Humza Yousaf: 'We have to accept our health service is not going to get back to normal in a matter of months'
Humza Yousaf has been having sleepless nights about the state of Scotland’s NHS. It’s not hard to understand why, with clinical backlogs, straining-at-the-seams A&E departments and ongoing industrial disputes bedevilling our most beloved national institution.
In truth, while the country is slowly moving on from Covid, the NHS remains in a critical condition. Long-standing problems which pre-dated the pandemic got worse as hospitals threw everything they had at meeting the biggest challenge in the NHS’s 74-year history.
More than two years on from the first Covid cases, many of us continue to struggle to get a GP appointment, while growing numbers are resorting to paying to have procedures done privately. Yousaf is under no illusions about the scale of the challenge, and it’s keeping him up at night.
“The things that keep me awake at night are Accident and Emergency, planned care waiting times, the CAMHS (child mental health) waiting times that are far too long, access to GPs,” he says. “These are very genuinely the things that keep we awake at night. I was up at 5am this morning just thinking about some of this stuff.”
Ten years into being a cabinet minister, the former transport secretary and justice secretary, and the man some believe to be a future leader of the SNP, finds himself with arguably the most difficult brief in government. As if to illustrate the point, in the day before we speak, figures from Public Health Scotland show the worst A&E waiting times on record, with under two-thirds of patients being seen within the four-hour target.
“I’ve had a variety of different roles and I enjoyed each one, each of which came with its own challenges,” Yousaf says. “But this is by the far the most challenging brief at probably the most challenging time. I think most people recognise that health secretary is a difficult job and that this is an extraordinarily difficult time.
“I try to get to as many parts of the country as possible to speak to as many staff as I can. I always say to my health board colleagues not to take me to the people they want me to speak to…there’s no point me getting a sanitised version of what’s going on. I need to hear directly from the people on the ground, and it is a difficult message. I do get my ear bent quite regularly and that’s part and parcel of the job…”
Yousaf says the recurring themes are on staffing levels, capacity in social care and now the growing concerns about the energy crisis and the impact it will have on care homes this winter.
Next week he will set out the Scottish Government’s winter plan for how the NHS will cope, amid ongoing pressures, with a likely spike in Covid cases and the anticipated resurgence of flu.
Statistics published last week suggested that on waiting times at least, things may be beginning to ease. Twenty-two out of 41 specialities now have no patients waiting longer than two years for their treatment, with nine others having fewer than ten people still waiting over that time. Still, Yousaf is taking nothing for granted.
“I think there’s a possibility this will be the worst winter the NHS has faced,” he says. “Nobody is resting on their laurels. Our job will be to expand the workforce where we can in relatively short order and we’re working on that at the moment, but also to reduce demand at the front door of hospitals so that people can be treated in the community.”
But could people die due to being unable to access care when they need it?
“We’ll do our best to avoid that,” Yousaf says. “Clearly, we know the harm that excessive waits can do…of course a firm focus of mine and the government is to reduce those excessive waits, whether they’re at emergency departments or in planned surgery.
“I can’t get away from the fact that excessively long waits do have harm attached to them and at the worst end of that scale is, unfortunately, people dying. I speak regularly to the First Minister on this issue. None of us are just expecting that will happen this winter – we’ve got a plan in place, that we’ve been working on for months to try and mitigate that harm.”
For most people, their first point of contact with the NHS remains their GP. Yet despite relatively low numbers of Covid cases, many surgeries have not returned to the service they were offering pre-pandemic.
Anecdotally, we’ve likely all either voiced or heard frustrations about getting an appointment to see a doctor. Yousaf says most surgeries should have returned to a semblance of normality by now, but he concedes that phone appointments are here to stay, a service he used himself for a recent flare up of eczema.
“I don’t get the impression from speaking to GPs up and down the country that the pandemic lightened their workload,” he says. “They would argue back, I think absolutely rightly, that there’s not been a lessening of the workload, it’s just been a different way of seeing people and treating people.
“I’ve made it very clear to my GP colleagues that access to face-to-face appointments for those who want it should be happening. One of the key areas that can help us with this is pre-bookable appointments. For too many people they’re phoning their GP at eight in the morning, they’re in a queue and it’s really a lottery whether they get an appointment that day. If not, they have to call back the next day, and the next, and that’s just not good enough.”
If the NHS already occupied national treasure status before the pandemic, the arrival of Covid and the superhuman effort put in by those working on the frontline helped cement it for generations to come. In the darkest days of the first wave with no vaccine on the horizon, the weekly Clap for Carers was a genuinely moving moment of togetherness at a time of heightened anxiety.
But the arrival of the coronavirus has increased the already considerable strain being felt across the health service and has led to concerns of a two-tier system opening up as more people pay to have procedures done privately. According to research by the independent Private Healthcare Information Network, self-pay admissions – those where patients pay for their own care rather than use private medical insurance – rose 39 per cent across the UK in the two years to the end of 2021.
Yousaf says he has a family member who has been waiting to have their gallbladder removed since before the pandemic. I ask whether he would recommend people paying for medical care if they can afford to do so.
“We don’t want people going private, of course we don’t,” he says. “We want to provide a healthcare system that is free at the point of use and is meeting people’s expectations.
“I’m going to do what I can to make sure everyone gets the treatment they need – including my own family member – on the NHS, but we can’t avoid the reality that people are choosing to go private. That’s a situation I want to do my best to avoid.
“I wouldn’t insult your intelligence to suggest [the creation of a two-tier system] is not a concern – of course it’s a concern. It’s a worry for me, hence the targets that we’ve announced that are re-focusing the system as a whole onto planned care.
“We have to accept that our health service is not going to get back to normal in a matter of weeks or months; it is going to take years. I’m sorry because that’s a really challenging message for people to hear, especially when it feels like life outside of the NHS has got back to normal.”
Yousaf says the NHS’s treasured status should not preclude us from talking about reform, but reforms which make things run smoother, not any kind of radical overhaul.
“The NHS is rightly a national treasure because for all the challenges it has; I have not seen a system that is more equitable anywhere in the world. We shouldn’t think that those values which underpin the NHS are able to be compromised on. We should definitely talk about reform, the use of more technology, a better digital offer…but it’s got to be within the parameters that the NHS remains a public service and free at the point of use.”
Since being appointed health secretary in May last year, Yousaf has noticeably reduced his Twitter use, something which had got him in trouble in the past, such as the time he called on Rangers to sack any players found guilty of “anti-Catholic hatred” after the appearance of a video – which it later emerged was doctored – appearing to show members of the squad using sectarian language.
Perhaps because of the demands of his brief, he has been less high-profile, the one obvious exception being when he and his wife sued a Dundee nursery alleging that it discriminated against their daughter.
And yet despite a lower profile, Yousaf continues to engender a considerable amount of antipathy on social media, where much of criticism for his stewardship of the NHS feels personal.
I ask him whether he gets more of that kind of abuse than some other frontline politicians.
“Without a doubt.”
Does he consider it to be racially motivated?
“I don’t doubt it for a minute. Much of it will be racially motivated – not all of it. But if you ask the same question to Anas Sarwar, to Kaukab Stewart, to any of my fellow politicians who are people of colour, they will tell you that we get significantly more abuse than our white counterparts.
“The thing I do is protect myself. I still tweet, but I’m not on Twitter very often and I mute notifications…These people who are hurling abuse at me, I don’t value their opinions so why would I allow them to enter into my life?
“I’ve taken measures to try and protect myself from some of that because, frankly, the mental health impact of that on me and my family was definitely taking its toll.”
Yousaf says he and Nicola Sturgeon would have been “lambasted” had they made some of the comments new Prime Minister Liz Truss made during the Tory leadership campaign, calling the first minister an “attention seeker”, describing Wales’ first minister as a “low-energy Jeremy Corbyn” and saying the “jury is out” on Emmanuel Macron after being asked whether the French president is a “friend or foe”.
But Yousaf is reserving judgement on his opposite number in England, Thérèse Coffey, despite reports that one of her first acts as health secretary was to tell civil servants to stop using the Oxford comma, that particular piece of punctuation apparently being a “pet hate”.
Scotland’s health secretary was among MSPs paying their respects to the Queen at a special meeting attended by King Charles following his mother’s death. On meeting the new king, Yousaf passed on his condolences in Arabic and received a reply back in the same language.
“I have known for a long time, and I think it’s well-known, that he takes an interest in the Islamic world, the Islamic faith and Arabic. I knew he would understand well, and he seemed to appreciate it. He was also very interested in the work I’ve done previously with Islamic Relief.
“It was a conversation I greatly appreciated at a difficult time. Scotland is multicultural and my ability to pass on my condolences in Arabic was, I hope, appropriate given the circumstances.”
Earlier this year, the British Social Attitudes survey found that satisfaction with the NHS fell sharply in 2021 to its lowest level in 25 years. Further research published last week found that a quarter of Scots did not receive medical treatment they needed in the past 12 months due to long waiting lists.
If the NHS remains a beloved institution, then our relationship with it has become a little strained of late. The challenges remain vast, with no end in sight. Scotland’s health secretary will likely have many more sleepless nights.