Rural Affairs and Islands
The first item of business is portfolio question time, and the first portfolio is rural affairs and islands. I invite any member who wishes to ask a supplementary question to press their request-to-speak button during the relevant question. As ever, there is quite a bit of interest, so I make the usual plea for brief questions and responses whenever possible. I will try to police that as lightly as is necessary.
United Kingdom and New Zealand Free Trade Agreement (Agriculture)
To ask the Scottish Government, regarding any impact on Scottish agriculture, what its most recent assessment is of the UK-New Zealand free trade agreement. (S6O-01804)
The UK Government’s economic modelling for the New Zealand deal shows that the agriculture and semi-processing sectors will be losing sectors. The former UK Government Secretary of State for Environment, Food and Rural Affairs shares our view that that deal and the Australia deal are “not ... very good” deals for the UK.
Scottish farmers have been clear that the trade deal—which provides New Zealand exporters with unfettered access to the UK market despite having lower operating costs and regulatory standards—will undercut domestic agri-food producers and put jobs and the rural economy at risk. The outcome is also in stark contrast to the outcome from the recently negotiated European Union and New Zealand trade deal, which better protects the EU’s agri-food sector. That reinforces our view that the best place for Scotland is within the EU.
I preface my next question by paying tribute to Scotland’s most famous farmer and poet, Robert Burns, on his birthday—25 January.
Is the cabinet secretary aware that Conservative Lord Hannan of Kingsclere and UK Government minister in the Department of International Trade Lord Johnson of Lainston both stated during a House of Lords debate that New Zealand lamb is better for the environment than home-produced lamb? Does she agree that that is not only wrong but an insult to Scotland’s farmers, who work extremely hard to provide a product of internationally renowned quality, and that it demonstrates the continuing failure of the Conservative Party to defend and safeguard the interests of Scottish farmers?
The member is absolutely right. We know that there has been a catalogue of failures to protect the interests of Scottish farmers. One example is Brexit, but there has also been the UK Government’s abject failure to secure trade deals that protect our agri-food sector. As I said in my initial response, the former UK secretary of state, who was in post during the negotiations on the trade agreements, has criticised them now that he is no longer in that post.
I could not disagree more with the comments that were made during that Lords debate. Scots lamb is produced to some of the highest standards anywhere in the world and, looking beyond quality at the wider production and supply chain, it supports jobs throughout our rural communities and economy. By eating Scots lamb, we are supporting our local producers instead of consuming a product that has been shipped halfway around the world, with the obvious climate impact that that has.
Blue Economy
To ask the Scottish Government what consideration it has given to how its blue economy vision for Scotland can support developing industries within the blue economy in the drive to net zero. (S6O-01805)
The blue economy vision represents a long-term strategy that serves as an overall framework for marine policies and actions. We have committed to mainstreaming a blue economy approach so that policies and decision makers have clear alignment with that vision.
For example, the blue economy vision is at the heart of the marine fund Scotland, through which we are providing £14 million annually in grant funding to a range of sectors that support Scotland’s net zero commitments. That protects and creates jobs in Scotland’s coastal communities, and it supports local supply chains and industries to adapt and invest for the future.
The value of natural capital is referenced across many of the Scottish Government’s policies and strategies, including the blue economy vision and the paper “Delivering Scotland’s Blue Economy Approach”. However, if we are to deliver good policy that benefits Scotland’s natural capital, we must have a complete understanding of what we have. Currently, there is a significant knowledge gap, as NatureScot’s natural capital asset index does not include marine habitats, citing the lack of available data as a reason for that exclusion. Given how vital good data is to good policy, how does the Scottish Government propose to improve the quality and quantity of its data gathering?
We are always looking to see where we can improve and what other information we can gather, because we want to base the decisions that we are taking on the best available science and data. Unfortunately, when it comes to the marine environment, the area is vast, so, even with all the resources at our hand, it would be nigh impossible to map out all the assets that we want to map out and gather all the science and data that we want. That is why we have set out a number of policies on how best we can adapt to the situation; how we can develop policy in the absence of science and data; and how we intend to work to improve the situation where we possibly can.
An important element of that process is looking towards collaboration. The question is about how we can work with our stakeholders, industry and academic institutions to build the science and evidence base.
The paper “Delivering Scotland’s Blue Economy Approach” states that we will
“consult on applying a cap to fishing activity in inshore waters ... that will limit activity to current levels and set a ceiling from which activities that disrupt the seabed can be reduced in the light of evidence as it becomes available.”
Why are we using evidence only to reduce activity instead of following wherever it takes us, even if that means an increase in inshore fisheries activity?
That question follows on from Brian Whittle’s point. Willie Rennie makes an important point about gathering data and evidence. I will not prejudge the outcome of any consultation, because we will look to set out more information and have more engagement on those policies in due course. I would be happy to discuss that question further with the member as we look to launch that consultation and as the policy continues to develop.
Question 3 is from Sandesh Gulhane, who joins us remotely.
Avian Flu
To ask the Scottish Government whether it will provide an update on avian flu, including any measures it is taking to tackle its spread. (S6O-01806)
Since the start of October 2022, there have been 18 confirmed cases of highly pathogenic avian influenza H5N1 in poultry and captive birds and 81 findings in wild birds in Scotland.
The Scottish Government responded to the risk of avian influenza from wild birds through the introduction of an avian influenza prevention zone in October 2022, which requires all bird keepers to follow strict biosecurity measures and continues to remind keepers of those obligations. The Scottish Government and its operational partners have a robust control strategy in place and a proven track record in dealing effectively and rapidly with controlling outbreaks.
I call Sandesh Gulhane.
I think that we might have lost Dr Gulhane’s connection.
I will take a brief supplementary question from Paul McLennan.
Understandably, this is a worrying time for poultry farmers and all those who keep birds. Scotland continues to be guided by the science, so will the cabinet secretary reiterate what the CVO has said on biosecurity? Given the key role of biosecurity, that message cannot be repeated enough.
I thank the member for raising the point, because he is absolutely right about getting the message out about biosecurity. We cannot stress enough how important those measures are. The scientific opinion from the European Food Safety Authority concludes that housing birds gives a twofold reduction in risk but that that is effective only if there are other good biosecurity measures in place. However, adopting that high level of biosecurity gives a predicted forty-fourfold reduction in cases.
Housing birds that are normally kept in a free-range way also has consequences for the welfare of birds, which we cannot forget about. We must remember that housing birds is not a panacea for the disease and its spread. I invite all members to support the chief veterinary officer in sharing those vital biosecurity measures with their constituents.
We still do not appear to have a connection with Dr Gulhane, so I call Beatrice Wishart to ask a brief supplementary question.
The spread of avian flu has had a dramatic impact on seabird populations, and Shetland is no exception. Mousa nature reserve is famous for its population of breeding European storm petrels. The island was closed to the public last August to help to prevent the spread of avian flu. NatureScot was to carry out a risk assessment review and report back in March 2023. Can the cabinet secretary provide an update on progress with the review?
It is obviously devastating to see the impact that avian influenza has had on our wild bird population. The member is right in what she says about the work that is being undertaken by NatureScot. I am happy to write to her to provide more of an update on where that work is at the moment.
Question 4 has been withdrawn.
Post-Brexit Border Control (Impact on Farmers of Delays to Introduction)
To ask the Scottish Government when it last engaged with the United Kingdom Government regarding the reported impact on farmers in Scotland whose livestock may be exposed to animal diseases as a result of delays to the introduction of post-Brexit border controls for checking meat and other products entering the country. (S6O-01808)
The Scottish Government shares the member’s concerns and takes disease prevention and control very seriously. As the UK Government continues to develop its new border controls target operating model, we constantly emphasise that those controls must be based on veterinary and plant health expertise. We regret that we were not consulted when the UK Government took the unilateral decision to postpone the previously planned introduction of import controls last year.
We continue to bring in safeguarding measures whenever appropriate to maintain our high biosecurity standards, and Scotland’s chief veterinary officer is an active participant in the UK-wide animal disease policy group. I will, of course, stress the point when I meet UK minister of state Lord Benyon on 30 January.
I thank the cabinet secretary for that answer. The view of the NFU Scotland is that
“Amongst all the chaos of securing a ‘Brexit deal’ the mechanics of how border controls would operate was somehow lost”.
That is a reference to the UK Government kicking the can down the road last April. While we sit in limbo, the threat of African swine fever has become of particular concern to our pig farmers. Does the cabinet secretary share my dismay at how the Tories and the Brexit that they forced on us have left the agricultural sector exposed in this way?
I agree with Graeme Dey. In particular, African swine fever, which he mentioned, is a concern and a very real threat. Not only that but, right now, we have a situation in which our producers and businesses in Scotland have an unlevel playing field: importers have the freedom to bring their goods to the UK, but our exporters have had the barriers of checks since day 1.
Not only is that a competitive disadvantage that has impacted, and continues to impact, on businesses here, but it poses a very real risk in relation to biosecurity. I raised that with the UK Government way back in September 2021 in a letter to Lord Frost, in which I stated that the difficulties that led to that decision are due entirely to the UK Government’s reckless approach to exit from the European Union, which is repeatedly being shown to have been done without responsible planning or co-ordination. The results of that are clear. We have inconsistency and constant change and delay, which result in the incurring of unnecessary costs, resource difficulties and delays across the economy and our communities.
Farming (Help with Costs)
To ask the Scottish Government what it will be doing in the coming year to help farmers to mitigate any impacts of rising costs in the sector. (S6O-01809)
The Scottish Government has committed to measures that are worth almost £3 billion this year as a whole to help with the cost crisis. Farmers and crofters will benefit from some of the general measures that we have set out, both as individuals and as a sector.
In relation to the sector in particular, we announced in June last year that farm payment dates would be brought forward to as early in the year as was practicably possible in order to provide support to businesses, which we know had immediate cash-flow challenges. We have delivered on that commitment. More than 17,250 businesses have already benefited from the change, with around £413.5 million having been paid out to date.
We are in the midst of a cost of living crisis, which, in turn, is a cost of business crisis, which is a cost of farming crisis. The rising costs of fertiliser and fuel are well documented. Just in the past week, it has been announced that the price of soy—a major constituent of animal feed—has risen to £100 per tonne. In addition, we have issues such as new and second-hand tractor prices increasing by 30 to 40 per cent. As the member for Edinburgh Southern, I am surprised to find myself bringing up tractor prices in Parliament.
Nonetheless, what steps is the Scottish Government taking to monitor those costs, and what contingencies is it considering so that it can step in and prevent farmers in vital parts of the agricultural sector from going under due to unforeseen rises in costs?
First of all, I note that we absolutely do not want that to happen.
We monitor the on-going situation in a number of ways. Daniel Johnson will, no doubt, be aware that I established a food security and supply task force last year. It was a short-life task force and produced a number of recommendations towards the end of June last year. We agreed to have a further two meetings in order to continue that monitoring capacity and to ensure that we were delivering on the recommendations. We had one meeting towards the end of last year and are looking to set up the second meeting shortly, when we will, no doubt, discuss some of the key issues that the sector is facing.
There is also a monitoring group at United Kingdom level. We had the interministerial group meeting with the UK Government and the other devolved Administrations at the start of this week, at which we looked at the outcome of monitoring and discussed the importance of collecting and sharing data among the Administrations.
I assure Daniel Johnson and members across the chamber that we continue to monitor the situation and to consider what support we can provide, where necessary. I highlight again that not all of the matter falls within the remit of the Scottish Government. However, where we can help, we always strive to do so.
I will take two brief supplementary questions.
There is someone who could have made a really big difference to farmers in terms of mitigating costs—the Chancellor of the Exchequer. Instead, the UK Government decided that farming businesses should be classified as non-high-energy businesses. Does the cabinet secretary agree that, in that decision, the Tories have shown us all what they think of our farmers and our food security?
Be as brief as possible, cabinet secretary.
I am, of course, aware that energy costs are a serious issue that I know is causing a great deal of concern right across the farming sector. Energy pricing is reserved, and we have repeatedly called on the UK Government to clarify how businesses, especially small and medium-sized enterprises such as our farmers and crofters, will be supported through the energy crisis from April, after the energy bill relief scheme ends. Unfortunately, we are still waiting for answers.
I call Emma Harper, who will be brief.
In addition to the increase in costs for farmers associated with the cost of living crisis and Brexit, farmers also experience attacks on their livestock by out-of-control dogs, which has financial and emotional impacts.
Will the cabinet secretary join me in encouraging all dog owners to ensure that they are following the Scottish outdoor access code? Will she agree to meet me so that we can further publicise the Dogs (Protection of Livestock) (Amendment) (Scotland) Act 2021, which I took forward in the previous session?
I thank Emma Harper for highlighting the legislation that she took through Parliament in the previous session. It is really important, because we now have penalties that reflect the seriousness of sheep worrying, which we know is a significant issue in rural areas. I would be happy to meet her to discuss that further and to see what more we could do collectively to build awareness.
Squirrelpox
To ask the Scottish Government what steps it is taking to curb the recently reported outbreak of squirrelpox. (S6O-01810)
We have had outbreaks of squirrelpox, a virus that affects mainly red squirrels, in various parts of Scotland since 2005. I am aware of the local outbreak that has been reported near Lockerbie through the Saving Scotland’s Red Squirrels partnership. Action is being taken to tackle the spread of the virus. That includes targeted grey squirrel control, encouragement of the public to report sightings of infected animals, and asking them to remove and clean feeders in order to minimise transmission. Where we have had outbreaks in the past, targeted grey squirrel control has ensured that local red squirrel populations have successfully recovered.
The minister will know well the importance of ensuring diversity in species across the country and across our natural world. My home city of Dundee and neighbouring Angus have a long history of trying to preserve our red squirrel population. I would appreciate any reassurance that the minister can give that she will continue to monitor the situation and to report back on further outbreaks.
I thank Michael Marra very much for the question, and I encourage local enthusiasm for red squirrels and biodiversity in general. Fortunately, the virus has currently been reported only in the south of Scotland, which is one of Saving Scotland’s Red Squirrels key priority areas. So far, no cases of squirrelpox have been detected in red squirrels on the Highland line or elsewhere.
To make sure that that remains the case, the teams are engaged in strategic squirrelpox sampling of red and grey squirrels. When the virus is detected in a grey squirrel in the area, the teams deploy a rapid response monitoring and control protocol.
The recent reporting of squirrelpox in the Borders is cause for concern. The 2022 great Scottish squirrel survey has shown that concerted efforts in Aberdeen have been very successful, with red squirrels returning and the grey squirrel population significantly decreasing.
Will the cabinet secretary join me in commending the efforts of those who have worked to preserve that iconic Scottish species in the north-east?
Cabinet secretary. I am sorry—I mean minister.
I thank the member for the promotion and for asking her question. I recognise the hard work and perseverance of the people who are working to support the survival of our iconic red squirrel. The dedicated work of those who are involved in the Saving Scotland’s Red Squirrel project, particularly the grey squirrel control officers, has been vital in protecting the Highland line. That has ensured that the red squirrel population in the Highlands has remained safe and free of grey squirrels and squirrelpox. I thank the people concerned for that and for protecting our native biodiversity.
Aquaculture Regulatory Framework (Update)
To ask the Scottish Government whether it will provide an update on the aquaculture regulatory framework. (S6O-01811)
I welcomed the independent regulatory review of aquaculture consenting last year, when I announced an immediate change in the validity period for new marine licences for shellfish and fish farms, from six to 25 years.
I established and chair the Scottish Aquaculture Council to ensure that progress is made across all our commitments. That includes progress of the regulatory review, in addition to delivery of the actions that are set out in our response to the salmon interactions working group report and the new vision for sustainable aquaculture. I am pleased to inform members that they can keep up to date with developments at the Scottish Aquaculture Council on the Scottish Government’s website. Recent activities include establishment of a dedicated consenting task group to explore and pilot new ways of working in the consenting process.
The Scottish Science Advisory Council is currently considering the use and communication of science in the fish farm consenting process, and I look forward to receiving the conclusions of that project this spring.
The cabinet secretary will be aware of the importance of the salmon industry to my constituency, with 600 jobs being based at Mowi in Rosyth. How much more time is to elapse before the Griggs report is fully implemented? What is the reason for the delay of nearly a year in doing so? Has the Scottish Environment Protection Agency been supportive, or otherwise, of the process?
I recognise, and the Scottish Government recognises, the importance of aquaculture to the member’s constituency and a number of constituencies across Scotland. It is an important sector to our economy, and we remain committed to its sustainable development. That applies not only to where farms are located, but to the wider supply chain and the jobs that the sector supports, including the jobs in the member’s constituency.
I emphasise that there has not been a year-long delay. I hope that the member will recognise, given what I said in my initial answer, that a number of pieces of work have been initiated and are currently under way. We always knew that the timescales that were put forward in the Griggs review would be challenging to meet, but we wanted to make sure that we hit the ground running and got started.
We have made significant progress since the report was published. That progress includes the establishment of the Scottish Aquaculture Council and the consenting task force.
I want to assure Annabelle Ewing and other members that SEPA is fully engaged with us on the journey and is a positive and active member of both groups. We want to and will maintain momentum to ensure that we deliver a fit-for-purpose consenting system for aquaculture as soon as possible.
I have two supplementaries. It would be good if they and their responses were brief.
I refer members to my entry in the register of interests as a wild salmon fisher.
In 2018, the Rural Economy and Connectivity Committee published its salmon farming report, which had 65 recommendations. It is clear that the industry is not improving. Fish farm mortalities increased to a high of 29,000 tonnes last year. If we were to put them all in lorries, we would have a nose-to-tail queue of rotting fish from here to Edinburgh airport and beyond. Mortalities are unacceptably high—
Question, please.
Does the cabinet secretary agree and what will she do about it?
Again, I refer to the action that we are taking across the piece, on the back of the Griggs review. We are making progress on a number of its recommendations. I also outline that we have made significant progress since publication of the reviews. I would be happy to write to Edward Mountain with more detail on that and to outline all the progress that has been made in that time.
There is a growing interest in sustainable kelp cultivation rather than kelp dredging. The sector would benefit from an independent regulatory framework, as was recommended in the aquaculture regulatory process review. What progress has been made on establishing such a framework for a kelp farming industry?
Of course, one of the first steps that we have said we will take is publication of our vision for aquaculture. It is an exciting and burgeoning industry, and we want to make sure that it is developed sustainably and that we get regulation of it right. The first step will be publication of the vision, and we will take forward further work from there
That concludes portfolio questions on rural affairs and islands. I will allow a brief pause for front-bench members to change places.
Health and Social Care
The next portfolio is health and social care. If members wish to ask a supplementary question, they should press their request-to-speak button during the relevant question. Again, there is quite a lot of interest in this portfolio, so I would appreciate brief questions and responses that are as brief as possible from the ministerial team.
Drugs and Alcohol (Harm Reduction)
To ask the Scottish Government what steps it is taking to reduce the avoidable harms associated with drugs and alcohol. (S6O-01812)
We have a range of activity under way to reduce harms from drugs and alcohol. That includes a drugs policy national mission specifically to save and improve lives, which is focused on early intervention and prevention and which will also improve the quality of and access to treatment. That was set out in the cross-Government plan, which was published on 12 January.
Furthermore, our national alcohol framework sets out our national prevention aims on alcohol. That includes evaluation of our world-leading minimum unit price policy and our alcohol marketing consultation, which is currently open to responses. Those activities are aimed at reducing consumption and minimising alcohol-related harm.
Health inequalities are a feature of alcohol-specific deaths. Deaths attributed to alcohol are 5.6 times as likely in the most deprived areas of Scotland as they are in the least deprived areas. What steps is the Scottish Government taking within its powers to tackle the root causes of health inequalities and the disproportionate impact that alcohol has?
Ms Tweed is right to highlight the social gradient of alcohol harms. Maree Todd will continue to lead the work on minimum unit pricing and the consultation on the restriction of alcohol advertising and promotion, which work is crucial to changing Scotland’s troubled relationship with alcohol. Much of the work that I lead on the drugs policy national mission has a direct bearing on improving the quality of and access to alcohol treatment through, for example, the expansion of residential rehabilitation, which is supporting families and tackling stigma and trauma.
To overcome the wider root causes of health inequality, the Government is investing £4 billion in social security, including an extension of the Scottish child payment to £25 per child per week for eligible families, and, this financial year, an additional £3 billion to help households who face the United Kingdom’s cost of living crisis, £1 billion of which is providing services and support that are not available anywhere else in the UK.
Scottish National Party and Green ministers approved a cut of £1 million to the alcohol and drugs budget in November, at a time when more than 100 families were grieving the loss of a loved one because of drugs. My thoughts are with those families and I send them my condolences. The SNP has said that tackling the issue is a national mission, but it cannot mean that if it then cuts funding. Front-line services are key to saving lives. Will the minister commit to reversing the cuts to the alcohol and drugs budget, to ensure that services are fully supported to tackle the on-going crisis?
The draft 2023-24 budget for substance use overall is £160 million, which is an increase from £146.5 million. It includes investment in health boards and investment in the crossover between addiction and mental health, and—crucially—an increase from £85.4 million to £99 million is proposed in the alcohol and drugs budget. Of course, people can look at the budget line by line, but the overall budget is increasing.
The synergy between my work on drugs policy and our work on alcohol policy is important. For example, over the lifetime of this parliamentary session, the £100 million that is to be invested in residential rehabilitation and aftercare will benefit as many people with alcohol problems as it benefits people with drug problems.
On Monday, Public Health Scotland published its rapid action drug alerts and response quarterly ?report, which, tragically, confirmed an increase in the number of suspected drug deaths in October and November 2022, with a 20 per cent increase in November compared with the same month in the previous year. Every one of those deaths was preventable, and every one of them was a tragedy. What action is the minister taking, in response to those figures, to ensure that we make significantly faster progress, particularly on the implementation of medication-assisted treatment—MAT—standards?
Part of the national mission was to publish more data and information more quickly, so that services could respond on the ground.
Public Health Scotland has issued an alert around a new substance, nitazene. The number of suspected drug deaths went down over the first nine months of last year, but the member is correct in saying that there was an increase over October to November. It is still too early to say whether there is a direct link between nitazene and the increase in suspected drug deaths in October.
On the action that has been taken, an alert has been issued to drug and alcohol services, emergency services, healthcare and high-risk settings that underlines the on-going importance of naloxone as an effective treatment, along with good harm-reduction advice. There has also been a warning about counterfeit medication: people are being warned not to take oxycodone tablets unless they have been prescribed by a medical person.
Outreach facilities are important as part of the implementation of MAT, and Public Health Scotland has been engaging directly with areas where issues have been detected.
Transvaginal Ultrasound Examinations
To ask the Scottish Government what its response is to reports that some women have been denied transvaginal ultrasounds on the basis of not yet being sexually active. (S6O-01813)
As the Royal College of Obstetricians and Gynaecologists has said, no one should ever be denied access to healthcare on the ground of virginity.
Specific guidance on transvaginal ultrasounds has been produced by the British Medical Ultrasound Society, which all national health service boards are encouraged to adopt. The guidance sets out that a patient who has not had penetrative sex is still entitled to be offered a transvaginal ultrasound, in the same way as cervical screening is offered to all eligible patients regardless of whether they have had penetrative sex. Not yet being sexually active should have no bearing on clinical decision making around access to diagnostic scans.
It is critical that no one is denied access to vital healthcare on the basis of their not being sexually active. Although the number of reported cases of that happening in Scotland is low, one case is too many. Will the minister commit today to ensuring that the guidance notes that are provided for practising and future doctors on transvaginal ultrasounds are clear in saying that women who are not sexually active are eligible for procedures, to give everyone the best opportunity to detect abnormalities?
I am happy to commit to that, and I am more than happy to work with the member if she wants to contact me with ways in which we can ensure that that message goes out loud and clear.
Given that it is cervical cancer awareness week, I take the opportunity to reiterate the point that cervical screening is routinely offered to all eligible patients. It is one of the gynaecological myths that persist in the present day that a woman does not need to have a cervical smear if she is not sexually active. The cervical smear is offered to all eligible patients regardless of whether they have had penetrative sex. I thank the member for the opportunity to reaffirm that in the chamber today.
NHS Greater Glasgow and Clyde (Hospice Beds)
To ask the Scottish Government whether it will provide an update on the number of hospice beds available in the NHS Greater Glasgow and Clyde area. (S6O-01814)
NHS Greater Glasgow and Clyde has a total of 38 hospice beds across the health board area. It is the responsibility of integrated joint boards to plan and commission palliative and end-of-life care services using the integrated budget under their control, so that is a matter for health and social care partnerships, working with NHS boards and independent hospices.
Last week, I met with a general practitioner in my constituency who raised concerns over hospice beds in NHS Greater Glasgow and Clyde, with patients being admitted to the acute hospital sector due to a lack of beds. After a discussion with one hospice, it was suggested that some of the capacity issues relate to on-going Covid restrictions. Can the minister confirm which of the restrictions that are in place could be creating capacity issues and whether there are plans for those restrictions to be removed?
It is fair to say that our NHS is experiencing immense pressure at the moment, which means that there has been a redoubling of our efforts. There has been a power of work going on across the board to ensure that patients can access the right care at the right times and as close to home as possible.
On Covid-19 measures, the continued transition to national infection prevention and control—IPC—guidance sees a return to service user placement based on the assessment of risk alongside the application of routine standard infection control precautions and transmission-based precautions in line with the pre-pandemic IPC practices. However, some pandemic measures remain, and those are the subject of continuous review. That guidance remains in place for a large number of community-based services, including hospices throughout the whole of Scotland. As part of our work on developing a new palliative end-of-life care strategy for Scotland, we will seek to ensure that there is palliative care wherever and whenever it is needed. To that end, we are mapping the services and support that are delivered across Scotland through hospitals and community settings, including in people’s homes and care homes.
NHS Lothian and NHS Borders (Meetings with Government)
To ask the Scottish Government when it last spoke to NHS Lothian and NHS Borders. (S6O-01815)
Ministers and Government officials meet regularly with the leadership of all national health service boards including NHS Lothian and NHS Borders, to discuss matters of importance. It will be no surprise at all to the member that the most recent discussions have centred around the challenging winter pressures. Ralph Roberts, the chief executive of NHS Borders, was on the most recent Scottish Government resilience call, which was chaired by the First Minister last week, in his role as the chair of chief executives.
The cabinet secretary will be aware that, in November last year, NHS Borders launched a single-point-of-contact cancer hub for people who are referred to Borders general hospital with a suspected cancer diagnosis, to provide support and information and to relieve stress. That is being phased in now, and everybody who requires it should have access to that service by spring 2023. Does the cabinet secretary, like me, welcome the initiative, and would he like to comment on it?
I welcome the initiative. All members across the chamber—whether we have personal experience of going through a cancer journey or know somebody, such as a constituent, who has—know that one of the common points of feedback that we get is that people often feel that they are being passed from pillar to post. They want a single point of contact to help to navigate a very difficult time in their lives.
The initiative is one of the key actions in our national cancer plan, and it will remain an important part of our new cancer strategy, which is due to be published in the spring. I commend NHS Borders and the other boards that have the single-point-of-contact cancer hub in place. As the member says, we will look to roll the hubs out nationally.
NHS Greater Glasgow and Clyde (Non-urgent Elective Operations)
To ask the Scottish Government when non-urgent elective operations will resume in NHS Greater Glasgow and Clyde. (S6O-01816)
I have been clear that health boards can and should take the necessary steps to prioritise and protect critical and life-saving care if that is deemed necessary. Local health boards, healthcare professionals and clinicians are best placed to judge what reasonable measures should be taken in each board area to manage the severe pressures.
Like other boards, NHS Greater Glasgow and Clyde has taken the decision to pause non-urgent elective procedures to ensure that those with urgent healthcare needs, including cancer, are prioritised. That decision was not taken lightly and it is under constant review. I spoke with senior management at NHS Greater Glasgow and Clyde and they assured me that they are monitoring the situation daily.
I expect that, where there has been an impact on non-urgent elective operations in a health board area, they will be resumed as soon as possible.
In the NHS Greater Glasgow and Clyde health board area, there are something like 11,000 patients waiting more than a year and nearly 2,000 waiting more than two years for elective surgery, which is an increase of almost 50 per cent since the current cabinet secretary took office. Can he offer clarification of whether urgent and day-case surgery is still going ahead in Glasgow? I know of patients who have had urgent procedures cancelled at the last minute. Given that day surgery does not require overnight beds, can he explain what is going on?
I say again that it is non-urgent elective surgery that has been paused. If Jackie Baillie or any other member knows of cases that are deemed urgent in which procedures have been cancelled, I am happy to raise them with the health board. Equally, Jackie Baillie can raise those issues herself, and she will get an explanation as to why those elective procedures have been cancelled.
Non-urgent elective surgery is cancelled for out-patients as well. That decision was taken locally. We spoke about that with NHS Greater Glasgow and Clyde today. The ability to free up beds and staff can be very important, as staff may have to be relocated to busy sites and wards such as those in the NHS Greater Glasgow and Clyde area.
I give an absolute assurance to Jackie Baillie and other members who have similar concerns about not only NHS Greater Glasgow and Clyde but other health boards that have made similar decisions that the pause will not be in place for a second longer than it has to be. The decision is under daily review. I am happy for Jackie Baillie to pass on any individual constituency-related concerns that she has, and I will raise them with the health board.
Trainee Doctor Workforce (Update)
To ask the Scottish Government whether it will provide an update on Scotland’s trainee doctor workforce. (S6O-01817)
Trainee doctors account for approximately 42 per cent of doctors in hospitals, so they play a major role in service delivery. I am grateful to them for all the work that they have done, particularly during the past few years. The number of doctors in training is up by more than 24 per cent—or 1,295.6 whole-time equivalents—under this Government.
The recruitment of trainee doctors in 2022 was the most successful to date, with 1,073 posts being filled. More broadly, we are continuing to implement the recommendations that formed part of the 48-hour maximum working week—without averaging—for junior doctors from the Scotland expert working group’s report.
In 2011, junior doctor Lauren Connelly from East Kilbride tragically died while driving home from work. Since then, her father, Brian Connelly, has campaigned to reduce junior doctors’ working hours to make them safe. I am grateful to Humza Yousaf for meeting us last year.
Can the health secretary provide an update on the work that is being done to make the working hours of junior doctors safe? Does he agree with Mr Connelly and me that junior doctors should have a maximum 48-hour working week without averaging, which the First Minister committed to work towards in 2017?
I thank Collette Stevenson for asking such an important question. I once again pay tribute to Brian Connelly for continuing to campaign tirelessly to improve working conditions for the medical workforce. He has gone through the most unimaginable tragedy, but he makes sure that he campaigns day in, day out by advocating with his local MSP or directly with Government to ensure that working conditions are improved for the medical workforce.
During the past year, the Scottish Government has worked in partnership with junior doctors and employers to restrict consecutive days of long shifts—those that are longer than 10 hours—to four in any seven days for junior doctors. Progress continues to be made on implementing the broader recommendations of the expert group, including on improvements to facilities, rota design and staff governance.
In respect of the specific question on a 48-hour working week, without averaging, for junior doctors, I remain committed to pursuing that goal, as does the Government. I say to Collette Stevenson that we are seeking to address the longer-term issue. Achieving a 48-hour working week is a process that requires careful consideration to ensure that we get it right and make lasting improvements for the working conditions of our junior doctor workforce.
I am grateful to the cabinet secretary for sharing those details on trainee doctors in Scotland, but he will know that Australia and New Zealand are carrying out extensive marketing and recruitment campaigns that are targeted at trainee doctors who work in Scotland’s national health service. That is exacerbated by a lack of available specialist training posts and general burn-out due to high working hours. Can he advise us what proactive steps the Government is taking to retain those doctors once they have completed their foundation training? Why does he think they are being seen as such an easy target?
Please be as brief as possible, cabinet secretary.
What can I say? Paul Sweeney is of course right to raise the issue. First and foremost, we are making sure that we are creating the necessary training places for our trainee doctors here. We have increased them by an additional 725 places; 152 were agreed recently and will be recruited to this year. We will also seek to try to make the improvements that I outlined to Collette Stevenson so that their working conditions are improved, which I think will help to retain them.
On top of that, we will continue to discuss with junior doctors and the medical workforce more generally what we can do around pay and pensions to make sure that we retain those doctors in Scotland as opposed to losing them elsewhere.
NHS Shetland (Dentistry and Orthodontic Treatment Waiting Times)
To ask the Scottish Government what discussions it is having with NHS Shetland to address waiting times for NHS dentistry and orthodontic treatment. (S6O-01818)
The Scottish Government continues to meet NHS Shetland regularly to review all aspects of the board’s service delivery. The current areas of focus for dental and orthodontic treatment include addressing waiting times in the context of the board’s response to Covid-19. In addition, the board is developing an improvement plan for dental service provision, which is due to be concluded in the coming months.
There are continuing long-term issues for people in Shetland who are trying to access national health service dental services. I have a 16-year-old constituent who is on a waiting list to join an orthodontic waiting list and she says, “I was told that I needed a brace when I was 10, so I have been waiting for six years with a sense of insecurity.” Her case was confirmed as a priority case, but she has been waiting indefinitely to start treatment. The delay in treatment could have lifelong impacts on my constituent’s dental health. I am in dialogue with the minister about that specific case, but does she think that such delays in treatment are acceptable?
First, I understand the challenging position that NHS Shetland is facing with respect to orthodontic treatment. NHS dental access is undoubtedly challenging in certain areas across Scotland. In many cases, that has been exacerbated by Brexit controls as well as by the unique difficulties following the pandemic.
With regard to the specific case, I can reassure the member that the board has recently taken a number of successful mitigating actions to improve the provision of specialist orthodontic services, including the recruitment of a new specialist orthodontic consultant who has additional capacity at weekends. Provisional assessment by the board suggests that the service is now seeing substantially increased numbers of patients compared with previously. The board is also in a recruitment process to replace other clinical staff and we understand that that is looking very positive.
There are other mitigating actions on the way, including additional training with, in particular, the prospect of remote training for orthodontic therapists.
With regard to the individual case that the member raises, I understand that the board adopted a new model for prioritising patients, which was communicated to patients in October 2022. All patients on the waiting list have been fully informed of the current situation. The immediate priority in terms of catch-up is the patients who are currently under treatment. On completion of the treatment of that cohort of patients, the service will focus on the patients who are waiting for treatment.
I understand that that is disappointing for the constituent that the member mentions and it falls below the standard of service that we would hope for. However, the service has undoubtedly been challenged by the pandemic, as all our dental services have been. I am glad to see that it is an improving situation. I must also say that the board is very—
Minister, I am going to have to stop you there. I am keen to fit in a couple of supplementary questions. The first is from Jamie Halcro Johnston. It needs to be brief.
Too many dental practices across Scotland are going private or closing completely. Next month, Skye and Lochalsh dental practice will close its doors for good. Has the minister made any assessment of the impact that cuts to NHS dentistry will have on rural dentist practices? How does she expect dental practices across Scotland to provide NHS services at a loss now that crucial funding has been withdrawn?
I reiterate that, as I have said previously, the Government provided an enormous amount of funding to sustain NHS dentistry during the pandemic, when dentists could not operate at all. Without that Government funding, they would have gone under completely. We are now working with the dental sector to review and reform dental payments. Our intention is that there will be a more sustainable model going forward.
For the Conservative member to mention the challenges across dentistry without mentioning the word “Brexit” represents a serious omission because, if he was to visit any dental practice in Scotland, as I have, he will find that European dentists are no longer able to come to Scotland and sustain our workforce, as they could previously.
I will take question 8, but responses will have to be briefer.
Health Foundation Report (“Leave no one behind”)
To ask the Scottish Government what its response is to the report, “Leave no one behind”, from the Health Foundation. (S6O-01819)
The report is sobering. It is deeply concerning that in 2019 there was a 24-year gap in healthy life expectancy between people living in the most and least socioeconomically deprived 10 per cent of localities. We know that one of the reasons behind that and the driving force for it is the impact of Conservative austerity on public services, which is why we are using all the powers and resources that are available to us to create a fairer Scotland.
Infant mortality in the most deprived areas two and a half times that in the least deprived areas; people living in the poorest households almost eight times as likely to report poor health as those living in the richest households; and life expectancy—already the lowest of the United Kingdom nations for the past 70 years—not going up but coming down, even before the pandemic. Health inequalities are rooted in wealth inequalities; wealth inequalities are rooted in class inequalities. Does the Scottish National Party Government have any plan, any strategy or any idea whatsoever for tackling the inequalities that have been identified in this report, which, at their root, are based on the divisions of economic and social class?
I do not disagree with Richard Leonard that the cost crisis, which the Conservatives are the architects of, is a public health crisis. [Laughter.] That is why we are committing £19 billion to the national health service and social care services in the next year. The Conservatives might laugh when I say that the cost crisis is a public health crisis, but they would do well to listen to the points that we make about that.
That is why we are providing £4 billion in social security and welfare payments over the next financial year and extending the Scottish child payment to families with eligible under-16-year olds, increasing it to £25 per week, per child. We will continue to make the necessary investments with an absolute focus on people in the most deprived areas. I say to Richard Leonard: rather than leaving powers in the hands of the Conservatives, who are the architects of the cost crisis, would it not be much better to have all the financial levers in this Parliament?
That concludes portfolio questions. As time is tight, we will move straight on to the next item of business.
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