The first item of business is general question time.
Primary Care Services
To ask the Scottish Government what action it is taking to protect primary care services in light of reports showing the workforce and demand pressures on general practice. (S6O-01764)
I am immensely grateful to general practitioners and GP practice staff up and down the country, who are doing an incredible job during a period of significant challenge. We are absolutely committed to ensuring that being a GP remains an attractive career choice with a manageable workload.
Despite the pandemic, we have recruited 3,220 whole-time-equivalent healthcare professionals to provide support to GPs, underpinned by an investment commitment of more than £500 million since 2018. We have a record number of GPs working in Scotland, and we are committed to having 800 additional GPs by the end of 2027.
I thank the cabinet secretary for his response, but he should know that statistics for 2022 show that the WTE number of GPs has fallen to 3,493. That is 81 fewer than in 2017, when the Scottish National Party announced its intention to boost GP numbers.
Dr Andrew Buist of the British Medical Association has said:
“the SNP government’s failure to boost GP numbers and provide sufficient funding has locked primary care into a ‘vicious circle’ of rising workloads forcing GPs out of the profession.”
Does the cabinet secretary agree?
I am sure that Jackie Baillie knows—it was probably just an oversight—that our target for the period between 2017 and 2027 was based on headcount. Of course, the overall GP headcount has increased by 291 from 4,918 to 5,209, so there has been an increase in the GP headcount and we are making good progress towards the 800 figure.
On the whole-time equivalent issue that Jackie Baillie raises, we are engaging with Dr Andrew Buist, who I meet very regularly, and the Royal College of General Practitioners on what more we can do in relation to retention. However, it should be recognised that having more flexible working patterns is a good thing; it helps with work-life balance, which we hope will help with GP retention.
I commend the RCGP report that was released just before Christmas, which focuses on a number of initiatives that the Government might want to explore in relation to the retention of GPs. We will continue to engage with the BMA and the RCGP on those important issues.
Announcing total funding hides the fact that the Scottish Government may make cuts this year to GPs and primary care. The pressure on GPs will only increase, given that we have 23 fewer GPs than last year. Yesterday, NHS Greater Glasgow and Clyde announced that it is pausing non-urgent elective surgery and going on to an emergency footing—despite the money—which will increase the pressure on primary care.
On BBC Radio Scotland today, we heard from many people who are suffering from long Covid and who say that the service is failing them. A nurse who we cheered and clapped for during the pandemic says that she will lose her job and her home because of long Covid. If patients are saying that they cannot get help from hospitals, they will go to their GP and increase the pressure. What more is the cabinet secretary willing to do to help long Covid patients?
Dr Sandesh Gulhane is right: we had to make some really difficult choices around our budget this year, including the reprofiling of funding for primary care. We did that because his party completely mismanaged the economy of the United Kingdom, and high inflation costs meant that our budget in the health and social care portfolio was worth £650 million less than when we set it in December last year. Difficult decisions had to be made because we do not have the full fiscal levers in our hands.
We will continue to invest in multidisciplinary teams, which will help to spread the workload from GPs to other members of staff. We will also continue to invest in NHS 24, for example, from which people get really excellent advice.
I announced the additional recruitment of 200 staff for long Covid, and Sandesh Gulhane knows that we have committed £10 million over three financial years. We will continue to invest that funding to help long Covid sufferers as well as anybody else who is suffering from any condition at a time of great pressure on our national health service.
This week, a Shetland GP surgery posted on social media that
“Due to high demand and staff availability, we are currently dealing with clinically urgent requests only. If your request is of a non-urgent nature, please consider contacting us next week.”
What can the Scottish Government say to people who are seeking medical help and the staff who are under pressure in our island NHS services?
The period over the past few weeks has been and continues to be one of the most difficult periods that the NHS has faced in its existence. We know that that is a result of the cumulative impact of the pandemic, the rise in Covid cases—Beatrice Wishart will know that, on Friday, when the Office for National Statistics released the most recent data, the figure was one in 25—and the fact that flu cases are higher than they have been in many years, together with the rise in cases of Strep A and other viral infections. All of that was combined with the festive period and a snap of cold weather. The combination of those factors has made it a really difficult period for the NHS and social care up and down the country.
What are we doing? On Tuesday, I gave Parliament some detail on what we are doing to provide support, which includes helping with the issues around discharge and investing further in the NHS 24 service that is available up and down the country.
Difficult decisions will have to be made at a local level, whether in the NHS Shetland area or elsewhere, but I hope that those difficult decisions will be time limited. As the additional support that we have provided kicks in and as the flu and Covid cases begin to abate, as, in time, I hope they will, that will help the health service through what has been a really difficult time. I again express my gratitude to every member of the NHS and social care workforce, who are working so hard during these difficult times.
Scottish Government (Meetings)
To ask the Scottish Government when it last met with the Chancellor of the Exchequer. (S6O-01765)
I have not yet met with the current chancellor and I did not have the opportunity to meet with either of his two predecessors. I last met the Chief Secretary to the Treasury on 17 November, after the United Kingdom autumn statement.
Forecasts compiled by Consensus Economics show that the UK faces the worst and longest recession in the G7. The Office for Budget Responsibility predicts that we are facing the biggest fall in living standards since records began, due to inflation, and more than three quarters of members of the British Chambers of Commerce say that the UK Tory Brexit deal is not helping them to increase sales or grow their business. What economic levers does the Scottish Government need in order to escape a future of Westminster failure, to build on Scotland’s economic strengths and to become as successful as comparable independent European countries?
With all the available evidence, the extent of the economic damage that is being done by the Brexit that was imposed on Scotland by the United Kingdom Conservative Government is becoming very clear. Among the specific areas in which we are suffering is that of free trade with the European Union. Companies are suffering in that regard, so it would be an advantage for Scotland to be an independent country with the ability to rejoin the EU.
Given the failures in the energy market, the ability to redesign the energy market would be an important attribute for Scotland to have. The ability to use employment laws to ensure fairer work would be an advantage, as would the ability to have a migration policy that was designed to boost our working-age population. That can come only with Scottish independence, given the UK Government’s hostility to such approaches.
Mr MacDonald correctly highlights the severe economic damage that is being caused by Brexit and the opportunities that Scottish independence would give to create much more fiscal flexibility for the Government in Scotland.
Emissions Reduction (Reports)
To ask the Scottish Government whether it will provide an update on its response to the Climate Change Committee’s reports “Progress in reducing emissions in Scotland—2022 Report to Parliament” and “Scottish Emissions Targets—first five-yearly review”. (S6O-01766)
The Scottish ministers will take the appropriate time to consider the recommendations in the Climate Change Committee’s advice and will respond in the spring. We will work closely with the Climate Change Committee, as part of our continuous review of policy, to ensure that we benefit fully from the committee’s expertise while progressing delivery and considering possible new actions. The committee’s advice will also support the development of the next climate change plan, which will be published in full later this year.
The Climate Change Committee said that the Scottish National Party targets were not “accompanied by deep thinking” about policies, and it accused ministers of “magical thinking”. Clearly, this portfolio must be prioritised, but I have discovered that the Scottish Government has only six people working on its climate justice fund, while just four are dealing with the loss and damage fund that was announced at the 27th United Nations climate change conference of the parties—COP27. If we compare that with the 25 civil servants who are working on an independence prospectus costing £1.5 million a year, the Government’s skewed priorities are very clear.
Will the cabinet secretary be taking steps to realign Government resources away from the manufacture of grievance and division and instead direct them towards delivering practical priorities to address the climate emergency?
We always deploy staff in the civil service to take forward our areas of policy priority. That is why Scotland’s emissions are down by well over 50 per cent on the 1990 baseline, which takes us more than halfway to our target and has us ahead of other parts of the United Kingdom in addressing climate change.
I assure the member that we will continue to take forward a range of policies to tackle the issue of climate change and ensure that we do so in a fair and just way. I gently point out to the member that we certainly will not tackle climate change effectively if we are opening up new coal mines.
The Climate Change Committee’s report recognises key policy areas, such as industry and electricity supply sectors, that are reserved to the UK Government. To what extent is meeting our net zero targets here in Scotland reliant on decisions that are taken by the UK Government, and how is the Scottish Government working with the UK Government to ensure that our ambitions in Scotland are matched by the rest of the UK?
We take seriously the range of areas that are the responsibility of the Scottish Government, and we pursue policies to make sure that we deliver on our statutory climate change targets. However, there are also areas that are reserved to the UK Government that have a direct impact on climate change policy in Scotland. For example, in the energy sector, negative emissions technologies play an extremely important part in helping us to meet our climate change targets both in Scotland and across the whole of the UK. That is why taking forward carbon capture and the Acorn project are mission critical not only to Scotland’s climate change targets but to the UK’s. Any further delay in making a decision about supporting carbon capture, use and storage and the Acorn project just creates uncertainty, risk around employment and a lack of investment in key areas, and it places a greater burden on other policy areas. That is why we need the UK Government to step up to the plate, show leadership in this area and give the go-ahead to the Acorn project in Scotland.
If we are to meet our national target of reducing car mileage by 20 per cent by 2030, reliable, affordable and readily available public transport will be key. One of the Climate Change Committee’s recommendations for achieving that is to invest in sustainable forms of transport, yet the Scottish Government is proposing widespread service cuts to Scotland’s railway. Will the minister think again and rule out service reductions to demonstrate his Government’s commitment to Scotland’s railway, to protect jobs and to reduce transport emissions?
I recognise that access to good public transport is an important part of getting people out of their cars and on to public transport, which is why we have been making significant investment in our railways in order to decarbonise them. We are now at the point at which more than 75 per cent of all journeys on Scotland’s railways are on electrified routes that have been decarbonised as a result of the investment that the Government has made. We have also made significant investment in decarbonising the bus system, through grant schemes that support the electrification of the bus network with electric buses, which are now being rolled out.
I am sure that the member will also recognise that almost 50 per cent of people in Scotland travel free on our bus network as a result of the concessionary travel schemes for those who are over 60 or under 22. I am sure that the member welcomes that as an example of showing leadership in encouraging people on to our public transport network.
I would appreciate concise questions and responses.
Bladder Cancer Deaths
To ask the Scottish Government what steps are being taken to reduce bladder cancer deaths. (S6O-01767)
Bladder cancer mortality reduced by 14 per cent over the period 2010 to 2020 and we are committed to continuing to improve that. As outlined in our “Endoscopy and Urology Diagnostic Recovery and Renewal Plan”, we will refresh and implement once for Scotland clinical pathways to prioritise demand for cystoscopy, including for bladder cancers. We have also introduced six urology hubs in Scotland, which provide rapid access to diagnostic procedures to enable earlier cancer diagnosis and treatment.
Bladder cancer has one of the highest mortality rates of all cancers. The rate is currently around 50 per cent. It also has a high rate of recurrence, making it one of the most expensive cancers to treat fully, and Scotland’s ageing population will likely result in longer-term, more complex treatments. To that end, will the minister confirm what funding has been made available specifically for research into bladder cancer, including treatment of the disease and data gathering to enable correlative research?
The funding schemes that are supported by the Scottish Government’s chief scientist office provide opportunities for applied health research across a range of health challenges including bladder cancer. Applications are assessed through independent expert review with funding decisions being based on the recommendations of independent expert committees. They would be very happy to consider any applications for research into bladder cancer.
The CSO also contributes financially to a range of National Institute for Health and Care Excellence research funding schemes, which are open to applications from researchers in Scotland. In addition, the CSO invests through NHS Research Scotland in a cancer research network to support the delivery of studies in the area.
Finally—
Please be brief, minister.
—our national cancer quality programme has developed quality performance indicators for bladder cancer, which were first published in November 2021, and it is encouraging that targets relating to 30 and 90-day mortality rates indicate a good performance.
Young People’s Mental Health Services
To ask the Scottish Government whether it will provide an update on what it is doing to support young people’s mental health services, including in colleges and universities. (S6O-01768)
The Scottish Government continues to provide record funding for mental health services to ensure that all children and young people have access to the right mental health support at the right time. That includes continued investment in improving child and adolescent mental health services; funding for 230 new and enhanced community supports and services for children, young people and their families; and provision of access to counselling services for all secondary school pupils.
In addition, we have exceeded our commitment to deliver 80 additional counsellors in further and higher education, with 89 additional counsellors now working to support students across institutions.
If that is the case, I am flummoxed as to why the Government is even considering cutting the very mental health counsellors that the minister has just described in colleges and universities at the end of this academic year. I remind him that two thirds of college students report having low wellbeing and more than half report moderate to severe symptoms of depression. If that is the case, why is it that, when students need their help, the Government is withdrawing the support of the very people that were designed to help them?
As I said in my previous answer, we have exceeded the 80 counsellors that we planned for, with 89 supporting students. The student mental health plan that is being taken forward by the student mental health and wellbeing working group, which will sit alongside the Scottish Government’s forthcoming mental health and wellbeing strategy, will inform the Scottish Government’s future approach to student mental health and wellbeing. On its publication, in the spring of 2023, it will provide the framework for institutional action on the issue. As part of that, officials will work with the university and college sectors to move to a position where they fund elements of student mental health support, including counsellors, as part of their core offer to students.
Question 6 has been withdrawn. Question 7 was not lodged.
Caledonian MacBrayne Replacement Booking System
To ask the Scottish Government when it expects the replacement booking system for CalMac to be fully operational. (S6O-01771)
CalMac’s new booking system, Ar Turas, is expected to go live across all CalMac routes in the spring of 2023. I am extremely disappointed that there has been a delay in the introduction of Ar Turas, which I do not think is acceptable. My officials in Transport Scotland have engaged with CalMac and have been informed that it will be operational by this spring. I will meet CalMac next week to seek further assurances to that end.
The benefits of Ar Turas include better live deck-space management for the use of capacity, better communication about disruption and a standardised accessible digitally enabled service, both online and through apps, as a means to purchase tickets and apply any changes instantly.
I thank the minister for that reply, but the problem that the minister has is this. The project started as far back as August 2016. More than five years on, in December 2021, we were told by the Government that it would be completed and operational by February 2022. In July 2022, we were told that it would be completed and operational by November 2022. Just last month, on 8 December, we were told that it would go live in the spring, but 11 days later, on 19 December, we were told that it would not be operational until November 2023. Do Scotland’s islanders, who are dependent on lifeline services and work in fragile economies, not deserve an explanation, urgent action and a lot more honesty from the Government?
I will provide Mr Leonard with an honest response, and I hope that he heard in my initial response my own disappointment and my commitment to seek further assurances from CalMac in relation to the repeated delays to the introduction of the system. It is vital for islanders that we get the implementation of the new system right for Scotland’s island communities. CalMac has advised my officials in Transport Scotland that its user acceptance testing has highlighted that a number of issues have been anticipated, given the complexity of the number of routes that CalMac serves. It is important that those issues are addressed before the system is launched and the supplier has been working to address those issues. The member will also understand that I, as minister, require to have confidence that the new system will work for islanders and visitors to our islands alike. To that end, I will continue to work with CalMac on achieving that cast-iron assurance, to ensure that the new system will deliver the improvements that passengers and islanders need to see.