"The NHS is facing the biggest shock in its history"
Humza Yousaf’s new office comes with a new office. He’s moved ever so slightly up the ministerial corridor in the parliament, closer now to the First Minister.
Despite being in post for four months, his desk is uncluttered. Pictures sit in their frames on the floor waiting to be put up.
It’s a pokey wee room. There’s just enough room for his desk, a table long enough for two people to be socially distant, and the brand new knee scooter Yousaf’s been sporting for the last two weeks.
In a bid to do something about the pandemic pounds he’d piled on over the last year, the SNP minister dusted off his old badminton racket and challenged his superfit SFA coach neighbour to a game.
Despite the years passed since he was last on the court, the health secretary, who admits he’s competitive, says he was playing well right up until he landed on the back of his foot and ruptured his Achilles.
That tear of the tendon that connects the calf muscles to the heel bone means Yousaf’s badminton playing and even his walking looks likely to be curtailed for at least the next four months. Hence the knee scooter, an “innovative pain free alternative to crutches” according to the mobilityhire.com website.
“Frankly I’ve had a sedentary lifestyle for the best part of a few years,” the minister admits to Holyrood. “It’d be terrible to blame my two-year-old but certainly since she came into being it’s been particularly difficult. I’ve not played football, I’ve not played sport. I’ve not gone running, I’ve not gone to the gym.”
It wasn’t just about shifting the weight that he, like many of his colleagues (see the results of our exclusive poll detailed elsewhere in the magazine), has put on over the last 18 months, it was also about fortifying his head.
“This role I’m in, in particular, I think if you don’t take care of your mental health you will burn out really quickly,” he says.
Two days after Holyrood sits down with the minister, Yousaf and his scooter go viral.
After what turned out to be a particularly bruising session of First Minister’s Questions, the SNP politician was hot-footing it down the parliament's unimaginatively named Glazed Corridor before skidding and crashing to the ground right in front of the TV cameras.
A clip, shared on Twitter by the BBC's Glenn Campbell, has been watched 1.6 million times.
Nicola Sturgeon appointed Yousaf as Cabinet Secretary for Health and Social Care shortly after May’s election. He is, at 36, the second-youngest holder of the post - Susan Deacon was 35 when appointed to the job by Donald Dewar.
This is Yousaf’s fourth role in government, and it is, by some considerable distance, the toughest job he’s ever had.
It’s a big enough task to take on at any point, but it’s especially demanding to come into this post in the middle of a global pandemic.
Covid has permeated just about every nook and cranny of the NHS. Problems that existed before the virus took hold - and there were many - have intensified.
Waiting lists to see specialists, for procedures and checkups, for child mental health services are eye-watering. GPs are inundated.
The number of breaches of the government’s target for patients to be seen within four hours of attending A&E has gone from 2,086 in the last week of 2020 to 6,915 in the week beginning 5 September 2021.
In the media, there are stories of ambulances taking hours to turn up to emergency calls, and the ministers has received pelters for advising people to “think twice” before dialling 999.
Ahead of the interview with the health secretary, I speak to friends and family who work in the NHS and ask them how their pandemic has been and what they think I should raise with the minister. There are many, many, many suggestions, but what just about everyone I speak to agrees on is staffing.
Quite simply, they want more people providing primary care, and they want to stop their colleagues from burning out and leaving the service.
They want to be able to cope when one of their colleagues goes off sick. And, with the current Delta wave rampaging through Scotland, a lot of colleagues are off sick.
Vacancies, which were already high before the Covid outbreak, have reached “record levels”, with new figures showing that more than 500 consultant positions and almost 5,000 jobs in nursing and midwifery are lying empty.
The NHS workforce has always had to function pretty close to capacity. The pandemic has pushed it beyond its limit.
Given that it takes four to six years to train clinical staff to even junior levels, and up to a decade more to train them to senior levels to actually do the work needing to be done, the challenge of catching up with what we’ve got right now seems impossible.
“Unless you’re involved in an NHS or social care perspective it’s hard to just understand the significance of the pressure they’ve been under,” Yousaf says.
“The mental pressure, the physical exhaustion of our NHS staff is something that we take seriously,” he adds.
“The NHS is without a shadow of doubt facing the biggest shock it’s ever faced in its 70-year history. And I’m not going to pretend to anybody, let alone those who are working in it, that I’ve got a magic wand and I’m able to just magic away the effects of the last 18 months.”
“Our NHS staff is at a record level, but we’ve got to recruit more,” he adds.
That means a substantial increase in hiring, domestically and from the Common Travel Area, and also what’s known as “ethical international recruitment”.
That is recruiting staff from overseas, but not from developing or war-torn countries facing “the most pressing health workforce challenges”.
Yousaf says the government will have to take “some very short-term measures too”.
“For example, how can we increase overtime payments? That’s something we’re exploring and looking at to make sure we are getting as much as we possibly can out of those that we’ve got here, we’re giving everything possible.”
Part of the problem with recruitment and retention right now is that it’s not necessarily an attractive working atmosphere. Ahead of the election, the BMA surveyed its members and found that 40 per cent of doctors who responded were currently suffering from depression, anxiety, stress, burnout or emotional distress.
And, as nice as the overtime might be, for some doctors it could be costly, with NHS pension reforms in 2020 meaning that for many senior physicians any additional income from added work could breach their annual allowance and trigger huge tax bills. One extra shift could end up costing the clinician thousands of pounds.
“Now some of that’s in my gift, some of that’s not in my gift, some of that is in the UK government’s gift,” Yousaf says. “In my first couple of meetings with Sajid Javid, I raised the pension issue. And in fairness to the UK government, they said it’s a difficult one but they’d go away and look at it again.”
He says the government is taking immediate action where it can on recruitment and retention.
“Now, we’ve obviously know that we’ve got further consequentials coming. Clearly, we’re looking at how best to spend that to try to bolster the workforce. And wellbeing will be part of that. We’re spending £8m at the moment on wellbeing, I’d like to see that increase actually.
“We’re going to get the best out of our NHS staff if we make sure we’re attending to their mental and physical health too.”
On capacity, Yousaf again acknowledges that there were challenges pre-Covid.
“You’re not going to get me as health secretary saying everything was rosy. There’s also got to be an acceptance and a realisation that this has been, as I keep saying, the most significant shock that the NHS has ever suffered in its history. Therefore there are enormous challenges on the health service that have been exacerbated by this pandemic. So what you’ll get from me is upfront honesty. I’m not going to pretend that I can resolve the issues in a matter of weeks or even a few months.”
He says the plan is to increase outpatient capacity by 10 per cent and inpatient capacity by 20 per cent. But also to reduce demand.
However, guessing what demand may look like in the near future is difficult because of what the minister calls the “big unknown”.
“If you increase the capacity, then we’re confident of being able to work our way through those backlogs, some of them quicker than others and you’ve got to be quite honest and truthful about that, there’s always been a sense of prioritisation in the NHS but that is the plan.
“The big unknown, of course, is the pandemic.
“We are not out of it. There could be a new variant - goodness forbid - there could be a new variant that could be immune to the vaccine and then we are frankly back to the drawing board.”
“Even the flu season this year is unknown,” Yousaf adds. “We know flu will come, we just don’t know the magnitude of it. Last year, we didn’t actually have severe effects of flu because everybody was in lockdown. The feeling is that because of that, the immunity of those who are susceptible to flu is lower than it would have been.
“We’re hoping we’re heading into a more positive trajectory but even in our better case scenario plan we’re still talking about significant numbers of people in hospitals with Covid.
“Now that you could manage if, for example, you stop doing everything else, but the NHS is remobilising, so the headroom is far, far smaller than it was at the beginning of the pandemic.
“We plan for it is as best as we possibly can but the unknowns, the variants of concern that may well come to light in other parts of the world and make their way here, that is the one thing that is in the back of our mind constantly when we’re dealing with this virus.”
One success Yousaf has inherited from his predecessor is the rollout of the vaccine programme.
At the time of going to print, 75.8 per cent of over 16s had had one jab, and 69.3 per cent had had both. The government has also just announced a substantial expansion of the jag rollout, with, by the time you read this interview, 12-15 years olds able to turn up to a drop-in clinic to get some Pfizer in their veins.
However, despite the successes, there are still a significant number of people who haven’t yet had one dose. We used to call them vaccine-hesitant, but surely at this point of the pandemic, it’d be more accurate to describe them as anti-vax.
Yousaf disagrees. He prefers the term vaccine sceptics. He’s also sure there are still unvaccinated people out there who could be convinced, particularly in the 18-29 age cohort where take up has been the slowest.
“I think there are different groups. I think there are those who are vaccine sceptics, traditionally we would call them anti-vaxxers, but I wouldn’t necessarily use that term. They really oppose, strongly oppose, and actually, whatever we do, they will not want the vaccine. We’ll obviously keep trying everything we can to persuade them, but the chances of persuading them frankly are pretty low.
“I think there’s a group in the middle. I’ve a cousin in this bracket. He’s the cousin of the health secretary and he says to me, ‘it’s an old guy’s disease isn’t it, I’m alright, I’m very fit - he runs, he plays football - I’ve hardly been ill in my life, and the side effects, I can’t be bothered with that’.
Anyway, I persuaded him. And I think there’s a group there that can be persuaded. And the certification scheme actually might well help with that.”
Politics, I say to him, is surely about picking your fights. Is the benefit of vaccine certificates worth the fight the government has picked with nightclub owners, football bosses and festival organisers?
“One thing I’ve found really liberating about being health secretary is that whereas in other ministerial roles you’re always thinking about the political calculations you have to make, as health secretary, you can actually, particularly when it comes to the pandemic, rely on public health advice.
“It’s quite liberating to not have to think about the politics. That doesn’t mean I don’t think about it and it’d be foolish to suggest I don’t.”
“But you take the public health advice and then you make a decision based on that advice and it’s actually pretty simple,” he adds.
Yousaf says in the days leading up to the announcement on passports the take up in that younger cohort jumped by 10 per cent.
“Was it worth it? Yes, if it reduces transmission and if it increases uptake then it’s absolutely worth it.”
We don’t have much time. The cabinet secretary has to rush to the chamber to answer an urgent question before the First Minister’s latest Covid statement. As we’re talking about picking fights, I touch on recent events with the Little Scholar nursery in Broughty Ferry.
Yousaf and his wife, Nadia El-Nakla, are taking legal action after his daughter, Amal, was turned down for a place, while a white friend of the couple was told there were spaces for her son on three afternoons every week.
He can’t say much about what’s going on now that the courts are involved, but he tells Holyrood this fight, and making it public, was not a hard decision.
“I do my best to protect my children. It was a difficult decision to do this because it exposes my daughter to an extent, but it was an easy decision in the sense that when there’s that level of injustice, which I believe was taking place, then I have a real responsibility to expose that,” he says.
There was widespread sympathy and outrage on the family’s behalf across the political spectrum after the story broke in the Daily Record, but there was, predictably, criticism from the usual anonymous Twitter accounts.
Yousaf has often used his platform to talk about racism and about the lack of diversity in Scottish civic life, and even in the SNP. That’s a fight that has attracted attention from the global far right, and from racists closer to home.
His every tweet - and I mean every tweet - is met with racist abuse. While Nicola Sturgeon and Douglas Ross and just about every other politician in Holyrood have to deal with trolls and socal media abuse, there’s a certain online hate that exists just for our MSPs of colour.
“If I hadn’t been appointed health secretary, I think I would have deleted Twitter,” he says. “I was thinking about it before the elections. I thought I’ll keep it going, it’s a useful tool to communicate with voters, but I had it in my head that I would probably delete it. Or if I didn’t delete it, I would at least give it over to my office and just get them to use it as a constituency-based profile.
“But then I got appointed health secretary, and I think given the nature of the pandemic and things moving quickly I thought, right, I’ve got to keep it going.
“I will come off Twitter at some point whenever’s suitable. I think it’s a cesspit if I’m being frankly honest.”
He has, he says, after ten years in politics developed a thick skin, but as he points out, in the last two weeks he’s had people telling him that they’re going to kill him, and threatening to behead him. That can’t help but have an impact.
Counter terror police have recently been in to speak to him about his and his family’s security.
“I’m a father of two kids. There are times when I think is it really worth it? I’ve just got to remember that this is a public service and there’s a reason why I’m doing what I’m doing. I won’t lie to you, it’s tough, it’s not easy. That side of the job is one that grates on me quite a bit.”
One of the benefits of the lockdown for Yousaf was getting to spend time with his family and particularly his youngest, who wasn’t yet one when the pandemic struck.
“Being able to say to my team here, look from half six to half seven can you block off some time so I can do the bath and a bit of bedtime, I couldn’t do that if we hadn’t been working from home. I’m really blessed and lucky that there’s been a flip side, a positive to the challenges that we faced.”
There’ll be less time for home working in the new post, even if there is another lockdown. And if there’s not, then for this SNP minister, there’s campaigning to be done for indyref2.
Yousaf insists a new vote on Scottish independence before the end of 2023 is possible.
“Nobody’s denying that there’s going to be Covid consequences for a number of years to come, but what we’ve made very clear is that’s when we’re not in the absolute grips, in the midst of the pandemic - and we can be hopeful particularly given the success of the vaccination programme - I think, 2023, is absolutely realistic.”
But, as he’s already pointed out, we’ve still got a number of unknowns to come.
“If there’s variants of concern that suddenly take us back to square one, that the vaccine is completely ineffective against, then of course we’ll take stock of where we are. That’s always a caveat. Touch wood, we are not at this stage seeing any variants of interest that are converting into variants of concern, of significant concern at the moment, so we can only deal with what we know right now.”