Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, September 15, 2021

Official Report 1107KB pdf

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General Practitioner Services

I am required to remind members that social distancing measures are in place in the chamber and across the Holyrood campus. I ask that members take care to observe those measures, including when entering and exiting the chamber. Please use the aisles and walkways only to access your seat and when moving around the chamber.

The next item of business is a debate on motion S6M-01217, in the name of Annie Wells, on the return to normal general practitioner services.

16:37  

I am delighted to open the debate for the Scottish Conservatives on a motion on the return of normal GP services. We on these benches have called for this debate on an issue that is causing serious concern in communities across Scotland.

Let us be clear that national health service staff, including GPs, have worked flat out every single day to keep our services afloat. Throughout the pandemic, GPs have demonstrated their incredible resilience, whether in adapting to virtual settings or continuing to see the most vulnerable patients face to face. However, it is important to be clear that the NHS continues to be at crisis point. Whether it be enormous accident and emergency delays, ambulance services stretched to the limit or waiting times for diagnostic tests going through the roof, many services are completely overwhelmed.

I am sure that we were all astounded to hear the Cabinet Secretary for Health and Social Care declare just this morning that people should think twice before calling an ambulance.

Annie Wells says that she is astounded. A tweet by the Scottish Ambulance Service yesterday said:

“We’re facing an unprecedented period of significant and sustained pressure on our services, so please call NHS24 on 111, or call your GP during the day, unless it’s an emergency.”

That is what I said. Is Annie Wells right, or should we believe the Ambulance Service?

As the health secretary, Humza Yousaf has influence in this country—people listen to him. What happens if someone has a medical emergency? Do they remember what the health secretary said and think, “Maybe I’ll think twice about phoning”? Thinking twice is not the solution to the crisis for our Ambulance Service.

We must also acknowledge the severe staffing shortages that currently exist across much of Scotland’s health system.

Only last week, the head of Macmillan Cancer Support services in Scotland warned that, as the number of people who are diagnosed with cancer is set to soar in the years ahead, we simply do not have enough specialist cancer nurses to meet demand. For many who are battling cancer, having a nurse is a tremendous source of support, comfort and encouragement, so it is extremely concerning to hear warnings that we are set for a perfect storm of a shortage of nurses coupled with growing demand.

Despite the array of challenges that NHS Scotland faces, Conservative members are today urging the Government to act on the return of normal GP services. I am sure that most members have had concerned constituents get in touch to inform us that they—or someone they know—have struggled to access GP services, particularly those who would like a face-to-face appointment.

It is no secret that, even before anyone had heard of Covid-19, general practice in Scotland was not exactly in peak condition, as the British Medical Association Scotland highlighted last month. Between 2010 and 2020, there was a gradual decrease in the number of GP practices across Scotland. Meanwhile, the average practice’s patient list went up. That suggests that, in the decade prior to the pandemic, general practice had been under increasing pressure to meet the needs of Scots.

The pandemic has placed untold pressure on NHS services, which is forcing more people to go to their GP. One GP contacted me to explain the sheer pressure that they are experiencing because of unprecedented demand, which has been exacerbated by staff shortages across primary care. They told me that primary care is broken due to the increased and unsustainable pressure resulting from Scots waiting longer for secondary care.

In last week’s debate on the programme for government, I made the point that, although more funding for the NHS is welcome, the NHS recovery plan is, in many ways, limited in how it will tackle the huge issues that our health service faces. Not least, it fails to deliver a network of long Covid clinics. That awful aspect of the virus has the potential to place further pressure on front-line services if it is not properly addressed.

If we do not do what is necessary to get hospital, clinic and surgery waiting times under control, GPs will continue to be overwhelmed with patients. Desperate patients will attend A and E departments to get treatment, as many feel that they are left with no other choice, and that could severely compound the pressure.

People need help today. They need help now. As I am sure my colleague Dr Sandesh Gulhane will say in his speech, the situation has all the components to generate a brutal domino effect across the NHS in Scotland. Many medical conditions will continue to go undiagnosed and untreated, which will lead to tragic yet entirely avoidable consequences. Leading health professionals have admitted that the current pressures on the NHS are akin to those faced during the harshest months of winter, so the domino effect could soon worsen if warnings are not heeded. Therefore, the NHS needs a proper recovery plan—one with real substance and teeth—to get it back on track and to reduce pressure on general practice and our front-line staff.

As I said, GPs face overwhelming demands, but it is also true that video consultations should not become the default for patients who need to be seen face to face. Many people in communities across Scotland desire face-to-face GP consultations over appointments via telephone or the Near Me service, and that must be respected.

With the motion in my name, the Scottish Conservatives are clear that we will support patients who need to get back to seeing their GP in person. If the Government is confident that its NHS recovery plan will help to tackle the backlog and waiting times, it will have no issue in supporting our motion and committing to setting a target date for the return of normal GP services.

I move,

That the Parliament recognises that patients have a right to treatment by GPs, and calls on the Scottish Government to set a target date for a return to normal activity in practices, including face-to-face consultations.

16:44  

The past 18 months has been a time of unprecedented pressure in the NHS, as it has faced the biggest challenge of its 73-year existence. Cleaners adopted new cleaning regimes. Receptionists adapted to a more virtual way of supporting patients. Primary care teams of nurses, physiotherapists, optometrists and others helped to ensure a successful vaccination programme. GPs helped to staff Covid assessment services and, with their teams, led their practices through the pandemic.

We owe them all a huge debt of gratitude for stepping up when it really mattered, which is why the Cabinet Secretary for Health and Social Care wrote to all general practice staff last week to thank them personally for their efforts. In giving our thanks, we should also recognise the significant contributions of other parts of the primary care system, which include dentists, optometrists and community pharmacists, who adapted to new and safer ways of working to ensure that patients could access the treatments that they needed.

During the pandemic, many other healthcare professionals—optometrists, pharmacists, nurses—saw patients face to face. Does the minister not believe that now is the time that GPs started doing the same?

Let me be clear that any suggestion that GPs are not seeing people face to face because they do not want to is false, and I absolutely reject it. As our recovery plan set out, GP teams have often been working in constrained circumstances throughout the pandemic, but they have seen patients face to face when there was a clinical need to do so.

As we recover from the worst of the pandemic, I completely understand that some people, particularly in our elderly population, want to see a GP face to face. Having patient choice in a clinically safe and appropriate way is a critical part of our recovery. Public Health Scotland has recently published guidance on distancing and infection control measures in health settings that changes the 2m rule to a 1m rule, and further operational guidance that was published last week also makes it clear that there is no longer a need to triage every patient, although GPs and clinicians should continue to screen patients for Covid before seeing them face to face. I expect those actions to lead to an increase in the number of face-to-face consultations. Some people will still prefer to have a Near Me video consultation or a telephone consultation, so we will continue to promote choice.

I accept that there is a need to rapidly increase the availability of face-to-face appointments in partnership with the profession. I firmly believe that the steps that we have taken in the NHS recovery plan, the revised physical distancing and infection prevention and control guidance and the whole-hearted support of the BMA, the Royal College of General Practitioners and the wider profession will allow us to do that as quickly as possible and, more importantly, as safely as possible.

Of course, it is not just about ensuring access to services but ensuring that those services are high quality and inclusive for all communities across Scotland. We are working with our expert group to develop practical and innovative ways to improve access and care, including in our most vulnerable communities. We are considering how we can bring more healthcare workers to vulnerable communities, which will help to address issues around poverty, discrimination and injustice in access to and provision of care.

The minister has spoken a lot about communities. She wrote to me earlier this summer to say that the independent review of maternity services at Dr Gray’s hospital in Elgin would be with her in a number of weeks, but we are still waiting. Has she received that report and when will the local people in Moray hear its recommendations?

I have not received that report yet, but I will organise meetings with Douglas Ross, Richard Lochhead and other interested local MSPs as soon as I do. We will of course relay that information to the community, who are rightly concerned about the services that they receive.

Similarly, the health and care needs of our remote and rural communities need to be supported, which is why we are developing a rural centre of excellence to provide expertise and advice on the delivery of care in different rural, island and remote settings in Scotland.

People need access to a wide range of services in their community through general practice for both their physical and mental health. Our GP contract plans, which we developed jointly with the profession, focus on recruiting a range of healthcare professionals in the community, such as pharmacists, nurses and physios, and are backed by £155 million of funding this year.

During the current parliamentary session, we will also create a network of 1,000 additional link worker staff who can help to grow community mental health and social prescribing.

In summary, our pandemic response has driven the agenda on access forward at speed and, as with any change, it takes time to adjust and adapt to it and to find the right balance. The Government is committed to working with members, the public, the British Medical Association and the Royal College of General Practitioners and other professional bodies to recover from the pandemic and strengthen our primary care services. They are the bedrock of our NHS.

I move amendment S6M-01217.2, to leave out from “, and calls” to end and insert:

“and other appropriate primary care health professionals, such as dentists, nurses, optometrists and pharmacists; appreciates that GPs and primary care staff were asked to change the way that they worked in response to the challenges posed by the COVID-19 pandemic; thanks GPs and primary care staff for keeping practices open and their hard work during the pandemic; recognises that, for many patients, the choice of using ehealth and telehealth solutions to initially contact their GP has been convenient, but that it is not a solution that is appropriate for all; believes that face-to-face consultations will continue to be necessary and that they should be taken forward in line with clinical guidance and in a manner that is as safe as possible as quickly as possible, and welcomes the Scottish Government commitment to work with the Royal College of General Practitioners, British Medical Association, Royal College of Nursing and other stakeholders to deliver this.”

16:50  

Yesterday, we debated the extent of the crisis that is being experienced by the NHS, with services struggling to meet demand and waiting lists at a record high. Today, we are talking about GPs.

Much of the attention so far has focused on acute care in our hospitals and with emergency services, but the truth is that, if we are to resolve some of those problems, we need to mobilise and resource primary care. We all value our GPs. In fact, we value the entire primary care team—practice nurses, health visitors, dentists, pharmacists, and optometrists. They all do an important job in preventing and dealing with ill health, but they are often the first and most enduring contact in a patient’s journey.

It is unfortunate that the messaging from the Government has so far been confused, suggesting that somehow GP surgeries have been closed. In fact, GPs and their teams have been working really hard—[Interruption.] The minister might have got to the right message today, but in her previous appearances on media, she has suggested that surgeries have been closed.

GP teams have been working really hard. They are the ones at the vaccination centres, helping colleagues in hospitals with Covid patients, all while dealing with their own patients. Primary care has adapted and evolved, and yes, there might be more telephone or virtual consultations, but if someone needs to be seen, they should be given a face-to-face consultation.

I recognise that parents want the reassurance of a face-to-face consultation with their GP. Clinically, it is important, as some conditions need to be seen to be diagnosed, so virtual consultations should not be the default. However, GPs are operating to Scottish Government guidance, which wants a model of telephone consultations first. That has not changed, so it is ultimately up to the Government, and transferring blame to GPs is neither right nor appropriate.

Although I recognise the frustration that is felt by people over their access to a range of services, that is never a reason to be abusive to staff, who are doing their very best to help us to keep safe.

We all need to acknowledge the failure of the Government to support staff in primary care. That is not just a pandemic problem; it has been building for the past 14 years of the SNP’s mismanagement of the health service. The NHS recovery plan fails to address the pressure on staff, and the lack of a coherent workforce plan to build capacity to match demand is more than disappointing; it is a dereliction of duty.

During the previous parliamentary session, a promise was made to recruit an additional 800 GPs, but there is an urgent need for them now, not in 2027. Many are retiring early because they feel burnt out. What progress has been made on that? Multidisciplinary teams in GP practices were also promised, but progress on that has been, at best, extremely patchy. There are simply not enough physiotherapists or pharmacists in general practice. That is another pre-pandemic promise that has not been fulfilled. Mental health workers are also unlikely to be in place until 2026, which is five years from now.

Pharmacists have a contribution to make to NHS recovery, but the Government appears to be resistant to the opportunity, and I hope that that is not the case. If the Government extended the pharmacy first service, pharmacists could be the first port of call for many people. They could help with diagnostic testing to reduce antibiotic use, and deal with blood pressure, type 2 diabetes, and cholesterol testing. That would help to alleviate some of the load on GPs. Equally they could play a key part in helping with the management of those who have long-term conditions—[Interruption.] I genuinely do not have the time; I am in my final minute.

Pharmacists could provide pharmaceutical care and create the capacity for GPs to focus on acute presentation and reduce hospital admissions. More of that needs to be happening, so that we use appropriately the entire primary care team.

I will make equally brief mention of dentists. Patients are told that dentists are open for business, but Government guidance means that they are able to offer appointments to only a small number of patients. Again, there is mixed messaging from the Government, which leads to frustration for dentists and their patients alike. [Interruption.] The ministers may be laughing, but this is the truth. [Interruption.]

The member is in her last minute.

More and more people are going private. In effect, the Government is privatising the dental service by the back door.

We all value the primary care team, which has GPs at its heart. I think that primary care is key to the recovery of the NHS, but it needs to be resourced. So far, the SNP has failed to do so adequately. It is true that we need to remobilise and that patients want more face-to-face consultations, but the Government needs to be honest and manage expectation. Above all, it needs to resource GPs and primary care so that they can play their full part in the recovery of the NHS. As the BMA said,

“we are open for business, but it’s not business as usual.”

I move amendment S6M-01217.1, to insert at end:

“; recognises the important contribution that GPs have made throughout the COVID-19 pandemic, including stepping up to support colleagues in acute care and administering vaccinations across the country, and regrets the Scottish Government’s failure to remedy the alarming shortage of GPs and staff in the wider primary care team, with the current workforce feeling overworked and undervalued, all of which will severely undermine a sustainable future for primary care in Scotland.”

16:56  

As my colleagues across the chamber have done, I start by paying tribute not just to our GPs but to their practice managers, their nurses and everyone who supports them. In particular, I pay tribute to them for their role during the pandemic. Many GPs I know personally volunteered in the red zones of the Covid hubs, and they were instrumental in the foothills of the vaccine roll-out.

Seeing their GP is often the first stage on a patient’s journey of receiving a diagnosis for a mental, physical or chronic health condition. As with every other sector in our health service, the challenges that GPs have faced throughout the pandemic have been unprecedented. Their ability to deal with pressure and to use their skills to make a diagnosis and prescribe a course of action, largely over the phone or through video consultation, cannot be overstated. While that was necessary during the height of the pandemic, it is absurd that we cannot at least set a date for pre-pandemic activities to resume in practices. If people can go to a nightclub, an optician or a massage therapist, logic would suggest that it is safe enough for them to have an in-person consultation with their GP. I know many GPs who want to get back to that position, too.

The Scottish Liberal Democrats welcome the Conservative Party’s motion, because it highlights a problem that the Lib Dems are becoming increasingly concerned about. Last week, my colleague Willie Rennie asked the health secretary whether he would look again at the physical distancing requirements in primary care settings, and he was assured that the Government would do just that. The Government’s amendment is typical of its approach to our health service—there are plenty of warm words but an absence of action. Where is the evidence of that commitment?

I have two points to make. As the member knows, Public Health Scotland published guidance, probably last week, that reduced the physical distancing measures.

The member said that we will not give a date for the resumption of face-to-face consultations. Does he recognise that GPs are seeing patients face to face and that the BMA says that it would be absolutely wrong to set an arbitrary date? Who should we believe—him or the BMA?

I absolutely welcome the intervention of the BMA on that point. It is the interruption in the flow of face-to-face consultations that is causing a backlog and perhaps resulting in the missing of clinical signs, which could lead to far more acute conditions. That is why the GP workforce is so keen to get back to working as normal. I recognise that people are being seen, but they have not been seen in non-emergency situations.

I am as cautious about Covid as any minister in the Government is, but I am deeply worried about the long-term and deep-seated problems that continue to exist in the NHS. The BMA has described GPs as being under huge and unrelenting pressure, and has said that the workforce has a real feeling of demoralisation. That is because of not just the pandemic but the Government’s long history of poor workforce planning. It is all well and good for the Government to promise the introduction of more GPs to alleviate the strain, but those GPs cannot be magicked out of thin air. It takes the best part of a decade to train a GP. The seeds of the workforce crisis were sown upstream by the Government a long time ago.

We all know that the Government likes to create the impression that all the problems are new, but the problems in primary care were well established before the pandemic started. Recognition from the health secretary of the long-term nature of the problems would not go amiss.

The Government must set a date for the return of face-to-face services for GP practices, but it must also seek to improve the state of the services that were offered pre-pandemic. Long waits and a high-stress work environment might be normal in a public sector that is stewarded by this Administration, but that does not mean that it is good enough.

Increasing the workforce is part of the answer, but reducing the downward pressure on GP surgeries is also key, particularly around mental health.

The Scottish Government needs to increase the number of trained GPs in Scotland and embed more nurses, dieticians, physiotherapists and, crucially, mental health practitioners with GPs so that people can get a wider range of diagnosis, treatment and follow-up care within their community. That is how to reduce the burden on current staff and, crucially, offer the level of care that everyone across Scotland deserves.

17:00  

Our NHS is in crisis. It is not simply under extreme pressure, as the First Minister and the Cabinet Secretary for Health and Social Care say. The NHS in Scotland is overrun. It is crumbling from historical and systemic failures of Government to plan, resource, manage risk, listen and act. The writing on the wall was clear before the pandemic.

Let us be frank. We need to accept the extent of the crisis, we should deploy strategies for learning from failures and we need a plan. I do not mean a headline number or a sum of cash but a detailed plan that is underpinned by credible clinical pathways. I appreciate that that is no easy task, and I will illustrate why.

Behind the stats on A and E waiting times and patients trying to get through to their GP and beyond the unedifying comments from the health secretary advising sick patients to think twice before calling for an ambulance, endangering life—cabinet secretary, your words matter in medicine—this is what is happening. This week in my GP practice, the phones were as usual ringing off the hook. We have calls from patients who need to be seen in the pain clinic or to get an operation, but with no appointment date in sight, they are quite rightly ringing up, desperate and pleading for help. There are also new patients who have developed a lump or bleeding, and they are also trying to call us. It is demand on top of demand.

Let us be clear that GPs are working hard. GPs are seeing patients. GPs up and down the country are pulling out all the stops. However, they are overrun because the system is failing them. We need the capacity to be able to see more patients face to face. We never stopped seeing patients face to face, but we want to see more. GPs see patients whose management would change from being seen, but there are other patients we would love to bring in, such as an elderly patient who just wants to come in and be seen. However, the system is failing us and we are being overwhelmed.

Beyond my own practice, the picture across the NHS is shocking. More than 600,000 patients are waiting on hospitals. Those are the same folks who are calling wanting to know whether their family doctor can do more—something, anything—to help. I am afraid that, sometimes, they cannot, so patients go on suffering.

That has a knock-on effect on accident and emergency, which faces huge demand, such as from a patient with persistent abdominal pain who just wants—needs—to be seen by a specialist. All the while, Covid cases are soaring, piling even more pressure on to our fragile system and its exhausted staff in wards and intensive care departments.

Let us be frank—this is not a system that is simply under extreme pressure. It is an NHS in deep crisis. Two years ago, before the pandemic, morale was low. Healthcare workers struggled through the winters, but things got a bit better in the summer, and we just coped. The pandemic has exacerbated the problems and brought them into sharp focus. There is a perpetual state of winter crisis. The conveyer belt is jammed.

Let me explain. The NHS is a conveyer belt. As a GP, I see a patient and either treat them or put them on the conveyer belt to be seen in secondary care by the hospitals. They are then treated and drop off the conveyer belt. However, what is happening just now is that I am putting patients on the conveyer belt and they are going nowhere. They are still suffering, so they quite rightly come back to me again and again. They are not getting the help that they need. We need hospitals to start running at capacity again—in fact, we need them to run at more than capacity to catch up. We need more staff.

As NHS professionals, we have no choice but to carry on, because our patients’ lives depend on us. However, as a parliamentarian, I call on the Scottish Government to start producing details on how it plans to save the NHS under its watch. The system is failing our GPs and we need help.

As a declaration of interest, I note that I am a practising doctor. I refer members to my entry in the register of members’ interests.

17:04  

The Conservative motion is very short and simple. It says:

“That the Parliament recognises that patients have a right to treatment by GPs, and calls on the Scottish Government to set a target date for a return to normal activity in practices, including face-to-face consultations.”

That chimes with what Douglas Ross said in the chamber on 1 September:

“People cannot see their general practitioner in person”.—[Official Report, 1 September 2021; c 30.]

That statement was inaccurate, as we heard this afternoon and have heard before. Some would suggest that it was a complete fabrication even.

It surprised me that, on the very same day, Dr Gulhane MSP—someone whom I greatly respect—accused the health secretary of “attacking general practitioners” and causing his colleagues “a lot of distress”. He went on to ask the First Minister to ensure that his colleagues did not leave their posts, which would be an “unmitigated disaster”. I agree with Dr Gulhane—it would be a disaster if GPs left. I therefore suggest that the Scottish Tories, including their leader, stop spreading mistruths about patients not being able to see their GPs.

I am sure that the member will join me in giving heartfelt thanks to our GPs right across the country. In Dumfries and Galloway, GPs are seeing more patients face to face than they did pre-Covid. General practice is the front line of our NHS. Does the member agree that Nicola Sturgeon, who was warned about GP shortages as far back as 2008, has failed to adequately resource general practice?

I certainly disagree with Mr Carson—I am sure that he will not be surprised by that.

In his comments earlier today and yesterday, Dr Gulhane indicated that he had been seeing patients in his practice on Monday. I welcome the fact that Dr Gulhane is doing that, but GPs have been working tirelessly throughout the pandemic. They have been seeing patients face to face, and to suggest otherwise is unfair to GPs and their staff.

GPs are not happy with that characterisation. I will read a short extract from a reply that I received from a GP in my constituency after I wrote to them on behalf of constituents. They said:

“My complaint is that I feel you and your colleagues are engaging in lazy politics. You know we are working in a pandemic and you must be aware of the demands but yet regularly we receive emails from yourselves (and I know from other practices they have the same issue) going over the same issues ie when will you see patients face to face. We do see patients face to face and have always been doing so.”

[Interruption.] Sorry, but I cannot give way—I have already taken one intervention.

That goes back to the comments that Sue Webber made earlier and the comments of Douglas Ross on 1 September. The conversation continued for a couple more emails and then ended.

The email from that GP clearly shows frustration at MSPs spreading mistruths, and it does no one any favours to perpetuate that myth. Hearing the Tories in this chamber making those claims again today highlights yet again the lack of regard that they have for GPs. On how the debate should be framed, the argument about GPs seeing the same number of patients face to face is different from what the Tories are attempting to argue.

I know that the current situation does not suit everyone and that there is a demand to return to GPs seeing people face to face more regularly. However, I also know that some constituents have appreciated and like the telehealth and e-health that have been offered, although I accept that they do not suit everyone. [Interruption.]

The member is winding up.

It is clear that face-to-face appointments will be better for many patients, but the NHS Near Me video consultations will be better for others.

It was not that long ago that we were all clapping for the NHS. Sadly, the Tories have moved on to badmouthing our NHS and our GPs.

17:09  

Like many members, I have been inundated with requests from constituents who want to return to face-to-face GP consultations. For the most part, people simply want a feeling of assurance from a friendly face. After all, so many of our constituents, particularly older people, receive a great deal of social as well as medical support from their local GP practice. It is understandable that losing that has been a real drain on so many lives.

Given all that, I think that, within the sensible confines of Covid regulations, we should be returning to face-to-face appointments. We do not expect that to happen immediately; the public are simply asking for clarity about when it might happen, and at the moment there is little that I can tell people—I can only calm their concerns.

Equally, I understand why, with Covid cases rising and fears about the approaching winter, many people still have concerns about returning to some form of normality. We must be led by the science and a disciplined focus on utilising the proven methods that limited the spread of cases in the past.

In doing that, we must be clear with the public about what it means. Thousands of people have been patient and have stayed away from the NHS unless they thought that their cases were urgent, but that will undoubtedly mean that serious illness has gone undetected. We have to let people know—sooner rather than later—when they can get back to their doctors. I want to work with the Government on that, as I am sure all members do. We will get the message out, but there has to be some direction from the top.

In chorus with other members, I emphasise the amount of pressure and uncertainty that GPs and practice staff have been dealing with since March 2020. Public criticism of GPs is perhaps due to unclear communication, and the current situation is making things worse. No one should be under the illusion that care is not being provided. GPs, practice staff and their colleagues in wider primary care teams are supporting colleagues in acute care and are administering thousands of vaccine doses. In most cases, GPs and practice staff are working more than they have ever worked, and with that come fatigue, burnout and serious stress.

In a recent BMA survey of GPs, two thirds of respondents said that their current workload is unmanageable, and more than half said that their workload had got worse during the pandemic. In what sense does that suggest that the problem is under control? We seem to have stressed staff, patients who are worried that they will not receive the care that they need and ministers who are unresponsive to people’s plight. If we do not deal with the problem now, it will damage the NHS not just during the Covid period but for years to come.

Let us be honest. Staffing levels in local practices were a concern long before Covid became a part of everyday life. This is just one chapter in 14 years of SNP mismanagement of the NHS. A great many staff expressed concern about staffing levels in the years that led up to the pandemic. Had we listened, we might have a much easier road to recovery now.

Will the member give way?

I will.

The member is closing.

Sorry, Presiding Officer.

This should be a lesson about proactivity rather than reactivity. Let us not wait until something becomes a media scandal before we tackle it. I am not sure that Scotland can take the situation for much longer. We need to deal with it now, because a crisis could become a catastrophe.

17:13  

I congratulate Carol Mochan—she gave a fantastic speech, as did all the other Opposition speakers. It seems that SNP members have no idea what is going on out there among their constituents.

Rural constituencies such as mine have been let down badly for years by the SNP Government. There is a lack of urgency in responding to the GP and health recruitment crisis—on top of the pandemic, of course, which has affected face-to-face consultations.

Will the member give way?

Will the member just allow me to finish my first paragraph?

It is no wonder that I am contacted regularly, particularly by old and vulnerable constituents who are anxious about their worsening health conditions.

I wanted to make this point during the previous speech. Recruitment, retention and support for GPs have been on-going issues for some time, not just in Scotland but across the UK and internationally. What suggestions does the member have for action to address those issues in a collegiate approach to supporting the NHS?

If that is all that Bob Doris has, the situation is desperate.

We know that GPs have done a tremendous job throughout the pandemic and I thank them, as other members have today, for their wonderful work. However, there is an inescapable problem, and it is not new. Even before the pandemic, the SNP was failing general practice with underfunding and a lack of workforce planning.

Will the member give way?

I will give way to the cabinet secretary on workforce planning, to give him the opportunity to tell members how his Government is progressing with GP recruitment.

I am happy to do so. We have a target of 800 additional GPs by 2027, and I am pleased to say that we are on track to meet that. I am delighted with our record investment in the NHS, which is £400 million more than the Tories pledged in their manifesto.

On track? I can tell members that the figure is 237—

That is on track for 2027.

The target is 800 additional GPs by 2027, and the cabinet secretary says that we are on track with 237—that is interesting.

There are also substantial issues with a higher than usual number of A and E presentations. Patients’ conditions are worsening, and GPs tell me that they are getting phone calls from patients who are fed up because they cannot be seen by the hospital. The sheer volume of correspondence that I receive from constituents on that subject concerns me greatly. It is vital that we give our constituents the opportunity to return to person-to-person consultations. One of my constituents said:

“For me, it is wholly unacceptable that representatives of medical practices can tell me that a medical practitioner will call me back at some time during the day without telling me when. Hanging around waiting for that call, which may not come until later in the day, is preposterous.”

That constituent is just one of many who have shared with me their frustration about a lack of access to appointments, which is having an impact on them and causing their health to deteriorate. For the past 18 months, GPs have not been able to eyeball their patients. I believe, although it is not proven, that the lack of early intervention must be contributing to increased presentations at A and E.

In addition to a lack of face-to-face appointments, there is the constant threat of rural GP practice closures as a result of this Government’s failure to properly conduct workforce planning and its obsession with centralisation. Just two weeks ago, Coldingham practice, in the east of my constituency, was branded “not fit for purpose”, with challenges around recruitment, the retention of staff, health and safety and lone working.

For the benefit of those members in the chamber who have their fingers in their ears, I remind them that, in 2008, the British Medical Association warned Nicola Sturgeon that Scotland was facing severe shortages of GPs. That was 13 years ago—it is absolutely disgraceful that that has not been addressed.

I have taken a number of interventions, so I will conclude. We all know that it will be a long winter, and Scotland’s people want a pragmatic solution to the health crisis. Is it too much to ask the health secretary to set a date for returning to normal activity and, furthermore, to pledge that GP services will be protected and recruitment targets will be met?

17:17  

I am pleased to speak in the debate on behalf of my constituents—very few of whom have contacted me on this issue. I have listened to some of the—[Inaudible.]—today who appear to believe that although Covid-19 is undoubtedly a disaster of unprecedented proportions it should somehow not really have an impact on services. That is a weird position to take, and it is alienated from reality and, to some extent, from honesty. It is also extremely disappointing to hear members make assertion after assertion based on extremely flimsy evidence, but not taking the ministerial interventions that came in response.

The Covid-19 pandemic changed what was considered to be the safest way for GPs to operate. Surgeries are places where potentially ill people congregate in waiting rooms, so it made perfect sense, in the early stages of the pandemic, to switch to more use of remote and telephone appointments, where possible. The implementation of telehealth technology was a long time coming; as in so many walks of life, the gains from it should not now be cast aside in the rush to return to what was once considered to be normal.

I have used the telehealth method during the past two years—on far too many occasions; that is one of the benefits of ageing—and I have found it to be nothing but reassuring, speedy and efficient, at a time when I feared the exact opposite because of the unavoidable pressures that were being placed on our NHS, including our GPs, during the pandemic. However, I have also been seen face-to-face on more than one occasion because—despite what some members would have us believe—doctors can, and will, see a person if they have the slightest concern about their condition.

The Cabinet Secretary for Health and Social Care set out the NHS recovery plan last month; I draw members’ attention to it. It is an ambitious document that is backed by real investment in our health service, to the tune of £1 billion over the next five years. An important part of that will be the recruitment of more than 1,000 new mental health link workers in our communities to take some of the pressure off front-line general practices. I am glad that mental health continues to get the focus and resources that are needed for it to provide better help to people in communities across Scotland.

I also welcome the assurances in the document that, where possible, there will be a return to face-to-face GP services as soon as it is practical and safe to do so. I have been contacted by some—just a few—constituents who have been having difficulty getting appointments. Although innovative telehealth solutions like NHS Near Me video consultations are welcome, they do not always reach all the people in areas of higher deprivation, where access to the internet and to internet-enabled devices might be harder for some people to come by. It is clear that there are still parts of the population who are not yet able to access telehealth, so I would welcome an assurance that priority for face-to-face GP appointments will be given to people who are unable to access the other means of obtaining GP assistance.

The BMA believes that the demand for GP services has been pushed to record levels during the pandemic, so I am pleased to welcome the additional investment by the Scottish Government of £155 million to provide general practices and their patients with support from a range of healthcare professionals in the community, including community pharmacists so that people can have their prescriptions filled faster.

This has been a time of tremendous pressure on GP surgeries across the country; we all owe them a huge debt of gratitude for their work and their contribution to steering Scotland through the pandemic. GP surgeries in Scotland have done remarkably well in coping with the upsurge in demand for their services while having to adopt new ways of working to ensure the safety and wellbeing of staff and patients during this unprecedented and difficult time. They deserve more than being criticised and used as a political weapon by some members of the Opposition.

On a point of order, Presiding Officer. It was not possible to intervene on Mr Dornan when he was speaking. It is surely unparliamentary behaviour to cast the charge of dishonesty upon one’s opponents in the chamber.

Although members are responsible for the content of their contributions, I urge them to remember that the code of conduct requires members to consider one another with courtesy and respect at all times.

17:22  

I, too, pay tribute to Scotland’s incredible GPs, who have worked in extremely pressured and fast-changing conditions during the pandemic. The contribution of all practice staff has been immeasurable, so they deserve our sincere thanks.

They do not deserve the suggestions that general practice has been closed during the pandemic and that GPs have not been offering face-to-face appointments. I am seriously concerned about the tone of the Conservative motion in that respect. GPs have continued to deliver a 24/7 service, including out of hours services, and have always offered face-to-face appointments when they have been clinically necessary.

As the Government amendment notes, GPs

“were asked to change the way that they worked”

due to Covid and they rose to that challenge. They rapidly adapted their ways of working while also stepping in to help with vaccine roll-out and staffing at Covid assessment centres.

There were GP workforce shortages prior to the pandemic and, as we know, demand for GP services has risen considerably in recent months. People are now coming forward with conditions that emerged during lockdown and GPs are caring for patients who are on long waiting lists for secondary care. Contrary to what some people might think, remote working does not reduce people’s workload. Practice staff are tired, overstretched and demoralised, so I am seriously concerned about the impact of the debate on their morale.

We cannot afford to undermine GP recruitment and retention, but the Conservative motion has the potential to do just that. Instead of demanding that GPs return to doing something that they have been doing throughout the pandemic, we should be talking about how we can recruit more GPs and other members of the primary care team, and how we can best support practice teams’ mental and physical wellbeing in order that they can continue to deliver excellent patient care in difficult circumstances.

Does Gillian Mackay agree that the Scottish graduate entry medicine programme is a unique way that the Scottish Government is taking forward GP recruitment and training?

I absolutely accept that, and I thank Emma Harper for that intervention.

Of course, patients should be able to get a GP appointment when they need one, and that appointment should be face to face if that is clinically appropriate. No one is denying that. Remote consultations are not appropriate in all circumstances, which is recognised by GPs. However, for many patients, they offer more flexibility and reduce the need to travel.

According to the BMA, before the pandemic approximately 20 per cent of GP appointments were by telephone or video, so the presumption that a return to normal equates to a return to all appointments being face to face does not reflect the reality of general practice before Covid. There should not be a one-size-fits-all approach, and the Royal College of General Practitioners Scotland is clear that a mix of telephone, face-to-face and virtual appointments is the future of general practice.

We must also acknowledge that, due to on-going Covid protections, the physical capacity within general practices is limited. If we rapidly increase face-to-face appointments, patients could face longer waits for appointments due to reduced numbers of people being able to enter the building.

Patient safety is a serious consideration. For example, Asthma UK and the British Lung Foundation in Scotland do not support setting a target date for a return to majority face-to-face appointments because of the on-going risk from Covid-19 to people who are living with lung conditions. They have said that being worried about mixing with others in waiting rooms could force people to miss out on treatment.

I will end with a quote from a GP that has been provided by the BMA, which I think sums up why I have such serious concerns about the motion. The GP said that they have had a

“barrage of negativity from policy makers and smears from the media. General practice has been open all throughout the pandemic and yes, we are seeing patients face to face every day—examining, investigating, immunising, and treating.”

GPs deserve better and so do patients. They need us to be honest about the pressure that general practice is under and about why services are being delivered as they are. I hope that members will reflect on that at decision time.

I call Clare Adamson, who is the last speaker in the open debate.

17:26  

The pandemic has been with us for 18 months now but, for some people in the chamber, it seems to matter to them only when it is politically convenient. Colleagues on the Tory benches blithely switch between saying that the health service is in crisis and, at the same time, furiously opposing public health measures that the Scottish Government enacts to help that same health service at this time. They cannot sit both ways on this issue.

In a speech yesterday, I said that we cannot get “back to normal” and that we have to get “back to better”. That is what we should be doing. However, the motion epitomises an attempt to make political capital out of a deeply complex and precarious situation. As legislators and policy makers, we need to allow for nuance, we need to consider consequences, and we need to seek expert opinion and listen to advice.

“Set a target date” might sound good for a soundbite, but there is one thing I am sure of: the Covid virus is not working to a Google calendar.

Does the member agree, however, with BMA Scotland’s comments in relation to not having enough GPs before the pandemic? Does she agree with that statement?

I do, and that is why we have set recruitment targets. However, as Mr Doris pointed out, the problem does not exist just in Scotland; it exists throughout the UK, and the recruitment of GPs is a global crisis. The BMA has said that, but it has also referred to

“the clinical problem, the ongoing need to protect vulnerable patients and staff from risk of Covid19, and current workload pressures within GP which mean that GPs, like the rest of the NHS have to prioritise their time to meet the most urgent clinical need. BMA Scotland would not welcome an arbitrary target date set by the Scottish Government”.

The Royal College of General Practitioners has said that it refutes in the strongest possible terms any suggestion that general practice has not been delivering face-to-face consultations throughout the pandemic. That has been said many times but, as some interventions would indicate, people have not read the briefings, so I feel that I have to repeat them. The royal college’s briefing says that face-to-face consultations have been provided to patients where they are deemed clinically necessary, usually following a telephone or video consultation. That has ensured that general practice can continue to provide care to patients to help protect the most vulnerable of them. The royal college goes on to say that it would not welcome an arbitrary target set by the Scottish Government to reach such a position.

That is from the BMA and the Royal College of General Practitioners.

I am the sister of a retired GP and fellow of the Royal College of General Practitioners who still examines with it, so when I was invited to take part in projects with my local training GP practice, I was delighted to do so. For a number of years, I have been working with my local practice, which has included bringing GP trainees into the Parliament when it was possible to do so, to visit the Health and Sport Committee, have a cup of coffee or lunch, and speak about how the work that we do here influences their work in the future. I was also able to show them the open and welcoming interaction that we want to have with our colleagues in the health service.

During the pandemic, I was involved in a video call with the local and other training practices. Dr Logan, who was also involved, is the NHS lead clinical tutor in primary care. I learned that, in 2019, of the 300 medical students at the University of Glasgow, only 19—6 per cent—were choosing an elective in general practice.

It is an incredibly difficult, nuanced situation, and for members on the benches opposite to make political capital from it this afternoon is lazy politics that does no good for the health service.

17:31  

In closing for Scottish Labour, I echo the comments of colleagues across the chamber, and pay tribute to the GPs who are working in our NHS across Scotland. In particular, I recognise their dedication throughout the pandemic, their support of colleagues in acute care and the help that they provided to administer the vaccination programme, most notably to the oldest and most vulnerable in our communities.

We should also take a moment to pay tribute to all those who support GP practices, including the practice managers, practice nurses, healthcare assistants and admin staff. Those teams working together and knowing their communities makes a real difference to the health and wellbeing of us all.

In the debate, we have heard about some of the frustrations and worries that patients have experienced, particularly when they have been unable—or have felt unable—to access face-to-face appointments. In her opening remarks, Jackie Baillie referred to the frequent confusion in communications about whether GPs are open. Carol Mochan said that some of her constituents feel that they should stay away from their GP and the NHS.

From Sandesh Gulhane’s first-hand experience, we heard about the capacity that is required in order to support GP practices, and the current pressures on all parts of the system. We have to recognise that, for many elderly patients and patients with a learning disability, or perhaps due to communication or language barriers, digital is not always accessible or appropriate. Virtual GP appointments should not be the default position. Patients and clinicians must have the option to have face-to-face appointments when it is safe to do so.

Of course, we acknowledge that technology has its role to play, but we need to consider, along with clinicians, the appropriateness of when digital appointments are offered. In her contribution, Gillian Mackay spoke about Asthma UK and the British Lung Foundation, which have pointed out the importance of ensuring that diagnostic GP appointments, such as those for people who have lung condition symptoms, take place in person as soon as possible, to allow a holistic view to be taken of what is going on in that person’s life. Therefore, we call on the Government to make clear what more can be done to support GPs to see more patients face to face.

I highlight the issues that were raised by Alex Cole-Hamilton, and previously by Willie Rennie, around physical distancing, particularly in smaller and more rural practices, where space in waiting rooms is a concern, and the possible need for improved ventilation.

The member will know that, last week, Public Health Scotland published guidance around reducing physical distancing. Is he suggesting that we should not listen to the experts, but eliminate physical distancing altogether, which would be the concern?

My point, and the point that was made by other members, is that we need to look at the package of measures that can be put in place. For example, in smaller practices, we need to look at where people are waiting, where it is acceptable to wait and what ventilation is put in place. We need to consider how we can increase capacity by doing a variety of things.

It is clear that GPs and their teams are stressed and undervalued, and we must recognise that. We have heard about the survey by the Royal College of General Practitioners, which reported that 57 per cent of GPs who have been working during Covid-19 said that it has negatively impacted their mental health, and 58 per cent of respondents to its annual tracking survey reported that they are so stressed that they cannot cope at least once a month.

Many are leaving front-line practice altogether: they are leaving a job that they love, because they just cannot do it anymore. However, we know that, as with other crises in our NHS, those challenges existed before the pandemic and have been exacerbated by it. Indeed, the Royal College of General Practitioners, the BMA and others have pointed out that the on-going crisis in GP recruitment has been around for some time; that has been referenced today by colleagues.

Will you wind up, please?

Certainly.

Rachael Hamilton and Jackie Baillie made the point that the promise to recruit 800 new GPs is nothing new and has not yet been delivered.

We point again to the Government’s thin recovery plan and ask where the detail is to support retention and increase capacity to ensure a sustainable future for primary care in Scotland, with the wellbeing of patients and staff at its heart.

I call Humza Yousaf, the Cabinet Secretary for Health and Social Care. You have up to five minutes, cabinet secretary.

17:35  

I have listened closely to the debate, and it is clear to me that one point of consensus is that we all place a high value on access to our GP teams, those across primary care and, indeed, those who work within GP clinics up and down the country. Primary care teams have responded magnificently to the pandemic, ensuring that care is provided to those who need it, when they need it. I add my voice to the tributes rightly being paid to our GPs and other primary care staff. I also unequivocally say that any abuse aimed at our primary care staff is utterly unacceptable.

I understand the frustrations of a number of colleagues across the chamber who have spoken about the emails in their in-boxes from constituents. I too have received such emails and I completely sympathise and empathise with the frustrations that some patients might feel at not being able to see their GP face to face. Patient choice is crucial in accessing GP services, but it must be informed by the best and latest clinical guidance.

We must be mindful that we are still in the midst of a global pandemic and contending with a highly transmissible variant of the virus. However, that seems to have been ignored again by a number of contributors to the debate. In fact, the Tory motion itself speaks of a “return to normal activity” on the day that we have registered a further 30 Covid deaths. Such talk is as reckless as it is premature. Nevertheless, we share the desire of colleagues across the chamber to increase the number of face-to-face GP consultations.

There has been some significant disinformation during the debate on the scale of the Scottish Government’s investment in our primary care workforce, so I will correct some of those inaccuracies. It is the SNP that promised to deliver, and is delivering, record funding for our NHS.

Will the cabinet secretary take an intervention?

I will do so shortly.

It is the SNP-led Scottish Government that has committed to primary care and GP services receiving a greater share of NHS front-line investment over this parliamentary session—an increase of 25 per cent—and it is this Government that has increased that spending to £250 million.

We have focused a lot on recruitment, but does the cabinet secretary recognise the comment from the BMA that the NHS recovery plan “contains ... worrying gaps”, including the “crucial omission” of

“any plan to retain current NHS staff”?

I thank Finlay Carson for raising that important point. I had a good conversation with the BMA about retention and we have decided to continue to work together to see how we can retain the workforce. Finlay Carson has made a good point, because recruitment is important, as is retention.

We are, of course, increasing our workforce: we are increasing the number of GPs, paramedics, mental health workers and community link workers. All of that is backed by Scottish Government investment. Further, our GP workforce is at record levels. We have more GPs per 100,000 of the population than any other part of UK—the figures are quite stark. We have 94 GPs per 100,000, England has 76, Wales has 75 and Northern Ireland has 72. We are continuing to invest in our GP workforce.

As I have already said, I met the BMA and the Royal College of General Practitioners recently.

Does the cabinet secretary agree that the SNP’s GP contract not only harmed rural practices, reduced the help that they got and made patients travel extraordinary distances, but has not been delivered in areas around the country and has made things worse?

I do not agree with that characterisation at all. Again, Dr Gulhane forgets that we are in the middle of a global pandemic. Some of those issues around the GP contract have undoubtedly been affected by the global pandemic. [Interruption.] I ask members to listen if they can, as opposed to shouting from a sedentary position.

I have met representatives from the BMA and the Royal College of General Practitioners and, although Dr Gulhane’s entry in the register of interests shows that he is a member of both professional bodies, he has been conspicuously silent about what they have said, unequivocally, about the Tory motion that is in front of us, which is that the Tory demand to set an arbitrary date for increasing face-to-face appointments is wrong. When it comes to decision time tonight, will Dr Gulhane side with the professional bodies of which he is a member or will he toe the party line? In fact, he said:

“We have phones, videos and can be sent pictures. That means if you are a working person you don’t need to waste your morning coming in to see me; we can be in touch remotely and I can give you the help you need remotely.”

When talking about that technology, he said:

“because it happened so quickly that has led to consternation and people asking ‘Why can’t I see my GP this week?’ ‘Well, you can.’”

Do we believe the August edition of Dr Gulhane or the September edition of Dr Gulhane? He cannot have it both ways.

I ask the cabinet secretary to round up, please.

This winter will undoubtedly bring its share of new challenges, but I am confident that, collectively, we can meet them, and I thank all our NHS and primary care staff for their incredible efforts during the pandemic.

I call Craig Hoy to wind up the debate.

17:41  

The debate has shone a stark light on the problems that face Scotland’s hard-working and dedicated GP surgeries. Too many patients cannot contact their local surgery, let alone get an appointment with their GP, and when they get an appointment, too often, that appointment is virtual, even when the patient would like a face-to-face consultation.

Years of chronic underfunding and the Government’s total disregard for workforce planning have led to a systemic failure that has now come back to bite SNP ministers. Covid has given the SNP a cloak to hide behind but, as many patients and front-line practitioners are well aware, the problems that face GP provision in Scotland predate the pandemic.

Years of SNP cuts have eroded morale among general practitioners and their staff. [Interruption.] I have just started, so I will not take an intervention.

The on-going failure to train and recruit GPs into the service has created the perfect storm that we see today. Pressure has grown to the point where many GPs want to leave the system entirely, sometimes only a few years into their new careers.

However, today, there is no hint of an apology from the Government. It has an army of over 50 spin doctors, funded by the public purse, and more ministers than ever before, but not one of them has the word “sorry” in their vocabulary.

Today, we have heard valuable and insightful contributions. My colleague Sandesh Gulhane, who is a GP, told the Parliament that the Government’s mismanagement of primary care is shocking. Jackie Baillie said that we urgently need to remobilise and resource primary care services. Annie Wells warned that the Government must now do whatever is necessary to get hospital, clinic and surgery waiting times under control—otherwise GPs will continue to be overwhelmed. Alex Cole-Hamilton noted that many GPs wanted to get back to routinely seeing their patients.

Will Mr Hoy take an intervention?

I will give way.

I appreciate Mr Hoy giving way. The cabinet secretary talked about Dr Gulhane saying:

“We have phones, videos and can be sent pictures.”

Does Craig Hoy agree with Annie Wells’s motion, which says that we need to get back to the normality of face-to-face appointments or does he agree with Dr Gulhane that we need to have a mixed model going forward?

Forgive me; I thought that Emma Harper might be getting up to apologise on behalf of the cabinet secretary but, clearly, she was not.

The solution is a hybrid system and that is what we are arguing for.

Does Craig Hoy agree that we need to have telephone, video and face-to-face appointments and that we GPs would love to see more people? Does he also agree that the GP contract was in place in 2018, way before the pandemic started?

Thank you, Dr Gulhane.

I will speak directly to GPs. We are not blaming GPs for not seeing enough patients face to face; we are blaming the SNP Government for saying that GPs do not have enough capacity to see their patients face to face. However, this is not just a capacity issue. GPs are not being given clear guidance on how and in what circumstances face-to-face appointments can routinely resume.

GPs and their patients up and down the country urgently want to know when something resembling normality will resume. When asked whether patients have the right to see their GP face to face, the Cabinet Secretary for Health and Social Care said that that should be only when that is clinically appropriate. Perhaps he can tell the elderly man worried about his wife who is writhing in pain what “clinical appropriateness” actually is. When will ministers realise that their job is to give leadership and confidence to patients and practitioners as we emerge from the Covid pandemic?

Prior to the pandemic, around 1,200 video consultations took place each week on the Near Me platform; that is now running at 12,000 a week. We should be in no doubt that tele and videoconferencing suits many patients and practitioners.

Can I ask you to pause for one moment, Mr Hoy? I am aware that conversations are taking place around the chamber. I ask that members remain in their seats while the debate continues.

Although the system is called Near Me, for too many vulnerable and elderly people, that model of healthcare is simply too impersonal and too far beyond their reach. [Interruption.] I will not give way.

At the height of the pandemic, people were rightly anxious about the prospect of in-patient appointments. As other services shut their doors to patients, GPs worked on and demands on their surgeries and staff reached record highs. However, many patients dropped out of the system, were unable to get an appointment or were reluctant to e-consult. Now they are presenting with significantly more serious health conditions only a matter of months later.

The Government’s feeble and flimsy NHS recovery plan fails to get to the heart of the problems that are facing our NHS today. The Government is in denial about the problems that it has created and is in denial about the critical recruitment and retention crisis across our NHS.

Our NHS needs a bold, wide-ranging, ambitious and urgent recovery plan, not the back-of-an-envelope effort that we have seen from ministers. Our health service needs significant investment and greater understanding of workforce challenges, but after 14 years of SNP neglect, we will not get that from these ministers; nor will we get that from this failing SNP Government. I urge the Parliament to support the motion in the name of Annie Wells.