Good morning. The first item of business is general question time.
Rural National Health Service Boards (Support)
To ask the Scottish Government what steps it is taking to support rural health boards. (S6O-03174)
It is for health boards to plan and provide services that best meet the needs of local people, including those in remote and rural areas, consistent with national policies and frameworks. As someone who grew up in a rural island community, I recognise that remote and rural national health service boards experience particular challenges, which is why we continue to work to support the delivery of services that are flexible and responsive to local population needs and geographic challenges. An example of that is the national centre for remote and rural health and care, which was launched last October.
As for resources, the Scottish Government’s budget for this year provides funding of more than £19.5 billion for NHS recovery, health and social care, including more than £14.2 billion of investment for NHS boards, delivering a real-terms uplift of almost 3 per cent compared with what is happening through the United Kingdom Government’s continued austerity approach.
Steering away from the political debate around specific budgets, I am concerned that the current funding model does not take into account the ageing demographic in areas such as Dumfries and Galloway and the challenges in delivering health services across a wide geographical area. In the light of the recent work on rural depopulation, will the cabinet secretary look again at whether current funding formulas truly account for the needs of ageing people in rural communities?
I hope that, wherever Oliver Mundell appears to be steering to on screen, he is doing so safely.
To go back to the question in hand, I set out in my initial answer that I recognise that remote, rural and island communities have particular demographic challenges. I will always take representations from Oliver Mundell and other members who represent rural areas, and from members of our health boards, on how we can support them in the delivery of such services. I have already referenced the work that has been done on the national centre for remote and rural health and care, and I hope that its work will continue to inform the decisions that we need to take in that area.
As much as Oliver Mundell would wish not to talk about the budgetary situation, the financial landscape is incredibly pressing and we need to be cognisant of that as we take our decisions.
Because of staff shortages, NHS Western Isles is offering record salaries to general practitioners to relocate to the islands. Will the Scottish Government now reassess rural and island recruitment incentives to attract staff, given that the cost of employing locums is excessive?
Moreover, given that one of the reasons for the current difficulty is people’s inability to find homes, will the Government also take steps to address the housing crisis in those areas by placing a ceiling on the numbers of holiday homes and second homes that a community can sustain, and by placing a burden on homes that are subsidised by the public purse, to keep them within the local housing market?
My colleagues across Government will note Rhoda Grant’s calls on the housing front and her request that we crack down further on holiday lets. I know from the rural housing action plan, which my colleague Paul McLennan is progressing, that action is being taken to provide greater housing supply in those areas. I recognise that recruiters, not just for health and social care services but across the public sector, face that challenge in ensuring that we can attract people to live and work in those areas, and I will continue to work with my colleagues across Government on that.
As there is much interest in this session, concise questions and responses will be appreciated.
Medication in Schools (NHS Fife)
To ask the Scottish Government whether it has intervened to direct NHS Fife and the relevant education authorities to permit schools to issue basic medication, such as paracetamol and ibuprofen, without the need for a general practitioner prescription, in light of reports that primary care is struggling in NHS Fife. (S6O-03175)
The Scottish Government has not directed NHS Fife or Fife Council to give permission to schools to issue basic medication such as paracetamol or ibuprofen. Our guidance on supporting children and young people with healthcare needs in schools states:
“schools should not purchase non-prescribed medication unless using those powers permitted under the provisions of the Human Medicines Regulations.”
Those regulations permit schools to buy and hold salbutamol inhalers to treat asthma or adrenaline auto-injectors to treat anaphylaxis.
Parents may provide schools with non-prescribed medications, alongside clear and appropriate instructions for their use, and give consent for the medication to be administered. Alternatively, pupils—or parents or carers on their behalf—can access the national health service’s pharmacy first Scotland service, which is provided by community pharmacies, to receive advice and medicines to treat minor illnesses and common clinical conditions.
I draw attention to my entry in the register of members’ interests as a practising NHS GP and as someone who recently worked in NHS Fife, which proved to be far more challenging than it needed to be. I was unable to order blood tests that I could order at other health boards, and I could not organise radiological investigations. It was an absolute nightmare.
However, none of that compares to the disgrace that was the rejection of referrals from GPs to the hospital. It is clear to me, from having spoken to other GPs across the health board, that there is an underlying presumption of rejection of referrals, presumably to improve figures. I was told that it depends on the day and on the mood of the consultant whether a GP referral is rejected.
Forcing GPs to waste their time by issuing prescriptions for basic medications—because schools insist upon it; please just help sort that, minister—and by having to fight the system to get patients seen and treated is unacceptable. Will the minister call out that postcode lottery and undertake an investigation into the practices of NHS Fife?
That was quite a question. It is something that we will take note of and look at. We have regular meetings with NHS Fife, and we have discussions on those things.
With regard to prescriptions for schools, I laid out in my first response that community pharmacies are the places where families should go.
Health centres in North East Fife have not been given the members of the multidisciplinary team that they were promised. However, local GPs have offered to solve the problem by doing the recruitment themselves. The previous health secretary said that that would lead to different services in different parts of the country. Does the minister accept that people in North East Fife are already facing different outcomes? Will she allow GPs to recruit those staff themselves?
We have been working with GPs in Fife to ensure that we get the right volume of staff there. I am happy to look into proposals to allow GPs to appoint people within their practices, and I am happy to get back to the member on that.
Pupil Assaults in School
To ask the Scottish Government what action it is taking to reduce the number of assaults by pupils in schools. (S6O-03176)
I am absolutely clear that our schools should be safe and consistent learning environments for all. No teacher, support assistant or pupil should face violence in Scotland’s schools.
The behaviour in Scottish schools research that was published in November 2023 provides a robust and accurate national picture in relation to behaviour in Scotland’s schools, and the series of behaviour summits that I held in September, October and November, alongside the BISSR findings, are informing the national action plan. In my statement to Parliament last year, I confirmed that the multiyear joint action plan would be developed, together with local authorities, trade unions and others, to tackle instances of challenging behaviour, and that plan will be published in the spring.
This week, the First Minister and I launched the gender-based violence framework, which aims to address the issues of misogyny and gender-based violence in schools, a theme that was captured by BISSR.
I was recently contacted by a constituent in Angus, who told me how her son required hospital treatment after being assaulted by a fellow pupil. Unfortunately, my constituent has been dismayed by the school’s response: the headteacher has twice declined to meet her personally; a proposed safety plan was full of holes; and, incredibly, it was suggested that her son be removed from his peers and educated separately while requests to exclude the alleged attacker were rebuffed. Does the cabinet secretary believe that that family are receiving the support that they need? What will she do to ensure that they get that support?
I thank Mr Golden for raising his constituent’s query. Obviously, he has outlined some of the details of that case in the chamber. If he is able to share more details with my office, I will speak to officials regarding the specifics.
In that instance, it would, of course, be a matter for the local authority to engage with the parent and the headteacher. Mr Golden has outlined a challenging instance, and it is worth reflecting that that is also captured by the BISSR that was published last year. I am happy to engage with the member on the specifics of his ask.
Bill Kidd has a short supplementary question.
We know that poverty and child hunger have a key impact on children’s behaviour at school. What is the Scottish Government doing to ensure that no child in Scotland goes to school hungry?
We have the most comprehensive free school meal offer of any nation in the United Kingdom, and we are currently extending it to cover primary 6 and 7 children in receipt of the Scottish child payment from February 2025 as the next step towards universal provision in our primary schools.
School-based Violence
To ask the Scottish Government when it last met the Educational Institute of Scotland and other teacher unions to discuss school-based violence. (S6O-03177)
I meet our national teaching unions regularly to discuss a range of topics, including violence. I met the EIS and other teaching unions last Monday, and, on 31 January, I chaired a meeting of the Scottish advisory group on relationships and behaviour in schools to discuss the national behaviour action plan. That meeting was attended by the main teaching unions, including the EIS. I held a round-table meeting with the EIS and other teaching unions on 6 December to discuss their reflections on the national behaviour in Scottish schools research and their own views on actions that are required in the relationships and behaviour action plan.
The cabinet secretary will, no doubt, have heard from those unions about the disappointment that they felt that the Scottish Government was so desperately unaware of the EIS Aberdeen local association report on violence. Some 800 teachers had responded. A national plan is coming forward. Can the cabinet secretary confirm that teacher wellbeing will be added as a quality indicator in school inspections, given the impact of violence on our teachers?
The localised evidence that Martin Whitfield has spoken to is hugely important in informing the national action plan, which will set out a range of actions for the Government to respond to, and also for local authorities. It is important that that is understood.
I continue to engage with the EIS at the national level with Andrea Bradley and with the other teaching unions, a number of which have also published documentary evidence on the extent of challenging behaviour in our schools.
Martin Whitfield asked a specific question about a quality indicator in school inspections. I think that that would be a matter for the newly appointed interim chief inspector. However, I am more than happy to speak to her about that process and about including that indicator in future school inspections for her consideration.
Liam Kerr has a brief supplementary question.
Following the shocking EIS report on violence in Aberdeen, Aberdeen City Council is introducing a whistleblowing form for teachers who feel that they are discouraged from reporting violent incidents by pupils. Does the cabinet secretary welcome that move, or does she have concerns?
I do not think that I would have concerns. I think that that is an appropriate move from that local authority to respond to challenges in its area. I understand that other local authorities use similar protocol in relation to incidents of that nature. We will certainly seek to engage with Aberdeen City Council, as I have already done, on its approach to challenging behaviour.
Ministerial Population Task Force
To ask the Scottish Government how it is taking forward the work and priorities of its ministerial population task force. (S6O-03178)
The population strategy sets out the task force’s priorities around the opportunities and challenges for Scotland’s changing population. We are committed to a collaborative approach to delivering those ambitions, including with the Convention of Scottish Local Authorities and local authorities through our recurring population round tables, with membership from Scottish Enterprise, Highlands and Islands Enterprise and South of Scotland Enterprise on the population programme board, which supports the task force.
Our addressing depopulation action plan, which was published in February, states our commitment to working with regional, local and community partners to deliver a sustainable solution to population challenges. We will also launch our talent attraction and migration service this year. That will support our ambition for Scotland to be as attractive and welcoming as possible by helping employers to use the immigration system to fill skills needs and supporting individuals to move to and settle in Scotland.
I thank the minister for that substantial answer, and I appreciate the need for actions to address depopulation in some areas of Scotland. Conversely, however, we also require actions to meet the growing needs of areas with significant growing populations—such as my constituency of Edinburgh Northern and Leith. As the Scottish Government begins to consider its budget for 2024-25, will the ministerial task force examine rapid population growth in the Lothians, and will it consider meeting Lothian MSPs, local councils, NHS Lothian and other relevant bodies to hear about the pressures and concerns?
As the minister responsible for population, I am more than happy to meet anyone to discuss the impact of a lack of a balanced population, which affects those who face depopulation and those who face rapid growth, in different ways.
In 2023, the Scottish Government undertook exploratory research about the drivers and implications of rapid localised growth. That was considered by the ministerial population task force and local government partners.
As a next step, the Convention of Scottish Local Authorities is working with local authorities to develop an enhanced understanding of the implications of population growth, particularly in east-coast local authority areas. We are engaging directly with local authorities through the joint Scottish Government-COSLA population round table to hear about those distinct challenges. That work will build on our understanding of the challenges and will inform the next steps of the ministerial population task force.
Let us pick up the pace, colleagues.
Vaping (Action to Minimise Harm)
To ask the Scottish Government what public health measures are being taken to minimise harm from vaping, prior to the introduction of the proposed ban on single-use vapes. (S6O-03179)
Our tobacco and vaping framework, which was published in November 2023, committed to taking action to reduce vaping among non-smokers and young people. Vapes should not be used by young people or adult non-smokers; they are one of a range of possible cessation tools available for existing smokers to quit.
Alongside the framework, we launched the take hold marketing campaign, which successfully increased the awareness of parents, carers and children of the harms and risks of nicotine addiction from vaping.
New resources on vaping were also launched on the Parent Club, NHS Inform and Young Scot websites. We continue to work across the four nations on progressing the outcomes from the smoke-free generation consultation.
Organisations are concerned about how disposable or single-use vapes are defined. They are concerned that manufacturers might try to add a USB port to a disposable vape to get around potential regulation, as well as about the potential scope of exemptions in the regulations. Will the minister provide some assurances on those issues and detail any other work that is under way while we wait for a ban to be in place, such as instructing retailers to put vapes behind cover and tackling advertising?
The Scottish Government has published its draft regulations, which define a single-use vape as
“a vape which is not designed or intended to be re-used ... and includes any vape which is ... not refillable, ... not rechargeable, or ... not refillable and not rechargeable”.
The purpose of that is to support any future design changes to those devices.
Organisations can view the full proposed definition in the draft regulations on the Scottish Government website. As I have said, we are working closely with other United Kingdom nations to ensure a consistent definition across the UK, and with trading standards officers and other organisations to ensure that the definition is fit for purpose.
NHS Dumfries and Galloway (Funding Deficit)
To ask the Scottish Government when it last discussed NHS Dumfries and Galloway’s funding deficit with the national health service board. (S6O-03180)
More than £0.5 billion of increased investment is provided for front-line NHS boards in the 2024-25 budget. That real-terms uplift has taken total funding to £13.2 billion. Despite our significant investment, the system is under extreme pressure as a result of the on-going impacts of Covid, Brexit, inflation, the cost crisis and United Kingdom Government spending decisions.
The Scottish Government’s financial delivery unit is in on-going contact with all boards to address the financial challenge. That includes scrutinising and challenging financial plans and agreeing actions to support recurring savings and financial sustainability. The FDU last met NHS Dumfries and Galloway on 4 March.
NHS Dumfries and Galloway has projected that it will face a £54 million deficit by March 2025, and the Scottish Government has ordered it to find £29 million in savings in the forthcoming year alone. In a region where people cannot find an NHS dentist to register with; mums-to-be in Wigtownshire have to take a 150-mile round trip to Dumfries to give birth because the maternity unit in Stranraer remains closed; cottage hospitals that were closed in order to deal with Covid have not reopened; and there are record vacancies for consultants and record waiting lists, where exactly does the cabinet secretary expect NHS Dumfries and Galloway to make cuts of nearly £30 million in the next year alone without that having a devastating impact on patient care?
I thank Colin Smyth for his question and his interest in the area. Despite our significant investment, which I have already outlined, all NHS boards, like other public services, are under unprecedented pressure as a result of inflation and, quite frankly, yesterday’s budget.
The support that we are providing through the likes of the financial delivery unit consists of: funding to cover pay increases; scrutiny and challenge of three-year financial plans; considering and reviewing the financial impact of national and local service planning options; and work to deliver recurring savings of a minimum of 3 per cent, which is supported by our sustainability and value programme and the financial improvement group. That targeted additional support through the Scottish Government’s FDU will be there to monitor and support boards with their financial performance and to support financial improvement.
I recognise the challenges that Colin Smyth has set out. I will continue to work with boards to ensure that we see continued progression and improvement in our health service, while also addressing the significant financial challenges that we are facing.