Meeting of the Parliament 19 November 2025
I thank you, Deputy Presiding Officer, for allowing me to resolve my technical issue—so far, so good, but it is early days yet.
I congratulate the member on securing the debate, and I agree with him on the following points. There are huge pressures on the NHS at all levels across Scotland, with specific challenges in delivery in rural areas. In addition, the Covid-19 pandemic still has a residual impact on health and social care, and then there are the demographics, with an increasing number of elderly people—I am one myself, being 81—requiring healthcare.
The Borders has an ageing population, with the fifth-highest proportion of people aged 65 and over in Scotland, and a declining birth rate. If we add together the declining birth rate, young people leaving for towns and cities and older people retiring to the scenic Borders, we see that the ageing demographic can only increase, and there will therefore be more demand on health and social services.
That is the background, but NHS Borders is using innovative processes to tackle those demands. I do not congratulate NHS Borders willy-nilly—in this instance, the board deserves it. There is the hospital at home service, a Scottish Government initiative that has been piloted in the Borders that allows patients to be cared for—as it says on the tin—in their home. It is targeted mostly at older patients with suitable health conditions—with the patient’s consent, of course—and it has an overall 90 per cent-plus satisfaction rating.
We know that people prefer to be at home, if that is suitable, and that recovery is accelerated and their sense of wellbeing increases substantially if they are. It is no wonder—who would not prefer to be treated and supported at home by professionals, with family and friends in familiar surroundings, reunited with the cat and “Bargain Hunt” while lounging on the sofa?
As a result of its success, the region’s health board has been allocated £600,000 from a £3.6 million Government pot. Not only is recovery better, but hospital beds are freed up, as is staff time. The service tackles the spectre of delayed discharge. The virtual-ward model monitors patients in their house, with regular clinical follow-up and access to specialist advice.
In 2023-24, more than 14,000 older patients across Scotland used the service. A new report from Healthcare Improvement Scotland estimates that £14.9 million was saved in “traditional hospital admission costs”, with an estimated further £36.3 million saved in post-hospital care as a result of a reduction in re-admissions. That is more than £50 million in total.
In the Borders, the hospital at home service is currently limited to the central Borders. I have proposed to the cabinet secretary that it could be extended using community hospitals such as Hay Lodge hospital in Peebles. At present, some patients are already discharged to that hospital if it is suitable for them, often as an interim measure, following their discharge from the Borders general hospital, before they return home. With the hospital at home service, some patients could go straight home, which would, again, free up beds and staff, this time in Hay Lodge.
For completeness, I highlight the issue of accessing GP practices, which is, as members know, more complex. Most are private practices—businesses—that are contracted by the NHS to provide certain services, so GPs are not NHS employees. That is why there is such a divergence in how, for example, people can make an appointment.
Nonetheless, I conclude where I began: by broadly congratulating NHS Borders on modernising delivery. That includes its work in liaising with housing associations and reserving key workers’ houses; those key workers include staff in the health service, so that has encouraged recruitment to the Scottish Borders.
All those measures are tackling the delivery of healthcare across that extensive rural area, and I commend them—and commend NHS Borders—to members. I hope that those measures can be replicated, for example in my old hunting ground of Dumfries and Galloway.
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