Hansard

Imagine a scenario in which a country’s health service is in crisis, struggling to deliver timely care after years of failed workforce planning. Imagine that that country’s Government is fully responsible for running healthcare and that it controls, by diktat, the number of local school leavers who can enrol as student doctors, nurses and paramedics in our country’s universities. That is where we are in Scotland today. The Government consciously limits the number of locally domiciled students to just over half of all medical school places across Scotland’s universities. Those are the very students who are most likely to stay and work in Scotland once graduated. Little wonder, then, that there are staff shortages, and it is all down to the Scottish National Party.

Before discussing a solution to tackle the damage from a decade of failed workforce planning, let us consider the current calamity in more detail.

According to the Royal College of Nursing, our national health service needs another 3,400 nurses. That situation has not happened overnight but has happened under the watch of five SNP health secretaries. It is important to remind the country that, when the First Minister was in charge of health, she was the one who failed to future proof the workforce by cutting the number of student nurse places in 2012—a spectacular error of judgment. By 2015, our NHS had a shortfall of 1,613 nurses, and that number rose year on year: by June 2019—nine months before the pandemic—the shortfall was 2,879. Let us get this straight: that situation had nothing to do with Covid. The Government might argue that Scotland has more nurses now than ever, but there are also more vacancies now than ever—4,800 nursing and midwifery posts are unfilled. Where is the plan?

Let us now turn to students of medicine—our future doctors. According to the Scottish Government, just 54.5 per cent of nearly 5,000 students are Scotland domiciled, which is down from 63 per cent a decade ago. To be fair, the total number of medical students has risen over the past four years and the annual student intake has increased by 190, but that increase came on the back of year-on-year declines since 2007. Trainee doctors account for 44 per cent of doctors whom NHS boards employ.

I am sure that members now realise that chaotic knee-jerk reactions to a staffing crisis do not work. The situation has been unfolding for more than a decade.

Let us take primary care. It takes at least 10 years to qualify as a general practitioner and every year during that time students enter medical school and highly experienced doctors retire. The chronic shortage of GPs that impacts the health of the country today is a direct consequence of decisions that were made in 2009 when the First Minister ran health.

Let us not pin everything on the leader, because her successors are not crowned in glory either. According to the British Medical Association, 83 per cent of GP practices report that demand now exceeds capacity; 42 per cent report that demand substantially exceeds capacity; and 28 per cent report at least one vacancy, which means that as many as 225 full-time equivalent GPs are missing in Scotland.

Allow me to quote the Government’s own data: the number of full-time equivalent GPs in Scotland in 2019 was 3,613—62 fewer than in 2013. Between 2015 and 2018, only 39 additional GPs were recruited. I stress again that those figures are from before the pandemic.

According to Audit Scotland, even if the SNP managed to recruit 800 more GPs, the number of doctors who are expected to retire would wipe out the gains. When retirements are taken into account, the number of GPs would increase by only 18 in the 10-year period to 2027. The SNP-Green Government risks a bitter legacy. Where is the plan?

In our hospitals, workforce planning is also in chaos. BMA Scotland reports that vacancies for consultants have risen by 15 per cent. We now know that one in five consultants who were 45 to 49 in 2010 had left the profession by 2020. The BMA also finds that 45 per cent of surveyed consultants are considering retirement over the next five years. The SNP-Green Government is clearly too distracted by other matters to focus on retaining those highly experienced doctors, who are vital for patient care and for training the next generation of doctors.

There have been characteristically knee-jerk responses, such as the £32 million to create a further 139 trainee doctor posts, which, although welcome, is not at all part of a well-thought-out strategic plan.

On this side of the chamber, we want to provide solutions. I want to focus strategically on workforce planning. It is important to ensure that more Scottish nurses, doctors, paramedics enter universities in Scotland, because students who have gone to school or have a close connection here are more likely to stay when they graduate from a Scottish university. Those students will stay here to care for the patients in Scotland’s NHS and will go on to train the next generation of healthcare professionals.

I find it shocking to read that Scotland has a lower percentage of home-domiciled doctors than England and Northern Ireland. Around 78 per cent of England’s and 89 per cent of Northern Ireland’s foundation doctors are home domiciled, but only 54 per cent of Scotland’s are.

The problem is the arbitrary cap on the number of young Scots the Scottish Government will fund through medical school. As the workforce stats made clear, yearly decisions on the cap are not based on realistic workforce planning.

It is also not down to our young Scots not getting qualified. More and more Scots are meeting the academic entry requirements for medical schools. That has led Professor Angela Thomas of the Royal College of Physicians of Edinburgh to warn of a brain drain, where high-achieving Scotland-based school leavers with no place to go in Scotland move to England.

The cap also creates a barrier to medicine for students who come from less affluent families. Despite having the grades, if they cannot enrol in Scotland, they will be faced with university fees that they cannot afford. So much for widening access.