Seòmar agus comataidhean

All members in the chamber pay tribute to the outstanding work of health and social care workers across Scotland, but the reality is that they have been badly let down by the Scottish National Party-Green Government.

The NHS recovery plan was published more than a year ago, but things have gone from bad to worse. Only today, we heard that August’s A and E waiting times were the worst on record across every category. There are already reports of ambulances stacking up outside emergency departments, often for hours, including at Aberdeen royal infirmary in my region, and that is well before the winter months arrive.

The system is not just stretched, it is overstretched. Few people, apart from SNP members, will be reassured by the cabinet secretary’s statement, so I will put three questions to him. First, his statement mentions improved call waiting times for NHS 24. Given that, in June, one patient waited two hours, eight minutes and 15 seconds to be answered by an operator, can the cabinet secretary tell us how that will be achieved and what he considers to be an acceptable waiting time?

Secondly, there is no mention in the statement of NHS dentistry, which is at breaking point. Does the cabinet secretary realise the catastrophic impact that his funding cuts will have on the dentistry sector?

Finally, the statement mentions growing the NHS workforce through recruitment, but there is almost nothing about retention. Nursing vacancies are up by as much as 25 per cent compared with last year. Therefore, what is the Scottish Government doing to improve retention of NHS workers?

I know from conversations with police officers in the north-east that they are often the stand-in for other services when someone is in crisis out of hours. That is starkly reflected in the Mental Welfare Commission’s report, which quotes officers as saying that the police and ambulance services are the

“constant fall back for other services, when neither are the appropriate services to offer meaningful assistance beyond an assessment at A&E.”

What immediate steps is the Scottish Government taking to ensure that people in crisis can be swiftly and reliably referred to the right help and interventions out of hours?

For months, the Scottish Conservatives have said that people are paying the price of Humza Yousaf’s mismanagement of Scotland’s NHS. Earlier this month, A and E waiting times hit their worst level on record. The figures that were released yesterday are only fractionally better.

The sobering reality, which the vice-chair of the Royal College of Emergency Medicine emphasised last week, is that emergency department delays are associated not just with patient harm but with increased mortality.

I will put that into perspective. For the 3,400 patients across Scotland who spent more than eight hours in A and E a couple of weeks ago, 40 additional lives could be lost in a single month. That is why those statistics really matter.

Let me be clear: the buck stops at Bute house. NHS staff the length and breadth of Scotland have worked tirelessly to treat their patients in recent years, often at the expense of their own wellbeing.

In July 2022—almost a year after the NHS recovery plan was unveiled—one in every 25 patients waited more than 12 hours to be seen in A and E departments across Scotland. That was the worst month since records began.

What were Nicola Sturgeon and her SNP colleagues doing in July? They were refreshing the case for separation, with the launch of the SNP’s second independence paper. That is a massive distraction from our NHS’s recovery and hardly the “sharp focus” that the First Minister pointed to during First Minister’s question time last week.

In August, the Royal Infirmary of Edinburgh’s A and E department was over capacity every day—not just by a handful of patients but by dozens of them. That has implications for the safety of patients and staff. However, in August, Nicola Sturgeon appeared not once or twice but five times at Edinburgh’s fringe to hobnob with Hollywood actors and polish her public relations. That tells us exactly where the First Minister’s priorities lie.

Those appalling waits occurred during the summer months, well before the pressures of winter and colder weather pile on to our NHS. In my region, the medical director for acute services at Aberdeen royal infirmary said in August that

“the system is not working because it’s not fit for purpose.”

Ambulances are already stacking outside ARI because the hospital simply does not have the capacity. Paramedics and their patients are waiting hours outside A and E, meaning that ambulances cannot be deployed elsewhere. People in the north-east are being told to present to ARI only if their condition is life threatening.

Figures that were published yesterday show that, for the quarter ending in June 2022, NHS Grampian failed to meet the 62-day standard and the 31-day standard for cancer waiting times. In addition, there are long waits for magnetic resonance imaging scans, colonoscopies and access to psychological therapies.

Meanwhile, Montrose minor injury unit has closed in Angus; Aboyne community hospital has been shut because of staffing shortages; Friockheim health centre has closed its doors because of lack of doctors; and primary care across the north-east is under impossible pressure. Many NHS services are being centralised by stealth with NHS 24 acting as the gatekeeper, with lengthy waits to speak to an operator.

Quite simply, Presiding Officer—

I am nearly finished. I wish that Humza Yousaf would listen to what people are telling him. His NHS recovery plan has not worked. Things have gone from bad to worse. That is no wonder, given that Audit Scotland has said:

“There is not enough detail in the plan to determine whether ambitions can be achieved in the timescales set out.”

The health secretary will be appearing before MSPs in the chamber next week to address those issues. I know that he wants to mention them now, but I ask him to please listen—I am nearly finished. I sincerely hope that he will address the issues. After months of excuses, this is an opportunity to rethink his failing recovery plan and to tell front-line staff and the public what action he will take to reduce delayed discharge, increase the number of beds, improve workforce planning and focus on staff retention.

Everyone has had enough of SNP soundbites. Humza Yousaf and his colleagues need to step up—[Interruption.]—and get a grip. Too much is at stake.

I thank Alexander Stewart for securing this members’ business debate on out-of-hours GP services. It helps to bring into focus how pivotal those services are in delivering primary care when GP surgeries are closed during evenings, weekends, festive periods and public holidays. That can be as much as 70 per cent of the week, which is a reminder that general practice services are available not just between 8 am and 6.30 pm, but 24/7.

It is important to emphasise at the outset that out-of-hours GP services deal with nearly 1 million patient consultations each year. Those patients include people with long-term conditions, palliative care needs and mental health problems. For parents with babies and young children and for over-75s, the service is especially invaluable, as it is for those in rural areas.

In many parts of Scotland, the service is also desperately overstretched. Even before the pandemic, the chair of the British Medical Association’s Scottish GP committee argued that

“the root cause of this is simply the fact that there are not enough GPs working in Scotland—and those who are, face such demanding workloads that adding out of hours is just a step too far.”

That is an all-too-familiar theme. In 2015, the independent review of primary care out-of-hours services stated that

“serious GP shortages were compromising the sustainability of OOH services, which remain fragile and may worsen without resolute and urgent action.”

Time and again, the Scottish Government has been warned about NHS workforce planning, by political parties and, more importantly, by the people who matter on the front line. Kemnay medical group in Aberdeenshire has lost four GPs. In the Kemnay community newsletter, staff from the surgery described

“a creaking system where the pressures on clinicians have continued to grow, the demand for our time has rocketed and political promises of help have failed to materialise”.

They added that the national GP shortage is felt across Scotland but particularly in the north-east.

Yesterday, in the Health, Social Care and Sport Committee, we heard evidence that it is a step in the right direction but is really only scratching the surface. It is still not good enough—we cannot get enough GPs.

For example, Brechin medical practice is surviving with two GPs and regular locums, at significant cost; Inverbervie medical practice is struggling to meet demand; and some surgeries have not survived at all. I recently raised with the cabinet secretary the example of Friockheim health centre in Angus. The GP surgery achieved a 95.46 per cent positive score in the latest health and care experience survey, which was the highest across Tayside, yet it closed in May this year, displacing more than 3,000 patients. What was the reason for the closure? NHS Tayside wrote to patients to say:

“the main issue that is facing primary care and GP services is that there are not enough GPs.”

People in the north-east and across Scotland are paying the price for years of poor workforce planning by the Scottish National Party Government. Now, the Government is playing catch-up, pledging 800 more GPs by 2027 in various phases, but it is abundantly clear that the NHS needs more GPs now to fill existing vacancies and to cope with increasing workload demands. The health secretary says that he is working relentlessly on the issue but, frankly, we are tired of his relentless excuses.

The deployment plan highlights the fact that many health boards are using the Scottish Ambulance Service to reach deprived or rural communities. We know that the service is already under pressure. How will it be adequately resourced to ensure that those communities are not overlooked?

Friockheim health centre in Angus got a 95.46 per cent positive score in the health and care experience survey, which was the highest score across Tayside. However, difficulties in recruiting GPs to the surgery meant that it closed earlier this year, which moved 3,000 patients elsewhere. That was another huge blow for rural patient care.

The Scottish Government committed to a £20,000 golden hello to help to fill rural vacancies. Why is that not working?

On a point of order, Presiding Officer. I do not know whether my vote registered. I would have voted yes.

To ask the First Minister what assessment the Scottish Government has made of reports that incidents of bullying in NHS Scotland have risen by nearly 50 per cent in five years. (S6F-01255)