Meeting of the Parliament
Meeting date: Wednesday, May 31, 2023
Agenda: Point of Order, Portfolio Question Time, Presiding Officer’s Ruling, Education (National Discussion), Urgent Question, Members’ Expenses Scheme, Business Motion, Parliamentary Bureau Motions, Decision Time, Dewars Centre
- Point of Order
- Portfolio Question Time
- Presiding Officer’s Ruling
- Education (National Discussion)
- Urgent Question
- Members’ Expenses Scheme
- Business Motion
- Parliamentary Bureau Motions
- Decision Time
- Dewars Centre
Portfolio Question Time
Rural Affairs, Land Reform and Islands
The first item of business this afternoon is portfolio question time, and the first portfolio is rural affairs, land reform and islands. As always, I make a plea for succinct questions and answers so that I can call as many members as possible.
UCI Cycling World Championships (Forestry and Land Scotland)
To ask the Scottish Government what discussions have taken place with Forestry and Land Scotland regarding the upcoming 2023 UCI cycling world championships. (S6O-02292)
We are all delighted that Scotland is hosting that groundbreaking sporting event this summer. For one country to host all the UCI cycling world championships is unique, and 2023 Cycling World Championships Ltd is working with Forestry and Land Scotland on preparations to host various competitions and disciplines. The Scottish Government sits alongside Forestry and Land Scotland on groups such as the cycling world championships policy advisory group and the cycling world championships marketing and communications group to help to progress those preparations.
Although Glasgow will be the host city and it will undoubtedly rise to the occasion of giving competitors and spectators a warm welcome, all of Scotland will play its part in marking the occasion, with key events such as mountain biking being held at Glentress and Fort William, as well as in Glasgow. What role will our national forests play in supporting the historic and unique event?
It is important to highlight that Glasgow, given its track record and facilities, will be at the heart of activity, but our national forests will provide a spectacular backdrop for key disciplines. That includes the world mountain bike cross-country, which will be held at the Glentress centre, and the mountain bike downhill world cup, which will be at Fort William.
A key aim of the 2023 UCI cycling world championships is for the event to demonstrate our nation’s natural beauty as well as a warm welcome. We can really look forward to seeing Perthshire, Dumfries and Galloway, Fife and Stirling featuring and showcasing all that Scotland has to offer to an unrivalled world audience. Many events, such as the road races and time trials, will be free to view. I hope that that will help to introduce cycling and cycling events to a wider audience and encourage people from throughout the country to go along and view what will be spectacular events.
To ask the Scottish Government what steps it is taking to boost the Scottish salmon industry. (S6O-02293)
The Scottish Government remains absolutely committed to the sustainable development of our world-leading aquaculture industry, not least because of the significant economic value that the sector brings to more remote rural and island areas through farm businesses, the wider supply chain and all the jobs that the sector supports.
We are working to support business by streamlining the consenting process for fish farms to make it more effective, transparent and efficient. We are also supporting the Sustainable Aquaculture Innovation Centre and collaborating with producers and others to support fish health and welfare in Scotland.
It is well known that Scotland’s native wild salmon are in a perilous state, with populations continuing to decline. Predation is a key factor in that decline, with predators such as cormorants and seals impacting on numbers. The effects are intensified by anthropogenic pressures, including barriers and impoundments that alter habitats and disrupt migration.
Through fisheries and wider tourism, the wild salmon industry is a key component of the rural economy, not least in Fife, where a number of key fisheries are located. A recent Scotland-wide economic assessment of the wild fisheries estimated that the industry is responsible for 4,300 jobs and contributes to just short of £80 million in gross value added to the economy. Therefore, any review of fish-eating bird policies clearly needs to strike a balance in terms of conservation.
Ms McCall, we need a question, please.
I am just coming to it.
What is the Scottish Government doing to ensure that that balance is struck?
Roz McCall raises a vital point. I am glad that she has highlighted wild salmon, which is an iconic species for Scotland, and that she has emphasised just how important it is. I absolutely agree with her that wild salmon is a key component of the rural economy.
We recognise the importance of our wild salmon, and we are also seriously concerned about the declines in numbers that we have seen. That is why we set out our wild salmon strategy and published earlier this year a wild salmon implementation plan that outlines all the key pressures and what action we are taking in that regard. I would be happy to furnish Roz McCall with that information so that she can see what action we are taking against each of the pressures that salmon face, because we want to do all that we can to preserve and boost that iconic species for Scotland.
Our salmon industry is a national asset that provides a nutritious source of home-grown protein as well as employment opportunities in rural communities. With Europe reportedly continuing to be the top destination for Scottish salmon, does the cabinet secretary agree that the best way to enhance what our salmon industry has to offer Scotland and the world is to reverse Brexit and remove the bureaucracy and hardships that the Tories have forced on the sector?
Karen Adam will not be surprised to learn that I absolutely agree with her, because her assessment is absolutely right. Brexit has been harmful to our entire seafood sector, including the Scottish salmon industry.
The Scottish Government repeatedly warned the United Kingdom Government that the forced exit from the European Union would be damaging to Scottish businesses, and we still do not yet know the full implications of the trade and co-operation agreement for our aquaculture industry. Last June, I said in the chamber:
“It is hugely disappointing that increased costs are threatening the competitiveness of Scotland’s most valuable food exports.”—[Official Report, 29 June 2022; c 29.]
A year on, I simply repeat that remark, and I will continue to make clear that all of our food and drink sector would be better off with independence and with Scotland as a member of the European Union.
Last week, the Scottish salmon industry celebrated growth in exports to Asia. The salmon industry provides jobs to economically vulnerable island and coastal communities, but the sector faces concerns about the impact of Scottish National Party-Green proposals for highly protected marine areas. Will the Scottish Government boost the salmon industry by going back to the drawing board on HPMA plans?
I emphasise that we never left the drawing board in that regard. We consulted on HPMAs at the earliest possible stage in the process.
Beatrice Wishart will no doubt be aware that I visited Shetland a couple of weeks ago. There, I engaged with members of the aquaculture industry in order to hear their concerns directly. We are committed to that engagement and to on-going engagement with communities as well as with impacted industries and sectors. We are continuing to listen to that feedback, and we will analyse the results of the consultation before we set out next steps.
To ask the Scottish Government what its response is to the letter from the Scottish Creel Fishermen’s Federation, offering to assist with progressing fisheries management issues, including highly protected marine areas. (S6O-02294)
We received a letter, dated 22 May 2023, from the Scottish Creel Fishermen’s Federation, offering assistance, as the member said, in progressing various matters, including inshore fisheries management initiatives. We are in the process of considering the points that were made and will respond in due course.
Of course, the SCFF is involved in our co-management groups, and I encourage the federation to continue to support the fisheries management and conservation group and Regional Inshore Fisheries Group network.
Scotland has a legal duty to manage our seas to a good environmental status, which includes minimising sea bed damage and maintaining fish stocks and wider biodiversity. Supporting low-impact fishers, such as creelers and divers, will help us to achieve that commitment while maintaining jobs in fishing. Does the cabinet secretary agree that creelers and scallop divers must be at the heart of fisheries management policies that will complement HPMAs?
The member narrates very accurately much of what was put to us by the SCFF, which we are now considering very carefully. As part of delivering the United Kingdom marine strategy and ensuring good environmental status, we will shortly publish an updated programme of measures to include actions to improve the status of our sea bed. That will include working directly with fishing industry and international partners to focus on identifying practical and achievable actions to reduce pressures on the habitats that are most at risk. I commit to working with all fishers and wider communities to ensure that we have a healthy marine environment, including for commercial stocks, which, of course, are critical to maintaining jobs in the industry.
Brendan O’Hara, the Scottish National Party’s chief whip at Westminster, has written to 11,000 householders in Argyll and Bute, to encourage them to write to the First Minister over the ill-thought-out, ill-conceived HPMAs. In doing so, he has joined thousands of stakeholders and MSPs from across the chamber in condemning the policy. The process takes as fact that at least 10 per cent of our seas will be designated as HPMAs, which makes a mockery of the consultation. The Scottish Government is clearly only interested in discussing where HPMAs will be imposed and not whether there is a case for creating them. That is bad policy making.
Could we please have a question, Mr Carson?
Will the consultation ask only the question where the HPMAs will be in at least 10 per cent of our seas, or will it also ask whether 10 per cent of our seas should, indeed, be HPMAs?
I cannot quite believe that, this far down the line, Finlay Carson has obviously still not read the consultation. It is an incredibly broad suite of questions; there is not just the one that he has characterised but a great deal more about what ought to constitute an HPMA or what the site selection might be—running through blue carbon, ecosystem recovery, leisure and fish stocks. For goodness’ sake—he should read the consultation before he comes here and asks the Government questions that have no bearing on reality.
Creelers, divers and, indeed, the whole fishing community want to protect our seas, because doing so is crucial to their survival, yet their expertise appears to be ignored. Does the cabinet secretary agree that we need a joined-up fisheries management approach, which must be designed with and by the fishing community? How does she intend to re-engage creelers, divers and the fishing community, who have been alienated by the HPMA proposals?
I absolutely agree with the first point about interconnectivity between healthy marine environment and support for people who rely economically on the seas. That goes to the heart of our blue economy vision and what we hope to achieve through our marine environment policies. I direct Rhoda Grant to the work that is due to be on-going with the development of national marine plan 2. That will be a critical means by which we develop policies for our marine space, noting, of course, the increasing squeeze that is playing out there. As with the development of HPMAs, marine protected areas and priority marine features, we will engage widely with all of those who have an interest as we develop national marine plan 2.
Agricultural Support (Single Application Form)
To ask the Scottish Government how many farmers and crofters it has supported this year through the single application form. (S6O-02295)
The single application form is the application form that farmers and crofters must complete annually if they wish to claim a number of different support scheme payments. Last year, 19,408 businesses submitted a SAF. To date, approximately £557 million of funding has been issued under the various direct payments and Scottish rural development plan support schemes, with basic payment scheme and greening advance payments issued into the rural economy at the earliest time ever.
All scheme payments were started in line with the 2022 payment strategy timetable and have met, or are on course to meet, payment performance targets. The 2023 SAF submission period opened on 15 March this year, and the penalty-free submission period closed on 15 May, with 19,248 SAFs having been received to date. The late submission period runs until 9 June, with a penalty of 1 per cent per working day being applicable.
The support that flows from completion of the single application form is vital to the wellbeing of Scotland’s agricultural sector. In 2021, more than 93 per cent of single application forms were submitted online through Rural Payments and Services. What percentage of applications has the Government received online this year, and what efficiencies are achieved by farmers using technology in this scenario?
The member is absolutely right when she talks about the continuing importance of that funding coming through to the sector. I am pleased to say that more than 99 per cent of the SAFs that we received in 2023 were submitted online. We have had only seven paper applications submitted to date. That is a really big step in the right direction, because there are a number of benefits that come with submitting an online form. When it is submitted online, the information that is entered is validated, which reduces the risks of any errors or penalties.
The application is pre-populated with the most up-to-date land information at the time when an application is started, and farmers can choose whether to add seasonal land used the year before. Online applicants then continue to receive email updates and notifications about the scheme acknowledgements and the payment letters, as well as a whole host of other benefits.
As I said, I believe that it is a huge step in the right direction, and it is really positive that so many people are submitting their forms online.
I hope to be able to take the next three questions, so I will need succinct questions and also, cabinet secretary, succinct answers.
Ferries (Impact of Construction Delays)
To ask the Scottish Government, regarding its cross-government co-ordination on island connectivity, what discussions the rural affairs secretary has had with ministerial colleagues regarding any impact of the continued delay of vessels 801 and 802 on island communities. (S6O-02296)
I regret that the vessels are taking longer to deliver than estimated, and I am working with the Cabinet Secretary for Rural Affairs, Land Reform and Islands and other ministerial colleagues to understand the impact that it is having on island communities.
That also requires dialogue with our local authority partners, which is why we have re-established the islands transport forum through the islands strategic group. Furthermore, the First Minister’s policy prospectus includes a commitment to publish a new rural delivery plan that will cover the issues that are critical to Scotland’s island communities, including transport.
The minister will be aware that the connectivity of Scotland’s island communities has been severely hampered by the continued delay to those vessels, which are more than £200 million over budget and five years behind schedule. That does not include the economic impact to those island communities.
What is the Government doing to ensure that Scotland’s shipbuilding industry, which should be a national asset to our island communities as well as to the whole country, is resilient and able to flourish in the future to supply a continuous shipbuilding programme for ferries? Right now, it seems that the Government is content to simply capitulate on a national shipbuilding strategy and award future contracts for Caledonian Maritime Assets Ltd to Turkey. He must surely recognise that that is not sustainable and that we must create a continued shipbuilding programme in Scotland.
The Scottish Government supports the growth of commercial shipbuilding in Scotland and has welcomed the United Kingdom Government’s intention to introduce a shipbuilding credit guarantee scheme as part of the national shipbuilding strategy refresh.
We look forward to the launch of that scheme, and, once the finer details of it are known, we will work with the industry to establish how best to use the scheme and maximise its potential to support the growth of commercial shipbuilding in Scotland.
Regarding the co-ordination and connectivity questions that the minister mentions, and given the on-going pressures on the fleet, will he provide an update on progress with the delivery of the new vessels for the Little Minch and Islay services and on what benefits might be expected from their deployment?
Construction of the two new Islay vessels is well under way, and I am pleased to say that, on 25 May, steel cutting marked the official commencement of the construction of the first of the Little Minch vessels.
The vessels will bring benefits to island communities by improving the reliability, resilience and capacity of the ferry network. That includes the planned provision of a two-vessel summer service on the Little Minch route in place of the current single-vessel service.
This morning, I received a letter from the transport minister rejecting the idea of a ferry compensation scheme for island communities that are affected by problems in the network—problems that were caused by the catastrophic handling of ferry services by his Government over the years. In the light of that and the problems that the delays to the two vessels are causing to islanders, will the minister reconsider that position?
I have discussed that directly with a number of local businesses—I did so last week with Alasdair Allan in north and south Uist and Benbecula. Although I understand the calls to support businesses through disruption, our focus—rightly—must be on building resilience into the ferry network. That means that we are able to provide vessels such as MV Alfred, and we have invested £9 million in that regard to build on resilience.
I think that many folk understand that we really need to invest in our ferry network to get it right for people as we move forward. That is why we have vessels 801 and 802 and the four Islay class vessels being built at this moment.
Commercial Forestry (Effect on Farming)
To ask the Scottish Government what actions it is taking to mitigate any negative effects of commercial forestry on farming. (S6O-02297)
We have introduced positive initiatives to help farmers and crofters get the benefits of growing trees and to support their farming business. All woodland creation is assessed for its agricultural impact and recent analysis shows that all types of woodland, including commercial forestry, have a vital role to play in reducing net CO2 emissions.
The Scottish Land Commission has found that there has been a notable increase in off-market or secret sales of farms to turn them into forestry. Will the cabinet secretary tell me what the Government is doing to ensure that any secret sales are above board and that they are not sacrificing irreplaceable productive farmland to subsidise greenwashing through tree planting?
I welcome the report that the SLC has put together, and I want to engage with it to discuss directly the outcomes of that report.
As I said, we undertake impact assessments. This morning, I was at the Rural Affairs and Islands Committee, where we talked about forestry. I emphasised again that, ultimately, we want to see the right tree in the right place, and we want to ensure that any transactions in that regard are handled appropriately and in the right way.
I am more than happy to follow up and discuss the issue further with the member.
I have been contacted by constituents in Dumfries and Galloway who have provided examples of forestry having been planted on prime agricultural land. Given the need to ensure food security in Scotland, and our proud agricultural history, does the cabinet secretary agree that following the right tree in the right place strategy is important? Will she set out whether the Scottish Government is considering any action to stop large-scale commercial planting on prime agricultural land, such as that in Dumfries and Galloway?
The member raises important points. As I said in my previous response, I very much believe in and am supportive of the right tree in the right place approach, because we want to ensure that food production and the actions to address the nature and climate crises are taken together.
Through our work on the development of the agriculture bill, which will be introduced this year, and the recent consultation on the future forestry grant scheme, we will be supporting greater integration between farming and forestry through the incentives that we offer to land managers.
To ask the Scottish Government what its position is on whether agricultural support is delivering value for money. (S6O-02298)
First, I want to state that I remain committed to supporting active farming and food production, and we are doing that with direct payments to provide certainty and to support a just transition as we replace the common agricultural policy.
I am committed to co-development. We all accept that, to achieve our vision, we will require farmers and crofters to do more to deliver sustainable and regenerative farming and to maximise sustainable food production in ways that also actively benefit both nature and climate. That includes our commitment to shifting 50 per cent of direct payments to climate action and funding for on-farm nature restoration and enhancement by 2025.
In “Equality, opportunity, community: “New leadership—A fresh start”, the First Minister told us this. He said:
“it is imperative that transparency underpins our approach to delivery. My government will ensure the people of Scotland have the information they need to hold us to account”.
At the moment, when it comes to agricultural payments, we can see where the money goes and we can see what the money was claimed for, but we cannot identify who receives that money. So, in the interest of transparency, to ensure that the people of Scotland have the information they need, will the cabinet secretary commit today to publish, and update regularly, a list of Scotland’s landowners who receive Scottish Government agricultural support, including a league table, by value, in order, broken down by gender, from those who receive the most to those who receive the least?
I thank the member for raising that really important point, because his question highlights just some of the issues that we need to try to balance in that regard. I think we want to—well, I know we want to—increase the transparency of who owns land in Scotland. That is why we have undertaken some measures so far. We also want to increase the diversity of land ownership in Scotland, and the proposals that we bring forward in the land reform bill will be critically important in relation to that. I look forward to continuing these discussions as we bring forward our agriculture bill and bring forward our land reform bill to really deliver on that transparency and accountability.
We get better value for money by supporting our farmers, crofters and fishermen. We also get better quality by buying food that is locally produced to high environmental standards. Would the cabinet secretary be open to adopting Scottish Conservative plans to increase the amount of home-grown food that is purchased by local authorities by introducing a 60-60 target or strategy, in which, where possible, 60 per cent of the food purchased is sourced from farmers, fishermen and crofters who are within 60 miles of the region?
Those are commitments that we are already driving forward as a Government. Through our good food nation plan, our local food strategies and the food for life scheme, which we are delivering with the Soil Association, we want to deliver exactly that. If the member wants to have a discussion with me about the measures that we are undertaking or areas that we could look to develop further, I am more than happy to have that conversation.
Ultimately, we are all trying to achieve the same thing. We want to meet more of our own food needs sustainably, to produce that food in Scotland and to ensure that we have strong, local, resilient supply chains. First of all, we want to see more of our own produce ending up in the public sector in particular, where we have a lot of initiatives and a lot of levers that we can use to deliver that.
That concludes portfolio questions on rural affairs, land reform and islands. Sorry—I should have said that question 8 was not lodged.
There will be a very short pause before we move to the next item of business to allow front-bench teams to change position, should they wish.
NHS Recovery, Health and Social Care
We move to portfolio questions on NHS recovery, health and social care. I remind members that questions 3 and 8 have been grouped together; therefore, I will take any supplementaries on those questions once they have both been answered.
Maternity Services (Moray)
To ask the Scottish Government how many mothers from Moray it anticipates will give birth at Raigmore each year until the new service at Dr Gray’s is up and running, in light of its decision in December 2022 not to continue with model 4. (S6O-02300)
The member will be aware that, in March this year, the previous Cabinet Secretary for Health and Social Care approved the plan for integrated maternity services across the north of Scotland, with consultant-led obstetric services at Dr Gray’s hospital, and that the plan was supported with an initial investment of up to £6.6 million.
Although model 4 is not continuing as previously outlined in the Ralph Roberts review, the elements in model 4 continue to feature in the approved plan. Under that plan, Raigmore will continue to accept around one to two women per week who require emergency transfer in labour from Dr Gray’s. In addition, from 2025 and in line with the expected completion of building refurbishment work in Raigmore and increased staffing levels associated with the networked model of care, it is expected that Moray women will be able to choose to birth in Raigmore in addition to Dr Gray’s or Aberdeen maternity hospital. I expect to see the revised NHS Highland business case for Raigmore maternity services once it has been through board approval processes.
NHS Highland is spending £9 million to expand Raigmore’s maternity unit, with the help of a £5 million allocation from the Scottish Government. Can the minister explain how Raigmore will cope with an estimated 500 extra births per year, as was explained at the board meeting yesterday, when the updated unit, when built, will increase capacity by only one additional bed space in the labour suite?
The plan for a networked model of maternity care in the north, which was approved in March 2023, envisages women from Moray being able to choose to birth in Raigmore from 2025. As I mentioned, I expect to receive the revised business case from NHS Highland shortly. I am aware that it was discussed at the NHS Highland board meeting yesterday and is available online, but I will consider it fully and look at the points that the member has raised once it is submitted.
Although we should not be in any doubt about the scale of the challenges in delivering the plan, it is welcome that the services will now be rebuilt in a phased way to ensure that they are safe, sustainable and fit for the future. Given the importance of these developments, will the minister provide assurances that she will keep Parliament updated as the delivery period progresses?
Karen Adam makes an important point. She will be aware that the previous Cabinet Secretary for Health and Social Care on numerous occasions reiterated his commitment to returning consultant-led maternity services to Dr Gray’s, and that that is also a manifesto pledge. I can give an absolute assurance that, as progress is made, I am happy to keep Parliament updated.
General Practice (Independent Contractor Model)
To ask the Scottish Government how it is supporting the continuation of the independent contractor model in general practice. (S6O-02301)
The Scottish Government remains committed to supporting general practice, and the independent contractor model is a key part of that. I recently met the chair of the British Medical Association’s Scottish general practitioners committee to reaffirm that. The 2018 GP contract that was agreed with the BMA is designed to support and strengthen that commitment.
As part of the contract, and to support GP practices, we have recruited more than 3,220 healthcare professionals since 2018. That is underpinned by an investment of £170 million this year, and our policy prospectus commits us to sustaining that investment through the primary care improvement fund and investing more in practices that service disadvantaged areas. We remain committed to increasing the number of GPs working in Scotland by at least 800 by 2027.
The cabinet secretary will recognise that, although he has promised 800 more GPs, Audit Scotland has warned that progress is not on track. In my region, NHS Tayside has recommended that Invergowrie’s practice should close later this month, with more than 1,800 patients being allocated to other practices. In Fife, 40 per cent of GP surgeries have closed their doors to new patients, which is a higher figure than anywhere else in Scotland. Among the current workforce, it is estimated that more than a third are unlikely to remain in general practice for the next five years, which would mean around 1,500 GPs lost.
What action is the Scottish Government taking to improve the retention of GPs, which will be crucial if we are to reach the required number?
We are taking forward a range of work to support the retention of GPs in general practice. That includes the funding initiatives that we have in place to encourage GPs to work in rural areas. Alongside that, in this year’s recruitment programme for GP training, we have more or less reached the quota that was set to support further GP provision.
I understand the concerns that the member is raising on behalf of her constituents, but I reassure her that investment in primary care, supporting the retention of general practitioners, recruiting more people into general practice and expanding the primary care workforce are all critical to ensuring that we have a sustainable primary care system. We have, for example, recruited more than 3,000 additional staff in primary care to help the wider workforce to support individuals with their healthcare needs in primary care settings.
The cabinet secretary will be aware of the issues relating to the GP surgeries in Burghead and Hopeman, as I have written to him and to his predecessor about them. The very strong local action group, save our surgeries, is campaigning to retain those vital services, and I believe that there is cross-party support for that. Will the cabinet secretary agree to meet the campaigners, either in Moray or in Parliament, to listen to their concerns about the future of those two vital surgeries and to the local solutions that they are offering to keep them open?
I am aware of the issues relating to those surgeries. The principal route for those issues to be addressed is through the local integration joint board, health and social care partnership and health board, which will look at the design of services that are provided locally. The health board has a contract directly with the GP practices and will make decisions about the existing surgeries that are in place. It is important that that process is taken forward. I encourage the member and local campaigners to engage with the health board, the IJB and the health and social care partnership on those issues to ensure that there are sustainable services in the future.
Independent GP contractors in West Lothian have told me that having the ability to directly employ allied health professionals such as physiotherapists, occupational therapists and dieticians would make a real difference in allowing GPs to employ AHPs based on their practice’s needs, rather than there being centralised allocations. That would give GPs the authority to line manage the AHPs in their employ, and it would support flexibility, continuity and integrity of care for patients. Currently, our local health and social care partnership requires centralised recruitment and employment. Will the cabinet secretary consider that policy in order to support GPs to improve services for their patients?
I recognise the value of the wider skills group in supporting primary care. In particular, AHPs such as those who deal with musculoskeletal conditions, physios, OTs and dieticians can be used in a range of areas. We are trying to ensure that there is a steady increase in the number of AHPs being provided to GP practices across the country.
I recognise the concern that the member has raised. I have recently discussed the issue with GP practices in my constituency. I am not unsympathetic to looking at how we could improve the existing model in a way that would give GPs greater control over such matters. Equally, I want to ensure that the multidisciplinary teams in primary care expand and develop on a consistent basis, so that as many GP practices as possible can benefit. Some GP practices might want to do that directly; others might want that to be done centrally for them. However, I am certainly open to looking at how we can further improve the system.
National Health Service Dentistry
To ask the Scottish Government whether it will provide an update on what it is doing to tackle any challenges faced by national health service dentistry. (S6O-02302)
We are working apace to move forward with a modernised system of payment reform that will provide longer-term sustainability for the sector and encourage dentists to provide NHS care. The new system provides greater clinical freedom to dentists through a high-trust, low-bureaucracy model. The new policy prospectus, which the Government set out on 18 April, further commits us to sustained and improved equitable national access to NHS dentistry by 2026. That reaffirms our commitment to the sector and to patients in all parts of Scotland.
In a month’s time, the last NHS dentist in Kinross-shire is set to transform into a private practice. That will clearly be challenging for folk living in a vast rural area, given that there will now be a lack of accessible coverage in relation to a very important public health service. What more can the Government do to improve access to NHS dentistry in rural areas, including those in my constituency?
I recognise the concerns that Jim Fairlie has raised. We are working closely with NHS boards, a number of which have appointed task forces to support them to develop tailored solutions that will address local access issues.
I can confirm that we have recently expanded the Scottish dental access initiative grant support to Kinross. An attractive and unique financial support package has been offered to incentivise the setting-up of new practices or the extension of existing practices. There is the potential of up to £100,000 being offered for the first surgery, with £25,000 per additional surgery.
National Health Service Dentistry
To ask the Scottish Government whether it will provide an update on what action it will take to reverse the reported decline of national health service dentistry. (S6O-02307)
The new policy prospectus, which the Government set out on 18 April, commits us to sustained and improved equitable national access to NHS dentistry by 2026. The previous Cabinet Secretary for Health and Social Care recently confirmed the continuation of the bridging payment to 31 October 2023, while we prepare for the implementation of payment reform. Payment reform will comprise a new, modernised system that will provide NHS dental teams with greater clinical discretion and transparency for NHS patients.
Another month has passed and I am afraid that we still have no clarity about what the future fee payment system will be for dentists. Meanwhile, we hear from people such as Jim Fairlie that dentists are leaving the NHS system. When will the minister get a grip on the situation and bring forward the payment system so that we have more clarity and stop the rot in NHS dentistry?
I am sure that Willie Rennie will understand that our discussions with the British Dental Association need to remain confidential. However, I will update Parliament as soon as I can.
The Scottish National Party-Green Government does not understand NHS dentistry. The minister has said that there is a low-bureaucracy model; well, if you are a qualified dentist who has been practising for many years abroad, or even in England, Wales or Northern Ireland, and you want to come to Scotland, you have to be recruited as a vocational training by equivalence—VTE—assistant, which means working under supervision for a year and not independently as a dentist. As a result, we have the frankly ludicrous scenario of highly qualified dentists, often with many years of experience, being required to work as trainees for a year if they wish to move to Scotland, which deters dentists from coming to the country. Will the minister commit to removing that bureaucratic red tape so that we can attract qualified dentists to Scotland?
Sandesh Gulhane’s question refers to a United Kingdom-wide issue. The Scottish Government is working closely with the other nations; I am, in fact, in the process of writing to them to see whether we can find a better process to ensure that we get the right dentists—
That is factually incorrect—
It is not a UK-wide issue—
Please resume your seat, minister. The question has been posed and the minister is responding. We do not need sedentary interventions; there are other routes.
Please continue, minister.
I am in the process of writing to the UK Government to work with it in a four-nation process to try to alleviate that situation.
With the accessibility of NHS dentistry declining, oral health inequalities are widening and access to dental care, particularly for vulnerable groups such as children and young people, is crucial. What steps is the Government taking to support the recovery and future of oral health improvement programmes, such as the Labour legacy of Childsmile, caring for smiles and mouth matters?
I was going to reference Childsmile, too, because it is a fantastic project that really helps to educate young children about the importance of oral health. Over the longer term, we have seen significant improvements in child oral health. For example, the first year of the national dental inspection programme, in 2002-03, showed that 45 per cent of primary 1 children had no obvious decay experience. Despite the unique challenges of the pandemic, that figure has increased to 73 per cent.
As of 1 February last year, the Scottish Government introduced changes that permanently increased enhanced fees for examination appointments for both adults and children. For the first time, dentists would receive a fee for examinations for children.
What is the Scottish Government doing to proactively encourage the use of digital dentistry, particularly oral scanners, which offer significant time savings for dentists, thus increasing capacity; cost savings for the health service; economic development opportunities for Scotland’s live science sector; and which prevent Scotland from falling behind global best practice in that regard?
Ivan McKee raises a really important point. I remind the chamber that NHS dentistry is provided by independent contractors and that the use of digital technology is ultimately a business decision for them.
The use of digital technology in dentistry is becoming more commonplace, which I very much welcome. It affords dentists potential cost savings and provides improved patient experiences. I am confident that, through payment reform, we will enable dentists to make use of digital technology where they deem it appropriate—for example, by using digital scanners rather than taking physical impressions of teeth.
Does the minister accept that dentists are aware of all the policy initiatives that she talks about—the fact that payment is continuing until 31 October and that a new payments regime will come into place—but that they are still choosing to withdraw from NHS provision? More than 20,000 patients in Dumfries and Galloway alone have been deregistered from the NHS recently. Why does the minister think that that is happening, if the new regime is going to solve the problems?
Payment reform constitutes one of our national responses for dentistry. By putting in the framework of payment reform, it is our intention to lay the foundations to ensure further engagement with dentists to look at the points that the member has raised.
Question 4 was not lodged.
Dentistry (Engagement with Health Ministers)
To ask the Scottish Government whether it can provide an update on any recent engagement with health and social care ministers from the other United Kingdom Administrations regarding a co-ordinated approach to dentistry. (S6O-02304)
A co-ordinated approach is often not possible as dental services in Scotland operate on a fee for item of service model, which is entirely different from the contract model that is used in England and Wales. However, where we identify areas of mutual concern, such as workforce, the intention is to raise that with UK Government colleagues.
I thank the minister for that answer. I welcome the comments that Jenni Minto made earlier this month to confirm extended Scottish dental access initiative grants and the enhanced recruitment and retention allowance. Importantly, the minister also noted that she was working with and writing to UK Department of Health and Social Care ministers to seek improvements to the registration process for overseas dentists on a four-countries basis. Can the minister provide an update on any progress made on that work to increase dentistry workforce pipelines from overseas? Does she agree that that work is vital to address the destructive impact of Brexit and improve oral healthcare for patients?
Stephanie Callaghan makes an important point about the impact that Brexit has had on workforces in Scotland. The Scottish Parliament approved legislation that came into force on 8 March 2023, which provides the General Dental Council with flexibility regarding international registration. As Stephanie Callaghan mentioned, I am in the process of writing to Department of Health and Social Care ministers to ensure that changes are made on a four-nations basis to improve the registration process for overseas dentists. I can also confirm that the cabinet secretary will raise that matter when he meets the GDC on 15 June.
NHS Lanarkshire (Meetings)
To ask the Scottish Government when it last met with NHS Lanarkshire and what was discussed. (S6O-02305)
Ministers and Scottish Government officials regularly meet representatives of all health boards, including NHS Lanarkshire, to discuss matters of importance to local people.
We are seeing some really positive changes in primary care, with an emphasis on getting the right care in the right place. For example, NHS pharmacy first Scotland is an excellent service that allows pharmacy teams to provide advice, treatment and referrals. However, people are really struggling to get appointments with their GP. Can the cabinet secretary outline some of the wider work that is being done to improve primary care and how that modernisation will continue to benefit patients? With regard to GP practices, can the cabinet secretary set out how standards are set and monitored, including on the ease of booking appointments, and what opportunities members of the public have to give feedback?
The member raises an important issue on behalf of her constituents. As I mentioned in response to an earlier question, we have seen a significant expansion in the primary care team, with more than 3,000 additional staff being recruited to support primary care. That includes staff with a health practitioner background. We want to continue to see that expand as we move forward.
I am also aware of the services that are offered by the wider primary care network, such as through pharmacists and opticians, all of which can have a positive impact on the way in which patients can access particular services in their locality.
The member might also be aware that the former Cabinet Secretary for Health and Social Care set up the general practice access group, which is looking at some of the key principles around access to general practice. That work is on-going and we expect to receive that report in the coming months. I hope to be in a position to publish it in the summer.
The member will also be aware that, as independent practitioners, practices have to have arrangements in place that ensure that they comply with the GP contract in their health board area and that they ensure access to patients. Therefore, any patient who is concerned about access to their GP service can raise it with them directly or via their health board. It is important that GP practices provide access to patients so that they can make appointments as and when is necessary.
The cabinet secretary will be well aware of the problems that Lanarkshire’s accident and emergency units have been having. In March, only 57.2 per cent of patients in Lanarkshire were seen within four hours, and at University hospital Hairmyres in East Kilbride the figure was 52.3 per cent. That is against the national target of 95 per cent. Staff have been up against it for months, so what is the cabinet secretary going to do to help them to reach the national target?
The health board is taking forward a range of work, which I am sure that the member will be aware of. For example, recent fire break work was done to improve capacity in the A and E department and help with the flow of patients through the hospital. That has had some positive impact, and we hope to see further progress.
Alongside that, the Government is providing support and guidance to boards to ensure that they are doing everything that they can to improve the flow of patients, which has an impact on A and E performance. That includes the use of the Glasgow continuous flow—GLASFlow—model, which NHS Lanarkshire is presently looking to roll out to help improve the way in which patients move through the hospital.
That combination should help to support staff and improve performance.
Surgical Mesh Products (Independent Review)
To ask the Scottish Government whether it will initiate an independent review into the use of surgical mesh products within NHS Scotland. (S6O-02306)
The Scottish Government has already commissioned an independent review of transvaginal mesh implants and acted on the conclusions, which were published in March 2017. We have also implemented Baroness Cumberlege’s 2020 recommendations about transvaginal mesh.
More recently, we commissioned two reports from the Scottish Health Technologies Group on mesh used in hernia repair. Those reports supported its continued use, but stressed the importance of patient choice, availability of alternative treatments, informed consent and data collection—all of which the Government supports.
Freedom of information responses show that, from 2015 to this year, 8 per cent of all patients in NHS Ayrshire and Arran who were implanted with surgical mesh to treat a hernia were readmitted due to complications arising from the mesh. That suggests that there may be a connection, with surgical mesh products having a detrimental impact on the health of some hernia patients. Will the minister meet campaigners who are calling on the Scottish Government to undertake an independent review into the use of mesh?
I thank Katy Clark for her supplementary question, and I appreciate the concerns that her constituents have. Scottish Government officials have previously offered to arrange a meeting between a small group of Katy Clark’s constituents and the Scottish Health Technologies Group to discuss the findings of its reports into hernia mesh. That offer remains open, should they wish to take it up.
Action needs to be taken now to support women who have been affected by transvaginal mesh-related health issues. The median wait for referral to the complex mesh surgical service in Glasgow is 236 days, and the longest wait is 448 days. Women then need to wait a significant length of time to start treatment that will alleviate their symptoms—or even remove them, if they are fortunate. Women with that debilitating and life-altering condition need help, now. What action is the Government taking to accelerate the provision of that vital treatment?
The Government has taken note of the results of both the Health, Social Care and Sport Committee’s survey and one that was done by NHS Greater Glasgow and Clyde with regard to that issue, and it is looking at what improvements can be made.
Surgeries have restarted, a number have been carried out and the service expects that it will soon be able to operate within 12 weeks of a patient and her clinicians deciding on the course of treatment.
I confirm that the service is also taking action to increase its out-patient capacity, which includes an additional translabial scanner. That will allow more patients to be seen and I hope that progress from those actions will soon start to become evident.
That concludes portfolio questions on NHS recovery, health and social care.