Meeting of the Parliament 26 October 2022
Despite being the best-performing A and E departments in the UK, Scottish A and E departments are facing capacity issues, and not just in winter. I would like to put forward suggestions and thoughts based on conversations that I have had with clinicians.
Staff vacancies are the north-east’s biggest issue, and we have a worrying situation in GP services, with a number of surgeries in my constituency struggling to treat patients because they have so many unfilled posts. One of the impacts of that is that patients who would otherwise receive GP care resort to turning up at A and E, which puts even more pressure on the service. That is one of the reasons why I would like to see the ScotGEM programme being extended to include Grampian.
I note that the cabinet secretary has made a pay offer to nurses, and I hope that it is accepted, but there are pressures on other groups of our staff, too. A wide range of people in the NHS have advised me that they have concerns that too many GPs and consultants are retiring far too early. Just today I spoke to a consultant in NHS Grampian who is concerned that, because of tax and pensions implications, consultants as young as 40 are reducing their hours. A reduction in consultant capacity obviously impacts on A and E departments; I am concerned that that might also impact on measures that the Government puts in place to offer scheduled urgent appointments in hot clinics that are designed to relieve pressure on A and E departments.
If pensions arrangements are making staying on less attractive to people, that will impact on capacity. Our budgets are stretched and are finite, but we need to address any seemingly illogical contractual disincentives to working full time until retirement age. After all, we have invested in training those consultants.
On training, I recently hosted an event with the Royal College of Emergency Medicine at which I heard from an advanced clinical practitioner who pointed to the roll-out of more ACPs being vital to supporting emergency rooms. I ask the cabinet secretary what we can do, within the work of the urgent and unscheduled care collaborative, to facilitate that. I welcome the £50 million funding that has been used to put in place ways to reduce A and E waiting times, including offering alternatives to hospital-based treatment. However, we need to accept that there will always be a need for hospital-based treatment and that, in addition to getting more ACPs, we need to look at increasing postgraduate training places and targeting them at areas where we have the biggest recruitment challenges. I have been told that those areas are respiratory medicine, acute medicine and geriatrics.
I realise that, so far, my contribution to Labour’s debate about winter planning has pointed to long-term strategies. However, the measures that I have outlined would get us through not just this winter but all subsequent winters, and would also aid recovery from the toughest period that our NHS has ever known—not just because of Covid, but because of the tough recruitment environment that has been caused by Brexit, which is the elephant in the room that cannot be ignored. My Grampian NHS Board colleagues have consistently pointed to the damage that loss of freedom of movement has done to our NHS and social care systems. The Labour motion does not mention that, because it is to the party’s endless embarrassment that its leader does not care about taking us back into the EU common travel arrangements. Until that changes, Labour has zero credibility on workforce issues that affect our NHS. [Interruption.]
I have spoken before about how Labour always comes to the chamber with a list of demands, but no costed solutions. To date, Labour has made nearly £2.68 billion of social care demands, which I have here, but it does not have the first clue about how to fund them. However, today, Jackie Baillie has not even come forward with ideas for the A and E departments. Uncosted or not, there has not been a single idea from Jackie Baillie or Carol Mochan. [Interruption.]
I will make one final point. Frankly, the last two words of the Labour motion and Jackie Baillie’s speech are a disgrace. Every health secretary and every Government is dealing with the same issues, so grubby personal attacks like that are the worst thing about this place—