Seòmar agus comataidhean

I would hate to pre-empt our college inquiry report. I thank Mr Mason for his question, but, if he does not mind, we will wait until later in the year to see what that says.

Although there has been an increase of £26 million in the colleges resource budget for the coming year, that is only 0.6 per cent in real terms. It is important that colleges find out what that means for baseline funding in future years.

In 2022, Audit Scotland highlighted that capital funding has

“consistently fallen short of the level needed”

for maintenance in colleges. Furthermore, given that the ability of colleges to raise funds is limited, the committee is concerned that they will not be able to meet their net zero targets by 2045. We believe that an assessment of the current position and an investment strategy should be completed as a matter of urgency.

I will speak briefly about universities. Our universities have a fabulous reputation across the world. We welcome the students who come from across the world and we recognise the cultural diversity that they bring. However, Scotland’s funding model for universities is now structurally reliant on international fees; that source of revenue is forecast to overtake Scottish Government funding as a percentage of the sector’s total income, by 2023-24. We have asked the Scottish Government how it plans to ensure long-term sustainability and to mitigate the risks of reliance on international student fee income.

In closing, I am sure that members would like to join me in thanking the staff who delivered vital services to children and young people across Scotland.

I rise to speak on behalf of the Education, Children and Young People Committee. For our budget scrutiny, we chose to look at both ends of the educational spectrum: early learning and childcare, and further and higher education.

August 2021 marked the introduction of the duty on local authorities to secure 1,140 hours of early learning and childcare for all three and four-year-olds and eligible two-year-olds. Members will know that local authorities have a dual role: they are ELC providers and they commission services from private, voluntary and independent nurseries and childminders.

Since the roll-out of the 1,140 hours, PVI providers have faced significant difficulties in recruitment. The Scottish Childminding Association told us that, during ELC expansion, the sector has lost more than 1,400 childminders. The National Day Nurseries Association described to us a crisis in the ELC workforce caused by the expansion in local authority employment and the pandemic.

The issues that have been raised with us include the rates of pay for providers differing between local authorities, as the Scottish Government guidance does not set out a specific rate for local authorities to pay. The committee has recommended that a mapping exercise be carried out, because we want to find out what hourly rates are being paid to staff across local authorities and the PVI sector. We also want to know the extent to which staff are moving from jobs in the PVI sector into local authorities and the monetary value of the in-kind support that is provided to the PVI sector.

We found that the rates that are paid to the PVI and childminding sectors vary between local authorities. For three to five-year-olds, they range from £5 an hour in Orkney to £6.40 an hour in West Lothian. We found that different rates apply for two-year-olds and that different rates are paid to childminders in some local authorities.

The committee is aware that a small number of local authorities do not provide an uplift in funding to the PVI sector for two-year-olds, despite the increased cost of that provision. We were told that underfunding is an on-going concern for many of those in the PVI sector, with several now operating at a loss. We also heard that the Scottish Government is reviewing the overall process for setting sustainable rates. We look forward to receiving information about the financial health of the sector and about the critical issue of staff pay, terms and conditions.

As part of the inquiry, we learned that, although some two-year-olds are eligible for funded places, uptake has been low, at around only 13 per cent in 2020-21. Local authorities have struggled to identify eligible families. However, we were pleased to learn recently that new data-sharing arrangements will allow local authorities to target information to eligible households. We all hope that that will lead to an increase in uptake.

The choice of where and when children access funded ELC is very important to parents and care givers. Private providers can offer greater flexibility than local authority-run settings. That flexibility is essential to those who do not work around traditional office hours, such as healthcare workers, albeit not only to them.

Cross-border provision is available between a small number of local authorities. We heard some evidence on that, from Argyll and Bute. That flexibility has been helpful for parents who live and work in different local authority areas. Local authorities are expected to work together to resolve cross-border issues and the Scottish Government has offered to look at what further work might be necessary to allow families across Scotland to access cross-border solutions.

Another sector that offers vital services to people across Scotland is our colleges. They do fantastic work, and we all want them to thrive and to deliver the skilled workforce that is essential to growing Scotland’s economy. We heard about the significant funding challenges that are faced by our colleges. The Scottish Funding Council said that the sector forecasts an underlying operating deficit in every academic year to 2026-27. Staff costs make up a high proportion of colleges’ overall costs, and the sector projects significant staff reductions, of around 200 to 300 full-time equivalent staff members in each of the next five years.

On a point of order, Presiding Officer. I tried to change my vote, but my app froze and would not refresh. I should have voted yes.

Scottish National Party and Green ministers approved a cut of £1 million to the alcohol and drugs budget in November, at a time when more than 100 families were grieving the loss of a loved one because of drugs. My thoughts are with those families and I send them my condolences. The SNP has said that tackling the issue is a national mission, but it cannot mean that if it then cuts funding. Front-line services are key to saving lives. Will the minister commit to reversing the cuts to the alcohol and drugs budget, to ensure that services are fully supported to tackle the on-going crisis?

One health board has taken the decision to reduce its endoscopic capacity by 3,500 procedures over the next 12 months. That means that there are 35 people living with undiagnosed cancer. Because of Scottish Government cuts, rather than being able to increase its diagnostic endoscopic services to meet the demand, that board is being forced to cut the service. How can the backlog be cleared when diagnostic services are being cut?

To ask the First Minister what progress the Scottish Government has made in clearing the reported backlog of people waiting for key diagnostic tests. (S6F-01727)

Will the member take an intervention?

Yes, I agree.

I will continue to quote Lauren Bennie, who said:

“The difference between a 33-week wait and a 19-week wait can be devastating for people”,

as Alex Cole-Hamilton just outlined, especially those

“with arthritis whose physical and mental health are worsening by the day, slowly eroding their independence. Edinburgh University researchers found that people’s quality of life significantly deteriorates after each six-month period of waiting.”

People with arthritis who are waiting for hip and knee replacements live with severe pain, struggle to move around and are often unable to work. In terms of healthcare economics, those operations are some of the most effective treatments that the NHS offers, so it is unacceptable that people face long waits or financial instability to access them.

We increasingly hear from people who feel that they have no choice but to use savings or borrow to pay for surgery privately. The financial hit is especially devastating when living costs are soaring. Before I get any interventions, yes, that risks widening health inequalities further and thus has to change.

We must remember that pain is crippling and debilitating. People have little or no confidence in any practical steps to reduce the impact of their pain on their daily life. Reliance on pain medication is very high, and a lot of self-management resources have been suspended due to the pandemic. Medication options, from prescription to over the counter, take a toll, too—from fatigue to nausea and, dare I say, constipation. They, too, impact on the ability to work and have a normal life. We call on the SNP Government to introduce prehab for people awaiting treatment, so that people can live well while waiting. Reliance on pain medication is very high and impacts the quality of many people’s lives.

The cabinet secretary told us that all would be well when he brandished his NHS recovery plan in August 2021. He then claimed that everything was under control when presenting the winter resilience plan in October. Now he has been forced to concede that everything is far from well.

Rather than work collaboratively with other politicians who have plenty to offer in what is undoubtedly a national emergency, on Tuesday of last week, Mr Yousaf was utterly dismissive of the Conservative NHS action plan, which was produced by someone who knows what they are talking about. The Scottish Conservative’s 14-point recovery plan includes streamlined specialist super Saturdays, the expansion of same-day operations and more off-peak scanning.

My colleague Dr Gulhane is a practising doctor and a former orthopaedic registrar. As he said, he spent the holiday touring practices to get a genuine feel for what is happening across the country. I have spent more than 25 years working with healthcare providers in Scotland, England and Northern Ireland.

The SNP has spent years hollowing out our local councils. With savage funding cuts on the horizon, its plans for a national care service would scrap local accountability and impose total ministerial control.

Our NHS is on its knees. Waiting times for A and E and cancer treatment are at their worst-ever levels, yet more parliamentary time was set aside last week to discuss independence than was spent on our failing health service. As Jackie Baillie stated, it is only in Opposition debate time that we get to discuss the issues in detail.

Today, as one in seven people languishes on a waiting list, I want to focus on waiting times. The real-time impact of pausing and restarting elective surgery is that we never really know the accuracy of median waiting times. All that patients are asking for is clear and accurate data on approximate waits.

Public health data as it is presented shows average waits of 19 weeks. However, that data uses the average median and does not count urgent cases. As Dr Gulhane mentioned, some health boards are not doing any elective surgeries, so it is impossible to deliver a four-week wait.

Patients get angry and distressed when they deal with moving medical goalposts. They have this unrealistic ideal of their waiting time, so they have increased phone contact with their GP and make more calls to hospital secretaries as they wonder where they are on the waiting list. All of that adds to the daily pressures that our front-line staff are facing.

Lauren Bennie, Scotland head of Versus Arthritis, said:

“People need clear and regular communication about when they can expect to receive surgery and what information and support is available while waiting. Many fear being forgotten or feel abandoned to manage their pain alone.”

I am in my concluding remarks.

Last week in his statement, Mr Yousaf admitted that

“it is right for health boards to retain decision-making at local level so that they can determine how best to flex their services”.—[Official Report, 10 January 2023; c 37.]

Perhaps his Government should heed his own advice when it considers wasting £1.7 billion on ripping social care from local authorities.