Humza Yousaf leadership: Who's set to replace the new First Minister in the toughest job in politics, and why would they want to?

Humza Yousaf is set to pass on one of Scotland’s toughest roles in government – but who is set to become the next health secretary and is the health brief really a poison chalice?

The runners and riders to be the next health secretary come from two distinct categories – existing Cabinet secretaries who will be moved into one of the more high-profile portfolios, and Cabinet ministers who will be promoted to the top table.

In the former category, Angus Robertson would seem an obvious choice, given he has often been touted as a future leader of the party. However, given his decision to not throw his hat in the ring to be First Minister due to family commitments, he may not want one of the toughest government jobs going.

Keith Brown could follow Mr Yousaf’s footsteps in moving from justice secretary to the health portfolio.

Humza Yousaf has been officially elected as the sixth First Minister of Scotland.

In the latter category, of junior Cabinet members hoping for a promotion, is Angela Constance, the minister for drugs policy, Maree Todd, the minister for public health, women’s health and sport, and Kevin Stewart, minister for mental wellbeing and social care. Whoever takes the helm has their work cut out for them.

Mr Yousaf became health secretary shortly after the May 2021 Scottish Parliament election, in the midst of the then-ongoing coronavirus pandemic. Since then, Mr Yousaf has been subject to a barrage of criticism from opposition politicians, trade unions and NHS staff for his handling of Scotland’s healthcare system.

The new health secretary will likely face similar treatment, but there is also opportunity.

Under Mr Yousaf’s tenure, NHS Scotland experienced some of the worst pressures in its history, particularly over the winter, as A&E performance dropped to its lowest ever level, elective surgeries were cancelled and patients were stranded in hospital with no care placements to be discharged to.

NHS Scotland’s performance can’t get much worse, barring another pandemic, meaning Mr Yousaf’s successor will hopefully find themselves supervising short-term improvements.

As Mr Yousaf takes the helm at Bute House, the latest stats from Public Health Scotland show A&E performance is at its lowest level since January and amongst the worst it has ever been. For the week ending March 19, a meagre 62.9 per cent of emergency department attendances were seen and admitted, transferred or discharged within the four-hour standard.

During the week, 3,344 patients languished in A&E for more than eight hours before being admitted, transferred or discharged, and a further 1,382 people were left waiting in pain for more than 12 hours in an emergency department, despite the Scottish Government target of seeing all patients within four hours.

Scottish Conservative shadow health secretary Dr Sandesh Gulhane said the figures “are a humiliation for Humza Yousaf on the day that he’s promoted to First Minister” and described his time as health secretary as a “failed tenure”.

He added: “One of his first priorities as First Minister must be to belatedly get on top of the NHS crisis he presided over as health secretary.”

Meanwhile, Scottish Labour’s health spokesperson Jackie Baillie said Mr Yousaf was “leaving an abysmal record of failure in his wake”. She said whoever succeeded him as health secretary “cannot surely do a worse job than Humza Yousaf, who was the worst health secretary in the history of devolution”.

The scale of the challenge facing the next health secretary has already been voiced by trade unions and health associations

A spokesperson for the Royal College of Physicians of Edinburgh said A&E doctors believe fixing the problems in social care, including staff shortages and boosting the amount of care beds and packages, may help to ease delayed discharges from hospital, therefore improving patient flow.

“Humza Yousaf will have become aware of this during his time as health secretary, and we hope that he will address the situation urgently as First Minister,” added the spokesperson.

Meanwhile, Colin Poolman, the Royal College of Nursing (RCN) Scotland’s director, said the severe workforce challenges facing Scotland’s health and care services “must be a top priority”. “Whilst imminent strike action from Scotland’s nurses has been avoided, the chronic staff shortages and low morale are still very real,” he said.

“Over 4,000 registered nurses are missing from teams across Scotland, impacting on the safety and quality of patient care and putting even more pressure on staff who are already working extra unpaid hours to cover gaps and going home feeling that they are unable to provide the quality of care they want.”

Mr Poolman said Mr Yousaf must “live up to his promise to reform Agenda for Change and make nursing a career of choice once again”.

Dr Iain Kennedy, chair of BMA Scotland, called for urgent action on pay. He said: “There needs to be a short, medium and long-term plan for Scotland’s NHS, which includes in the short term a realistic plan to cope with immediate day-to-day pressures and the coming winter pressures of 2023/24, and an effective workforce plan to make sure that in the longer term we have the doctors and the wider multi-disciplinary team members we need if we want NHS Scotland to survive over the coming years and decades.

“Action is urgently required to improve doctors’ pay – for the good of the NHS and the people it cares for.”

The incoming health secretary will have to deal with the threat of strike action from junior doctors, with the ballot for industrial action due to open today.

Dr Kennedy said: “To avert the need for strike action, there has to be an immediate and urgent commitment from the new First Minister and Cabinet secretary to enter into formal and meaningful negotiations with our Scottish junior doctors on full pay restoration.

“By taking immediate action, the new First Minister can move relations in a much more positive direction.”