Part of the debate – in the Scottish Parliament am ar 21 Chwefror 2024.
I accept that. The problem that the minister faces is that we have had 17 years of the Government and promises of endless reform. I have to say that we are not much further forward. We still have the long waits that I talked about when people try to access their GP in the morning. I talked about the waits for mental health treatment. I know that the minister is saying that the very longest waits have almost been eliminated, but thousands of people are still waiting a hell of a long time to access mental health services. That is adding to the problem.
The minister did not refer to the fact that GPs are retiring early and hardly any of them go to their full term now. We need to get to grips with that, which feeds into what Fergus Ewing was talking about. We need to ensure that we keep GPs for longer. Secondly, an awful lot of GPs are going part time. That is a symptom of the pressure that they feel in their practices. We are into a vicious cycle, in which the GPs and all the staff feel the pressure. The demand increases, so they go part time, and the demand increases more because of the pressure on the staff who are left.
We have long-term problems with general practice, and I hope that the minister will try to address the issues around GPs. The pension changes at UK level will help a bit, but far too many GPs have already gone.
Paul Gray, the man who used to be in charge of the NHS in Scotland, warned the Government some time ago that, irrespective of the pandemic or Brexit, there were already deep-seated problems in the NHS. I am afraid that the response from the Government has been wholly inadequate. According to the RCGP, the Government is not on track with the recruitment of GPs. It is just not. In the past two years, there has been a decline. According to Audit Scotland, we are not on track to meet the recruitment targets for mental health staff, either. It says that the plan is at risk. I have raised with the minister the issue that there are pockets of the country where we are not able to recruit members of multidisciplinary teams. There has been an in-year cut in the mental health budget, which does not help, either.
We need action on recruitment and retention, and we need to explore the use of a bond. I prefer carrot rather than stick, but we need to think about whether we should consider a bond.
Fundamentally, we need to look at the long-term problem whereby, although primary care deals with the bulk of the work in the NHS and deals with most people, it gets a fraction of the budget. We have not shifted that dial enough. We need to increase the proportion of the budget that primary care gets. That is not easy, especially when there are significant pressures elsewhere in the system, but if we do not address the bit of the problem that relates to the gateway and the early intervention and prevention work that Ivan McKee talked about—