the Highland aluminium smelter; Burntisland Fabrications; Prestwick airport; the privatisation of ScotRail; free laptops or tablets for every child; bikes for the poorest youngsters; and renewing play parks. The SNP cannot even run a census.

On health and social care, the SNP promised to end delayed discharge from hospitals. There is a nursing and midwifery staffing crisis, there are record A and E waiting times and our social care sector is at breaking point—all on the SNP’s watch. We need to see decisive action and a commitment to quality, and we need to think about measurable outcomes.

Could the member tell us what the record is on those matters south of the border, where his party is in charge?

Sandesh Gulhane

I think that the member’s constituents, and the people of Scotland, will want to know what is happening in Scotland. Does he know why? Because we represent the people of Scotland and we should do better. That is why.

The SNP-Green Government should surely recognise that Scotland is strong in data-driven technology and that we should be adopting and integrating technological solutions to deliver our hospital at home care services. I was pleased to hear the minister underscore the importance of technology in a health and social care setting. Data-driven innovation and artificial intelligence in Scotland are thriving through United Kingdom and Scottish Government programmes; funding from major donors equates to more than £1 billion and is being pumped into innovation and skills development in Scotland.

In healthcare, Scotland has greatness literally at its fingertips. It has the potential to be a world leader, developing, testing and providing medical technology. We just need to want it.

Emma Harper (South Scotland) (SNP)

Would Sandesh Gulhane agree that the Scottish Government’s implementation of its “Respiratory Care Action Plan 2021-2026”, which includes technology in delivery, is a good step forward, given that that isnae happening south of the border right now?

Sandesh Gulhane

There is an obsession with what is happening south of the border, but I agree that using technology to help people in the way that Emma Harper describes is good for the people of Scotland. Scotland has the potential to be a world leader in developing testing and providing medical technology. We just need to want it more and to embrace our home-grown and home-funded start-ups and university spin-outs. I would argue that we do not really have a choice and that we need the Scottish Government to speed up funding.

We all know that our NHS and social care services face huge workforce challenges. On hospital waiting times, we have a toxic cocktail of delays, growing backlogs and delayed discharge, all of which impact our social care system, despite the incredible work of our health and social care staff.

A huge concern is the SNP-Green Government’s drive to create a national care service, which threatens to further delay reforms. The minister might wish to reflect on how centralised social care provision would simultaneously support vulnerable people in both Glasgow and Shetland.

Will the member take an intervention?

Sandesh Gulhane

I am afraid that I am now pushed for time.

The SNP Government forever complains about being hamstrung by a lack of cash, but we learned earlier this month that it has spent nearly £1 million on private consultants as part of its plans to centralise social care. One such consultant raked in £90,000 a month.

Audit Scotland has said that reform cannot wait for a top-down structural reorganisation. I urge the minister to accept that localism must be at the heart of social care reform.

Kevin Stewart

As we have spelled out, localism will be at the very heart of the delivery of the national care service. Can Dr Gulhane tell us how he would eradicate what is often a postcode lottery when it comes to care without bringing into play the standards that will come into play with the national care service?

It is amazing that you want to do that but are not able to do the same when it comes to long Covid clinics. Perhaps you need to have a consistent policy.

Please speak through the chair, Dr Gulhane.

Sandesh Gulhane

This is not the time to centralise social care services, and I am glad that the minister said that this is not the time to do so. Instead of pressing ahead with a bureaucratic overhaul of services, which could lead to an increase in out-of-care services, the SNP must engage with carers and those who need support to ensure that the highest level of care is delivered.

Let us consider what respected bodies outwith the Parliament have said about the SNP’s latest flagship adventure. The Convention of Scottish Local Authorities says that the plans for a national care service are “an attack on localism”. It says that it is

“deeply concerning that the consultation”

represents a

“considerable departure from the recommendations”

of the Feeley review. COSLA adds that

“Councils know their communities and all the evidence suggests that local democratic decision making works.”

Audit Scotland is concerned about the extent of the SNP Government’s plans for reform

“and the time it will take to implement them.”

Its report outlines that

“Many of the issues cannot wait for the Scottish Government to implement”

a national care service. Stakeholders told Audit Scotland of

“services in near-crisis and explained that a lack of action now presents serious risks to the delivery of care services for individuals.”

Lessons need to be learned from previous restructuring and public reform. Audit Scotland notes that previous reports on such matters have found that

“reform is challenging and public bodies have experienced difficulties implementing elements of reform—expected benefits are not always clearly defined”,

but they really should be. The Audit Scotland report goes on to say that

“reform does not always deliver the expected benefits, particularly in the short term.”

Will Dr Gulhane give way?

Sandesh Gulhane

I am afraid that I am pressed for time now.

Audit Scotland says:

“Any difficulties in implementing social care reform could have a significant ... impact on vulnerable people who rely on care and support.”

There is another highly qualified view that we should listen to. The Fraser of Allander Institute states:

“Until we know the final shape of the National Care Service, we can’t say too much about the funding settlement required.”

The Scottish Government’s programme for government states that it will increase spending

“by 25% over this Parliament—providing over £800 million ... by 2026-27.”

However, that is some way short of the more than £1 billion that is expected to come from national insurance contributions. Analysis by the Fraser of Allander Institute states that the

“definition of social care”

that the £800 million relates to is

“hard to follow”,

and that it is not clear whether it is a

“cash or real terms increase”.

No one is suggesting that reforming our country’s social care system is anything other than complex, but we need to focus on working with and supporting those who know the problems best. That is why the Scottish Conservatives have proposed a local care service, which would ensure that support is delivered as close as possible to those who need it, especially in our rural and island communities.

We must avoid imposing a centralised system, which could well be disjointed and fragmented and would lose local responsiveness and creativity. As we have seen with the SNP’s control freakery in asking its MSPs to submit supplementary questions in advance, the Government has a tendency to favour a command and control model and to have an insufficient focus on enabling flexibility. It is not as if we are dealing with an Administration with an amazing track record of delivering on its promises and goals and of delivering value—we most certainly are not.

Our health and social care staff continue to work incredibly hard and they deserve a system that works for them. That is why I will be pleased to move the Scottish Conservative amendment.

I draw members’ attention to my entry in the register of interests, which shows that I am a practising NHS doctor.

I move amendment S6M-04567.2, to leave out from “welcomes” to end and insert:

“supports increasing the focus on building and enhancing virtual capacity to provide alternatives to hospital and improve patient experience; agrees that more needs to be done to ensure that patients receive high-quality person-centred care and treatment in the right place, at the right time; requests that the Scottish Government provides regular updates on progress towards these goals; notes that care reform cannot wait for the establishment of a National Care Service; shares concerns that the National Care Service will be centralised, bureaucratic and less sensitive to local needs and geographical variation; is concerned that the National Care Service could lead to an increase in out-of-area care; regrets, in particular, that the centralisation of other public services in Scotland has made them more geographically remote; regrets more broadly that the commissioning of care at the moment is focussed on cost rather than quality or outcomes; calls, to this end, for a move towards ethical commissioning; notes that a lack of care-at-home packages is having a detrimental impact on delayed discharge; regrets that the use of technology and hospital-to-home services is insufficient, and welcomes the calls for a Local Care Service and a local care guarantee to protect individual choice and control, and ensure that support is delivered as close as possible to those who need it, especially in rural and island communities.”


Paul O’Kane (West Scotland) (Lab)

I begin by thanking our NHS and social care workforce. Their efforts over the past two years have been beyond exemplary, and they have worked tirelessly to keep our families safe and well, and to ensure that people continue to get the care that they need in their local community.

I note the aspiration that the Government has expressed in the motion and the debate. The minister said that there is a lot to do and that

“we have a long way to go”.

Forgive me if I take a few moments to question his unfettered optimism, but it is clear that there are significant challenges and barriers to building and enhancing virtual capacity to support a sustainable future and to provide alternatives to hospital while also improving the patient experience.

The Government’s motion fails to acknowledge many of the realities that patients and health and social care workers face. I am sure that all members have heard constituents say that they are waiting too long to see their general practitioner and are not always aware of how to access alternative clinical pathways or why they are doing so. That is in stark contrast to the Government proposition today. We cannot ignore the failure to meet accident and emergency waiting times, the continued delayed discharge figures and the lack of a robust plan to recover services and support staff as we emerge from Covid-19.

The Government’s motion puts significant emphasis on alternative pathways, but evidence to the Health, Social Care and Sport Committee has shown that nowhere near enough work has been done to make people aware of those services. Evidence that was submitted by people who work in services and who support patients to access them shows that waiting times are too long and that the route is often convoluted, which puts additional pressure on general practices and accident and emergency departments.

That is not just a recent trend that can be explained away by the pandemic. One respondent to the committee’s consultation said:

“Even before the pandemic waiting times are over long and normally by the time you see anybody your condition is worse”.

General practices are at breaking point and patients are paying the price, with the pandemic having exacerbated years of decline under the Government. In a poll that was carried out last month, 86 per cent of Scotland’s GPs who responded said that they have felt anxiety, stress or depression in the past year. That is what happens when the Scottish Government does not properly fund and support our NHS. The result is that patients and the people who care for them suffer.

Those examples are not just one-offs. The recently published 2021-22 health and care experience survey has exposed plummeting satisfaction with health and care services in Scotland. The proportion of people who are satisfied with the overall care that is provided by general practices dropped by 12 percentage points in two years, with almost a third of people rating their overall care negatively. I do not believe for a second that that is a reflection of our hard-working GPs and their support and reception staff; rather, it reflects the fact that there is not enough clarity and support for people who are on alternative pathways.

When it comes to building back the foundations of the NHS stronger than before, “NHS Recovery Plan 2021-2026” has failed to deliver. Audit Scotland has highlighted that the recovery from Covid-19

“remains hindered by a lack of robust and reliable data”

across the NHS.

For all the Government’s talk of increasing the number of allied health professionals, in December 2021, there were more than 1,000 whole-time equivalent vacancies. That is simply not good enough and shows that the Government’s rhetoric does not always match reality.

Social care is in dire straits. The SNP has presided over slashing of care packages and withdrawal of respite care, and it has failed to immediately implement key recommendations of the Feeley review, including on removal of residential care charges.

The crisis in social care clearly impacts on our NHS. Delayed discharges are hitting record levels and there are unacceptable waiting times in accident and emergency departments. Despite that, the pace of change in social care has been slow and is faltering in the face of growing pressures from increasing demand and demographic changes. For months, the Royal College of Emergency Medicine has been warning that longer waits will lead to more preventable deaths; this week it repeated its calls for 1,000 new beds across the system.

In short, I say that failure to tackle social care pressures is bad for patients and bad for key services across our NHS. Our social care workforce is demoralised and understandably feels undervalued. There are significant shortages across the workforce, which is resulting in a record high number of delayed discharges that puts strain on key services across our NHS.

Unfortunately, the Government is doing little to make social care a more appealing career choice. Only six months ago, the SNP Government rejected Scottish Labour’s calls to deliver an immediate pay rise to £12 per hour; instead, it opted for a measly 48p per hour increase.

Today, Scottish Labour is calling for steps to be taken to ensure that patients who need to be seen in person can receive speedy treatment. Urgent action is needed to fix our social care system. The “wait and see” approach of the SNP Government regarding the national care service is not good enough. Non-residential care charges must be removed immediately, and the recent narrowing of eligibility for care packages must be reversed and the independent living fund reopened.

There is an urgent need not only for reform, but for tackling poverty pay in the social care sector, which has a predominantly female workforce and experiences long-standing issues of gender inequality. The Scottish Government’s proposed pay increase does not reflect the skilled nature of social care work. The growing staffing crisis that is having a direct impact on our NHS will never be addressed while people can earn more by working in a supermarket or a pub. The future of our social care sector is dependent on a strong, stable and valued workforce. That is why Scottish Labour supports the “Fight for £15” campaign to increase social care workers’ pay. We believe that they need an immediate pay rise to £12 per hour, followed by a further rise to £15 per hour.

Will Paul O’Kane give way?

Will the member take an intervention?

I think that I am in my last minute.

You are, Mr O’Kane, and you have no additional time, I am afraid.

Paul O’Kane

I apologise to Mr Stewart and Ms Dunbar—I have no time. Had they tried to intervene earlier, I would possibly have given way.

Presiding Officer, I will conclude. Scottish Labour’s amendment proposes tangible actions that will truly focus on building the capacity that we need in our health and care system. Having a focus on our social care workforce, improving alternative pathways and ensuring that people can get home and that there is no wrong door for them as regards their healthcare will ensure that people can get out of hospital and improve their experience in our local communities.

I call on members to support the amendment in my name.

I move amendment S6M-04567.1, to leave out from “welcomes” to end and insert:

“supports the focus on building and enhancing virtual capacity to support a sustainable future, providing alternatives to hospital and improving patient experience, but is concerned by the ongoing pressures across primary care in Scotland, with many patients experiencing persistent problems in accessing GP appointments and Allied Health Professionals (AHP) clinical care pathways; considers that the Scottish Government must ensure that patients who need to be seen in person can receive speedy treatment; regrets the Scottish Government’s failure to take decisive action in addressing the social care crisis, with people unable to access essential care packages and unpaid carers reaching breaking point, whilst the sector faces a recruitment and retention plight; recognises that this is having a severe impact on NHS services, with delayed discharge at record levels and persistently long waits in A&E; agrees that the establishment of a National Care Service cannot be used as an excuse to delay reforms, and calls on the Scottish Government to immediately deliver its commitment to end non-residential care charges, as well as reverse the recent narrowing of eligibility to care packages, reopen the Independent Living Fund, and address poverty pay among social care workers by backing an increase in pay to at least £15 per hour.”

I again remind members that we are very tight for time.


Alex Cole-Hamilton (Edinburgh Western) (LD)

I am pleased to rise on behalf of my party in this important debate.

It will come as no surprise to members to hear me say that, as a Liberal Democrat, I will always champion services being kept as local as possible to the people whom they support. That is one of the principal reasons for my party’s being against the creation of a national care service. Centralising services to ministers is not the answer to the on-going crisis in social care. It would take good local services and bring them under Scottish Government control, which would take power away from the providers who—let us be honest—know far more about what patients and staff require than the Government does. We have only to look at the scandal of sending untested and even Covid-positive patients into Scotland’s care homes at the start of the Covid-19 pandemic to know that the Scottish Government should be nowhere near the issue.

However, it is not just the plans to create a national care service that highlight the fact that the Government does not want to keep care close to home, no matter what the motion may state. In Caithness, many expectant mothers now need to travel more than 100 miles down the A9 to Inverness to give birth. That journey takes more than two hours and there are on-going fears about unexpected complications for mothers and their babies. Women face being stranded too far from home or a hospital to give birth safely.

Compare that with the situation right here in Edinburgh. An expectant mother in my constituency—in Cramond, say—would need to travel for only half an hour to get to the maternity unit at the Royal infirmary of Edinburgh. Given the work that the Government has rightly undertaken to resolve issues with the Moray maternity service, you might think that it would strive to do something similar for Caithness—but, Presiding Officer, you would be wrong.

My colleague in Westminster Jamie Stone has been raising the issue since he was elected in 2017. He has repeatedly asked the Scottish Government to undertake a safety audit, and even got to the point of inviting the Cabinet Secretary for Health and Social Care himself to make the journey from Wick to Raigmore that many women are forced to endure every day.

The cabinet secretary has, it seems, so far refused to do so. He has not explained what meaningful action he is taking instead, which is simply not good enough. Every expectant mother in the country should be able easily to access maternity services close to home. They deserve access to the support that they need as they go through a major chapter in their lives. That should go without saying.

Earlier this month, my colleague Beatrice Wishart raised the fact that, north of Livingston, there are no dedicated inpatient mental healthcare beds in mother and baby units for new mothers to receive care alongside their babies. That means that mothers in places such as Lerwick, Stornoway, Ullapool, Dundee, Hawick and Stranraer could travel for miles to get the care that they need.

Kevin Stewart

Mother and baby units are highly specialised units for perinatal and infant mental healthcare, and they could never be everywhere in the country. That is why we are strengthening community-based facilities.

We currently have a consultation under way on MBUs, and I would like as many folk in Scotland as possible to respond to it. It closes at the end of this week.

Alex Cole-Hamilton

I am grateful for the intervention, but MBUs are not in the places where they are required and the peripatetic services that could offer the service are not on the ground. That means that mothers and their babies are forced far from home and from their networks of support just when they are most in need of support.

The Government might point out that MBUs need to support only 150 women a year, but it is vital to note that, every year, within 12 months of childbirth, 125 women receive treatment at an inpatient mental health unit, where they are separated from their babies.

The Government might also say, as the minister said earlier this month, that it is aware of barriers that are associated with receiving treatment far away from home, hence the existence of the mother and baby unit family fund. However, families need more than that. Women need access to treatment much closer to home. As the Royal College of Psychiatrists has said, they do not want a postcode lottery when it comes to perinatal health services.

Sadly, it is not only new and expectant mothers who have to travel far from home. Many of our children and young people have or are waiting for referrals to child and adolescent mental health services. I am sure that I am not the only MSP who has had, in increasing volumes, families getting in touch to share their experience of the system.

Will Alex Cole-Hamilton take an intervention?

Alex Cole-Hamilton

I am afraid that I do not have time.

Many of the young people who need support will have access to community services that provide help close to home. However, sometimes, more specialist treatment is required and, in such cases, options are beginning to become severely limited. There are only three inpatient units dedicated to the mental health of children and young people, and none of them is north of Dundee. In 2018-19, there were 118 admissions involving 101 young people under the age of 18 who desperately needed mental health support.

Will Alex Cole-Hamilton give way on that point?

Alex Cole-Hamilton

I really do not have time.

However, due to lack of space, many of those young people went to adult units.

We live in a time of increasing awareness about the mental health of our young people, yet we still fail to provide the right support for them. Some of them might be forced to travel hundreds of miles from their communities and families, just when they are most in need of stability and support. I find it appalling that this Government has allowed the situation to get to this stage. It simply must do better for our children and young people.

No one in the chamber or across the country doubts for a moment the vital work that our NHS does. That said, many people will not have access to that vital support in their communities, which must be rectified once and for all. This Government talks a good game when it comes to the health and social care of Scotland, but warm words and platitudes mean nothing to patients and staff who are having to suffer at the business end. It is time for the Government to act in their interests.

The Deputy Presiding Officer

We move to the open debate. Before we do so, I remind members that, if they intend to speak in the debate, they must be in the chamber for not just the closing speeches but the opening speeches.


Gillian Martin (Aberdeenshire East) (SNP)

There is lots in the Government motion and the minister’s speech to mention, but I want to talk about two aspects of reform: the roll-out of national treatment centres and the types of working that keep elderly people living independently for longer. I will highlight evidence on those issues that has been received from people who have engaged with the Health, Social Care and Sport Committee over the past year.

I am obviously pleased that NHS Grampian is one of the five boards to receive Scottish Government funding to build a national treatment centre. The likely location for the Grampian centre is Aberdeen royal infirmary. It is planned that the centre will be up and running this year, with the aim being to improve the patient care service. The services to be included in the centre are out-patient, urology, dermatology, respiratory medicine, day surgery, endoscopy and facilities for magnetic resonance imaging and computerised tomography scanning. One aim of the development of the 10 centres is to reduce waiting times and give patients quicker access to procedures and diagnoses.

I will point to something that the Health, Social Care and Sport Committee has heard a few times and that I want to draw to the minister’s attention, because it needs serious investment—patient information. We have often heard that patients feel that they have been left in limbo when they are put on a waiting list and hear nothing more until they get an appointment letter. A system in which patients could monitor where they are on a waiting list and when they can expect their treatment would reduce anxiety, manage patient expectations and allow people to plan and get ready for procedures.

Clinicians have said to the committee and to me that if a patient knows when they will undergo an elective procedure that allows their GP and other health professionals to work with them on pre-operative care, it can mean that there can be dietary programmes, exercise, physiotherapy and other regimes ahead of surgery that can ensure that the body recovers more quickly. It also allows the patient to feel that they are working towards treatment, and that they have a locus and are actively involved in the treatment, rather than simply waiting for a letter to arrive. That is a psychological thing, but it is important. There can be quite a gap between diagnosis and finding out that they will have a procedure and actually getting a letter about that.

I said at the start of my speech that I would also mention independent living and care packages for the elderly. That issue will chime with any of us who have elderly loved ones, which is probably all of us. Many of this country’s elderly population end up having quite long hospital stays when that could be avoided. There are variable rates of delayed discharge among health board areas. I was very encouraged to hear that there are only 19 delayed discharges at Aberdeen royal Infirmary. The minister mentioned that in evidence last week when he talked about the success of the Granite Care Consortium’s strategies for getting elderly patients out of hospital swiftly and with appropriate care packages.

The goal is to have systems and interventions that keep people living independently for as long as possible. We know from clinical evidence that elderly patients can become disoriented outside their familiar home environment, and that physical strength and mobility can also deteriorate when they are in hospital. That can mean that some patients might not be able to go home at all, while others might need intensive nursing home care. Waits for enhanced care packages can mean that patients are in hospital for far longer than they need to be, or for longer than is good for their mental and physical health, given the potential for deterioration that I have just outlined.

A hospital at home system—which was mentioned by the minister—with targeted acute care interventions being delivered at home, can prevent hospitalisation in the first place. I look forward to evaluating how that will be rolled out. I realise that it has not yet been rolled out to the whole country, but I look forward to seeing how it is rolled out and what the outcomes are.

I am obviously going to mention good practice in Aberdeen as much as possible. That is what I was going to mention in an intervention on Alex Cole-Hamilton when he talked about CAMHS, because there is a success story about CAMHS in the Aberdeen and Grampian area.

The good practice in Aberdeen was highlighted by Dr John Macaskill when he came to speak to our committee in February. He pointed to agencies working in collaboration to prepare care packages at the assessment stage and doing so with the person whom they are supporting. That person is made aware of the available options and can exercise control and choice with the front-line worker whom they see all the time. That front-line worker is also able to exercise autonomy, because they know their client’s needs best. They do not have to get a second opinion from someone else; they do not have to go through any procedure. There is trust.

Dr Macaskill highlighted the interesting role of the care technologist in allowing people to live independently in their own homes for longer. He again pointed out that Aberdeen is getting that right. That good practice should be rolled out and communicated across health boards and health and social care partnerships.

That good practice is not only best for so-called clients—a word that I hate—and people who need care; it also creates a culture of trust in which front-line workers will be best able to do their jobs and, hence, more likely to have the job satisfaction that will keep them in the sector. We keep hearing about people leaving the sector, and about churn.

I will finish by quoting Dr Macaskill’s words on the successful model. He said:

“There are lots of models, but they have a consistent thread, which is partnership, collaboration, equality of treatment and, critically, trust.”

He added:

“What best practice has as its heart is collaboration rather than competition, and trust rather than suspicion.”—[Official Report, Health, Social Care and Sport Committee, 22 February 2022; c 13.]


Alexander Stewart (Mid Scotland and Fife) (Con)

I am grateful for the opportunity to contribute to this debate, which is key to the Parliament setting out its vision for care services in the coming years. I speak in support of the amendment in the name of my colleague Sandesh Gulhane.

As others have done, I put on the record my thanks to all the hard-working staff in the care sector in my region and across Scotland. Those individuals have faced immense pressures over the past two years, yet they have gone above and beyond to provide services to those who require them.

The debate concerning how our social care system should be delivered is rightly being viewed with fresh eyes as the country continues to learn the lessons of the past two years. However, although this is a good time to be debating the issues, it is also clear that many of the questions predated the pandemic entirely. The case for meaningful investment in and reform of our care system has long been clear, but how far such reform should go and how quickly it should be delivered is far less clear.

Unfortunately, the sector is facing the prospect of significant centralisation. Change may be needed, but now is not the time to overhaul care services in the way that has been proposed. Our amendment mentions the importance of services being tailored to meet local needs. Sure enough, one thing that was clear to me throughout my 18 years in local government was why care services are most effectively delivered at a local level. It is no accident that good-quality care has always been associated with highly localised delivery of care, and any changes to that must be scrutinised very carefully.

For 15 years, I worked as a senior support worker for Ark Housing, which gave me a first-hand insight into the processes and procedures in the sector and the difficulties that face both the sector and the service users.

We are clear that care services are best delivered at a local level, but it is equally clear that their effective delivery depends on them being properly funded. This is not the time to rerun debates about local government funding, but the erosion in real terms of funding that local government has endured over the past decade is part of the reason for some of the problems that the care service has to deal with daily. As colleagues have said, there are many challenges, and providers need financial security—they continue to provide support services, but reforms are required.

Kevin Stewart

Mr Stewart talked about funding, as did Sandesh Gulhane in relation to the national insurance increase and the possible consequentials that will come to Scotland. Will Mr Stewart and his colleagues join me in asking the chancellor for clarity on when we are likely to see that money and how much we are going to get here, north of the border?

Alexander Stewart

I thank the minister for the intervention. I say to him that billions of pounds have been supported by the UK Government into Scotland over the past few years, and will continue to be. I have no doubt that that money will come in close contact.

The Fraser of Allander Institute has stated that the total cost of the national care service is not known at this time, but Audit Scotland has estimated that the reforms will cost about £600 million—a figure that may rise even further depending on the full reach of the reforms. We are yet to receive clarity on the costs and a commitment from the Government that it will meet them, despite the fact that we and COSLA have been calling for that since last September.

The Government has had issues with workforce planning for some time and it is still getting it wrong. The warnings from BMA Scotland about the health and social care workforce pressures predate the pandemic. We need to support the workforce and its professionalism. The publication of the national workforce strategy in March was a step in the right direction, but it leaves many important questions unanswered.

The strategy very much emphasises the importance of attracting people into the caring professions, but we also need to look at the long-term retention of workers. Although I welcome the 1,800 training places for caring roles, which will be funded through the national training transition fund, it is important that the uptake of those places is monitored closely to ensure that the supply meets the demand. The recruitment strategy for social care, which is due to be published by the end of 2022, must be appropriately ambitious, given the scale of the challenges that the sector is facing.

Fundamentally, we believe that a local approach should be central to any care reforms, and that local government should receive the support that it needs to deliver high-quality, integrated services that meet the demands of the individuals and the community.

The title of the debate is “keeping care close to home”. That is a good soundbite. However, I hope that, in the coming years, it will become not just a narrative but the reality for communities all across Scotland, because that is what they deserve.


Paul McLennan (East Lothian) (SNP)

The past two years have been the most difficult that this country and indeed any health service have ever seen. No one could have forecast the impact that the pandemic would have, is still having, and will have for quite a while yet.

Most people want to be cared for at home, if possible, and to recover at home as soon as they can. A number of Scottish Government policy developments seek to keep care close to home and improve outcomes. I will touch on those later.

The NHS in Scotland remains under severe pressure. Covid-19 created a growing backlog of patients who had to wait much longer for treatment. That backlog creates a significant risk to our recovery plans, as the minister acknowledged.

Reform is key to the sustainability of the NHS, and must remain a focus, building on the innovation that was seen throughout the pandemic. During the pandemic, many new and different ways of working were developed to support the continued delivery of critical services. We need to support innovation in and redesign of services, to ensure that more patients receive person-centred care in the right place, at the right time, and in a way that helps staff to deliver high-quality care and treatment.

A range of partner organisations are central to research, innovation and service redesign, including the new national centre for sustainable delivery, NHS National Services Scotland, the Digital Health and Care Innovation Centre, Healthcare Improvement Scotland and the Scottish health industry partnership group.

The increase in digital, which was planned for before the pandemic and significantly accelerated as part of the response to it, means that the time is now right to ensure that digital is always available as a choice for the people who access services and the staff who deliver them. That will allow more people to manage their condition at home, to be able to carry out pre and post-operative assessments remotely, and to continue to manage their recovery from home.

The new national centre for sustainable delivery for health and social care will be particularly important in driving innovation. It has been established to pioneer and deliver new, better and more sustainable ways of delivering services. It will be key to supporting NHS recovery and will aim both to reduce unnecessary demand for services and to help to develop new pathways of care. It will work collaboratively with partner organisations, academia, the third sector and industry to identify and implement improvements to care pathways across Scotland. It will also ensure that patients have access to appropriate, clinically relevant information to inform their decision making, and will make sure that they are aware of the alternatives that are available to them, including non-operative interventions.

As part of our recovery, NHS and social care workforce planning has never been more important. Our workforce is at the heart of delivering health and social care services to the people of Scotland. More than 400,000 skilled and compassionate people work in many different roles and settings, in an integrated way. The Scottish Government has introduced measures to support staff and is monitoring the effectiveness of those. Its plans to recruit and retain staff are ambitious and will be challenging to achieve, given the NHS’s historical struggles to recruit enough people with the right skills.

Our NHS social care and social work staff have been remarkable throughout the challenges that have been faced in the Covid-19 pandemic. We all have to acknowledge the significant pressures that the workforce has faced and the fact that sustained actions are required—from planning for and attracting people into the workforce through to supporting and developing that workforce—in order to deliver its recovery, growth and transformation. The workforce strategy sets out a framework for achieving the vision of a sustainable, skilled workforce.

The Scottish Government has a track record of investing in our people, with record staffing levels in our NHS and 10 consecutive years of growth.

In 2021, the Scottish Government published the “NHS Recovery Plan”, which set out key ambitions and actions to be developed and delivered over the next five years, in order to address the backlog in care and meet the healthcare needs of people across Scotland. It is part of a wider whole-system response, including social care and support from within communities.

I want to touch again on hospital at home, which I referred to earlier. Hospital at home is one of the main ways to provide more care in the community and reduce pressure on hospitals. The minister referred to the £3.6 million that was available to support the expansion of hospital at home services, with the aim of doubling current capacity by the end of 2022. The purpose of the service is to reduce hospital admissions for elderly patients by providing them with treatment in the comfort of their own home. All health boards can apply for money to either develop or expand the services. The Scottish Government’s total investment in the service is £8.1 million since 2020.

Evidence shows that those benefiting from the service are more likely to avoid hospital or care home stays for up to six months after a period of acute illness. We know that frail patients tend to occupy hospital beds for a longer period, and that is why the scheme has been expanded. By reducing the number of long hospital stays, we will free up more hospital beds.

In 2021, our new £20 million community living change fund to help redesign services for people with complex needs was launched. It helps to address issues that were raised in the 2018 “Coming Home” report about the need to avoid out-of-area placements and delayed discharge. The community living change fund is available to health and social care integration authorities to design and redesign community-based support for people with complex needs, who in the past have endured long stays in hospital settings or had to seek care outside Scotland.

Continuing investment in the NHS workforce and digital transformation, combined with specific stay-at-home initiatives, will see more people cared for at home, where they want to be.


Sarah Boyack (Lothian) (Lab)

I add my thanks to all those who work in our NHS and care workers for their incredible work through the pandemic. The challenge is that their work is still pressured. They are still having to work long hours and we are still dealing with the after-effect of the pandemic as our health system and care sector recover.

I was prompted to speak in the debate by the emails from constituents that I have been receiving regularly. They are getting in touch because they need help in accessing care for either themselves or their relatives, and they cite deeply troubling and frustrating experiences. For example, I have been contacted by relatives of people with dementia, who are very worried about the length of time that it is taking them to get access to care. That means that the person with dementia can be stuck in hospital or be at home without the support that they need, which worries their relatives.

There are people who have been stuck in hospital for a variety of reasons, the key one of which is that there is not care available for them at home, or their home needs to be made physically accessible for them but delays are preventing that from happening. Again, that creates stress not just for the person but for their family. That is not good for people’s health and it has a definite negative impact on our NHS.

If we look at the delayed discharge numbers in NHS Lothian, we still see more than 200 beds per day taken up by people who are ready to leave hospital. That does not mean that they are entirely healthy and well, but they are at the point at which they no longer need hospital care and now need care at home or step-down care.

It is really important that we get an approach that looks at all those things. The problem that I have with the SNP motion is that it does not begin to acknowledge the scale of the crisis faced by the people who are currently getting in touch with us.

Kevin Stewart

I am happy to meet Ms Boyack to discuss the kind of cases that she has. I agree that the waits here in Edinburgh are unacceptable. In terms of comparing and contrasting, as Gillian Martin pointed out, there are currently only 19 delayed discharges in Aberdeen. What we need here is replication of what is going on in Aberdeen. Front-line staff need to be given the autonomy that has been given in Aberdeen, to make sure that we get it right for people in this city as well.

Sarah Boyack

The challenge is that the city has an ageing population. People are living much longer, so there is an infrastructure issue in respect of the accessibility of people’s homes in the city and the care that is being provided. That is not just from the pandemic; the delayed discharge statistics go way back.

I am worried that the minister does not acknowledge the scale of the crisis in the city. Nobody should fear growing old, getting ill or becoming vulnerable and not living a full life with dignity and respect, and people’s families should not have to worry about that. I will take up the minister’s offer of a meeting, because people have raised particular issues that the Government could act on now.

A key issue that is raised with us regularly by nurses and carers whom we meet is that, although they have enjoyed the clapping for support through the pandemic, there are real issues to do with finance and salaries. Delivering national terms and conditions and creating career opportunities are absolutely vital if we are to retain people in the care sector and recruit them, and if we are to make such jobs an attractive choice for people. We are in a cost of living crisis, so pay is critical to success. That is why our amendment refers to not just an immediate rise to £12 an hour but the need to go up to £15 an hour. As Paul O’Kane said, an extra 48p an hour does not cut it. The cost of private rent in Edinburgh is £1,000 a month. That is a lot of money for people who are on low incomes. Many contracts are insecure or temporary, and 15 per cent of staff have to work unpaid overtime. That means that people will not see opportunities in the care sector as reliable, long-term career opportunities, and that is one reason why we are experiencing shortages in recruitment.

I have received feedback from families who are deeply unhappy about not being able to earn an income while caring for a relative. It is simply not sustainable for many families to look after a relative full time without limit without an income. Tomorrow, we will have a debate on community wealth building. I ask the minister to reflect, in summing up, that there is a direct read-across to that debate. We could support community and co-operatively owned not-for-profit care companies. That would give people decent employment, let them shape care in their communities, and enable people to work as carers for relatives and reinvest in our communities. Distraught constituents have got in touch with me directly about that.

For too long, we have relied on unpaid carers without giving them proper support and acknowledging the sacrifices that many people make. In a cost of living crisis, the pressure will be ramped up massively if people have to give up work to care for a relative. We have to rethink how we support families.

In his opening comments, Paul O’Kane made points about addressing the funding gap that was identified in the Feeley report, giving people access to social care where they need it, reopening the independent living fund, and looking for funding for respite care to support unpaid carers, as they need to be able to keep caring, as well. We also need to look at reversing the narrowing of eligibility for care packages.

There is a lot that could be done now. It is really worrying that, in a recent survey, 43 per cent of carers said that they did not feel supported to continue caring.

There is the issue of care at home.

Please bring your remarks to a close, Ms Boyack. Thank you.

We need to ensure that we fund people. We also need care homes. We will potentially lose five council care homes in Edinburgh. I hope that our new councillors will look at that alongside care at home.

I call Christine Grahame. I advise that we have no time in hand. Speeches should be a maximum of six minutes, and interventions must be absorbed within the allocated time.


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

Point duly taken, Presiding Officer.

I will start with what we all agree on: the consideration and dedication of our care workforce. I think that we also agree that we want people who need care to receive that care at home or as close to home as is practicable. The practicality will depend on the level of care and, of course, the level of funding available.

I will confine my contribution to care of the elderly, and I will start with the positive. Free personal care was introduced in 2002. It is by no means perfect, but it was introduced under the Labour-Liberal Executive and supported by the SNP. It is a recognition that helping someone to dress or to open a can of beans and heat it, for instance, should not incur a charge, as that would not be charged for in a hospital setting. According to the most recent information that I could find, in 2017-18 it cost nearly £500 million, and of course, that cost is rising. In 2019, the Scottish Government introduced legislation to provide such care to the under-65s, at a cost of £2.2 million.

Secondly, there was the integration of the funding of health and social care. In 2016, the Scottish Government legislated to bring together health and social care in a single, integrated system. That was not easy. It was intended to stop the competition between NHS budgets and social care budgets, by giving the money to the health boards in the first instance. That was an important step forward. It has had its successes, but it has also had its difficulties.

Both of these examples recognised the reform that was needed as the ageing population grows. Being a septuagenarian, I am, regrettably, part of that ageing population, so I appreciate the physical difficulties that arise as age interferes with your lifestyle—notwithstanding all that you try to do.

Covid has exacerbated the need for radical reform and the extent of the demand. Therefore, I welcome the intention to create a national care service, which sets out—this is for Dr Gulhane, in particular—inter alia, to provide for consistency and improvement to be led at the national level, but ensuring that service provision is locally accountable and responsive to the needs of communities and that services are designed at a local level, with the input of those with lived experience.

Let us see how that develops. I do not read a power grab into that. I read consistency in the level of the services, but with the delivery and design at local level—the best of both worlds.

Why has it failed so miserably with the GP contract?

Christine Grahame

I am tackling the national care service. Dr Gulhane’s point was that it would interfere with local design and delivery. That is not what is in the proposals, which can be challenged at a later date.

All the proposals take money. Where does that money come from? That takes us back to everything that we debate in the Scottish Parliament.

Currently, the biggest chunk of the Scottish Government budget goes to the NHS. Over 80 per cent of that is allocated to fixed costs—for hospitals and for all the staff, laundry, transport, ambulance services, medicines, GP services and so on. If we want to do more, then money must be raised, but we have very limited tax-raising powers. We have some powers over income tax levels, but none on VAT, companies’ tax or fuel duties. Given that, the list of demands in the Opposition amendments—although I think them perfectly reasonable—fall at the first fence: funding.

We know that £770 million has already been taken from our budgets to mitigate Tory cuts that affect the very vulnerable in Scotland. In real terms, 5.2 per cent has been cut from our resource budget and 9.7 per cent from our capital budget—those are not Scottish Government figures, but come from the independent Scottish Fiscal Commission.

To look for nations that have the highest ranking for care of the elderly at home, we should cast our eyes over the North Sea to Finland, Norway, Sweden and Denmark. Those countries are internationally recognised as topping the charts; they are small independent nations with taxation powers to ensure that their care services meet demand with compassion—and can be funded.

Will the member take an intervention?

Christine Grahame

I am in the final minute of my speech.

How can those nations do it, yet Scotland cannot? We have similar populations and we have some similar communities. The difference is that they have control not only over the social policies—I agree with the Labour members on those—but over their economies. They are independent countries. They tax justly; they tax the right people to deliver the services that we all want to see.

Opposition members come back here and collectively ask for more and more. In the summing-up speeches, I would like to hear how those things will be paid for and which budgets the money will come from. The Opposition should not mislead people into thinking that such things can be done when our hands are tied financially.


Gillian Mackay (Central Scotland) (Green)

I echo the comments of those who have spoken before me about the dedication of our health and social care staff.

The NHS is currently set up as a national sick service. Too much care is still provided in hospitals, and treatment services are prioritised over prevention. Meanwhile, demographic changes, as we have heard from Sarah Boyack and Christine Grahame, have placed increasing pressure on services, which have struggled to keep pace with demand and have faced significant challenges due to the pandemic. The Christie commission made the case for shifting care into the community 11 years ago, but we have not seen the progress that we might have wanted since then.

I therefore welcome the clear acknowledgment from the Government that we need to increase our focus on prevention and early intervention to support people to live healthier lives, and that begins in the community. Supporting and building community services and the community workforce will not only improve health outcomes, but will also enable hospitals to focus on acute and specialised healthcare.

To effectively shift care into the community, we need to take a holistic whole-system approach that acknowledges the need to build community provision while reducing pressure on hospitals. Building capacity in social care will help to reduce delayed discharges, which will alleviate pressure on hospitals and ensure that no one is stuck in a hospital bed when they do not need to be.

Not everyone needs to be in hospital, and not everyone needs acute care. There is ample evidence that health outcomes can worsen if people are in hospital when they do not need to be there. I have heard from stakeholders about the impact that a stay in hospital can have on people with certain health conditions. Disruption in routine and removal from familiar surroundings can contribute to a deterioration in conditions.

Gillian Martin raised many important points of good practice from her constituency, which centred on an important point that has been a running theme at the Health, Social Care and Sport Committee, which is how we ensure the sharing of best practice without adding a burden to clinical staff. I do not think that we have the correct answer to that yet, but it would help many services, not just in terms of how we deliver good care locally.

We need to expand services such as hospital at home, which provides treatment and support while allowing people to be cared for in their own home. That is particularly important for older people with frailty, who are at particular risk of being affected by institutionalisation and delirium. According to Healthcare Improvement Scotland, 30 to 56 per cent of older people experience a reduction in their functional ability between admission to hospital and discharge. Reducing hospital admissions, where appropriate, can lower the risk of deterioration and support people to live more independently at home.

For many people, being discharged from hospital is just the beginning of a difficult journey, and people living with long-term conditions are at higher risk of readmission if they are not supported to self-manage their conditions.

The third sector plays a vital role in supporting people in the community, and great work is being done to assist people after discharge. Chest Heart & Stroke Scotland’s hospital to home service supports people who are returning home after a stroke or have been discharged from hospital with a chest or heart condition. It works with the NHS to build a personalised flexible package of support, which can include setting recovery goals, emotional support and help in maintaining physical activity and exercise. That is a great example of how third sector services can work alongside the NHS to make sure that people can get the care that they need in the community, without having to go into hospital.

Primary care will also continue to play an essential role in supporting people to live healthy lives in the community. Ninety per cent of patient contacts are through primary care, and GP practices are often the first point of contact for patients. We need to expand the multidisciplinary team and increase the range of services that people can access at their local practice. During the Health, Social Care and Sport Committee’s inquiry into alternative pathways to primary care, we heard much about the important role that community link workers play in general practice and connecting patients with resources in their community.

GPs often have only 10-minute appointments with patients, which can limit the issues that they can cover, but link workers can spend more time speaking about complex social issues such as housing, benefits and employment and engage patients with social prescribing, which was described by one witness as

“the bridge between the community and the NHS.”—[Official Report, Health, Social Care and Sport Committee, 22 March 2022; c 6.]

The Royal College of General Practitioners Scotland has been calling for the roll-out of community link workers to all practices in Scotland. I am therefore pleased that as part of the Bute house agreement, the Greens and the Scottish Government have committed to expanding community provision of mental health services linked to GP practices. Enabling people to access mental health support in the community without having to go on a waiting list will mean that more people can get the help that they need when they need it, while also reducing pressure on acute and specialist services.

The Scottish Greens also support the embedding of welfare rights advisers in GP practices, so that people can be connected to services that can support them with money advice and benefits, and I welcome the Government’s commitment to place money advisers in up to 150 GP practices in deprived areas. We know the impact that stress and pressure on income can have on those with long-term health conditions, and it is essential to ensure that people can afford to keep themselves well.

Alongside providing services in GP practices, it is important that we empower people to access community support themselves. During health committee sessions, we heard about the role of a local information system for Scotland—ALISS—which aims to allow people living with long-term conditions, disabled people and unpaid carers to access the information that they need to help them live well.

Having one point of contact for people who are looking for resources on support within the community is valuable, as it allows people to find out for themselves what is available, without having to search through multiple sources. However, although ALISS was felt by some committee witnesses to be a useful resource, others described it as difficult to use, as it was not updated regularly. I would be grateful to hear from the minister what plans are under way to improve ALISS, as it seems to be an invaluable resource that we should be making the most of.

In conclusion, Presiding Officer—

Yes, please bring your remarks to a close, thank you.

Gillian Mackay


I am pleased that, in this session of Parliament, there is a renewed focus on prevention, early intervention and community care, but that must be followed up by real action. We must act now to keep care close to home. I look forward to working with members across the chamber to realise that ambition.


Jackie Dunbar (Aberdeen Donside) (SNP)

I am pleased to be able to participate in today’s debate and add my support for the Scottish Government’s motion.

I would like to add my own personal thanks to Scotland’s NHS and care staff after the incredibly difficult period that we have all gone through. We really have to appreciate their efforts on the front line of the pandemic. It was one of the most challenging periods for our NHS, and that must be recognised.

Our NHS and social care staff played an immensely important role on the front line of the pandemic, providing healthcare and/or social care for those who required it, and we should never forget the selfless work that they put in throughout the pandemic. We must make clear our thanks at every single opportunity.

As we look to recover from the Covid-19 pandemic, we must use this opportunity to learn from the past two years and to build back better, investing in our healthcare system after the pressure that it has been under and using the lessons learned to build a more resilient healthcare system that is fit for the needs of the population and for the future.

It is key that we invest in our NHS and social care staff, who have given so much during the pandemic, and ensure that they feel valued and are able to react to the changing needs of our healthcare system.

I am well aware of the public sector’s commitment—-my sister-in-law is a nurse in the intensive care unit at Raigmore hospital and was there at the very heart of the pandemic. It was not just her who was affected; it was also her family. I remember FaceTiming my nephew, who was barely 12 years old at the time. He said to me, “Auntie Jake, I am so proud of my mam—I worry about her every day going to work, but I know that she is doing her best to try and help as many people as possible.”

The pandemic has seen our NHS come under immense levels of pressure, and the recovery will not be easy, with waiting times for non-urgent procedures much higher than we all would like. However, our Scottish Government has my full confidence to get us through this, with a record £18 billion committed in the Scottish budget to help both healthcare and social care deal with the challenges around moving out of the pandemic and into the post-pandemic era.

Within that spend, £1.6 billion has been committed for social care integration, which will lay the groundwork for our new national care service. Although Opposition members may like to view that as centralisation, I welcome the Scottish Government’s commitment to ensuring that services are designed at a local level while engaging with folk who have lived experience to achieve a person-centred approach, with strong local accountability.

People need to be at the heart of the decision making around all this to ensure that we get it absolutely right—not just for patients, but for our health and social care staff. That is why I am pleased that the Scottish Government is investing in the wellbeing of our health and social care staff as well as in the mental health of patients. I am sure that everyone agrees that such jobs are incredibly difficult mentally and physically. It is crucial for our staff to be able to seek assistance when it is required, which allows them to perform at their best.

We will continue to have a healthcare system that works for patients only if we continue to invest and innovate. The investment that the Scottish Government has committed is absolutely key to the future of our healthcare system. Investment is also needed in our staff to ensure that we have facilities that are fit for the needs of the population and for the future.

We need staff who are paid well and who can cope with the mental and physical pressures that their jobs may create. In its amendment, Labour says that it would like the workers’ pay to rise to £15. Across the chamber, most of us would love to do that, if it was possible, but I understand that we get no consequentials for pay rises, so we must absorb pay rises into the budget. We have not seen a budget alternative from Opposition parties.

Will the member take an intervention?

I hope that Jackie Dunbar is coming to her last minute.

Jackie Dunbar

I ask Labour to say in summing up where it would take that amount of money from.

I said that some members in the chamber would like to give a pay rise, but the Conservatives suggested that public sector workers should take a pay cut of 20 per cent at the height of the furlough scheme.

The commitment that the Scottish Government has shown to investing in our health service by committing to increasing investment in front-line health services by 20 per cent over the parliamentary session and to investing £10 billion over the next decade to upgrade our health infrastructure will ensure that we have an NHS that is fit for the future and which will provide an environment where patients continue to access high-quality care and world-class facilities. That is why I support the motion and the establishment of the new national care service.


Jeremy Balfour (Lothian) (Con)

I would like to declare an interest. It will not have escaped the notice of people in the Parliament that I have a disability and that, as such, I rely on carers to help me in my life. Without them, my life would be more difficult. They work hard every day to ensure not only that my life is easier but that the lives of a number of people are easier.

Excuse me, Mr Balfour—could you please resume your seat? Could I please ask members to show courtesy to Mr Balfour and not turn their back on the chair? Thank you very much.

Jeremy Balfour

For the reason that I have given, I say from the outset that I understand that the debates that we have on this topic are about real people who do real good in the lives of some of the most vulnerable in our society. We should never forget that fact.

The United Kingdom is unique among nations in how we provide care through our NHS for those who are in need. We saw clear evidence of that throughout the pandemic, when doctors, nurses, porters and others stepped up to care for all of us in unbelievably tough and stressful conditions. That stands as an example of how the people of this country look after those who are in need. There is no discrimination on the basis of the nature or timing of need.

We in this country care for those who are in need. It is of the utmost importance to preserve that national instinct for care and ensure that those who need care get it. The only way to achieve that is by properly supporting our carers in their jobs.

There are more than 700,000 unpaid carers in Scotland, none of whom is properly supported in the essential work that they do. We have to ensure that, regardless of circumstance, all the people who provide care are appropriately compensated, so that they are not forced to look for two jobs but can see care as a viable career option.

Today’s debate encompasses many elements and issues. I turn to the proposed national care service—a proposal that I fear represents another instance of the SNP conflating doing something with doing something helpful.

Will the member take an intervention?

Jeremy Balfour

I am sorry—I do not have time.

Lots of arguments can be made in favour of a local approach to care as opposed to the centralised national service that the Government is proposing. The most compelling argument to a sceptic such as me is that every time that this Government has attempted to absorb power locally and centralise it in Holyrood, it has gone poorly and badly wrong, to say the least.

One would think that a Government that has been in power for 15 years would have learned some lessons from its experience. However, every time that the Scottish Government has attempted to centralise the power of an institution, it has found itself presiding over a decline in efficiency and in good service for the people it is trying to serve.

I am not the first, nor will I be the last, to bring up the issue of Police Scotland. Let us look at what happened with the centralisation of the police forces. Since the formation of Police Scotland in 2013, more than 900 police officers have been cut from local divisions, and 140 police stations have closed, which has affected rural communities in particular. Far from benefiting communities, the merger has had the opposite effect.

This Government has the opposite of the Midas touch. Every time that it takes it on itself to hoard power in a central bureaucracy, communities and individuals suffer. I fear that that is the road that we are heading down with the national care service. The Government will expect a central power to deal with the unique needs of Scotland’s communities and, as has happened so many times before, the people who rely on that care will suffer the most.

I will briefly make reference to the issue of food as it relates to care. In Parliament recently, a presentation was made to the cross-party group on older people, age and ageing on the importance of food in social care. Although that presentation was specifically about older people’s needs, food is important for everyone because of its impact on health and wellbeing. It is particularly important if we are to take action that will help social care. I hope that the Government will consider that in everything that it talks about.

We need to protect the most vulnerable; centralisation will simply not do that.


Alex Rowley (Mid Scotland and Fife) (Lab)

Many of today’s speakers have—rightly—thanked NHS and social care staff for the work that they have done, and the work that they are doing, under immense pressure. Indeed, the Government’s motion says:

“That the Parliament thanks Scotland’s NHS and social care staff for going above and beyond during the ... pandemic”.

However, I think that many of those staff would say that, although it is great to get a thank you, they want the Government to listen to their concerns and to what needs to happen.

Interestingly, before I came into the chamber today, I received a letter from the Unison Fife health branch, which states:

“The health and care system is under pressure to ensure services are delivered in a safe and timely manner, and the COVID-19 pandemic has intensified existing pressures on staffing and resources in all health and care settings.”

The minister has acknowledged that.

The letter continues:

“The NHS has been tested to its limits, and so have many of our members. Staff in NHS Fife are reporting serious concerns to their union all underpinned by safe staffing concerns, issues include:

Dangerous staffing levels for both patients and staff.

Staff not receiving proper rest breaks.

Staff not being given opportunities to report serious incidents on Datix, the NHS electronic incident reporting system.

Serious breaches of health and safety regulations.

In June 2019 the Health and Care (Staffing) (Scotland) Act became law, the first legislation in the UK to set out requirements for safe staffing across both health and social care services. The political announcement and assent of the Act have been rightly celebrated as a significant step towards a safer environment for patients and staff.

Whilst UNISON accepts that COVID19 has delayed much of the developmental agenda it is concerning that the implementation of the Act, which is fundamentally concerned with safe staffing and patient safety, seems to have been forgotten.”

Perhaps the minister and the Government can pick up on that point. I note that the health secretary, whom I assume is busy, was unable to stay for the debate, but I will write to him as soon as it finishes with the very serious concerns that trade unions in Fife are raising about health and safety issues for staff and patients. As Gillian Mackay highlighted earlier, the NHS is a holistic service, and if different bits are not working, that will affect every part of it. We need to address that.

I visited Culross last Friday and was quite shocked to hear the concerns of the west Fife villages community councils. They say that patients are struggling to access health services at the Valleyfield health centre, as the health centre is the busiest GP surgery in west Fife and yet it has only one doctor for 4,094 registered patients. They talk about the difficulty in trying to access those services and get appointments, and the failure of NHS Fife to engage with the community. Again, that is not acceptable. People are raising concerns and being ignored by the NHS. We can imagine the knock-on effect that that situation has on other vital services.

I finish by returning to social care—an issue that I have raised with the minister on many occasions. This morning, I looked at the Fair Work Convention’s report, “Fair Work in Scotland’s Social Care Sector 2019”, which is very clear. It says:

“Our overarching finding is that fair work is not being consistently delivered in the social care sector. Despite some good practice and efforts by individual employers, the wider funding and commissioning system makes it almost impossible for providers to offer fair work. We found that this mainly female workforce has limited ... collective voice. Effective voice is highlighted in the Fair Work Framework as vital to delivering fair work, providing the mechanism for workers to pursue other dimensions of fair work, such as security, fulfilment and respect.”

I reiterate that point to the minister. Another member mentioned the number of debates that we have had on social care in the chamber. We keep coming to the chamber and debating the subject, and the Fair Work Convention’s report sets out clearly what is fundamentally wrong in social care at present, yet we are doing nothing to address that.

The minister can take that point away. He will remind me that the Government has increased pay; I acknowledge that, although—as Labour’s amendment alludes to—it does not go far enough. Nevertheless, he completely fails to recognise the significant impact that the current terms and conditions are having. People can go elsewhere and get jobs that are less pressured, stressful and demanding, and get paid for the hours that they actually work. In social care, workers are being treated appallingly. Unless the Government addresses that, all the talk in this place amounts to mere rhetoric. We must treat social care workers with fairness and decency.


Karen Adam (Banffshire and Buchan Coast) (SNP)

I am pleased to have the opportunity to speak on the motion, with the caveat that everything that I will highlight has hard-working staff behind it; I acknowledge them and everything that they have done throughout the Covid pandemic.

Since forming a Government, the SNP has built a strong record of delivering high standards of care across the country. That is driven by our ethos of compassion, dignity and respect, which is at the centre of everything that we do on health and social care.

That was firmly outlined when Shona Robison brought forward the new health and social care standards for Scotland in 2017. Traditionally, health and social care has involved those who require support being taken out of their homes and placed in unfamiliar settings. However, as we have moved forward with the integration of health and social care, we have ensured that person-centred care and support is at the heart of everything that we do. That has led to more people being able to receive support in the comfort of their own homes. By doing that, we are continuing to improve outcomes for people who require care while utilising the best technology that we have access to.

By scaling up our services through the £1 billion NHS recovery plan, we can tackle the pressures on our NHS. We are providing general practices and their patients with support from a range of healthcare professionals in the community, and we will recruit 1,500 more staff over the next five years for our national treatment centres, alongside 1,000 community mental health staff. We are increasing primary care investment by more than 25 per cent to support GPs, dentists and pharmacists, and we are investing more than £400 million to create a network of 10 national treatment centres across Scotland.

I was really pleased to see record investment from the Scottish Government across our health and social care sector, with £18 billion going to fund health and social care. That will go a long way in supporting people to access the support that they need while ensuring that carers who work in the sector are paid more, which is a key aspect that underpins the service.

Investment in our services and our population is key to Scotland’s recovery from the pandemic. More than ever, we realise the fragility of our mental health as well as our physical health. In part of my constituency, the Aberdeenshire health and social care partnership has moved progressively to develop a hospital at home policy. The health and social care partnership recognised that it had an ageing population and that, in order to have a system that supported the delivery of a long-term, sustainable service, a fundamental shift in thinking—progressive thinking—was required.

The opportunity to develop a hospital at home service presented itself when NHS Grampian undertook a whole-system redesign, which included the transfer of resource from acute to community services. That change meant that acute geriatricians could be aligned to manage patients within the community. Alongside the redesign was the acknowledgment that our population is better served when we receive care, whenever possible, in our communities. That has been at the forefront of the Government’s record in health and social care.

Before the introduction of the hospital at home service, various community models were already in place in Aberdeenshire. Those included community hospitals, virtual community wards and a multidisciplinary approach, so the concept of managing patients within the community was already well established in the health and social care partnership. The hospital at home service was the next logical step.

In the context of our response to Covid-19, we have benefited from strong relationships with local authorities and the NHS. That enabled us to take a swift and cohesive approach that ensured that our residents and staff had the protections and support that they needed to stay safe.

Operation home 1st, as it is known, became the next phase in the health and social care response to Covid-19 across NHS Grampian. The partnership involved all three health and social care partnerships and the acute sector, and it harnessed the strong collaborative working and the whole-system approach that were adopted across all sectors during the response phase. That innovative and person-first principle, in which place-based care is of paramount importance, embodies a framework in which we can create the right environment for keeping people at home safely, reduce hospital admissions when an alternative intervention is possible and ensure that people who need care in hospital do not need to stay there for longer.

A key focus is directing support towards prevention, and there is an increased community focus to improve outcomes for all, not least elderly people. That prioritises the goal of home first for all care, which will ensure that the system remains flexible and agile enough to respond to any surges in demand and that the whole person—their circumstances and support—is considered. That model of best practice can be reflected across Scotland in a national service.

I am sure that I am not the only carer in the chamber or the only person to have experienced a loved one receive care. In that respect, choice is an absolute necessity. The option to stay at home must be a right. For many people, there is no place like home, and I am glad that that sentiment is embedded in policy for a progressive approach to healthcare for all.

We move to the closing speeches.


Carol Mochan (South Scotland) (Lab)

I am pleased to close the debate for Scottish Labour and, once again, to give my and my party’s thanks to all health and social care staff and unpaid carers. We agree that the importance of having care at the centre of our communities, close to people and easily accessible, cannot be overstated. However, its usefulness is diluted considerably when waiting times are too long, services are overstretched and workers feel undervalued because they are overworked and underpaid.

Our constituents tell us that they are waiting too long to see their GP and have trouble accessing alternative clinical pathways. The Scottish Government knows that, and SNP and Green back benchers know it. It is time that they listened and spoke up for their communities and hard-working, dedicated staff. We need some honesty to fix the problem.

The Government’s motion is rather self-congratulatory, but, in reality, as we have heard, for many on the front line and many who use services, the picture that the Scottish Government has painted of investment and progress is not representative of their true experience. Indeed, for some in our communities, it could not be further from reality. That is evidenced, unfortunately, by the recently published 2021-22 health and care experience survey, which, as my colleague Paul O’Kane said, exposed plummeting satisfaction with health and care services in Scotland.

It is important to note that, under the Government’s handling of health services in recent years, we have witnessed health inequalities in Scotland becoming increasingly divisive. We live in a country where women from areas with higher levels of deprivation are less likely to attend cancer screening appointments.

Gillian Martin

Does Carol Mochan agree with some of our witnesses at today’s meeting of the Health, Social Care and Sport Committee that the mitigation that the Scottish Government does is very difficult when an awful lot of money is being taken out of people’s pockets by things such as universal credit issues and social security at a UK level? That was very strong evidence.

Carol Mochan

The member knows that I strongly object to some of the policies of the current Government at Westminster, and I recognise how difficult the situation is for people, but we must do all that we can here, in Scotland. We, on the Labour benches, want to do the things that we can do now. That is where we differ in our approach—we want to talk about what we can do and actually get it done.

Will the member take an intervention on that point?

I will take a short intervention.

Christine Grahame

It is short. I hope that the member, in her summing up, will give the costings for the demands that her party makes at the end of its amendment about ending non-residential charges, reversing the narrowing of eligibility for care packages, reopening the independent living fund and paying care workers £15 an hour. Those are all laudable aims, but I would like to know the costs, please.

Carol Mochan

The member will recognise that we need to spend longer discussing all the ins and outs. If the member believes that the SNP is doing everything that it can, I say to her that it is not. There are alternatives, and it is about political priorities. That is what being a politician is about.

As my colleagues have highlighted, Scottish Labour supports the focus on building and enhancing virtual capacity to support a sustainable future, but the pressures on primary care services and the aforementioned impacts of such pressures cannot and must not be ignored, as was recognised. It is not too late to bring care closer to our communities. Nor is it too late to invest adequately in the services that we know will reduce reliance on hospitals, such as local government family-based services and link workers. Those will improve health outcomes across Scotland, but we are running out of time, so we call on the Scottish Government to act radically and with purpose.

On a number of occasions during the debate, we have heard about the pressures that our social care workforce faces. Like our primary care workforce, our social care workers are the very best of our country, they have exceeded all expectations during the pandemic and they have protected the most vulnerable in our communities at a most serious time. It is a disgrace that so many of them have been made to feel so overworked, underpaid and undervalued. That is the reality, and we need to hear more honesty about it. Sarah Boyack described well how that situation is presenting in Edinburgh.

I believe that the reforms that a national care service could bring should be welcomed and could address significant failings that we currently see because there is too much involvement of and reliance on the private sector. However, reforms cannot wait for the national care service; we need them to happen now. Therefore, I echo the calls of my colleagues, and those highlighted in the Labour amendment, in saying that non-residential care fees must be removed immediately, the recent narrowing of eligibility for care packages must be reversed and the independent living fund must be reopened. Moreover, to ensure that social care is both available and accessible in our communities, we must seek to improve pay in the sector.

The self-congratulatory nature of the Scottish Government’s motion does not sit well with Scottish Labour. We cannot accept that people cannot access GPs, that care packages are not available for people who need them or that carers feel unsupported. We can—we must—do more. That is the point—

Ms Mochan, could you bring your remarks to a close, please?

Scottish Labour’s amendment sets out what we can do. I urge members to support it.


Sue Webber (Lothian) (Con)

I welcome the chance to close the debate on behalf of the Scottish Conservatives. I, too, pass on my thanks to everyone who delivers health and social care in our country right now and to those who will do so for the foreseeable future.

As we have heard from my colleagues during the debate, the SNP urgently needs to address the social care crisis that has occurred on its watch. Now is not the time to centralise care services, as it is planning to do. Instead of pressing ahead with a bureaucratic overhaul of services, the SNP must engage with carers and those who need support to ensure that the highest level of care is delivered.

Gillian Martin

Ms Webber has been at all the recent meetings of the Health, Social Care and Sport Committee, at which she will have heard repeatedly that, in some areas, social care is doing really well and there is good practice. Would having a national care service not see such standards rolled out across the country, to places that are not doing so well?

Sue Webber

We have heard a lot about the inequity of services across the country. However, it does not need a national care service to deliver much more equal provision, as will be brought out in the point that I am about to make.

We have good policies in Scotland, and we cannot argue that the will is not there. However, we are consistently referring people into services ineffectively.?We have people ricocheting around our services because nothing quite fits or meets their needs.?There is no use in having good intentions, policy document after policy document and paper after paper if they are not being put into action. Our approach is fragmented and therefore causes distress to people who are in the most dire need.?Having access to services is, indeed, key but, as Jeremy Balfour stated, we often lose sight of the person who so desperately needs our assistance and support. We need equitable services, working across all the sectors.

As I have just stated, though, we currently have inequity in service provision, which only widens the inequalities that we face. Social care is patchy and broken. Right now, and in recent history, integration authorities have had only one priority: they have been focused on budgets, not people. All the resource and focus has been on reducing the burden of care, reducing the amount of care that is provided and delivered, and delivering efficiencies and cost-saving plans. People have come second.

Reform is needed, but a national care service is not the answer. That is why the Scottish Conservatives have proposed a local care service, which would ensure that support was delivered as close as possible to those who needed it—especially those in rural and island communities.

COSLA said that the plans for the national care service are “an attack on localism”, and it added:

“Councils know their communities and all the evidence suggests that local democratic decision making works.”

Audit Scotland has shared its concerns about the extent of the SNP Government’s plans for reform and the time that it will take to implement them. It is not clear what the costs of the national care service might be. The Fraser of Allander Institute has stated that, until we know the final shape of the national care service, we cannot say much about the funding settlement that will be required.

If we are truly determined to tackle health inequalities, we must surely recognise and celebrate the fact that every community has different needs. We need community services. We hear, time and time again, about person-centred care, but all the evidence that I hear, time and time again, is that people have to adapt to and accept what is available from the service and not the other way around.

One of my constituents was a carer for her husband, but then she suffered a stroke. Both were assessed as requiring a home care package, but limited availability meant that a package was put in place for the wife that allowed only for assistance with dressing and meals; it did not provide enough for a daily shower or for assistance for her husband. After an intervention, her care package was extended to allow for a daily shower, and a package was added to allow time to assist her husband. However, it took an heroic effort by my staff to achieve that.

Another constituent of mine has suffered the consequences of not keeping care close to home. For her over-70s breast screening, Margaret had to travel to Newcastle, where, following the test and follow-up appointments in the Royal Victoria infirmary, she was diagnosed with breast cancer. How many women over 70 have undiagnosed breast cancer? Margaret would have been one of them if she had not travelled to Newcastle. The SNP Scottish Government’s approach does little to suggest that it is really doing all that it can right now to improve outcomes.

We are not short of examples of the SNP failing to keep care close to home. The SNP has had to be brought kicking and screaming to the realisation that eye care in the Lothian region should be local; the SNP wanted patients to travel to Glasgow. Although the commitment to the new eye pavilion was a welcome U-turn, no real progress has been made since the SNP’s pre-election pledge in 2021, and NHS Lothian is facing a huge and crippling bill to maintain the existing building.

The SNP urgently needs to address the social care crisis that has developed on its watch. Heroic staff continue to be overwhelmed, having gone above and beyond during and after the pandemic. They have not been given the leadership that they need from the SNP Government.

I will speak about some of what we have heard from members during the debate. Dr Gulhane referred to the toxic cocktail of delays and delayed discharge that is contributing to the hampering of a recovery of services. Ms Boyack mentioned that the SNP motion does not acknowledge the scale of delayed discharges that is faced in Edinburgh and the Lothian region. Those issues all existed before the pandemic. I know that, because I was a member of the Edinburgh integration joint board.

I support the motion that was lodged by my colleague Sandesh Gulhane.


Kevin Stewart

I thank many folks for their valuable contributions in what has been an extremely important debate.

I was hoping to say that it is encouraging to know that we are united across the chamber on the importance of transforming and improving health and social care, but I am not sure whether we are united. We heard from many Tory speakers—including Alexander Stewart and Sue Webber—that now is not the time for any change or reform. Folks out there who are working in health and social care would disagree vehemently and say that now is the time to ensure that we get transformation and improvement in our health and social care system.

We are all clear that health and social care services are a lifeline to many. Our current system is under extreme pressure, especially as a result of the pandemic. In her speech, Carol Mochan talked about honesty, and we have to be honest about all this, because there is greater demand on the system than ever before, there are people with higher levels of need for acute and community offers than ever before, and recruitment and retention has been challenging over the past couple of years. Let us be honest about all that.

The Government will work hard to address the issues, matching reform and recovery with investment, so let us look at some of the suggestions that have been made about investment and recovery.

Some have rightly referred to the pay rise that the Government has put in place for social care workers. That is a 12.9 per cent pay rise in one year. The Labour Party feels that that does not go far enough. I would like to go further, but to increase care workers’ pay to £12 an hour, I would have to find £620 million, and to increase it to £15 an hour, I would have to find £1.75 billion. Even then, I would not have the ability to ensure that the money would get into people’s pockets and purses, because of our disparate employment situation. In her speech, Christine Grahame was honest about the fact that we must cost any proposals that we make here and say how we will pay for them.

Mr Rowley and I have had a number of conversations. I always appreciate Mr Rowley’s contributions, although they are sometimes hard-hitting and ask the Government for more. I say to Mr Rowley and others who have talked about conditions that the Government and I, in co-operation with COSLA, want to go further on conditions. I will be honest: I will take any help that I can get from any member who persuades our colleagues in COSLA to walk that mile with us and improve conditions for the social care workforce. I know that Mr Rowley will be part of that journey, but my door is open to all.

The same goes for the persuasion to remove charges for non-residential care. The Government wants to do that, but we must do so in partnership with COSLA. I will gladly take any help that members can provide on that front.

Paul O’Kane

On that point, and given his commitment to doing so, when does the minister intend to remove charges for non-residential care? Does he accept that Labour’s plans have been costed and presented? They are based on £2.6 billion in Barnett consequentials between now and 2024-25. We have outlined that plan several times in this chamber.

Kevin Stewart

Mr O’Kane is spending money that has already been spent, as Labour normally does. There must be a degree of honesty about that from Labour members. If Mr O’Kane wants to have a conversation with me about funding, I will happily do that, but the first thing I would have to do is to show him that his figures do not add up.

As I said, it is not within my gift to remove charges for non-residential care. I must have the co-operation of other partners and we will continue seeking that. [Interruption.]

No, I must make some progress because many other members made valuable contributions to the debate.

There has been a lot of talk about digital today. Dr Gulhane says that we are doing well here in Scotland. I agree that we are, but we are still on a journey to improve and increase digital services.

Gillian Martin talked about how we could provide greater information to patients to let them know about and monitor their progress on waiting lists. I say to Ms Martin and others that NHS 24 is currently developing a website that will be available this summer and will give folks a greater idea of waiting times and their journeys. We have some way to go, but we are at the start of a journey that will be beneficial to patients across the country.

Gillian Mackay mentioned the ALISS website, which is run by the Health and Social Care Alliance Scotland. We will get in touch with the alliance about plans to update that. I understand that there have also been discussions with it about social prescribing, and I can maybe update Ms Mackay on that front as we move on.

I think that we have done well on digital. In some cases, we are at the very beginning of the journey, but the Government takes all of that very seriously.

I turn to care homes. As a Government, we have set out one of the biggest changes to public services in a generation with the creation of the national care service. As we recover and rebuild from Covid, we need to act now and improve both outcomes for the people who use the services and the wellbeing of the staff who work across the sector.

In the debate, we heard a lot about the innovative work that is happening. We want to build on that, scale it up and increase the pace of change. As a country, we have been successful in embedding care and support closer to home and ensuring that individuals have choice about their care through self-directed support. However, we cannot forget care homes. They are people’s homes, too, and we know that healthcare for residents can sometimes be fragmented, reactive and poorly co-ordinated. That is why I am delighted to say that we will soon publish a healthcare framework for adult care homes, which will be a bold and ambitious document that provides a series of recommendations that will aim to transform healthcare for people living in care homes.

We must continue to collaborate across services to ensure that we get unscheduled care priorities right. We need to strengthen those partnerships as we move forward. The existing strands of work under the unscheduled care programme that I have mentioned today—discharge without delay, virtual capacity and the redesign of urgent care—are already delivering improvements and they are pivotal to our approach. We are dedicated to getting this right.

In conclusion, we are determined to explore every possible avenue to improve health and social care by investing in our community healthcare pathways. By doing so, I know that we will improve the support and services that are offered to the people of Scotland. I thank folk for their contributions to the debate. I look forward to working with folk across the chamber as we realise our vision for improved health and social care in Scotland.