Meeting of the Parliament (Hybrid) 17 November 2021
I have much sympathy with the intention that underlies the Conservative motion, so we will support it at decision time, but I am genuinely concerned about the practical implementation of lifting the cap on medical training places. I also think that restricting the proposed measure to front-line staff could result in an unfortunate focus on some parts of the NHS and not others where there are critical shortages, too.
I thought that the SNP amendment was a tad self-congratulatory, considering that the SNP has been in charge for the past 14 years. I cannot help recollecting that we were discussing workforce planning 10 years ago, when I was last Scottish Labour’s shadow health secretary. It is beyond depressing that nothing much has changed in that period. There is no getting away from the fact that it is the SNP that has presided over historic workforce planning failures across our NHS.
The problems are not new—they pre-date the pandemic—but they have absolutely been exacerbated by the pandemic. I well remember Nicola Sturgeon cutting the number of nursing places when she was health secretary, despite warnings from me and the Royal College of Nursing about the consequences of so doing. In fact, during her tenure in that role, she presided over some of the smallest intakes of medical students in the past 14 years.
To deliver on removing the cap on funded places, there will require to be additional investment in our medical schools across the country and in the capacity to deliver foundation places to all graduates on completing their degree.
I am not sure that the Conservatives have done their sums on that or that they have any idea what that would cost. Where would they set the bar? Should everyone who applies be given a place? Last year, 9,530 people applied to study medicine in Scottish universities and 1,290 were given a place. I am sure that the Conservative proposition is not that all 9,530 people should be offered a place, so a limit would probably need to be set. Understanding that is critical.
Who are regarded as front-line staff? We know that there is a shortage of accident and emergency consultants, a shortage of nurses and a shortage of GPs, but what about consultants in neurology, vascular surgery or psychiatry, or allied health professionals in physiotherapy, diagnostic radio therapy or occupational therapy? There needs to be an expansion in their training places, too.
There is no doubt that there are acute shortages across the NHS. Just listening to the evidence that was presented to the Health, Social Care and Sport Committee should leave no one in any doubt about that. John Thomson of the Royal College of Emergency Medicine told us that there was a shortfall of 130 A and E consultants. The BMA told us that the vacancy rate for consultants stood at 15.2 per cent, which was more than double the official Scottish Government figure. Dr Lewis Morrison told us that doctors were
“washed out, physically and mentally”,
and Margo Cranmer of Unison said that nurses were “stressed and exhausted”. A paramedic whistleblower said that they were “exhausted, undervalued and overwhelmed”. All of that is before we reach peak winter pressure.
We need to urgently address workforce planning, but that will not alleviate the pressure on the NHS right now. It takes a long time to train those people for those roles.
Scottish Labour has put forward a series of suggestions about what we think needs to be done now. Let us start with a working time review for every member of staff who is planning to retire early and offering them flexible working so that we do not lose their skills from our NHS. Let us ask the hundreds of staff who have left the NHS recently to come back to help their community, especially over this winter. Let us give staff better facilities in the workplace, such as hot meals, rest spaces and access to mental health support. I know that the Government has made money available but, in some areas, improvement is far too slow and too patchy.