Meeting of the Parliament [Draft]

Meeting date: Thursday, June 27, 2024

Official Report 988KB pdf

---

General Question Time

Good morning. Our first item of business is general question time. Question 1 was not lodged.

---

Scottish National Investment Bank (Advisory Group)

To ask the Scottish Government what its position is on whether the Scottish National Investment Bank is operating legally, in light of reports that the advisory group that was meant to be established by the Scottish ministers has not yet been established. (S6O-03646)

Now that the bank is fully established and has a growing portfolio of investments, it is the right time for the advisory group to be established. I have already agreed a remit for the group and a shortlist of potential members. Officials are now contacting individuals with a view to the group’s first meeting taking place this summer.

The bank was established in November 2020, and the legislation says:

“The Scottish Ministers must establish and maintain an advisory group to provide them with advice on the Bank’s objects, conduct and performance.”

Through a freedom of information request, I found out that the wage bill for the bank has almost doubled over the past two years, to a whopping £9.7 million. Cabinet secretary, when there is no advisory group in place to monitor the bank’s conduct and performance, how can we be assured that the Scottish National Party has not created another gravy train?

I remind the member always to speak through the chair.

The member will know that the Scottish National Investment Bank’s individual decisions are all made entirely independently of the Scottish Government and that the advisory group is there to provide advice to ministers. The group has no impact on the bank’s existing governance procedures or its operational independence. The member may be conflating two issues that are actually quite distinct.

One core aim of the Scottish National Investment Bank is to make strategic investments to help boost green growth and meet the significant up-front costs of reaching net zero. Will the cabinet secretary say more about how the bank has been working to help Scotland decarbonise, while also growing the economy?

The figures regarding the bank’s investments are really quite remarkable. Since its launch in November 2020, it has invested almost £278 million in supporting businesses and projects that contribute to the shift towards net zero. That investment has levered in a further £555 million of third-party capital, which brings the total investment to more than £830 million. I hope that that will be welcomed by members from across the chamber. The bank’s investments have also generated approximately 2.25GW of renewable energy, which is the equivalent of powering 610 homes in a year.

---

Primary Care (Areas of Population Growth)

To ask the Scottish Government whether it will provide an update on what it is doing to ensure access to primary care in areas that have a high projected population growth. (S6O-03647)

The global sum allocation for each general practice is adjusted every quarter to account for changes in its registered patients list, and growing practices should therefore receive a greater share of national funding. The Scottish Government uplifts general medical services funding annually to account for population growth. In 2023-24, that uplift amounted to £8.3 million.

Because of the indicative figures for future years’ capital budgets from Westminster, the Scottish Government has paused health capital projects. I am well aware of the particularly acute issues in Mr Beattie’s constituency and I await the outcome of the cross-Government review of infrastructure investment.

Many of my constituents in areas such as Wallyford and Whitecraig have raised concerns about access to services because of financial pressures on the local health and social care partnership. Will the cabinet secretary give an update on the impact on health boards’ capital budgets of financial constraints as a result of cuts by Westminster to the Scottish Government’s capital budget? How will he support my constituents to receive the best possible primary care, as the population of Midlothian North and Musselburgh rises?

I look forward to meeting Colin Beattie later this afternoon to discuss such areas. He is right that the United Kingdom Government did not inflation proof its capital budget. Based on the latest forecasts, our block grant for capital is expected to reduce in real terms by 8.7 per cent by 2027-28, which represents a cumulative loss of more than £1.3 billion. The result of that cut is that all new health capital projects have been paused.

Our emphasis for the immediate future will be on addressing backlog maintenance and essential equipment replacement to help to improve productivity. We will be able to give greater certainty on funding following the review of infrastructure investment that the Cabinet Secretary for Finance and Local Government is carrying out, but I am clear that I want as many as possible of those projects to advance for the continued recovery and improvement of our health services, including those in Midlothian North and Musselburgh.

Three weeks ago, I asked the Deputy First Minister—who is in her place in the chamber—about the funding situation in Prestonpans group practice. Prestonpans is an area that has experienced significant population growth, with a growing population in the surrounding areas, including Blindwells. Will the cabinet secretary update me on what is happening and when my constituents and I will be able to meet him to discuss the financial cuts?

I am aware of the situation. We are in discussions with NHS Lothian on the issues that the member raises, and we have received assurances about some of the dispute resolution processes that it is looking to put in place. However, I am cognisant of the challenge that many GP practices have faced as a result. I know that Mr Whitfield has written to me on the matter and I will endeavour to get an appointment in the diary as soon as possible to have that discussion with him.

The cabinet secretary will appreciate that the population of my constituency is growing rapidly and significantly. In recent years, I have raised the possibility of creating a GP surgery at Ocean Terminal in Leith in order to meet new demand for GP practices in the area. That would likely have a lower cost than building new premises, and Ocean Terminal has recently been a very successful vaccination centre. I would be grateful if the cabinet secretary, working with the health and social care partnership, gave that idea further consideration.

I am acutely aware of the pressures that exist on services across Edinburgh, including those in Mr Macpherson’s constituency. I know that he has raised the issue on a number of occasions, including with my predecessor, and I am grateful for his continued efforts in that regard.

As Mr Macpherson knows, it is for NHS Lothian and Edinburgh health and social care partnership to decide whether new GP practices are needed in his constituency as a result of new developments or whether existing practices can expand. I am aware that access to services is an acute issue in Mr Macpherson’s constituency—as it is in Mr Beattie’s constituency, as we have just heard. In principle, we would support the use of facilities such as Ocean Terminal for new practices, but the decision is ultimately for the health board and the partnership to take.

---

Emergency Departments

To ask the Scottish Government what it is doing to tackle any inappropriate care and overcrowding in national health service emergency departments. (S6O-03648)

The Government is committed to ensuring that the people of Scotland can access NHS services that meet their needs and provide the highest standard of care. Through our whole-system urgent and unscheduled care collaborative programme, we are working with health boards to reduce accident and emergency delays and deliver sustained improvement. That includes actions to strengthen arrangements to avoid unnecessary hospital admissions, such as same-day emergency care services; utilising the hospital-at-home services that we have funded; and optimising flow navigation centres. The national centre for sustainable delivery continues to support boards to implement changes that will target the key challenges in their systems, such as the ones that Mr Stewart outlined.

On an average evening at 10 pm, more than 10 per cent of patients across Scotland’s emergency departments are being treated in corridors, because of a lack of space. Worryingly, more than half the emergency departments that were surveyed had patients in corridors. Delayed discharge also continues to be a concern. Last year, Shona Robison said:

“we remain ... committed to eradicating delayed discharge.”—[Official Report, 21 September 2023; c 13.]

One year on, are we any further forward in giving back to patients the dignity and respect that they deserve?

I agree with Mr Stewart that delayed discharge is a major issue. That is why the First Minister has been engaged alongside the Convention of Scottish Local Authorities and it is why I am undertaking weekly meetings of the CRAG—the collaborative response and assurance group, which is the collaboration between COSLA and health services—to look at what more can be done, particularly in pressured areas where performance has not been good enough, in order to see improvements come through.

What are the challenges? What can the Government or the health service do to support improvements to the delayed discharge picture that is providing the choke, as Mr Stewart outlined, in the flow through the hospital from accident and emergency into the wards and then back into the community? I am committed to working in partnership with council colleagues to see improvements in that.

I recognise that our hospitals face congestion because of the challenges that are associated with delayed discharge—which is due in part to the significant reduction in the workforce that delivers care packages in communities, as a result of the United Kingdom Government’s immigration policy. Does the cabinet secretary agree that, notwithstanding the disastrous impact of Brexit on our health services—[Interruption.]—Scotland remains a welcoming place for overseas staff to work and live in?

In spite of the heckles that came from Tory members, I whole-heartedly agree with Audrey Nicoll. She is absolutely right. This Government values those from overseas who choose to live and work in Scotland, which is quite in contrast to what we saw in the debates last night and previously from those who wish to become Prime Minister, who compete with each other to be toughest on migration. That does not serve the interests of our economy or our public services. People from overseas make a vital contribution to the soundness of our workplaces and communities.

The UK Government’s immigration policy fails to address Scotland’s distinct demographic and economic requirements. We are therefore pressing for a fair and managed immigration system that meets the needs of the people of Scotland and of our public services and economy. In collaboration with NHS National Education for Scotland and COSLA, our Government has provided funding to create the centre for workforce supply social care, which will test and develop an ethical and sustainable model of international recruitment for adult social care providers in Scotland.

In my answer to Alexander Stewart, I referenced the work that we are already doing to improve the delayed discharge picture.

---

Air Service between Uist and Stornoway (Access for People with Reduced Mobility)

To ask the Scottish Government whether it will provide an update on its consideration of the impact of the change in subsidised air service provider between Uist and Stornoway on access to services, including health services, for people with reduced mobility. (S6O-03650)

Before I call the cabinet secretary, I advise members that question 5 was withdrawn.

I am aware of the difficulties that Rhoda Grant mentions and I have been working with the Cabinet Secretary for Transport to continue to understand those challenges, which is why we are working on possible solutions in collaboration with Comhairle nan Eilean Siar and NHS Western Isles. I am also keenly aware of the need for solutions to be developed and owned by local partners. I will shortly convene a meeting in Uist to support that process. The local MSP, Alasdair Allan, has also corresponded with me to request that. The Scottish Government is also working closely with NHS Western Isles to ensure that health patients continue to have full access to services.

The provision of air services within the Western Isles is for Comhairle nan Eilean Siar to decide on, and it is therefore for that council to ensure that it has made a suitable assessment of the impacts. However, we will look at what we can do in collaboration between the health portfolio and the transport portfolio to support it in those endeavours.

I look forward to receiving an update about the meeting between the council and the health board. However, the issue is even more pressing due to the lack of availability of health services in the Uist and Barra hospital, many having been pulled back to the Lewis hospital in Stornoway. Will more services be available locally, so that those who cannot access the new aeroplane can get health treatments and chemotherapy closer to home?

I of course commit to making sure that Rhoda Grant is kept up to date. My understanding is that there are difficulties with the Uist and Barra hospital due to clinicians not being able to travel to the site, and that the alternative option will be the transfer of services to the Western Isles hospital and NHS Near Me clinics. We will continue to work with NHS Western Isles and with the local authority, as I have set out, to improve the situation for people in the Western Isles. As I said, we are working together on that across Government, as we recognise the challenge that impacts local residents.

The cabinet secretary will be aware that the Islander aircraft has been the workhorse of the lifeline air services in Orkney for many years. However, growing numbers of constituents with mobility issues, on islands such as North Ronaldsay that do not have a roll-on, roll-off ferry, are missing hospital appointments or other medical appointments due to the inaccessibility of the Islander aircraft. I have spoken to the cabinet secretary about those concerns, but can he confirm that he will agree to meet me and representatives of NHS Orkney, Orkney Islands Council, Loganair and other stakeholders when he is in Orkney during the summer, so that we can look at finding a resolution to the issue—which will only get worse, given demographic trends?

Mr McArthur will know that I have an awareness of the situation that he outlines, having been a passenger on the ferries serving the northern isles and on interisland aircraft. I have given a commitment to meet Mr McArthur to discuss the matter when I am on my family leave in Orkney later in the summer, and I look forward to that discussion to see what more we can do to provide support on a cross-Government basis.

---

Ardrossan Harbour (Redevelopment)

To ask the Scottish Government whether it will provide a further update on plans for the redevelopment of Ardrossan harbour. (S6O-03651)

In my response to the motion debated in the Scottish Parliament last week, on 20 June, I confirmed that

“we have been progressing the Ardrossan business case and cost exercise”,

and that it is

“substantially complete”.—[Official Report, 20 June 2024; c 40.]

Transport Scotland is working with partners to finalise the exercise, and any updates on the project will not be until after the pre-election period.

Ardrossan has been the main port to Arran for 190 years, as it is the shortest and quickest route. Humza Yousaf signed off its redevelopment in 2018, but six years of delays, for successive reasons, means that ferries will now be running from Troon. Will the cabinet secretary ensure that there is a final announcement in July, with a plan for the redevelopment of Ardrossan harbour?

Not just Katy Clark but Kenneth Gibson, as the local MSP, as well as others, have repeatedly made the case for Ardrossan, and I absolutely understand that. It is essential to get the substantial investment that is required, and that a robust business case is set out that meets all the requirements for good decision making. I understand the frustrations not just of the people of Arran but of the people of Campbeltown, who want the situation to be resolved, but I have been and will continue to be clear and open, and I will talk with partners on the task force as soon as it is practically possible to do so.

An undignified public spat is taking place between Peel Ports and CalMac at the moment, which is symptomatic of wider issues and a breakdown in relationships between stakeholders across the marine network.

Instead of rebuilding berths and ports, the Government should be rebuilding relationships among stakeholders. What is the cabinet secretary doing to intervene in the matter to ensure that stakeholders are working together for the greater good and for the benefit of our island communities?

I take that point very seriously indeed. The success of any development would indeed involve partners working collaboratively together. I reassure the member that we had a very constructive task force meeting in May—I think that it was in May, but I will correct the record on the date—that provided an opportunity for everybody to understand the progress made and the elements that still had to be resolved. That, I think, is evidence of my personal involvement with the task force to take forward the project.

---

Midwives

To ask the Scottish Government what action it is taking to ensure that the provision of midwives by the national health service meets demand.

I should declare an interest, in that I have a daughter who is a midwife. (S6O-03652)

The Scottish Government values every single midwife and the extraordinary care that they provide day in, day out. I am aware of the decline in applications to midwifery undergraduate programmes, which is exactly why the education and development of students and staff has been a key workstream of the nursing and midwifery task force. The task force will report in the autumn, and its work will help to support the demands that the workforce is facing as it develops actions to diversify education and training pathways, to support longer-term workforce sustainability and to improve workplace culture, practice, flexibility, recruitment and retention.

Last month I attended a Royal College of Midwives event in the Parliament, where three student midwives shared their experiences with me. We know from the RCM’s report and from student evidence that 70 per cent of students incurred additional debt due to their studies, while 60 per cent worry that they may need to drop out for financial reasons. That is even more concerning after learning that roughly 45 per cent of those students are over the age of 30. Will the minister consider an apprenticeship route into midwifery to help with the financial issues of mature student midwives?

The chief midwifery officer attended the round-table meeting that Mr Whittle also attended. She updated everyone who was in attendance on our plans to review finance for nursing and midwifery students and also the wider work that is happening. We are very much considering alternative career pathways into nursing and midwifery. We recognise the growing interest in flexible learning models, which will allow students to earn while they learn. Apprenticeships are certainly part of that work.