National Health Service
Good morning. The first item of business is a debate on motion S3M-6469, in the name of Jackie Baillie, on the national health service.
09:15
Three weeks ago, we came to the Parliament to debate the NHS quality strategy against an emerging backdrop of cuts being made to front-line services in the NHS. This week, the Labour Party seems to be the only main Opposition party that wants to hold the Scottish Government to account for its cuts to the NHS—cuts that are made in Scotland by the Scottish National Party.
I am sure that we all recall with a degree of fondness the SNP’s election slogan: “More Nats, less cuts.” It did not really work for the SNP then and it sounds pretty hollow now. It is perhaps more a case of more nats, fewer nurses. The hypocrisy of their claiming to protect front-line services on the one hand while, on the other, presiding over the worst cuts since the advent of devolution is breathtaking and hugely disappointing. Cuts to the numbers of doctors, nurses, midwives and physiotherapists—all involved in providing front-line services—are only some of the cuts proposed.
I congratulate Jackie Baillie on having a grammatically correct slogan, in contrast to the Scottish National Party. I ask her to tell us, so that I can properly follow her line of argument, whether the Labour Party’s position is that the NHS in Scotland is underfunded. If it is, by how much is it underfunded?
No, that is not the case at all. As I develop some of the arguments on finance, perhaps Nicola Sturgeon will realise that she has less of a share of the Scottish budget than she deserves and requires.
I will take members through the arguments about how the finance stacks up, but I will first rehearse some of the emerging numbers on doctors, nurses and midwives. I am not, as the Tories would claim, fixated by numbers, but we need to understand the scale and likely impact of sweeping job reductions. NHS Greater Glasgow and Clyde intends to cut 1,252 posts from its workforce. More than half of them are nurses. NHS Lothian reports that more than 700 jobs are to go this year alone and that the total will be 2,000 next year. More than half of them will be nurses. In NHS Tayside, 588 jobs are to go. In NHS Grampian, it is almost 600 and in NHS Highland just over 100. NHS Lanarkshire, NHS Ayrshire and Arran, NHS Forth Valley, NHS Fife and NHS Borders all plan reductions. As many as 5,000 jobs may go in this year alone.
At least the comment in NHS Grampian’s workforce plan is refreshingly honest:
“It is recognised that there is a risk that such changes to the workforce will bring with them a significant impact to the continued provision of services at current levels. It is unclear how the organisation will be able to maintain the achievement of certain standards and, in some situations, this could lead to a reduced service.”
Let me put that more simply: it will have an impact on front-line services. The standards that NHS Grampian may not achieve relate to cancer, cleanliness and the care of newborn children. It is, therefore, critical that all the NHS workforce plans be published.
The Cabinet Secretary for Health and Wellbeing spent much of yesterday phoning the trade unions and offering them a new partnership forum in which to examine the details of the workforce plans. She was, apparently, not happy with some of those plans, and I understand why. I also understand from a Scottish Government response to the Scottish Parliament information centre that it is up to NHS boards to publish their workforce plans and that that could take up to October.
Therefore, I am delighted that the cabinet secretary appears to have agreed to publish in the next day or so—let me get this right—the data relating to the plans, which effectively amounts to the same thing as the plans. I called for that three weeks ago and have called for it on various occasions since. Nothing short of full publication of workforce plans for this year and indicative plans for next year will do. Some boards even have three-year plans. However, I am disappointed that the cabinet secretary decided to act only yesterday when faced with the Labour motion on NHS cuts.
Leaving aside the timing, I also welcome the opportunity for the trade unions to have a direct influence on the workforce planning, sitting round the table with the cabinet secretary. That is as it should be, and I commend her for that. However, I regret that it appears that one of the SNP press team went on to spin the message to the media that the trade unions had signed up and were comfortable, the implication being that they accepted that the job cuts were inevitable. That, of course, is simply not true: the trade unions were clear yesterday that they are opposed to job cuts and remain opposed to them.
Although I am pleased that the cabinet secretary is responding to Labour’s call for transparency, she must be aware that her response cannot be a short-term political fix to get her out of a tricky debate. We now expect to see results and real, substantive changes to health board plans. Does the cabinet secretary have the final sign-off of the plans or are they ultimately for boards to determine? She has never shirked her responsibility and I respect her for that. She regularly tells us that the buck stops with her. I applaud that approach, but do the health boards understand it?
For Murdo Fraser, I will turn to money—it is never far from our minds. There is no doubt that we face real economic challenges and a tightening of future budgets. That should exercise us all, but the SNP must stop indulging in its usual fantasy economics and be honest with members for a change.
Let us talk facts about finance. Fact 1 is that the Scottish budget has an extra almost £1 billion on top of last year’s money. That is an increase, not a cut, but let us not allow the facts to stand in the way of a good story. Fact 2 concerns the budget allocation to health. The cabinet secretary tells us that there is £264 million extra on the health budget line, but does not tell us that that is the lowest settlement made to the NHS in Scotland since the days of the Tories.
On fact 3, I must apologise to members because I said three weeks ago that the £264 million extra represented a real-terms increase of only 0.1 per cent. I got that wrong. It appears that I was being overgenerous. According to figures from SPICe—who will explain the matter to members far better than I can—there is a rounding effect in the overall budget figures, which means that the increase in the health budget is less and the real-terms figure is a decrease of 0.4 per cent. Is that complicated? Absolutely. However, to put it simply, the £264 million represents not a 0.1 per cent increase in the health budget but a 0.4 per cent decrease. I am grateful to SPICe for putting me right. Imagine thinking that there had been an increase—albeit one of tiny proportions—when the reverse was the case. That happened at a time when the budget for the NHS in England was rising by 4 per cent. Labour’s record is much better than the SNP’s.
The savings that were outlined to the Health and Sport Committee were described as efficiencies. Health boards have to achieve those so-called efficiency savings, which are already assumed in the budget allocation. Perhaps the cabinet secretary would listen instead of shouting at Duncan McNeil, because those efficiencies are actually cuts. There must be no more pretending; let us call a spade a spade.
The SNP promised that there would be more staff in the NHS at the end of this parliamentary session than when Labour left office in 2007. To be frank, that promise does not amount to much. Let us look at the facts again. Fact 1: the SNP’s claim of 10,000 extra staff is taken from the public sector employment survey; it is perhaps interesting to note that, according to information from SPICe, that figure was not provided in briefings from civil servants to ministers. Fact 2: the whole-time equivalent figure—that is, the actual number of full-time posts—is 8,200. Fact 3: if we take out the year for which the previous Labour-Liberal Administration budgeted, the actual number of extra whole-time equivalent posts under the SNP is 5,100. The maths ability of members is not so strained that we do not realise that subtracting 5,000 cuts from 5,100 posts gives us precisely 100 more posts. Surely the SNP promise is not achieved by this appalling sleight of hand.
However, that rather misses the point. One has to assume that the extra staff were necessary to cope with rising demand. Indeed, the NHS is treating more patients than ever before. One wonders whether, if we remove that additional capacity, it will inevitably have a detrimental impact on patient care. Is the cabinet secretary suggesting that those posts are all unnecessary? Can she tell the chamber how many she will cut, and will she guarantee that none of them will be from front-line services? We have another SNP promise, but we do not need to wait for the SNP Government to break it, as it does not amount to very much to start with. I am disappointed, as this appears to take Government cynicism to a new level.
There is more. It is not just the number of posts that will go through redundancy; there are proposals to review the skills mix, freeze vacant posts and reduce hours. NHS Greater Glasgow and Clyde plans to replace almost 400 registered nurses and midwives with half the number of nursing assistants. Let me be clear that having an appropriate skills mix in any team is always welcome, but that is not the issue. This is substitution—nothing more, nothing less. Glasgow is not alone: Highland, Grampian, Fife, Forth Valley—the list goes on.
What is the impact on front-line services? In the previous debate I gave examples of some of the services that will be cut or altered. In NHS Lanarkshire we have seen the cancellation of the 130-bed acute mental health facility, the removal of podiatry services and the halving of the number of smoking cessation staff. That is a matter of much regret, but emerging in Glasgow is another reduction, this time in the number of beds. Members know that there have been changes in how patients are treated and that services are consequently redesigned, but that is not what is going on there. It is a straight reduction to save money.
I will share with the chamber details of e-mails that were sent to me both last week and this. I have been told by a group of consultants in Greater Glasgow and Clyde Health Board, who are unanimous in their view, that the impact on patient services will be “drastic”—their word, not mine. There was also a matter of fact statement that beds across NHS Greater Glasgow and Clyde are being reduced by 20 per cent, and a senior surgeon is reported to have said:
“I’ll be very surprised if patients’ operations aren’t cancelled just before surgery”.
I understand that the figure of 20 per cent has been denied, but that the health board has admitted that it will be 5 per cent. That is about 350 beds.
Will the member take an intervention?
No, I am running out of time.
I am concerned that the consultants, who are operating on the front line, are saying that the reduction in beds is a lot more. Who are we to believe—the health board or the consultants?
As I said, last week the consultants said that surgery would be cancelled; this week I have been contacted by two constituents, one of whom had their surgery cancelled with less than four hours to go. The constituent was told that it was human error and that there were too many admissions, and she was told that the surgery might be postponed to July or August. It was not about the availability of the surgeon; it was about beds. Today she got a call with a date for next week—she is mightily relieved because she is actually quite ill. However, it is not as simple as that, as she needs to phone the hospital at 5.30 am to check that a bed is still available; otherwise she need not come in. It is a problem with getting a bed.
That is only one recent illustration of the situation, but I am conscious of time.
These are the consequences of the real cuts that the SNP is making to the NHS. It will seek to transfer the blame to others, as is ever its way, but it is responsible. The SNP promised to protect front-line services, but on the evidence so far I regret to say that it has failed. We cannot have the kind of hypocrisy that allows the SNP on the one hand to promise to protect front-line services but on the other to preside over cutting nurses. This really is a case of more nats and fewer nurses, and I suspect that the people of Scotland would prefer fewer nats and more nurses. That is a view that I share.
I move,
That the Parliament notes with concern emerging details of workforce projections submitted by NHS boards at the request of the Scottish Government; notes that thousands of posts are proposed to be cut across the NHS in Scotland and that these include frontline staff such as nurses, midwives and allied health professionals; further notes that job and service cuts are taking place in this financial year when the overall Scottish budget has increased by almost £1 billion; believes that such a loss of frontline posts will inevitably have a detrimental impact on patient care, and therefore calls on the Cabinet Secretary for Health and Wellbeing to publish the workforce projections immediately and intervene urgently to prevent cuts to frontline NHS services.
09:29
I welcome the debate because it gives me a chance to state again that the NHS is a top priority for this Government. That is evident in the decision that we took this year to give the NHS a real-terms increase in funding despite the fact of a real-terms cut in the overall Scottish budget amounting to £500 million.
Our commitment to the NHS will also be evident in the decisions that we take in future. The new coalition Government has promised real-terms increases for the NHS and that is welcome. If that commitment is honoured, we will ensure that every single penny of the resulting Barnett consequentials is applied to the NHS in Scotland. That is the strength of our commitment to the NHS.
Let us contrast that with Labour, whose demand for more money for the NHS now that it is in opposition is staggering in its hypocrisy. Let us remind ourselves of what Labour said when it was still in government. On 10 April 2007, Jack McConnell said that, if Labour won the election, education would get all the extra spending and other departments—including the NHS—would have to “cut their cloth” accordingly. If Labour had won the election and Jack McConnell had continued as First Minister, the NHS would have had less money, not more.
Will the cabinet secretary give way?
No, thanks. Not just now.
That was before we had Alistair Darling promising cuts “deeper and tougher” than Margaret Thatcher’s.
Today, we have Jackie Baillie, again with breathtaking hypocrisy, talking about bed numbers in Glasgow. Putting to one side for the moment the fact that she is downright wrong in her assertion and even the fact that 2009 was the first year in a decade when the number of beds across Scotland actually increased, let us look at this key fact: between 2000 and 2007—under Labour, in case Labour members have forgotten—bed numbers in Glasgow reduced by 2,030. Jackie Baillie is therefore right about a 20 per cent reduction in bed numbers; unfortunately for her, it happened under Labour and not the SNP. That is the reality of Labour on the NHS, and that is why I will take no lessons from Labour members on standing up for the NHS.
We will protect the NHS, but let us talk reality. Even with that commitment in this and future years, NHS budgets, just like everybody else’s budgets, are tight and will continue to be tight for the foreseeable future. Let us be clear about one thing: that is a direct result of the economic and financial mess presided over by the previous Labour Government.
The job of this Scottish Government, and my job as health secretary, is quite simple. It is to ensure that the NHS manages the financial challenges that it faces in a responsible way, without compromising the quality of patient care, and to ensure that it takes the right decisions now to secure the sustainability of its services. That is the responsibility of government. It is tougher than opposition, but it is a responsibility that I will not shirk from.
In recent years, NHS boards have been challenged to deliver services more efficiently and they have done so. Over the past three years, the NHS has secured £537 million in efficiency savings, every single penny of which has been reinvested in front-line care. That commitment to reinvest efficiency savings continues this year.
The drive to deliver services more efficiently involves looking at staffing requirements, and this year, as in all years, NHS boards have been producing workforce projections. The projections of some boards have already been shared with area partnership forums locally and are in the public domain—they are Glasgow, Lothian, Grampian, Tayside and Highland, together totalling reductions of approximately 3,100. I have asked the chief statistician today to publish on the Scottish Government website the workforce projections of those and all other NHS boards, and they are now available in SPICe. The remaining 17 boards that I have not already mentioned are between them projecting a net reduction in posts of 624 this year.
Let me make it clear that all the projections are subject to on-going discussion with unions locally. They are not set in stone. I expect boards to maintain a downward pressure on reductions by working hard to maximise non-workforce-related efficiencies. I also want to make it clear that I expect local partnership discussions about how efficiency savings targets are to be achieved to be genuine, robust and meaningful.
As that work proceeds, will the cabinet secretary confirm that health boards will be able to retain the 2 per cent efficiency savings next year, too?
We have made it clear that we want boards to retain efficiency savings. We will decide on future years once we know the budget for future years. Our commitment to the NHS is beyond doubt. [Interruption.]
Order.
In scrutinising the workforce projections that boards have submitted, I have insisted on three key guarantees. First, I have made it clear to boards that staff efficiencies must not compromise the quality of care. [Interruption.]
Order. Would members mind not debating among themselves across the chamber, please? The person who should be speaking is the person who is on their feet.
NHS boards have a responsibility to demonstrate that efficiencies can be achieved by service redesign, by advances such as increasing day-case rates and by greater productivity. I hope that we all welcome and encourage that.
To ensure that the commitment to quality is delivered in practice, I am establishing a national scrutiny group—to which Jackie Baillie referred—that will comprise unions, NHS employers and the Scottish Government. The group will subject board workforce plans to on-going scrutiny to ensure that they are the result of genuine partnership working and that they do not impact adversely on the quality of patient care. The group will liaise closely with local area partnership forums and will raise concerns with the Scottish partnership forum and directly with me.
I repeat my question. Does the responsibility for signing off workforce plans fall ultimately to the cabinet secretary or is it a matter for health boards?
As Jackie Baillie should know if she looks at these things, we operate through partnership working, discussion and dialogue in the NHS. The scrutiny group’s detailed remit and operation will be finalised shortly, but I am pleased to say that the main NHS trade unions—Unison, the Royal College of Nursing, the Royal College of Midwives, Unite and the British Medical Association—have all welcomed the group and agreed to participate.
The second guarantee that I have given, and I repeat it today, is that there will be no compulsory redundancies in the health service—no one in the NHS will lose their job and any Opposition politician who suggests otherwise is doing a disservice to those who work hard in our NHS.
Grampian Health Board is to make redundant or not fill vacancies in 500 posts, so that is completely unplanned—the board has no idea where the vacancies will arise. From a human resources and management point of view, that will not work.
I am not sure whether Mike Rumbles advocates a policy of compulsory redundancies—if so, the Government disagrees with that. The commitment to no compulsory redundancies gives NHS staff job security that few others—certainly no one in the private sector and few in the public sector—enjoy in the current economic climate, but those who work in the NHS thoroughly deserve that job security.
The third guarantee that I give—to which Jackie Baillie should listen carefully—is that more people will be working in the NHS at the end of this parliamentary session than at its start. That is another example of the Government’s commitment to the national health service.
Most reasonable people—I accept that that does not include all Labour members—are understandably concerned about the financial climate’s impact on public services, but they will welcome the guarantees that I have given and our commitment to guiding the NHS through difficult times in a responsible and managed way. Labour’s approach of sitting on the sidelines and shouting “cuts” is not only hypocritical in the extreme but insulting to the Scottish public’s intelligence.
The public know the reality of Labour’s financial legacy. The public know that we are dealing with Labour’s mess. Labour members’ refusal to accept the reality of the situation and their determination to bury their heads in the sand—compounded by their daily calls for even more spending—are not clever politics, regardless of what they think. That is just another reminder that Labour is a party with no economic or financial credibility or competence whatever. Labour is showing itself to be barely fit for opposition, let alone government.
Any position of responsibility in the NHS is tough—[Interruption.]
Order.
Such a position is tough in the best of times and tougher still in difficult times. However, my commitment to the NHS, to those who work in it and to the services that it provides means that I have a duty to support the NHS in facing up to these difficult times and to ensure that it is in a fit state to weather the financial storms that lie ahead. That is exactly what I as Cabinet Secretary for Health and Wellbeing intend to do.
I move amendment S3M-6469.1, to leave out from “with concern” to end and insert:
“the real-terms increase for the NHS budget in 2010-11 despite the previous UK administration cutting the Scottish Government budget by £500 million; notes the commitment by the new UK coalition government to real-terms increases in the NHS budget in future years and agrees that all resultant Barnett consequentials should be applied to the NHS in Scotland; understands that, notwithstanding the above, NHS budgets are tight as a result of Labour’s economic mismanagement and that all NHS boards require to deliver services more efficiently, but welcomes the commitment that quality of patient care will be the paramount consideration, that there will be no compulsory redundancies in the NHS and that there will be more staff in the NHS at the end of this parliamentary term than there were when Labour left office in 2007.”
09:40
I agree with Nicola Sturgeon. What has been laid bare this morning is what will for the next 11 months undoubtedly be the Labour Party’s line of attack on the SNP Government and—when it fits better—on the parties of the United Kingdom coalition Government. The line is to raise the spectre of cuts in the NHS and elsewhere and to try to lay the blame for them at the door of the Scottish Government or the Conservative and Liberal Democrat parties as it so fits. That is a deeply dishonest line of attack with which we should have no truck.
After listening to Jackie Baillie setting out the case for the prosecution, I fear that she has watched too many screen adaptations of John Grisham novels. Picture the scene in a crowded courtroom in a hot southern US state: Jackie Baillie is the dogged district attorney, in the Susan Sarandon role, and Nicola Sturgeon is cast as Sandra Bullock playing the sparky young defence attorney. Sadly for the prosecution, its case is full of holes and the jury of the Scottish people is unlikely to be convinced.
The argument that Labour sets out in its motion is that cuts are being made to the NHS, that they will have a detrimental impact on patient care and that the cabinet secretary should intervene urgently to prevent them. The motion’s subtext, which is not made explicit, is that the cuts result from NHS budget cuts. It is curious that, when I intervened to press Jackie Baillie on the point, she denied that the Labour case was that the overall NHS budget had been cut; she was less convincing later in her speech. I am now altogether confused about what Labour blames the cuts on—is it management in the NHS or cuts in the overall budget? If Jackie Baillie would like to intervene to provide clarity, I would be delighted.
Every penny of the consequentials from the UK Government’s health budget to the Scottish Government has not been applied to the health budget. How else can the Scottish Government explain the funding increase of 4 per cent for the NHS in England but a 0.4 per cent decrease here? That is a consequence not of the overall budget but of decisions that the SNP Government made to give health less.
Jackie Baillie makes a different point from that which she made in response to my intervention. The Labour Party’s position is now that not enough money is being spent on the NHS. However, as Nicola Sturgeon said, the fact is that NHS spending in Scotland has risen, as it has in previous years.
If cuts were made to the Scottish budget, the responsibility for them would rest fairly, squarely and solely with the Labour Party, which was responsible in government for the most chronic mismanagement of the public finances in our country’s history. Any cuts that are coming to the Scottish budget are Labour cuts—not Tory cuts, SNP cuts or even Lib Dem cuts.
If the Labour Party were honest in its concern about NHS funding—if it were really concerned that Barnett consequentials were not coming through to the NHS in Scotland—we might have expected it to make proposals to increase NHS spending in this year’s budget discussion. However, the Labour Party lodged not a single amendment to the Budget (Scotland) (No 4) Bill to provide for additional funding for the NHS. Neither has the Labour Party indicated which budget lines should be cut to fund an increase in the NHS budget. Any party that argues seriously for more money must make it clear where that will come from. Labour has failed on that score.
Like the rest of the public sector, the NHS has of course been tasked with finding efficiency savings. Those efficiency savings of 2 per cent per year are lower than those that were recommended by Jackie Baillie’s good friend Wendy Alexander. When Wendy Alexander was Labour leader, in a period that has now been conveniently airbrushed from Scottish Labour history, she famously called for efficiency savings of 3 per cent per year—half as much again.
Does the member acknowledge that the 3 per cent included both cash and time-releasing efficiency savings, whereas all of the SNP’s 2 per cent savings are cash savings?
The important point is that efficiency savings mean that money comes out of the budget. I am interested to hear that the Labour Party is retreating from the position that Wendy Alexander took.
I reject Labour’s proposition that efficiency savings will automatically have a negative impact on front-line services. The challenge for the NHS is to ensure that savings can be made but that front-line services are protected. We believe that that can be done. As we pointed out last weekend, by changing the way in which drugs are procured—moving to generic drugs from brand-named drugs—six health boards have been able to save more than £20 million per year; the others could follow suit. There are savings to be made. We reject the nonsense that that will automatically have a negative impact on patient care.
The final and most damning criticism of the Labour case on cuts is that it is sheer rank hypocrisy. After all, as the Minister for Health and Community Care, Jackie Baillie’s colleague Andy Kerr—a man who, unsurprisingly, is now rarely seen at health debates in the Parliament—proposed real cuts to front-line services: namely, the closure of the accident and emergency units at Monklands and Ayr hospitals. Voters in Lanarkshire and Ayrshire will remember that those real, front-line service cuts were proposed by Labour, not by the Scottish Government or the Conservative party.
I welcome the terms of the Government amendment, especially the reference to the UK Government’s commitment that health service spending will be protected. The Barnett consequentials from that will mean additional money from the Scottish Government. I welcome Nicola Sturgeon’s commitment last week, which she has repeated today, that all of those Barnett consequentials will be applied to the health service.
Even with the additional sums, there will be a need for efficiency savings. What is important is that front-line services are protected. In the NHS, we should measure outcomes, not inputs. By doing things differently, we can find money to be reinvested. We should test the NHS not by the number of people who are employed in it but by the quality of patient care. It is important that we shift our perspective.
My amendment makes a further point about NHS funding—that Labour’s jobs tax would have removed £40 million from the budget of the NHS in Scotland. Thank goodness that the new coalition Government at Westminster is reversing that proposal, which will mean more money for the NHS. I am sure that that decision will have the full support of Labour members, so concerned are they about NHS funding north of the border.
I fear that, today, the district attorney will be disappointed. Having heard the case for cuts that Jackie Baillie has set out, I fear that it is not so much a question of the case being not proven as of there being no case to answer.
I move amendment S3M-6469.1.2, to insert at end:
“, and also welcomes the commitment from the UK coalition government to reverse Labour’s increase in national insurance, which would have cut £40 million from the budget of the NHS in Scotland.”
09:48
We are not making much progress on the central issue. We got closest to it in the few words that Murdo Fraser said about the need to focus on outcomes, not inputs. So far, there has been barely a reference to patients, far less a reference to patient care. That seems surprising and a bit odd, given that we are debating the NHS.
The difficulty in this debate for both the Government and all of us who are in opposition is to do as every speaker so far has said, which I shall repeat—to have a more open and honest debate about the NHS and where we think that it is going. Jackie Baillie was right to refer to real-terms increases, but we have not discussed the fact that real terms are measured by a number of indices that do not include NHS inflation. That makes the term rather curious.
Jackie Baillie cited the figures for redundancies that have been announced. However, the starting point for a more honest debate is the figures that health boards have supplied for the amount that they need to save just to break even. Those are telling as regards their management. Greater Glasgow and Clyde NHS Board is £62 million short, Forth Valley NHS Board is £26.5 million short, Dumfries and Galloway NHS Board is £6.75 million short and Lothian NHS Board is £31 million short.
I will take Ross Finnie back a couple of sentences, as I know that he attaches great importance to precise language. Will he care to correct himself and to acknowledge that the numbers that he referred to are not redundancies, given the commitments that I made earlier?
I will come on to the workforce issue, but I want to start by establishing the basic position. The public do not understand a debate in which we are told that more money is being supplied to the health service but in which the same health service is threatening to make redundancies. That is the service’s phraseology, not mine. The terminology may be unhelpful, and the cabinet secretary may have a grievance about it—we will come on to that—but that is the situation. My colleague Mike Rumbles will elaborate on the real problems and threats to services that his area faces and will pose a number of serious questions that are not being answered openly and honestly.
I am confused about where we are trying to go. It appears that the situation is serious and that all of the health boards that I have mentioned must make savings just to cover where they are, never mind any future cuts that may be in the pipeline—those are not the issue. What is the health boards’ position? Again, there is huge disappointment. One cannot generalise, but, when pressed by the Health and Sport Committee, the health boards’ approach was astonishing. They appeared to have managed to make many savings, in many areas of their activities, without any real difficulty. I was not impressed. That suggested to me that managers, who are there to manage every pound from the public purse, have not been doing the job as well as they should. Boards should not be in the position of still seeking extra savings for their budgets to break even. Based on the evidence that they gave to the Health and Sport Committee, they should have been managing the situation in the first place.
Many people have constructively contributed to this debate, but I must give credit to the Royal College of Nursing. Although 40 per cent of all manpower costs are in nursing, the college has not shouted and bawled from the rooftops that there cannot and must not be any change. In fact, it has supplied every member with an interesting briefing in which it talks constructively about how we can improve the delivery of services but lays down clear conditions that any health board must meet.
There are other issues about which health boards are not being honest. What is meant by non-filling of posts? That can lead to huge inefficiencies. It appears that if someone leaves, their post will not be filled. Is that post needed or not? Non-filling of posts and voluntary redundancy can result in people whose skills we need leaving. Using those phrases outside the context of proper workforce planning is nonsense.
The Royal College of Nursing makes sensible suggestions about service redesign, which it defines as
“new ways of providing health services more efficiently but still meeting patient need.”
The point of service design must be to reduce the amount of care that patients require, which, in turn, reduces the cost. If health boards across Scotland did that, we would be talking about proper efficiencies and proper management.
The point that we want to make in this debate is quite clear. I am glad that the cabinet secretary is taking responsibility for establishing a scrutiny group and that she will retain responsibility for exactly what workforce planning will mean. That is not a simple solution but a thoroughgoing exercise that will involve a whole range of criteria. There has to be a robust risk assessment of what the changes will mean for the safety and quality of the health care that is to be provided. That will require nationally agreed workforce and workload planning tools, and there must be the right quality and range of skills and the education and training to support that.
The cabinet secretary will have to return to the chamber to report on the outcome of the scrutiny group so that members of the Parliament can test all those elements as rigorously as they need to be tested.
I thank Ross Finnie for his thoughtful analysis. Does he accept that when Audit Scotland was invited to look at efficiency savings, it said that it was unable to validate them? That is why looking at them closely will be so crucial.
Please respond briefly, Mr Finnie, and you must close thereafter.
Yes, I accept that. That was an astonishing discovery by Audit Scotland, and I have commented on it in the chamber before.
In accepting that we must move forward and focus our attention on patient-centred care, we on the Liberal Democrat benches are clear that many questions are yet to be answered. In our amendment, we focus on workforce planning and a series of objective criteria that simply must be met. We welcome the establishment of the scrutiny group but, more important, we look for the outcome of its work to be reported to the Parliament so that it can be subject to parliamentary scrutiny.
I move amendment S3M-6469.1.1, to insert at end:
“, and calls on the Cabinet Secretary for Health and Wellbeing to publish immediately NHS boards’ workforce projections and to carry out robust scrutiny, including risk assessment, of the impact on the safety and quality of patient care and the provision of frontline NHS services.”
09:57
The First Minister and indeed other ministers and cabinet secretaries talk about deferring cuts until next year. We all have news for them: the cuts are here now, and they are savage. As for the £500 million—
Will the member take an intervention?
I am only just starting.
As for the £500 million, again, I have news for colleagues: the Government simply cannot spend the same money twice.
Fears have emerged that there will be significant job losses as NHS Fife seeks to make almost £10 million of savings in the current financial year. Just how many job losses are involved is being withheld from the public in Fife. We are told that the losses will be achieved by not filling posts and through natural wastage, but, as Mike Rumbles has said, that is probably the worst sort of non-planning that we could have. If anyone wants to see the dramatic effect that it is having, they need only look at the front pages of our local newspapers, which are reporting the cuts. That is happening all over Scotland, so it is not a figment of anyone’s imagination. It is happening, and it is happening now.
The decision by NHS Greater Glasgow and Clyde sent shock waves through the health service in Scotland. As Jackie Baillie rightly said, one estimate has put the total number of health posts that will go throughout the country at about 5,000. Understandably, the trade union movement has reacted furiously to the announcement of those job cuts. The unions have branded the situation as an absolute disgrace.
I will give one piece of anecdotal evidence. When I was scanning NHS Fife’s board papers yesterday, I was concerned to notice some evidence of the impact of the cuts. Under the consideration of an endowment request, committee members were asked to consider a request to purchase an ultrasound breast scanner for radiology. There is nothing unusual about that. The papers said that the new scanner would replace the existing unit, which is old and considered to be a clinical risk. The committee members approved the purchase, which totally wiped out the scanner appeal endowment fund. In my eyes, it is sad that we are having to resort to using endowment funds to replace essential equipment, and the very fact that the scanner was regarded as a clinical risk illustrates Ross Finnie’s point that we need to demonstrate the impact on patients.
As choices have been made by the SNP Government, supported all the time by the Tories, we have to remember that they have all been about populist, giveaway budgets at the beginning of the Government’s term of office, leaving nothing in the pot to address all the issues that need to be addressed now. If we know anything, it is that dealing with staffing costs is the most critical factor. We should consider the evidence that Tim Davison of NHS Lanarkshire gave to the Parliament’s Public Audit Committee on 24 March. He told the committee:
“It is absolutely inevitable that we have to reduce our wages costs. There is no avoiding that.”—[Official Report, Public Audit Committee, 24 March 2010; c 1609.]
The Royal College of Nursing’s briefing states:
“As nursing and midwifery posts make up over 40% of the NHS workforce, this is the section of the workforce that is likely to be hit the hardest.”
It goes on to outline precisely the kind of measures that will be taken, such as the loss of posts through natural wastage. Those measures will just result in a huge lack of planning for redesign, on which the Health and Sport Committee has taken evidence from health boards throughout Scotland. They said clearly that we must ensure that redesign is done carefully and on a calculated basis and that we do not have random cuts that leave health service staff demoralised and in a situation where they just do not know what surprises will come around the corner next. That is the danger.
When we read board papers from throughout Scotland, we find that they are all undertaking risk assessments, but they all say that, in the current climate, they cannot be sure what the actual risk to their patients will be. That must concern parliamentarians and ministers. We speak to visitors to the Parliament all the time and we hear what they are saying. It is worrying when we hear that specialist clinicians are being taken away to serve on wards and their specialist skills are no longer used. We have been reassured in all the arguments and debates that we have had, for example on the “Right for Fife” plans, that the way forward is not just to rely on consultants and doctors but to have specialist nurses and paramedics, but I have news for the cabinet secretary: if those people are not there to be those specialists, where does that leave all the arguments that were used to persuade us to agree to the changes in the “Right for Fife” plans and the changes that we have seen in the NHS throughout Scotland? The situation is not acceptable.
It will be unforgivable if the Parliament agrees to the amendments in the names of Nicola Sturgeon and Murdo Fraser. I hope that colleagues will support Labour’s motion, because Labour is showing that it cares very much and that the health service is our priority. That has been demonstrated over the years by the massive amounts of public funds that have been invested in it throughout the United Kingdom but, more important, here in devolved Scotland.
10:03
Given the seriousness of the matter in hand, I wondered whether the Labour Party would recognise how important the subject is to the people of Scotland. I wondered whether Labour members would treat it appropriately or would simply launch into their “SNP—bad people; Labour—good people” party rhetoric, so I had two versions of my speech ready. One version was inspired by Jackie Baillie’s words to the Standards, Procedures and Public Appointments Committee on 4 March 2008, when she said:
“I think that we have a duty to be accurate in the chamber and not to mislead anybody either unintentionally or deliberately.”—[Official Report, Standards, Procedures and Public Appointments Committee, 4 March 2008; c 151.]
Quite. Call me naive, but, encouraged by those words, and looking forward to a sensible and sincere debate, I prepared a version of my speech that is full of phrases such as “working together” and “cross-party support for NHS workers”. As members can see, it is rather light in weight, for I held out little hope, and how right I was.
What we have just heard is the largest Opposition party in the Parliament absolutely revelling in the irresponsibility of obstructionist, partisan oppositionism, choosing scaremongering over constructive, honest and rigorous debate in the chamber. I guess that I will not need the first version of my speech.
I want to consider three things: the Labour Party’s problem with amnesia, the cabinet secretary’s excellent record and, last but not least, the people who should be at the heart of the debate.
I still intend to be constructive in using the second version of my speech, but I cannot ignore the fact that the Labour Party seems to be suffering from self-inflicted collective amnesia. It seems to have forgotten that it crippled our health budgets with private finance initiative/public-private partnership project repayments, and it appears to have slipped the minds of Labour Party members that, in 2007, the Labour Party committed to diverting money away from the health budget. Departments, including the health department, would simply have had to cut their cloth, according to Lord McConnell, who was but an ordinary man of the people in those days.
Perhaps those times are too far back for Labour members to remember, so let us consider more recent events. This year, the NHS capital expenditure budget was cut to the tune of £129 million. That was a Labour cut—it was the first on its deeper-than-Thatcher wish list. John Swinney rightly moved to address that issue, first by using end-year-flexibility money, and then by reluctantly cancelling the Glasgow airport rail link. That is the same rail link that we have heard so much about from Labour members.
Will the member give way?
Jackie Baillie ought to know from what I have just said that I am not giving any more airtime to the Labour Party today.
The SNP Government is taking forward the largest health project in Europe. There is massive capital investment in the new Southern general in Glasgow, but apparently, unless the Labour Party is able to print money, Labour members would prefer that their city council colleagues were able to get from Glasgow City Council chambers to the airport for their fact-finding missions slightly faster using GARL. That is up to them. Speeding up the removal of Labour councillors in Glasgow is tempting in some ways, particularly when we consider the fiasco that is unfolding over community health and care partnerships. We have had from Labour a preferred option of spending on GARL, a promise to divert money away from health—I wonder whether Labour is now saying that it would have broken that promise—and real cuts from its bosses down south.
Despite all of that, our NHS in Scotland has performed incredibly well under Nicola Sturgeon’s leadership. NHS funding is at record levels in the toughest financial circumstances since devolution began. The usual cry from the Labour pantomime, with principal boy Jackie Baillie leading the chorus line, is, “Oh no, it’s not,” but the health board chiefs beg to differ, and they have no axe to grind. When he gave evidence to the Public Audit Committee earlier this year, the chief executive of NHS Grampian, Richard Carey, said:
“the financial performance of the NHS in Scotland hitherto has been a success story. The levels of funding that we have enjoyed during the past few years have enabled us to grow the health service in a positive way”.—[Official Report, Public Audit Committee, 24 March 2010; c 1609.]
What have the additional funding and sound stewardship meant for the patients and the workforce, who really ought to be at the heart of the debate? Deaths from cancer, heart disease, stroke, AIDS and suicide are all down, waiting times have been decimated beyond recognition, and hidden waiting lists are, I hope, gone for ever. Those are quite remarkable achievements in an economic climate that has been tougher than the party to my left—geographically speaking only—ever had to deal with. I dread to think how it would have managed.
The last time that I spoke in such a Labour debate, I was so angry that I lost my voice for three days.
Members: Hooray!
I know; some would say that that is no bad thing. My mother said, “Just try to be nice in future, Anne.” I explained to her that that is difficult with such motions. That is not because the SNP is being criticised, but because of the unnecessary fear and alarm that are instilled in people who have difficult enough jobs as it is without also having to worry needlessly about losing them.
I will end with the last part of what Jackie Baillie said to the Standards, Procedures and Public Appointments Committee in March 2008. She said:
“Do not underestimate the extent to which people will study the words that are spoken in Parliament and take meaning from them.”—[Official Report, Standards, Procedures and Public Appointments Committee, 4 March 2008; c 151.]
With that mind, there is no excuse for a motion and speeches that refuse to recognise the position of strength from which the NHS will face the inevitably tough times ahead, that ignore the cabinet secretary’s promise that quality of service will be at the heart of all planning, and that blatantly disregard the fact that there will be no compulsory redundancies.
I can reach only one conclusion from what I have heard today: Labour members put their party before NHS workers, their politicking before Scottish patients, and their need for headlines—I say to Helen Eadie that headlines do not make things true—before the truth. They should be thoroughly ashamed of themselves for that.
10:10
We are proud of the NHS, and our constituents rightly expect us to ensure that the service continues to deliver for them. That expectation is why so many parties in the latest UK general election stated that they would protect health spending. Unfortunately, in Scotland, where we have an increased budget, NHS boards are now facing cuts. More nats, fewer nurses.
Those cuts are happening now. Between Christmas and the end of the financial year, NHS Highland closed beds in an essential rheumatology unit to make cash savings. It did not pretend that that was done to improve patient care; rather, it needed to save money. It is now reviewing that service in order to move it closer to patients, but it has stated that any changes must be cost neutral. Everyone knows that it takes more staff to deliver services closer to people’s homes, especially in remote and rural areas, where professionals must travel large distances to get to their patients. How can the changes be cost neutral when more staff will inevitably be needed to deliver the same level of service? The only conclusion that I can reach is that that is another cut rather than a service improvement.
The rebalancing care argument has been used to cut beds in various local hospitals throughout the Highlands, but there has been no corresponding rise in staffing numbers in the community. The Government and health boards deny that those cuts impact on patient care. However, following recent bed closures at Portree hospital, a patient told me that they were forced to travel to Broadford hospital because no beds were available in Portree. They were required to make a journey of more than 26 miles on poor roads that can be treacherous in the winter. I cannot see any efficiencies in that or any improvement in patient care.
I want to touch on the inequalities of health board funding allocations due to the NHS Scotland resource allocation committee formula. That formula was implemented in 2008, despite the adverse impact that it would have on remote and rural health boards.
Will the member give way?
I want to make my point.
At that time, the cabinet secretary acknowledged that the data that were used for the formula were poor at best. Because of that, she set up the technical advisory group on resource allocation to review the data and refine the formula. That group has been sitting since then, but the formula remains unchanged. I was told in an answer to a written question that it met only four times last year and that it would report early this year. From subsequent questions, I have learned that it will not report until August. Why the delay? What action has the cabinet secretary taken to speed up the review? I suspect that the advisory group could more aptly be called the long grass group. Perhaps the Minister for Public Health and Sport will reassure me.
Will Rhoda Grant clarify that it is Labour’s position to oppose the NRAC formula? If so, what health boards would it take money from to make the funding change that is being suggested? Clarity on that would be useful.
I do not think that any party supports a formula that is based on data that are not right. The cabinet secretary has admitted that the data are incorrect and she has set up an advisory group, which is indeed a long grass group. [Interruption.]
Shona Robison should stop muttering.
Mr Foulkes, if members have to stop muttering, I will tell them so.
Delivering health care in remote and rural areas is more expensive because of sparsity and geography. NRAC has forced NHS Highland to consider cuts that were previously thought to be too scary and untouchable. It does not take an advisory group to tell the cabinet secretary that the formula is wrong and that it needs to be changed.
I and other Highland MSPs recently met NHS Highland, which told us that it was looking at a staffing cut of 100 people—70 from management and administration and 30 from the nursing staff. That begs the question how services can be delivered closer to the community with fewer nurses. Therefore, we rightly complain about cuts in nursing jobs. There will be cost savings by caring for patients in the community, but they will not come from cutting nurses.
We cannot ignore the jobs of backroom staff either. Less administrative support will mean that medical and nursing staff will take more time away from direct patient care to do administrative work. My mother was in hospital recently, and most of my dealings were with nurses and doctors, but I was given valuable information and support by ward receptionists and medical secretaries. If that support were removed, it would place an additional burden on front-line staff. Although we rightly guard nurse numbers, we must also ensure that we value the support workers and their jobs. New technology can create efficiencies. However, the health service is not renowned for its fast implementation of technology.
We face problems with the number of junior doctors, which has fallen from 4,500 in 2008-09 to 2,400 this year. In the past, health boards faced challenges filling junior doctor posts in some of their most remote and rural areas, and indeed in some specialties. In August last year, NHS Highland had 27 unfilled vacancies, seven of which have still to be filled. With numbers falling, it is impossible to see how the situation will not be worse this year. If those posts are not filled, locums will be required to fill the gaps, leading to higher costs. I raised those concerns with the cabinet secretary in health questions, and she appeared unconcerned. I ask her to look again at the issue to ensure that it does not become a problem.
Efficiency is welcome, but cuts are not. The Scottish people rightly value their health service and its dedicated staff. Those staff do not need uncertainty. They do not need to see their jobs slashed—such cuts would be a false economy. The health service needs to be modernised and to use technologies to deliver services more efficiently. Cutting front-line staff to balance the budget is not the answer.
10:16
During the near half century that I have been associated with the NHS, there have been enormous changes in what it has delivered and how it has delivered it. Techniques, drugs and procedures are available now that were undreamt of when I was a medical student, and others are long since obsolete.
From what was a paternalistic organisation, where the consultant was god and the patient was the passive recipient of what was thought to be best for him, the NHS now rightly seeks to involve the patient at every level of his journey through the system. There is a much greater emphasis on prevention of disease and, increasingly, patients are encouraged to take personal responsibility for managing their long-term medical conditions. More and more demands are placed on the NHS, which to some extent is becoming the victim of its own success. People are living far longer, which is made possible by the long-term treatment of many conditions that killed off previous generations.
Thankfully, since the inception of the NHS, Governments of whatever colour have remained committed to it, and resources have been made available whenever possible to enable it to flourish. Medical fashions have come and gone, and political ideologies have influenced how the organisation has developed and been managed. Despite that, though, as we have heard today, we still have a health service that, although not perfect, is one that we can be proud of, and an NHS workforce that is committed to doing its best for the patients it serves.
It is therefore good news, when our new Westminster Government has to face up to the enormous debt crisis left by the outgoing Labour Government, that the Conservative-Lib Dem coalition has clearly stated its commitment to the NHS by guaranteeing a real-terms increase in health spending in each year of the Parliament. It is further good news for Scotland that the SNP Government has agreed that all resultant Barnett consequentials will be applied to the NHS in Scotland. That means that the financial crisis that we have inherited from Labour should not impact on the NHS as it will on other public services.
However, if the NHS is to live up to the rising standards of patient care that people nowadays expect and deserve, it has never been more important to ensure that resources are deployed efficiently and effectively. There is an urgent need to look at how the NHS delivers and to consider introducing reforms that will achieve our ambition to have a world-class NHS that delivers the best health care possible. I agree with Ross Finnie that we had a helpful and constructive briefing from the Royal College of Nursing.
Patient needs are paramount, and any changes and efficiency savings must ensure that patient welfare is not compromised. As Murdo Fraser said, that is achievable; by considering carefully the outcomes for patients under the care of the NHS, and planning with that in mind, it should be achievable. Easy accessibility is very important for patients, which is why my party believes in local provision of NHS services wherever possible. If we make local access easy for patients, it becomes easier for them to self-manage their long-term conditions. With the help of good primary care services, they are less likely to need the much more expensive secondary and tertiary services that are provided in our major hospitals. That is one way of saving money for the NHS.
Local access is important day and night, which is why we feel that out-of-hours cover must be improved, particularly in more remote parts of the country such as Kinloch Rannoch, with whose petition to the Parliament I have a great deal of sympathy; I hope that the cabinet secretary responds appropriately to it. The need for local accessibility is why we fought the previous Scottish Executive’s plans to centralise A and E and maternity services. It is why we were delighted that A and E services were retained at Ayr and Monklands, and why I as a North East Scotland MSP was relieved when Andy Kerr was finally persuaded, after a hard-fought campaign, to retain and develop some of the local maternity services in Aberdeenshire. It was also important for the north-east that we were able to retain neurological and children’s cancer services in Aberdeen, rather than having them centralised in Edinburgh or Glasgow, as proposed by Labour. Such centralisation would have been to the detriment of patients.
As the NHS evolves, service changes and efficiencies will always be necessary, but those must all have the interests of patients at their core. Some of the best improvements come from suggestions made by members of staff. Health boards will always benefit from involving staff in any plans that they have for generating efficiencies. Small changes in delivery can lead to far-reaching benefits for patients.
Of course, people are fearful of change, particularly when that change can affect how staff are deployed in running the service. However, I do not share Labour’s gloomy outlook on the future. We have been assured that there is a commitment to having no compulsory redundancies in the NHS in Scotland, but there is also a realisation in the service that funding is going to be tight for the foreseeable future. I think that staff will willingly do their best to deliver efficiencies while protecting high standards of patient care. I welcome the independent scrutiny group that is being set up, which I have no doubt will make certain that standards are kept high.
When resources are under pressure, priorities become increasingly important. For my party, it was extremely important to reverse Labour’s plans to increase employers’ national insurance, which would undoubtedly have put jobs at risk in the NHS. We also oppose the SNP’s plans to abolish prescription charges completely, because the money that that would lose the NHS would, in our opinion, be far better spent on treating patients than on affording free prescriptions to people who are able—and indeed willing—to contribute towards their cost.
In the hard times ahead, it will be essential to deliver health care in the most cost-effective and efficient way possible. However, that need not and should not be to the detriment of patient welfare. It is therefore important that health boards and Government consider carefully their current workforces and skills mix, and produce workforce plans that will ensure that those are appropriate to meet the current and future needs of the service. That is why I am happy to support the SNP and Conservative amendments.
10:22
It is with sadness rather than anger that I note the depths to which a once-proud party has sunk, as exhibited in the tawdry motion that lies limply before us today—a motion lodged by a party that pledged in the 2007 Scottish parliamentary election not to increase health service expenditure. It is a motion lodged by a party that has placed health boards throughout Scotland in hock for years to come as a result of its incontinent, wasteful expenditure on expensive PFI projects—
Will the member give way?
If I have time, I will certainly give way.
It is a motion submitted by a party that promised to close vital A and E departments, against the will of the populations they serve. While we are on that point, let not the Lib Dems try to hide under a stone, because they were involved in that policy as well.
The Scottish public can be very pleased indeed that they rejected the Labour Party and its colleagues as the guardians of its vital health service. How dare that party carp now, when others have to sort out the mess created by its mishandling of our finances at a UK level. As the outgoing Chief Secretary to the Treasury, Liam Byrne MP, accurately remarked, all the money has gone—and it was that lot that spent it.
Let us consider a few facts. It is a fact that, when the four years of this parliamentary session are over, there will be more doctors, nurses and other health service workers—apart from managers—than there were when the SNP Government took over from Labour. It is a fact that, despite these troubled financial times, there will be no compulsory redundancies in the Scottish health service. How many other organisations and businesses can make that promise? It is a fact that all changes taking place will be monitored rigorously to ensure that quality of service is not compromised.
That latter point about quality is very important, because although we value the dedication and professionalism of our staff, we must not forget the main purpose of the health service. It is not primarily an employment agency whose worth can be measured by the increasing number of folk it employs, as is implied in the motion. The value of the health service, as Murdo Fraser so ably put it, is the standard of care that it provides and the health outcomes that ensue.
As treatment protocols and procedures change and new technologies become available, staff needs inevitably change. In the dim and distant days when I was a youth, hospitals employed scores of nurses and other staff to look after patients with polio who needed to be treated in so-called iron lungs, which were huge machines that kept people alive when their breathing muscles had become permanently paralysed. Today—thank goodness—such machines are relegated to museums. The development of effective immunisation against polio has seen to that. However, that has also meant that all the hospital staff who were involved are no longer needed for those tasks.
Do we really subscribe to the theory that posts that are no longer needed should continue to be filled in order to reach some artificial employment target? The example of polio is history, but there are plenty more recent examples. The introduction by health boards of lean management techniques, including kaizen blitzes, has meant that various procedures can be conducted equally or more efficiently with fewer staff. Members of staff are involved in that process. Operations or other procedures that, in the past, involved weeks of in-patient care now allow patients to be discharged home after just a few days. Maternity hospitals used to be called lying-in hospitals because of the length of time for which mothers remained in them. Now, mums can return home within hours of giving birth.
Does the member think that that is always wise, particularly in the case of breastfeeding mothers?
The length of time for which a woman remains in hospital after giving birth is a matter of clinical judgment, but I do not think that it was right for women to stay in bed for days and days automatically, as used to be the case.
Hip replacement operations used to involve a hospital stay of three weeks; now, it is more like three days. Keyhole surgery for abdominal and other complaints also reduced the length of in-patient care. Modern local anaesthetic techniques enable much more day surgery to be undertaken.
The redesign of such services reduces the burdens on hospitals and the requirements for staff. Of course, that often places an increasing burden on primary care resources and results in some consequential increases in the need for primary care staff, but the vast majority of general practitioners are independent contractors and the staff whom they employ directly are not included in the figures before us today. Not only are those figures theoretical projections, rather than an accurate snapshot of the situation; they are potentially misleading, because they do not reflect the total pool of health workers who are employed in primary care.
Health boards were created to reflect and respond to local circumstances. It was rightly thought to be incorrect for masses of relatively small decisions to be micromanaged from St Andrew’s house. A combination of the spinelessness of many appointed non-executive directors of health boards and the tendency of central Government to centralise has tended to vitiate those responsibilities.
I hope and believe that the advent of directly elected health boards will restore some balance but, even before that happy day, we must give individual health boards more freedom to manage their resources as they see fit, which includes vacancy management. We all have to make savings, as money is scarce. Let us trust those appointed to manage local services to do the job, provided of course that they also submit to and satisfy external, independent quality controls.
The motion is tawdry and opportunistic. Let us give it the fate that it deserves—total rejection—and let us support the SNP amendment.
10:29
Plans to cut 500 jobs over the next year are on the verge of being approved by Grampian NHS Board. According to reports in The Press and Journal, it estimates that 226 jobs will be cut by leaving vacancies unfilled and some 274 will be cut through voluntary redundancy. It is all very well for the health secretary to say that there will be no compulsory redundancies, but surely that is not the point. It is about reducing the number of staff employed to serve patients. I thought that we were supposed to have a patient-focused service. The health board’s proposal will reduce the service that patients receive—there can be no getting away from that fact. If that is not the case, what on earth has the health board been doing over the years employing those staff?
What about effective workforce planning? Redundancy is supposed to be about posts, not people. If posts are to be reduced in the most appropriate way—for patients—having voluntary redundancy and not filling vacancies will result in unplanned gaps throughout the health service. The health secretary needs to acknowledge that fact and deal with it appropriately.
Does Mr Rumbles accept that, for the eight years that his party in coalition with Labour was running the health service, the form of vacancy management that he so graphically described was commonplace?
No. I thought that we had changed the whole process. I thought that, over the years, we had won the battle to ensure that we focused on the patient, not the staff, the building or anything else.
Nicola Sturgeon rose—
I will proceed and give way again in a moment.
If we are to focus on the patient, proper workforce planning is essential to the task.
In addition to the proposed cut of 500 staff posts, we are being told that almost 30 major and necessary projects are facing the axe in the NHS Grampian area. Proposed new medical centres or investment upgrades across my constituency, such as at Banchory and Braemar, and in other parts of Aberdeenshire, such as Inverurie, Insch and Kintore, are to be shelved, with the health board discussing budget cuts of up to £100 million.
That comes at the very time when both the new coalition Government at Westminster and our Scottish Government here in Edinburgh are assuring us that no cuts will be forthcoming this year and the Scottish Government is taking up the offer from the coalition Government not to reduce current budgets.
I asked Brian Adam whether he would be in the chamber to hear this, but obviously he is not. I heard him on the radio this week criticising those of us who were asking questions about this issue. He said that we should “get real” about these “inevitable” cuts. I was shocked that a fellow north-east MSP could indulge in that, instead of fighting our corner for the people whom we serve.
Shona Robison rose—
Let me finish the point.
Brian Adam well knows that the funding formulas used by the Government in allocating cash to the north-east are already discredited but, instead of fighting our corner, he seems to be saying that we should roll over and accept the inevitable.
If Mike Rumbles, whose party is now a party of government, is saying that staff numbers should remain static and there should be no change to them, from where would he take the money to fund that? If he is not saying that, is he arguing for compulsory redundancies as an alternative to what we are suggesting? It has to be one or the other.
I have never said that staff numbers should be frozen. What I am pointing out to the health secretary is that her statement that there should be no compulsory redundancies is not patient focused.
Nicola Sturgeon rose—
Do I have time to give way again, Presiding Officer?
Briefly.
Shona Robison’s point deserves to be answered. I take Mike Rumbles back to his attack on the policy of having no compulsory redundancies. Is he arguing that we should have compulsory redundancies or that staffing numbers should never change to reflect changes in service delivery? It has to be one or the other.
I am surprised that the health secretary is suggesting that I am saying that staff numbers should never change—of course they change. Ian McKee made a great point about the iron lung and the staff associated with such treatment. We should be doing that all the time, but I am astonished that the health secretary does not recognise that and seems to relegate the importance of efficient, effective and proper workforce planning. That is what it is all about. It is interesting that the Scottish health secretary is unaware of that.
I return to the point that I was making about the plans to take away £100 million of investment in decentralising the health service in Grampian. There has been a huge drive for decentralisation, which I thought the health secretary backed. This is the very time when many of our health services can be administered more effectively and efficiently in rural community hospitals and heath centres in places such as Aboyne and Banchory in my area. People can use those centres instead of having to travel 60 or 80 miles every time they want to see somebody for treatment. The health board’s approach is wrong-headed and I hope that the cabinet secretary will address the issue. It is a huge mistake to put that investment on hold.
Something very wrong is going on here. Why is the Scottish Government saying that it is protecting our budget from the forthcoming cuts that the rest of the UK will face as a result of the coalition’s emergency budget on 22 June? We are being told that we will not face any cuts to devolved budgets this year. That offer was given by the Chancellor of the Exchequer and accepted by our First Minister. What, then, is going on at the behest of the Scottish Government? Why are our health boards meeting to draw up these huge cuts in our heath service budgets?
In summing up the debate, the minister needs to be open and frank about what is going on here. The Government has more money available to it than ever before. Why, therefore, is Grampian NHS Board being instructed—I assume that it is and that it is not doing this of its own volition—to cut £100 million from its budget and slash 500 jobs? Our constituents have a right to know and the minister has a duty to tell the Parliament.
10:36
I start by commending Murdo Fraser for his sterling defence of SNP policy. It is clear that that alliance is alive and well. It certainly augurs well for their political future, although whether it does anything for Murdo remains to be seen.
Those of us who have been members since the early years of the Parliament will recall the numerous complaints that we received in our constituency postbags and at our surgeries about health-related problems. People were concerned about the length of time they had to wait for an appointment to see medical staff and about the quality of care and facilities. Those complaints justified the very real investment in the health service that the Labour-Liberal Democrat coalition Executive made to address those problems.
Was the investment justified? It was. Did it work? I think that it did. If members think of the inquiries that we receive from our constituents, I suspect that most of us would say—or would have said until recently—that there has been a significant fall in the number of health-related complaints. That is not to say that such complaints have been eliminated completely or that we will not receive individual complaints about things that cannot be justified, but the general picture is that the volume of such complaints has reduced. However, like many other MSPs, I am beginning to see a recurrence of complaints about waiting times, waiting lists and the level of service and other general concerns about the health service.
Murdo Fraser was right to say that we should measure outcomes and not look only at inputs. Ian McKee ably identified where progress can be made and has been made in the health service over many years. The problem is not that new techniques and methods of health service delivery are resulting in staff no longer being required; it is that advances mean that conditions can now be addressed that previously could not be addressed. Despite the progress that Ian McKee described, demand for our health service has not reduced. People now, rightly, have a higher expectation that the health service can meet their needs and demands. That is what we have to address.
We will always be faced with the perennial problem of whether we should have a bottomless health budget that allows any medical condition to be treated, irrespective of the cost. That is a philosophical and ethical debate and it will, no doubt, continue for many years. Yes, it is right for us to look at outcomes and not only at maintaining health service jobs, but the demands on the health service are sufficient to justify maintaining the number of medical staff at existing levels.
Anne McLaughlin said that it is wrong to spread unnecessary fear and alarm among staff about their jobs, but I think that she missed a fundamental point about the concerns of health service staff. By and large, health service staff are dedicated to the health service—they are dedicated to their patients and want the best for them. When health service staff express fear and concern, they are talking not only about their own jobs but about the impact that colleagues’ job losses have on their ability to deliver the service that they believe they should deliver for patients. Staff are concerned. I am sure that Anne McLaughlin has heard the same comments from medical staff that I have heard. People are worried about their ability to do their job if the cuts impact in the way that is being suggested.
As Ross Finnie rightly said, the debate should not be about only budgets and figures. He said that there was barely a reference to patients in the motion but, understandably, any debate on the NHS is predicated on the amount of money that is available and the number of staff who are required to do the work of our health service.
However, Ross Finnie was right in saying that it is the human story that is important in a debate such as this. I will conclude by raising some of the complaints that I am now hearing in increasing number in my constituency work—and I have no doubt that the situation is replicated elsewhere. All the complaints that I will raise relate to podiatry services, which can at times be dismissed as not being vital but which are critical to the quality of life of many people in our communities, particularly the elderly. The first case is that of an elderly gentleman who had received chiropody treatment at the Royal Alexandria hospital in Paisley. Recently, he had need to contact the podiatry service again but, when he did so, he was told that he would have to wait at least six weeks for an appointment. After telling staff that the nature of his problem meant that he could not wait that length of time, he was told, “You will have to go private then.” Is that the answer that we now want to give to elderly people if they can no longer get the service to which they had been accustomed—just go private? Ministers need to reflect on that.
I was contacted by another constituent with diabetes. We all know the significance of the problem that diabetes causes and will continue to cause in Scotland. My constituent used to have his toenails cut every three months, as his mobility was made difficult if the nails were left to curl. He has not had a home visit since October of last year. His carer has tried time and again to make an appointment for him, but she was told, “Well, you can just cut his nails.” Are we trying to shift the responsibility on to carers?
Will the member take an intervention?
No, thanks.
The third and final example involves a woman whose mobility was restricted as the result of a broken ankle. She contacted the podiatry service in Paisley only to be told that no home visits were available and given no appointment for a later date. That is the human impact that the cuts are having even before we start to see the consequences of a loss in staff numbers. That is something that the Parliament needs to address.
10:43
We are committed to the success of the NHS in Scotland, and are interested specifically in the quality of front-line patient care. That deserves the highest priority and should be the fundamental principle when deciding policy and budgets for the NHS. The SNP Government has a proud record of working to improve the NHS and patient care. We have created greater access to dentists, introduced the phasing out of prescription charges, cut waiting times—thanks, in part, to our abolishing Labour’s hidden waiting lists—and met key targets for cancer treatment.
Listening to the speeches from Labour members in the debate this morning, one could be forgiven for thinking that the huge cuts that are being imposed on Scotland this year and those that will come next year have nothing to do with their Westminster bosses’ shockingly inept handling of the UK economy. Under the previous Labour Government, unemployment increased by one million, gave the UK its biggest deficit in history and widened the gap between rich and poor to its greatest extent in 80 years, according to the former Secretary of State for Health, Alan Milburn.
Let us consider what this week’s Economist says, to put in context the legacy that the SNP Government in Scotland and the coalition Government in the UK must deal with. Projected economic growth in the UK this year is less than a third of that of Australia or Canada, a sixth of that of Brazil and a seventh of that of Singapore. Manufacturing output this year is projected to be a quarter of the European average.
Iain Gray, Labour’s group leader in Holyrood—dithering, as usual—has failed even to say what Labour’s position is on the £332 million cut that the coalition Government has said can be imposed in this or the next financial year. What level of leadership are we receiving from the Labour Party on that issue?
Labour planned to introduce 3 per cent efficiencies in the NHS, 50 per cent more than the SNP’s 2 per cent—and would have been top-sliced. The SNP allows for the reinvestment of savings back into NHS front-line services, whereas Labour planned to move that money from the health budget to education. That would have meant £77 million less for Scotland’s health services, according to Labour’s own manifesto commitment and the comments that Jack McConnell made when he was Labour’s First Minister prior to the 2007 election.
The SNP Government has made it a priority to provide the greatest possible quality of care. Despite the cuts from Westminster, we have increased NHS resources by £264 million this year. We should recall—as my colleague Anne McLaughlin pointed out—that the Labour Party made no proposal whatever to increase spending on the NHS this year. In fact, Labour would, no doubt, have taken money from the NHS in other budgets to put into the white-elephant project that is the Glasgow airport rail link. Amazingly, there was an eruption of opportunism one week after this year’s election—suddenly, the Labour Party became all too interested in the NHS.
One of the problems that Scotland must face is the legacy that we inherited on PFI.
Paul Martin rose—
Paul Martin has bounced up and down every time PFI has been mentioned. He will now be like a hen on a hot griddle, desperate to intervene.
Will the member give way on that point?
I will let my esteemed colleague Mr Martin in, but I ask him to let me actually say something first on the issue, before he comes in with his pre-prepared comments.
£1.1 billion in payments will have to be paid by the NHS over the next five years alone. Between 2011 and 2015, NHS Lothian will pay £271 million for the Royal infirmary of Edinburgh, despite the capital costs of that hospital being only £206 million; NHS Lanarkshire will pay £136 million for Wishaw general, a project that is worth £121 million; and £106 million will be paid for Hairmyres hospital, which is worth only £68 million.
I thank Kenny Gibson for giving way. He is concerned about the Labour Party’s support for PFI. I remind him that his minister is signing new PPP projects, one being in my constituency, at Stobhill hospital. The minister has recently signed an extension to the PPP project there. Does he defend the minster on that?
The most savage indictment of Labour and its pals in the Lib Dems when they were in power is not that PFI contracts were signed; it is the level of interest that Labour agreed to. Would Paul Martin buy a flat for £100,000 and agree to pay £120,000 in interest over four years? I do not think so, yet he is happy to see his colleagues do that with public money. The PFI payments will come to £8 billion over the next few years.
So desperate is Labour to make some capital on issues around the NHS that the Labour Party group leader, Iain Gray, has tried to mislead the chamber. For example, on 13 May, he stated at First Minister’s questions:
“a new kidney unit is being cancelled in NHS Ayrshire and Arran”.—[Official Report, 13 May 2010; c 26190.]
My colleague Willie Coffey wrote to Ayrshire and Arran NHS Board about the issue, and the chief executive replied:
“the renal dialysis bays have been increased on the Crosshouse site with a second phase which brought the capacity to 40 bays ... The strategy also set out a proposal to build another unit within NHS Ayrshire and Arran and also to expand home based haemodialysis.”
Will Kenneth Gibson take an intervention?
NHS Ayrshire and Arran’s chief executive went on to say:
“In terms of your specific question regarding the cancellation of our Kidney Unit, I can confirm that the Renal Satellite Unit is still on the Board’s Capital Plan to deal with future hospital capacity if that is required.”
Everything that is happening in Scotland should be kept in context.
Will the member take an intervention?
I am in my last minute. Otherwise, I would have done.
No?
I have got seconds left.
The bottom line is that Labour is misleading us. We should recall that the NHS down south was told to make 10 per cent cuts in staffing—137,000 jobs over the next three to four years. We should hear no more of Labour’s crocodile tears on that issue.
If Scotland had full fiscal powers, including over oil and whisky revenues, we could mitigate the too-often arbitrary whims of Westminster. Sadly, Labour and some other political parties that are represented in this place would rather have Scotland lose money in its budgets and in its health service. The best way forward for Scotland’s NHS is to secure the re-emergence of Scotland as an independent sovereign state with full control of its own resources.
10:50
To return to the topic in hand, the delay in being clear about the number of jobs that are to be lost in NHS Scotland because of SNP cuts has brought anxiety and confusion. For example, NHS Tayside announced in one week that 500 jobs were to go over two years and, the following week, it announced that the 500 posts were to go over a single year. We need clarity on what is happening and why it is happening, not confusion.
The Scottish Government is quoted as saying—and repeats—that staffing levels have gone up by more than 10,000 under the SNP, and that cuts are now needed to make health boards more efficient. However, in a comparable period, between May 2001 and the end of 2003, the number of staff who were employed in the NHS under Labour rose not by 10,000 but by 11,800. Is the SNP’s mantra just an attempt to soften the blow of the cuts?
Where does the 10,000 figure actually come from? To repeat one of the important points that Jackie Baillie made, it appears to come from the public sector employment survey. Between the first quarter of 2007 and the end of 2009, there was indeed an increase of about 10,000 staff, but those are head-count figures that do not distinguish between part-time and full-time staff. Once that is taken into account, the 10,000 extra head count shrinks to about 8,200 full-time equivalent staff.
Let us compare that with the figures that were released recently by three health boards: 1,200 full-time equivalent posts are to go in NHS Greater Glasgow and Clyde over the next 18 months, 700 full-time equivalent posts are to go from NHS Lothian, and 500 full-time equivalent posts are to go at NHS Tayside. That is already 2,400 posts, with next year’s figures still to come—and that is on top of the ward closures that have already been announced, including in Tayside.
I am not sure whether Marlyn Glen is referring to the Royal Victoria hospital. Does she acknowledge that the clinicians there have said that they support the move to Ninewells? They want to be assured that the quality of service there will be as good as that at the Royal Victoria. It is misleading to suggest that they oppose the ward move.
Sadly, it is not just the ward at the Royal Victoria that we are talking about—it is also ward 31 at Ninewells. That has been in the press, and Gerry Marr has been involved. There is huge concern about the matter.
To recap, there are the employment figures, and there is what we know so far about ward closures. It is clear already that thousands of posts will be lost in NHS Scotland, even more than the 2,000 posts in teaching that have been lost so far under the present Government. The SNP has shown that it cannot even protect public services in the good times, when its budget is rising.
The SNP refused to publish the information swiftly, so we must listen instead to what the people who work in the NHS are saying. They say that NHS Greater Glasgow and Clyde plans to replace more than 380 registered nurses with about 220 nursing assistants, which is more than 160 fewer staff over the next three years. NHS Grampian is to freeze vacancies for nurses this year, as has already been mentioned.
If the NHS supposedly has too many staff now, and it needs to be made more efficient, why do professional bodies such as RCN Scotland report otherwise? Why do the Scottish results of the Royal College of Nursing’s 2009 employment and morale survey show that 44 per cent of nurses think that patient care is compromised at least once or twice a week, 51 per cent think that there are not enough staff to meet the needs of the patients for whom they care, and 52 per cent think that they are too busy to provide the quality of patient care that they want to provide?
We hear from the Government that NHS services are being redesigned to improve efficiency and quality. We are not against change just because it is change. I am sure that some services can be redesigned to be more efficient. However, changes must be costed and supported, and it is self-evident that if change is to be successful there must be full and proper consultation of staff.
The releasing time to care initiative pilots have enabled the time that nurses spend on direct patient care to increase by up to 40 per cent. That is good news. However, at a time when health boards are being ordered to make millions of pounds of so-called efficiency savings, how will the Government guarantee the finance that will enable the initiative to be introduced successfully in all health boards?
We must consider SNP cuts in services and posts in relation not just to current provision but to the promises that the SNP made but did not keep. I will give three examples. First, in its 2007 election manifesto the SNP promised to double the number of school nurses. There were 221 school nurses in 2007, but in two years the SNP increased the number by just 36.
Secondly, the SNP promised to reduce the use of antidepressants by 10 per cent by 2009. According to the manifesto, that was to be achieved through the use of counselling and talking therapies in each community health partnership area. The initiative would be backed with ring-fenced funding to health boards and local authorities. However, in reply to my inquiries, Dundee City Council and Angus Council said that they had received no such funding from the Scottish Government for those services in 2008-09.
Thirdly, in December 2006 the SNP website carried a commitment to introduce a breast screening programme for women over 40—the current approach is to screen women over 50. That has not happened, either. Meanwhile, in England, the NHS breast screening programme has been phasing in the approach from this year.
It is disappointing that it has taken a Labour debate to force the cabinet secretary to publish the workforce projections. The cabinet secretary must urgently intervene to prevent cuts to front-line NHS services and to promote the best possible patient care.
10:57
It is no surprise that the tone of the debate has been a wee bit less than constructive. However, Ross Finnie made a valid point when he said that patients should be central to the debate. I am sure that he will find that my speech reflects that concern.
Helen Eadie talked about the use of endowment funds when there is a shortage of funding. The League of Hospital Friends Inverclyde has operated at the Inverclyde royal hospital since 1973 and has donated more than £1 million to local health services. Last week it donated a £50,000 eye scanner to the health board. According to Helen Eadie’s logic, surely that means that there has been a shortage of funding in health boards in the West of Scotland since at least 1973.
There is some amnesia on the Labour benches about the NHS in Scotland and about the financial implications for public services in Scotland and throughout the UK as a result of the shambles that is the UK public finances. Members should make no mistake: we will be paying for the debt that was left by Labour at Westminster for many years to come, and the population of Scotland and the UK will suffer. The best thing the Scottish Parliament can do is to try to find a united voice to speak out against further cuts to the Scottish budget. We had cuts of £500 million from the previous UK Labour Government, and cuts of £332 million have been deferred until next year.
There are a few points that need to be aired. There are issues in the public sector; there always have been and always will be. Nothing in this world is perfect and the job of every Government, whatever its political hue, is to try to improve the services for which it is responsible.
If Labour thinks that job losses
“will inevitably have a detrimental impact on patient care”,
as it says in the motion, we must question why staffing levels in 2007, when Labour was in power, were lower than they are now. Surely if we follow Labour’s logic we must agree that Labour underfunded and underresourced the NHS in Scotland for eight years.
Will the member take an intervention?
I need to make progress.
Labour wanted to close the A and E facilities at Ayr hospital, Monklands hospital and the Inverclyde royal hospital. However, I am thankful that all the units were saved: the first two by the SNP Government and the IRH by a vociferous campaign by the people of Inverclyde. If the units had closed, more staff would have been made redundant under Labour.
Let us consider maternity units, particularly in the West of Scotland. The removal of consultant-led services at the IRH and the Vale of Leven hospital and the centralisation of services at RAH in Paisley during the previous session of Parliament had an effect on delivery of care. Pregnant women might well have been sceptical about the services that were available locally while they were being directed to go elsewhere, which left a question about the viability of services. I am thankful that Nicola Sturgeon agreed to instigate an independent scrutiny panel to consider the future of community midwife units. Recently, there was a record number of deliveries in the CMU at the IRH, which proves that keeping the unit at the IRH was the correct decision.
Labour seems to have forgotten about the services that were under threat when it was in power. It might also have escaped Labour members’ memories that Labour attacked the programme to make and then to reinvest 2 per cent efficiency savings. The former Labour leader in the Scottish Parliament, Wendy Alexander, said that 2 per cent was not an ambitious enough target and that the target should be 3 per cent.
During the Labour campaign in 2007, Jack McConnell said that education would get investment but other budgets would need to “cut their cloth”. How can Labour seriously claim that the NHS in Scotland would have been in a better position under Labour? Labour’s position on the NHS is somewhat opportunistic and typifies the negativity of which much of Labour politics reeks.
No element of the public service is perfect—there is always room for improvement and greater efficiency. The taxpayer wants to know that they will get the services that they require and that service delivery will improve.
There are three central points about the SNP Government’s delivery of health services. First, we have 10,000 more NHS staff members than we inherited from the Labour-Lib Dem Administration. Secondly, funding for the NHS in Scotland is at record levels and, thirdly, the cabinet secretary has given a commitment that there will be no compulsory redundancies.
Service redesign is happening across a range of public services, and more joined-up working is taking place, instead of the silo approach of the past. I do not for a minute think that any member would seriously argue that the old silo ways of working are acceptable in the challenging financial climate. We should be striving for more joined-up working, better service delivery for patients and better outcomes for patients and health care staff.
I will continue to campaign for strong local service delivery in the West of Scotland, as I did before I was elected. Under Labour, campaigns to save services in the community in which I live were a regular occurrence, so I am thankful that there has been a period of stability since then, although there have been issues, for example the CMUs.
There are challenges ahead, but I am sure that, with strong leadership, we can weather the storm while ensuring that the safe delivery of health services remains at the forefront of the health agenda.
11:04
I think that most Scots have not just a political commitment but an emotional attachment to our national health service. That is right and understandable. The NHS touches our lives at every age and stage—the good times and the bad. All of us will have had the experience of seeing sick or dying loved ones being cared for by the NHS. The fact that I have a son is due almost entirely to the expertise, skill and care that was available in NHS Lothian. Those are debts that I will never be able to repay, but that is the thing about the NHS—it is not about paying, but about meeting patients’ needs, and the Cabinet Secretary for Health and Wellbeing has never deviated from that core value, that belief, that conviction.
It is very easy to play politics with the NHS and it is all too easy to scare people and go for the cheap political hit. However, given these financially chastened times and Labour’s legacy—an economic and financial mess that it has walked away from, abdicating all responsibility to the Tories and Liberal Democrats in London—we should take some comfort from the fact that there will be no compulsory redundancies, P45s or redundancy notices.
Does Angela Constance acknowledge that the SNP is presiding over and is responsible for the lowest allocation of funds to the NHS in decades? In fact, there has been a 0.4 per cent decrease at the same time as a 4 per cent increase in England. I think that that demonstrates Labour’s record in Government.
I actually wonder whether Ms Baillie can count. If we want to talk about cuts, let us talk about Labour cuts. It was the Labour UK Government that cut the NHS capital budget by £129 million in 2010-11 as a Barnett consequential of spending in England.
Despite the toughest financial circumstances since devolution—and contrary to what Jackie Baillie says—NHS funding in Scotland is at record levels, with a 4.3 per cent increase, if we include the efficiency savings that, unlike other Governments, the SNP Government allows public agencies to keep for reinvestment in front-line services instead of clawing them back or top-slicing them. Despite the £500 million decrease in the Scottish budget, all health boards in Scotland have benefited from a real-terms increase. Moreover, Nicola Sturgeon’s amendment clearly states her commitment to apply Barnett consequentials to NHS Scotland if the UK coalition Government’s commitments to increase health spending come good. We are clearly in difficult times, but the NHS in Scotland faces them from a comparatively strong position.
I began by speaking about the emotional attachment that all Scots have to the NHS. Historically, the Labour Party has benefited from that attachment. No more, though: the Labour Party tore up its own legacy and reneged on its social contract with the people when it introduced public-private partnerships. It is Labour’s biggest shame: it was all about buy now, pay later and it now means having to pay £1 billion over the next five years and getting one hospital for the price of two. Over the next year, the unitary charges for the Edinburgh royal infirmary will be £271 million, or £65 million more than its capital cost of £206 million. That is galling when one thinks that a magnetic resonance imaging scanner costs £1 million to run; that free prescriptions cost £40 million a year; and that £65 million could employ 3,000-plus nurses. After looking at its position on this matter, I do not think that we will be taking any lessons from the Labour Party.
Will the member give way?
No, I am not accepting any more interventions. I have already given way to Jackie Baillie.
The Labour Party also oversaw creeping managerialism; indeed, it was managerialism gone mad. I had the privilege of working for five years as a social worker in a state hospital. It was a great hospital, and we in Scotland can be proud of it. Social workers, like doctors and nurses, work with people, but I found myself having to count things: the number of meetings I attended, things that I was obliged to do under law, and things that had absolutely no bearing on patient care. Of course, somebody else had the job of counting the things that I was obliged to count, so I have to wonder about the ratio of managers to front-line staff.
We certainly should not let Labour away with its amnesia, so we should keep repeating that there was no commitment in the Labour manifesto to increase health funding. Instead, all sectors, apart from education, were to “cut their cloth”.
Both recently and in times gone by, there has been much reflection in this Parliament about the economic need for more powers. We need to grow our economy to pay for the social democracy that we want. When it comes to the NHS, the Labour Party might have the past, but the SNP has the future.
11:10
Angela Constance’s speech was important in setting out the relationship between the NHS and its users, and I associate myself with her remarks. That particular relationship is deep and special.
I will try to draw out from the previous speeches the points with which I and my party are in accord. Jackie Baillie referred to sweeping job reductions and read out the various figures in that respect. It is true, as Rhoda Grant said, that NHS Highland recently confirmed that 100 jobs are to go. Whatever the financial reasons are—the various arguments have gone back and forth across the chamber this morning—the fact is that those 100 jobs are going.
Jackie Baillie was correct to say that NHS workforce plans must be published and be totally transparent, and I have no reason to doubt that we shall soon be in that situation. However, she also raised the important question whether at the end of the day the cabinet secretary will sign off those plans. That certainly needs to be addressed.
The cabinet secretary mentioned, again, the cuts from Westminster and referred to the fact that the new UK Government is going to protect and, in fact, increase NHS spending. She also talked about reinvesting efficiency savings in front-line services. However, on the question of who signs off the workforce plans, she mentioned partnership, which I feel is something that still needs to be explored and is certainly fundamental to points that I will make towards the end of my speech.
Murdo Fraser made several valid points, in particular when highlighting the fact that Labour did not lodge any amendments to the budget with regard to NHS services. He also raised a very sensible point about drug purchasing, which is an issue that should be kept in mind.
In speaking to my party’s amendment, my colleague Ross Finnie was quite correct to say that we need to focus on outcomes, patient care and patients. Indeed, I am grateful to other members for complimenting him on highlighting what is—or at least what should be—the nub of this debate. Mr Finnie also mentioned NHS inflation, which is sometimes not built into the figures in the way it should be, and pointed out that health boards are having to make savings just to break even or to stay where they are. Rightly, he wondered just how convincing is the quality of management, and provided some good examples about which we might well raise some questions in that respect. He also asked about the effect of the temporary non-filling of posts or redundancies on those who remain and who have to take on the burden, and he asked what the independent scrutiny group would come back to Parliament with. As our amendment makes clear, the group’s findings must be brought to the chamber, because we need to hear what the cabinet secretary has to say and each of us needs to be clear about what is going on. This issue is too important.
Rhoda Grant’s speech made my ears prick up. She is certainly correct: we Highland members simply do not understand why the rheumatology unit in Dingwall seems to be on the list for downgrading and for having beds removed. I do not think that Ms Grant will disagree with my contention that, unfortunately, there was not the level of dialogue between service users, the professionals and the NHS bosses that we would have liked. She also referred to the difficulty of recruiting junior doctors. As NHS Highland has confirmed, recruitment is very difficult in Highland and most difficult of all in Caithness. I find the situation extremely worrying and we are all keeping a very close eye on what that might mean for health service delivery in that remote part of the country, and whether people are getting the level of service that they deserve.
As I said, Rhoda Grant referred to rheumatology services and junior doctors, but I feel that one other issue nicely highlights what we are facing. I am sure that other Highland members will, like me, have had e-mails from concerned constituents about midwifery services in central and east Sutherland. If it would be all right with the Presiding Officer, I would like to read out an extract from one such e-mail. Its author says:
“I am writing to you as I am concerned about a proposed change within NHS Highland with regards to midwifery services in Central & East Sutherland. At the moment most of the community midwives in the area have a ‘dual role’ as a community midwife and district nurse. As far as I am aware it is planned that dual role positions will no longer exist and a midwifery service will be offered separate from that of the district nurse. It seems that the number of midwives will be reduced to 2.2 posts to cover the vast Central & East Sutherland area. I understand that the existing CMWs/district nurses have opted to revert to single roles as district nurses rather than re-apply for the new positions, indeed one is retiring as a result.”
To a layman like me, that does not seem to make any sense whatever. On the face of it, it looks as if what is proposed will result in an increased cost.
I would like to establish to what extent the cabinet secretary signs off such decisions. Are groups involved in looking at such proposals? Decisions on such matters must be given extremely careful consideration. How on earth will 2.2 midwives be able to cover the vast bulk of Sutherland, given that two midwives might be required for a delivery? One thing is for sure—if NHS Highland goes ahead with its proposal, it will mark the beginning of the end of home deliveries, which would be most unfortunate.
I will conclude with a point that I make in every health debate in which I speak. Everyone has a right to a basic level of health services, even if they live in the most remote parts of the country. That is why I read out the e-mail, and it is why I whole-heartedly recommend that the amendment in Ross Finnie’s name be supported.
11:16
Several Labour members mentioned the Conservative-Liberal Democrat coalition at Westminster. I remind them that the governor of the Bank of England confirmed the feasibility and advisability of tackling the deficit this year. He said:
“The bigger risk at present ... would be for a new government not to put in place clear and credible measures to deal with the fiscal deficit.”
I thank Ross Finnie and Hugh Henry for concentrating on the outcomes of quality of care and ensuring the essential skills mix. I agree with what Rhoda Grant said about NHS Highland’s rheumatology unit, for treatment at which there is no waiting list. All Highland members attended that unit, where we saw at first hand what could be done. The same quality and intensity of service could not be offered in a patient’s home. I also thank my colleague Dr Nanette Milne, who always brings to debates the background of her own experience and her experience as the wife of a GP.
We are grateful to the Labour Party for selecting health as the topic for this morning’s debate. In the current dire financial circumstances, it is right and proper that we discuss our national health service. It is also right and proper that we set the standard for debate in Scotland by focusing on patient care and treatment, managing long-term conditions, prevention and public health. For too long, the NHS has been judged by how many beds it provides, how many wards it runs, how many hospitals it has and how many prescriptions it hands out. As Ian McKee said, such judgments are made against a background of modern day surgery, which allows patients to go home on the day of surgery rather than having to stay in hospital for up to two weeks, as used to be the case. Hip replacement patients used to be hospitalised for up to three weeks. They are now in hospital for as little as three days. Last night, at a round-table discussion on infant nutrition, the midwives and health visitors told us of mothers leaving hospital six hours after giving birth, without even returning to a ward. Mothers who have had a Caesarean section, who used to face a minimum stay of 10 days, can now go home after three days.
Today’s debate also takes place against a background of efficiency savings in Scotland’s NHS. I do not think that I was the only member of the Health and Sport Committee to be shocked to find out about the waste that is being rooted out of the NHS, which begs the question why taxpayers’ money was not spent more efficiently in the past.
I will give some examples. NHS Ayrshire and Arran found energy savings of £230,000. NHS Lanarkshire reduced its hospitality costs by 50 per cent and its postage costs by £120,000. Another health board cut its costs in half by sharing a store for aids and adaptations. A representative of NHS Borders told the committee that it had a “fair bit of duplication” because there were separate waiting lists for primary health care teams and community teams. Merging those two waiting lists enabled the board to make better use of resources and to streamline services for patients. None of those changes affected front-line patient care.
In evidence to the committee, it emerged that NHS Lanarkshire could take £1 million out of its public health budget and could guarantee that that would not affect patient care or public health now or in the future. I asked the witness from NHS Lanarkshire about that three times and she stated firmly that that was the case. The same health board has cut 117 jobs, all in administration. The witness from NHS Lothian said:
“although there has been significant investment across the NHS, there has not necessarily been huge activity gain, so there is an issue with productivity.”—[Official Report, Health and Sport Committee, 12 May 2010; c 3157.]
Does Mary Scanlon agree that it is quite hard for NHS Lanarkshire to justify the cut in the number of smoking cessation nurses in that area from seven to three? Surely that will affect one of the main issues that the Parliament has been concerned about—the number of people who continue to smoke, especially in deprived communities.
Before commenting on that, I would like to find out what is being done in community pharmacies, which I recognise play an excellent role in smoking cessation, and whether they could pick up more people. I would prefer to focus on more people stopping smoking, however that is achieved. We might be looking at only half the equation.
The point that has been made by many Labour members and others is that how the efficiency savings that are sought are managed is the critical issue. I do not want the NHS to stifle innovation or not to adopt a modern approach to the delivery of high-quality services. There are many examples of spending to save in the NHS, and in that regard I make no apologies for again mentioning mental health. Giving patients the appropriate early diagnosis, early intervention and early treatment, tailored to their individual needs, would prevent stress, anxiety and mild depression from becoming severe, chronic and enduring in the long term.
Will the member give way?
I will do, once I have finished my point.
The provision of good care and treatment at the right time would not only save money in the NHS, but allow people to continue to work rather than being destined for a life on benefits.
The member’s time is up.
I apologise for not taking the intervention.
Finally—
No—I am sorry, but the member’s time is up.
11:23
I have listened carefully to the debate and, leaving to one side some of the alarmist, scaremongering and misleading rhetoric, some excellent speeches have been made, which have focused on the fact that we can be truly proud of our health service and its staff. Only recently, we debated the outcomes of those efforts—the fact that waiting times are at a record low and that the performance of the NHS continues to improve. I was pleased to hear so many members focus on those outcomes, as they are what are most important to patients.
I pay tribute to everyone who works in the health service in Scotland and reiterate the guarantees for the future that Nicola Sturgeon gave in her speech. This Government was quick to recognise the huge contribution that is made by all those who work in our NHS.
In our first year in office, we published “Better Health, Better Care: Planning Tomorrow's Workforce Today”, which established our direction of travel to ensure that NHS workforce planning is fully integrated with service and financial planning so that workforce changes fully reflect emerging models of care in the modern world and contribute to efficiency and best value for money. That is right and proper. It is important that the projections that have been debated today—which are in no way about arbitrary cuts or the downgrading of services, whatever the nay-sayers may say—are set against that backdrop.
I want to respond to some of the comments that were made in the debate, because a number of them were important. I will start with Jackie Baillie. There is confusion at the heart of Labour’s argument. On the one hand, in response to Murdo Fraser’s intervention, Jackie Baillie said very clearly that she does not believe that the NHS is underfunded and yet, minutes later, she turned that on its head and claimed that, in some way, the NHS is underfunded. I will talk about the figures in a moment. If the latter is the case, at no point has Jackie Baillie or any Labour member in this Parliament said where the extra money should come from—perhaps she will tell us now. She and all her Labour colleagues missed the opportunity to lodge amendments to this year’s budget; I certainly did not notice Labour lodging any amendments to the budget to change the funding for the health service. If the major Opposition party in the Parliament thinks that more money should be made available to the health service, it has a responsibility to tell us where that money is coming from. If Jackie Baillie would like to tell us now, that would be most helpful.
I will give three places for starters: homecoming, referendum and national conversation. Labour has not underfunded the Scottish budget. The SNP has been solely responsible for a 0.4 per cent decrease in the health budget when the health budget in England has risen by 4 per cent. Where is the missing money?
The figures are very important. Jackie Baillie has just reiterated the 0.4 per cent figure.
It came from SPICe.
Jackie Baillie talked about the SPICe figure earlier and she has just done so again. It is interesting to note that Labour has not put the SPICe figure into the public domain. I wonder why—could it be that the figures that Jackie Baillie is talking about are for the overall health and wellbeing budget rather than the NHS budget? The overall budget was of course reduced because of the capital acceleration of the housing budget, which Labour supported. We should also remember that we requested a further £350 million from Darling to spend on housing this year, and Iain Gray supported that, but Alistair Darling refused.
SPICe has confirmed that, had the Labour Government given us that £350 million, and had we spent it all on housing as promised, the overall health and wellbeing budget would have increased by 3.2 per cent in real terms, which is 5.5 per cent in cash terms. I can only describe as sleekit the use of those figures by Jackie Baillie.
Coming from you, that is outrageous.
Order.
I move on to some of the more reasonable contributions that have been made during the debate. Murdo Fraser exposed very well the hypocrisy of Labour’s position; Labour members do not like the truth.
Ross Finnie made an important contribution, but we must be careful about the language that we use. No compulsory or voluntary redundancies are being proposed. Only two boards are looking at a very small-scale voluntary severance scheme. It is important that we send out an accurate message to staff about that point.
Anne McLaughlin made an excellent speech, reminding us all of the good outcomes that the NHS is delivering, despite the challenging financial environment.
Rhoda Grant made clear her opposition to the current NRAC formula for health board funding, and confirmed that that is Labour’s position on the matter. We are entitled to expect the Labour Party to clarify what formula it would support and which health boards would be the losers under its alternative formula. We will pursue an answer to that question.
Nanette Milne reminded us of Labour’s collective amnesia about what happened under its term of office when children’s cancer services, neurological services, maternity services and accident and emergency were under threat of being centralised. Labour members have very short memories indeed, and Nanette Milne reminded us of that.
Ian McKee made a considered speech and laid out facts to correct some of the fiction. He talked about how service redesign can release resource to be better invested. He mentioned keyhole surgery, day surgery and the shift of the balance of care towards primary care, which was one of the most important points in the debate. The fact that GPs and other staff who are working in primary care are seeing the shift from the acute sector is important. Everyone in here talks about supporting that shift, so I hope that when that happens, and resources are moved from acute to primary care, members do not stop supporting it. The previous Administration supported that policy.
The minister should be winding up now.
I will finish on this point. Mike Rumbles made an important point, and I say to him that it is important that changes in staffing levels are not ad hoc. The redeployment of staff to the posts that need to be kept is important and it will be managed properly. It will not be ad hoc. I hope that I have reassured Mike Rumbles on that point.
The minister must stop there.
I am happy to support the cabinet secretary’s amendment.
11:31
I will deal with some background figures first. There is no doubt that the coalition has promised that the NHS will be protected in real terms by a future increase in the next Parliament. We can all agree on that point. We should also be able to agree on the fact that the relative spend on the NHS in Scotland, compared with England, is less. There is no doubt about that. The SPICe figures make it absolutely clear.
The other historical fact on which we can all agree is that the funding for the NHS more than doubled under the Labour and Liberal Administration. We can agree on that, and therefore accept all the points that a number of members have made about the vast improvement that has occurred in the health service during the past 11 years of devolution. There is no doubt about that. As Hugh Henry said, we must also recognise that there are some real challenges with new technology, new drugs and the increasingly ageing population.
There is one other financial fact that we need to get out of the way and state very clearly. When Labour and the Liberal Democrats left office, the SNP inherited £1.5 billion of end-year funding, which was banked with the Treasury. It has now been unbanked and spent, so it is simply gone. That creates a problem. If that amount has been poured into the system, we will face problems in the future.
Another financial point that we need to get clear is the point about NRAC that Shona Robison referred to and which Rhoda Grant mentioned in her speech. Labour supports NRAC as a concept.
That is not what was said earlier.
I want to make it clear to the minister—she should not mutter about it—that we clearly support NRAC. However, when the Health and Sport Committee questioned the NRAC people, we required them to examine the data on which NRAC was based. A critical analysis of that needs to be done, and we have not got it yet. Rhoda Grant made the point that the Government has kicked it into the long grass. We were promised a critical analysis of NRAC in the early part of this year, and we have not got it yet.
When the economy is growing, NRAC is not so important, but when it is contracting, at a standstill, or has been cut in real terms, as SPICe says that it has been, NRAC becomes fundamental to boards such as the Borders, Grampian, Lothian and Highland.
Let us look at the situation around efficiency savings and cuts, which we have to distinguish between. I welcome the fact that the cabinet secretary has, under pressure, finally published the workforce plans. I regret that that was not done some days ago, because if it had been, this debate might have been based on the facts for all the health boards and not just those four boards that presented their findings to the Health and Sport Committee.
The Labour Party is accused of being negative about this whole thing. I say to Anne McLaughlin and others that we entirely accept the fact that we must make efficiency savings and changes. As Jackie Baillie said, we are not opposed to changes in the skills mix; however, when changes in the skills mix are presented as a reduction in staffing, with 300-plus qualified nurses being swapped for 220 unqualified ones, that is a cut. I cannot understand why the Government cannot see that that must be a cut. We are not against changes in the skills mix.
Will the member give way?
I am sorry, but I have very limited time.
Other efficiency savings could be made. The introduction of voice recognition software may allow us to reduce the number of secretaries. However, as Rhoda Grant and Hugh Henry pointed out, if that meant that patients did not get the information that they needed, which receptionists and secretaries often provide, that would not be a good thing. We could reduce the number of records that are held, the number of lost records, the number of attendances and the number of did-not-attends, which the Government said that it would do but has not succeeded in doing. We could reduce the number of bank staff and premium-rate locums, but if that were done in the way that it is being done in Glasgow that would be unacceptable. If getting rid of bank cleaners resulted in a reduction in the number of cleaning hours, that would be not an improvement in efficiency, but a cut.
Another example is the fact that heart failure nurse specialists in Glasgow are now being required to do 8 per cent of their work on the wards. That might not be a bad thing if they were in the cardiology wards and it kept them connected to their teams, but they are not even in the cardiology wards—they are in totally random medical wards. Were those heart failure nurse specialists whose job is to keep patients out of hospital underworked? No, they were not; yet, they are now being redeployed to save bank nurse and locum costs. The way in which the situation is being managed is inappropriate.
I welcome the national scrutiny group that the Government has set up—I suspect as a result of the pressure that we have been putting on it—but how does that work with the nurse partnership arrangement and who will finally sign off the workforce plans? The Government has not made that clear. Is it still to be the boards or will the cabinet secretary have the final responsibility?
Will the member give way?
I will give way in a second.
According to the figures that we have got through SPICe in the past few minutes, 68 doctors are going, 1,523 nurses are going and 230 allied health professional posts are going. Those posts are going—they are not being replaced by more allied health professionals and nurses; they are being removed from the system. In my book, those are cuts.
Let us turn to vacancy management. As a doctor, I have suffered under vacancy management. Vacancy management is entirely appropriate when it is decided that a post is not needed any more and it is planned that, when the post holder retires, they will not be replaced. However, we are not talking about that. History shows that, in the 1980s, when vacancy management was a big factor, when a vacancy came up management delayed the appointment of an individual to it. In NHS Forth Valley, a paediatric consultant gave six months’ notice of the fact that he was retiring but the post was not advertised until the month after he retired. That post was still necessary, but it took another four months to appoint someone to it, during which time the health board saved four months’ pay and great stress was caused to the other professionals.
Will the member give way?
No, the member is in his last minute.
I apologise.
Vacancy management is not planned—that is Mike Rumbles’s point. Voluntary redundancies are not the planned cutting of posts; they are asking people whether they would like to go if they are offered good terms. We did that in the universities and we lost people who were really needed. That does not work.
We are not against efficiency savings and improvement, but the Government’s proposals are SNP cuts. If we get more nats, we get fewer nurses—that is undoubtedly the case, and the Government’s figures, which are in SPICe today, prove that. We will have 1,523 fewer qualified nurses in the health service in Scotland this year—more nats, fewer nurses.