Plenary, 03 Mar 2004
Meeting date: Wednesday, March 3, 2004
Official Report
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National Health Service Reform (Scotland) Bill: Financial Resolution
The next item of business is consideration of a financial resolution. I ask Malcolm Chisholm to move motion S2M-227, on the financial resolution in respect of the National Health Service Reform (Scotland) Bill.
Motion moved,
That the Parliament, for the purposes of any Act of the Scottish Parliament resulting from the National Health Service Reform (Scotland) Bill, agrees to any increase in expenditure of the Scottish Ministers payable out of the Scottish Consolidated Fund in consequence of the Act.—[Malcolm Chisholm.]
The SNP will have to oppose the financial resolution, given that ministers have not taken the opportunity to agree to revisit the issue. The reasons for our opposition were given in my speech. There is no funding for the establishment of community health partnerships, despite the reservations expressed by the NHS Confederation in Scotland and by others. No money will be received to ensure that public involvement is done properly. The costs of the powers of intervention will be pushed on to health boards, and there will be no resources to ensure that the Scottish health council is established.
It is not just the SNP and other members, including some on the Executive's own benches, who are raising concerns about the costs of the bill. Influential and important organisations such as the NHS Confederation in Scotland, which represents managers in the health service, are also concerned. It is just not good enough to say that costs can be met from within savings, because those savings will not be seen immediately and yet there are immediate costs from the bill.
The Deputy Minister for Health and Community Care said—and I hope that I am quoting him accurately—that there will be no immediate poverty in health boards. He should tell that to the health boards and to the patients who see cuts to local services across Scotland, and to the MSPs who sit at health board meetings listening to the financial savings that are having to be made and implemented over the next few years because resources are being stretched to meet the new responsibilities, particularly those of junior doctors' working hours and the rise in drugs budgets. All the resources are being stretched to meet those new responsibilities, so any new responsibility that the Executive puts on to health boards that is not fully funded will, yet again, put further pressure on budgets so that those resources will have to be met from patient services. That is not good enough. Legislation that is made in the Parliament should receive funding to ensure that it can be implemented without the funding having to come out of money in the health budget that is designated for other services.
I urge members to follow their consciences, to listen to members such as Kate Maclean and to support our amendment to the motion on the bill. I ask the Executive to go away and think again about the financial resolution.
The Conservatives are against the financial memorandum because the Minister for Health and Community Care said clearly at the beginning of the debate on the bill that he expected any cost to be met out of the increased funding that is already in the system. In the financial memorandum, the minister did not identify, as he should have done, what the costs are likely to be and who will bear them. The principle that has operated in this Parliament over the past five years has been that every financial memorandum should have clarity and be robust. This financial memorandum is neither clear nor robust; I will not go through the litany of problems.
There is a marginal administrative saving over the first two years, which could average as much as £1 million per health board, but that is a drop in the ocean compared to the up-front costs that will be suffered by health boards throughout Scotland if the financial memorandum goes through.
I am not surprised that, once again, the only substantive contribution that the SNP can make to a health debate is to call for more resources. That is the SNP's answer to all the issues in the health service.
In response to the Conservatives, I point out that we acknowledged in the financial memorandum that there would be some additional costs. However, we also said that there would be some savings. We need a financial resolution in the Parliament to cover the former but, as Tom McCabe said in his winding-up speech, there have already been savings in NHS Borders and NHS Dumfries and Galloway, where trusts were abolished earlier than elsewhere. There have been savings of £500,000 in one year in NHS Dumfries and Galloway and the same kind of amount has been saved in NHS Borders, although over a slightly longer period. It is a case of there being some costs and some savings.
The key issue is the more effective use of existing resources: the £173 million extra that is already going into health improvement; the sum of more than £2 million that already supports the health council movement; and the £1 million that is supporting managed clinical networks, which will help to improve regional planning.
Shona Robison started by talking about community health partnerships. One of the key issues in respect of CHPs is the delegation of existing resources to the front line; it is about using the resources that are in the system. Management costs are also in the system already in the local health care co-operatives and in the primary care trusts; it is a matter of using the resources more effectively.
Let us not forget that although there are, of course, pressures in the health system, we have record resources in health. Those can be used more effectively and that is what the bill is all about.