Coronary Heart Disease and Stroke
The next item is a debate on motion S1M-3450, in the name of Malcolm Chisholm, on action against coronary heart disease and stroke, and on two amendments to that motion.
The incidence of deaths from coronary heart disease and stroke has declined over the past few years. Progress has been made through service developments and health improvement initiatives in equal measure, but it has been much too slow. Today we seek a step change in both the health care and health improvement sides. Mary Mulligan will speak in more detail about the health improvement agenda later.
I emphasise at the start the strong health inequalities dimension to our agenda. In our most disadvantaged communities, people over the age of 65 are three and a half times more likely to die from coronary heart disease than those in the most affluent areas are. A key focus of the strategy for improvement and care must be to deal with that shocking manifestation of the opportunity gap.
With our national demonstration project—Have a Heart Paisley—we have made a good start. It is acting as a test-bed for action that will reduce the impact of CHD on the population of Paisley. I have been pleased to visit the project on two occasions. I know that the lessons learned from it will be rolled out through the CHD learning network, which will be headed by Professor Phil Hanlon of the Public Health Institute of Scotland.
We owe it to those who have CHD or have had a stroke to ensure that they receive treatment of the highest quality. That means ensuring that new, effective treatments come on stream as soon as possible. It means treating people earlier, with the better outcomes that result from that. It means ensuring that people who have had a stroke are cared for in a specialist stroke unit, which will result in reductions in the number of deaths and admissions to long-term care.
Our overall targets are to halve deaths from CHD and stroke among the under-75s over 15 years and to reduce waiting times for procedures such as angioplasty and heart-bypass surgery. We have no difficulty in accepting the SNP amendment. Median waiting times for bypass surgery have already fallen from 152 days in 1999 to 50 days today. However, we seek a maximum wait of 18 weeks by 2004 from angiogram diagnosis to angioplasty or bypass surgery.
The basis of our strategy is to provide more integrated care, particularly across primary and secondary care. We seek the empowerment of patients and front-line staff in the managed clinical networks, which I shall describe in a moment, to deliver services, lead change and make spending decisions.
I am entirely in agreement with the first part of the Conservative amendment, which refers to
"a reformed health service that empowers patients".
However, the second part of the amendment, which refers to "the number of providers", is inappropriate as a blanket statement, particularly in the context of today's debate. We want and shall have more staff to provide care. It is definitely our objective to have more health care teams. However, sometimes it is better to concentrate staff. It is always better for staff to work together in new, integrated ways across primary and secondary care. Our agenda of modernisation and reform is rooted in integration, decentralisation and empowerment. It is not to be measured by the simplistic numerical barometer of how many providers exist. For that reason, we must oppose the Conservative amendment.
The strategy takes the model of managed clinical networks as the method for delivering cardiac and stroke services in future. The networks involve all the people who provide a service, alongside patients. They integrate services by eliminating traditional boundaries between primary and secondary care, between different health professions and between one national health service board and another.
I have mentioned more than once before the highly successful cardiac services managed clinical network in Dumfries and Galloway. This morning I was pleased to hear from two patients from the area who have benefited from that network. They talked about thrombolysis and clot-busting drugs delivered in the community. They talked about the service that they have received from cardiac nurses, the rehabilitation services that they have had and the new ways in which they have been involved in the planning of care in Dumfries and Galloway. Through the strategy, we intend to roll out that model across Scotland.
Local cardiac services managed clinical networks will have to address a wide range of issues. Those include developing prevention strategies based on the lessons learned by Have a Heart Paisley; setting targets for secondary prevention and rehabilitation; helping to develop rapid-access chest-pain clinics, which the First Minister and I heard about at the Western general hospital in Edinburgh this morning; conducting needs assessments for CHD services in deprived and remote communities; and considering new, extended roles for health professionals in the network.
Each of the local networks will link to the Scottish cardiac intervention network. That Scotland-wide network will link the five existing cardiac surgery centres, including the national waiting times centre. It will also cover the 11 hospitals in which angioplasty is currently carried out. Along with regional planning groups, the Scottish cardiac intervention network will be responsible for the commissioning of all revascularisation in Scotland. It will develop guidelines and protocols so that all patients get the treatment that they need. The network should become operational by January 2004.
The network will be part of the national standards agenda. There is a balance to be struck: the strategy is a national strategy with national standards and national funding, but delivery will be at local level through the managed clinical networks, in which clinicians will be on the front line with patients, where they can deliver services and lead change.
I have not read every word in the strategy, but I was quite surprised at page 17 of the strategy document, which states:
"NHS Boards should give consideration to making innovative appointments to MCNs, rather than to institutions."
Will the managed clinical networks be a new form of employer?
For managed clinical networks to employ people directly is a good development. Part of the strategy will mean that every managed clinical network will certainly have a dedicated manager as well as a lead clinician. The employment of people by managed clinical networks is an example of the new integrated, decentralised health care that we will develop. That will be described in more detail in the forthcoming white paper.
Managed clinical networks are also the model for stroke services. Each NHS board is to have a stroke network in place by April 2004. Those stroke networks will build not only on the generic lessons from Dumfries and Galloway, but on Lanarkshire's demonstration stroke network and Highland's reconfiguration of stroke services.
We believe that managed clinical networks are the way ahead because they are about integrated working between primary and secondary care. They put patients and clinicians in the lead in driving service development. The key role for patients means that we can be sure that, as with clinical standards, we deliver the services that patients really want.
The strategy also has important recommendations about setting up national databases for both CHD and stroke. That may sound rather dull, but it is absolutely fundamental. The huge gap in data for primary care makes the proper planning of services difficult. Moreover, we cannot be sure that services are of the proper quality unless data are available. We cannot give optimum care to individuals unless the full patient record is available and up to date in every care setting.
Will the minister give way?
If I have time, I shall give way after I have finished the next bit of my speech, which is about staff.
The strategy also highlights the need for additional staff in the medical, nursing and allied health professions to make the strategy work. It is most explicit about the need for more cardiologists and stroke specialists. I fully acknowledge that need. The strategy also recognises the need to develop multidisciplinary team working with new and extended roles. I acknowledge that as well.
We are all keen to move directly into the implementation phase. I am setting up a project group to take forward the detailed planning of the Scottish cardiac intervention network. I am pleased to be able to announce that Dr Nick Boon, who is a consultant cardiologist at Edinburgh royal infirmary, will chair the network. The project group will act as our national advisory body on CHD issues. Its immediate tasks will include developing the thinking on the integration of the national waiting times centre with other cardiac surgery centres and the planning of a national heart failure centre in Glasgow.
I am also pleased to announce that Professor Martin Dennis, who is a consultant stroke physician at Edinburgh's Western general hospital, has accepted my invitation to chair the national advisory committee on stroke that we are setting up. The committee will provide advice on all aspects of stroke services.
NHS boards are already devoting considerable resources to CHD and stroke. Those resources will continue but, to help with the implementation of the strategy's key recommendations, I can today announce that an additional £40 million is being set aside over the next three years. The advisory bodies that we are setting up will help to ensure that resources are allocated to the aspects of the strategy that patients and clinicians consider should have priority. However, many of the spending decisions will be made in the managed clinical networks.
I will now give way, if the Presiding Officer allows me.
The minister has one minute remaining.
The minister may have answered my question in his remarks. Will he clarify whether he envisages that the managed clinical networks will have control of funds and whether they will be able to buy in services and purchase the care that is needed if it is not provided by the health boards?
Yes, some funds will go directly to the managed clinical networks, although clearly some of the money, as I have just described, will have to be spent on important infrastructure, particularly information technology.
That is a bit like the cancer strategy, where we have given money to cancer groups—involving clinicians on the front line and patients—which make the decisions about spending priorities. I was pleased that one of the leading cancer experts in the UK yesterday praised our approach to cancer in Scotland and said that it was the best model in the United Kingdom.
By giving patients and health professionals a strong voice in the way in which services are managed and developed, we can bring about huge improvements. I firmly believe that today marks the start of a new era in our struggle against the twin scourges of CHD and stroke, which have taken an unacceptable toll on our families and communities for far too long.
I move,
That the Parliament recognises the unacceptable toll which coronary heart disease and stroke continue to take on Scottish families and communities; acknowledges the role of front-line staff in delivering and developing services for the thousands of people affected each year; supports health improvement initiatives to reduce the incidence of the diseases and the disproportionate burden suffered by the most disadvantaged communities, and looks forward to the development of more integrated services that are backed up by significant and dedicated resources.
I welcome today's debate. Tackling coronary heart disease and stroke is a major challenge in Scotland and will continue to be so for the foreseeable future. Too many people in Scotland have their quality of life diminished and their lives cut short by those conditions. As the minister pointed out, rates of, and deaths from, heart disease have steadily declined over the past 20 years, which is good news. Nevertheless, Scotland still has the second-highest mortality rate from heart disease in the whole of Europe and the highest by far in the United Kingdom. Every year in Scotland, 12,500 people of all ages die from heart disease. As the minister said, those who live in deprived communities are far more likely to suffer from symptomatic disease and to die from it than are those who live in more affluent circumstances.
The strategy that has been published today is a welcome contribution to meeting that challenge and I have no hesitation in supporting its contents. The question that I want to pose is whether the strategy goes far enough in two key areas to ensure that the Government targets can be met.
Those targets are rightly ambitious: a 50 per cent reduction in the number of deaths from heart disease and stroke among the under-75s by 2010 and a reduction in maximum waiting times for cardiac treatment from 36 weeks to 26 weeks by 2005. I am sure that everyone in the chamber and everyone in Scotland will enthusiastically sign up to those targets. However, if the targets are to be met, we must achieve two things: first, a reduction in the number of people who get heart disease or suffer strokes—in other words, a more effective focus on prevention—and, secondly, improvement in the speed of diagnosis and the quality of treatment that patients receive.
I will concentrate the remainder of my remarks on prevention and the need to shorten waiting times. The obligation that the strategy places on all NHS boards to develop heart disease and stroke prevention strategies by 2004 is a step in the right direction, but the strategy offers little in the way of new ideas about how we should tackle some of the root causes of heart disease and stroke. I welcome the indication that Mary Mulligan will focus her remarks on those issues in summing up the debate.
The strategy tells us that
"Smoking is a major preventable cause of CHD and stroke",
that
"Dietary factors may be responsible for significant amounts of CHD and stroke"
and that
"Physical inactivity is a major … risk factor".
We know those things already. The strategy lists some of the initiatives that are already under way, but it says much less about how we can effectively tackle those factors.
Was the member a bit surprised, as I was when I read the strategy, that it goes into detail on smoking, diet and physical activity, but does not mention alcohol and the tragic contribution that alcohol consumption can make to coronary heart disease and stroke?
I will make two points in response to Keith Raffan's intervention. First, I do not think that the strategy goes into enough detail on smoking and diet and, yes, it completely ignores the contribution of alcohol, which is an omission. Secondly, and more generally, if the ambitious targets that have been set are to be met, fresh thinking will be required in all those areas. In that regard, I will focus my remarks on smoking.
One in five of all deaths from heart disease and one in 10 of all deaths from stroke are caused by tobacco. In the under-64 age group, nearly half of all deaths from heart disease are tobacco related, yet all the strategy does is restate the Government's targets for reducing smoking and claim that
"A wide range of work is in hand".
That is not entirely reassuring when we consider that, five years after it was promised, we still do not have a ban on tobacco advertising. I hope that Mary Mulligan will give us more detail in her speech. For example, what more is the Government going to do to discourage young people, especially young girls, from taking up smoking? Let us remember that nine out of 10 smokers start smoking before their 19th birthday.
Will the ring-fenced funding for smoking cessation, which is about to come to an end, be continued? Will it be increased, given that the demand for smoking-cessation services already outstrips supply in many parts of Scotland? Perhaps even more fundamental than that, is the Government prepared to show leadership on the need to protect people from the effects of passive smoking, which increases the risk of heart disease by about 20 per cent? I hope that the minister will give us more detail on those questions when she sums up.
More detail would also be useful on the further measures that the Government intends to take to tackle poverty and deprivation. The strategy document rightly makes the link between poverty, particularly child poverty, and higher rates of heart disease and stroke. However, progress on tackling that problem is painfully slow. When Labour came to office, one in three children in Scotland lived in poverty. Today, one in three children in Scotland still lives in poverty.
Does the member agree that progress is shamefully slow, given that the most recent statistics state that some 27,649 more children are now living in poverty? Does she agree that unless we tackle that we will not be able to improve the health of this country?
The Government's record on tackling poverty is, to use Tommy Sheridan's word, shameful. However, more worrying than that is that this Parliament lacks the tools, such as the power of benefits and taxation, to tackle the problem effectively. That is the context in which the strategy will be implemented. The strategy does not say nearly enough about those issues.
Speed of diagnosis and speed of access to the best treatment are prerequisites for cutting the number of deaths from heart disease and stroke. The scale of the challenge is enormous—I accept that Malcolm Chisholm has acknowledged that. We all want waiting times to come down, but in some areas they are not even going in the right direction. For example, waiting times for angioplasty increased from 31 days to 41 days between 1999 and this year.
The emphasis that the strategy places on developing integrated care through managed clinical networks is important, as is maximising the contribution of existing staff across professional boundaries within those networks. Notwithstanding all that, tackling staff shortages is an essential prerequisite for improving the quality of care and reducing waiting times. In my view, the strategy is most lacking in that respect.
The task force that reported last year recommended the appointment of an additional 30 consultant cardiologists. However, the strategy commits only to an additional 10 specialist registrar posts in cardiology. The gap between what was recommended and what is being delivered is enormous.
Will the member give way?
I am in my last minute. I am sure that the minister can come back to the issue.
Missing from the strategy is a clear statement of how we get from what is a second-best position to the optimum staffing level that the task force recommended. Of course consultants cannot be magicked out of thin air and the shortage is a problem that crosses professional boundaries as well as national boundaries.
Will the member give way?
Have I got time?
Yes, you have a minute.
I just want Nicola Sturgeon to reflect on the fact that the 10 additional specialist registrars would not be a one-off. Thirty consultants is an overall figure and 10 specialist registrars a year would add up to 30 quite quickly.
That is a useful clarification. However, a meaningful strategy would address two additional issues. First, what will be done in the medium-to-long term to attract consultants, so that we have a chance of meeting the task force's recommendation? Secondly, in the short term, what guarantees can the Government give that the 10 specialist registrar posts will be filled, either on a one-off basis or on a continuing basis? The difficulties in attracting consultants are perhaps less severe than are the difficulties in attracting staff to other posts, but they still exist. I would like to hear more about that.
It is worth pointing out that the number of specialist registrar posts in cardiology has fallen in the past year. In 2000 there were 30 whole-time-equivalent posts, but in 2001 that number fell to 25. There is clearly a problem. It is incumbent on the Executive to say more about how we will go about recruiting to those posts.
The strategy is commendable as far as it goes, but in my view it does not go far enough to meet the Government's own targets to start to turn around our quite appalling record on coronary heart disease and stroke.
I move amendment S1M-3450.1, to insert at end:
"and result in shorter waiting times for patients."
The Scottish Conservatives welcome the opportunity to discuss the strategy for coronary heart disease and stroke in Scotland. We find little to disagree with in the Executive's motion, which we will support.
The debate gives the Scottish Conservatives a chance to air our record in the sector. In the last three years of the Conservative Government, NHS heart bypass procedures increased by 56 per cent, whereas over a similar number of years under the Scottish Executive and Labour, there was only a 22 per cent increase. It is even more worrying that we now admit fewer people from the coronary artery bypass waiting lists than we did in 1997. I am sure that the Minister for Health and Community Care will say in his defence that many more day cases are being treated, but I am afraid that that is not the case.
I raised that question at the Western general hospital this morning. The answer is that many more angioplasties are being done. It was explained to me that many people who would have had heart bypasses in the past are now more appropriately treated by angioplasty.
I thank the minister for giving me the opportunity to point out that statistics released today by the information and statistics division of the Common Services Agency show that that is not the case. When the Conservatives left office, only one person was waiting for more than a year for angioplasty and angiography; now, 36 people are waiting for more than a year for that treatment. I am afraid that that tears the First Minister's pledge to shreds. As Nicola Sturgeon said, waiting times are heading in the wrong direction—they are increasing. That is an important point. We saw the new targets that Labour issued in June, when the Executive said that it would reduce waiting times to six months, yet waiting times are increasing. We will not hold our breath on that pledge.
Let us look closely at whether changes to the structure of health care delivery under the Executive will produce the better conditions and services that people across Europe take for granted. We should expect reforms to deliver similar standards, given that our country tops the European league of gross domestic product spend on health care. Like Mr Milburn—but certainly not like Mr McConnell—I am not wedded to the ideological argument and I do not care for a health care structure that is a single state monopoly. Members may see in our manifesto proposals that Mr Milburn would describe as reforming. We must reform if we are to tackle the problems with service delivery in the areas of heart disease and stroke.
Previously, the SNP attempted to reduce waiting times by effectively reintroducing commissioning at the local health care co-operative level. I am delighted to welcome the SNP back to elements of the internal market. Something is very wrong with the system if health professionals and patients have to wait with bated breath for handouts from the minister, who is acting like a Russian tsar or a Soviet leader. Only the other day, it was announced that £12 million was to be handed out to resolve the winter crisis—as if such handouts will change things. If the system is not changed, I do not think that there will be a shift in any of the data on treatment times of more than a few days.
Yesterday in Blackpool, the Government consistently talked about giving the patient the choice to choose their providers and doctors. The Government down south has built on some of our earlier reforms, which are producing benefits—the waiting times there are reducing, whereas our waiting times are increasing, despite the fact that we are spending more. It would be better if we could decide on a structure that would resolve the problems that the strategy rightly identifies.
Nye Bevan said that the NHS was designed
"to provide the medical profession with the best and most modern apparatus of medicine and to enable them freely to use it, in accordance with their training, for the benefit of the people of the country … The individual citizen must be free to choose his doctor and the doctor must be able to treat his patients in conditions of inviolable privacy."
Nye Bevan recognised that the health service existed to provide choice. By utilising that choice, the patient's journey would be improved and their needs would be responded to. I do not see much in the strategy to indicate that heart disease and stroke patients have that choice, which would empower them by allowing them to purchase surgery or whatever service would benefit them most.
Mr Wallace has gone into all that business about structure and ideology, but can he answer a simple question? What are the Conservatives going to do about social deprivation and its impact on health—social deprivation causes coronary heart disease and strokes—other than have their leader pay the occasional visit to a Glasgow housing estate with his "A to Z"?
It is rather ironic for Keith Raffan to make such a remark, because during the past few weeks his party has harped on about complete structural reform of the NHS, right down to the idea that regions will be able to run mini-health services. His party also believes in a hypothecated tax. We will not take lectures on structural reform from the Liberal Democrats.
We acknowledge that poverty problems, such as smoking and diet, must be solved. I have often commended the Executive for some of its initiatives to improve health, especially those that are aimed at the young. We will strongly support moves to increase physical activity, because that helps to cut the development of heart disease.
The other half of the strategy relates to managing the delivery of heart disease services. It is important that we have a debate on that. I have read all the cancer documents that the Clinical Standards Board for Scotland has produced. Professionals say that, although those documents contain many good things, they do not empower professionals to implement the proposals that they contain.
I was heartened by the minister's plans to empower the clinical network to deliver. Empowering the clinical network will be the key to success. It is right to expect a better standard of service for our money. We should consider other reforms and should not restrict ourselves in relation to providers. The important thing is that people in Scotland get the best service, whoever provides it, to treat their heart disease and stroke problems.
I move amendment S1M-3450.2, to insert at end:
"in the context of a reformed health service that empowers patients and expands the number of providers."
Coronary heart disease and stroke are major causes of death and ill health in Scotland. Half a million people are estimated to have coronary heart disease and about 12,500 Scots die from it each year. Many of those who die are middle-aged men in the prime of their lives. Their deaths are premature. They are people like my father, who died at the age of 51, leaving a family that felt bereaved, distraught and very cheated. That is the bad news.
The good news is that there has been a decline in deaths from coronary heart disease of about 30 or 40 per cent since the peak, which occurred in the 1970s. The decline appears to be the result of better acute coronary care treatment and, crucially, of secondary prevention—people changing their lifestyle by reducing smoking, controlling high blood pressure and lowering cholesterol levels through better diet and more exercise.
The good news is that coronary heart disease and stroke are preventable. In the past, Scandinavian countries such as Finland have tackled the problem head on with a total community approach and have seen a remarkable turnaround. We are making progress in reducing the incidence of CHD and stroke, but the rate of progress is not as fast as that of many of our European neighbours. The numbers are still far too high.
The reasons and risk factors are well known: age, gender, smoking, having a poor diet, taking little exercise, alcohol consumption and high blood pressure. Behind those reasons are the effects of deprivation. In the most deprived communities, the death rate among men aged under 65 is still more than double the rate in affluent areas. That is why the Liberal Democrats who work in the coalition have introduced, through the Executive, a number of measures to tackle some of the underlying issues. In some cases, that has been achieved through the use of hypothecated taxes.
Such measures include smoking cessation treatments that receive funding from the health improvement fund, the physical activity task force and the Have a Heart Paisley demonstration project, which the minister mentioned. That project works through primary care and uses local co-ordinators in each of four locality networks. The local authority is committed to supporting the project in schools, community centres and leisure centres. Such an approach ought to be developed across the country.
We welcome the publication of the strategy and the announcement of additional funding of £40 million over the three financial years beginning next April. We also welcome the minister's comments, in which he reiterated targets for cutting waiting times and early deaths.
A key element in the strategy is the development of managed clinical networks, which will pull together a multidisciplinary group, covering everything from prevention to treatment and rehabilitation services. That mechanism will help to deliver a better patient journey from secondary to primary care and across health board boundaries.
We must accept that by the time that someone is received in a coronary care unit or is rushed into accident and emergency with a heart attack, we have already failed them. That makes it even more important that the managed clinical networks focus on prevention and on working with high-risk groups, such as patients who have high blood pressure or diabetes, those who live in the most deprived circumstances and those who smoke. A whole-population approach is also necessary.
There is an opportunity for public health nurses and specialist nurses in cardiac and stroke services to work at community level to advance the aims of that strategy.
Although it is important to improve services at community level, it is also important to have national bodies to ensure that the strategy is implemented and backed up by the performance assessment indicators, to ensure that boards are doing what they are meant to do and that the services and strategies are properly monitored.
I welcome the development of the Scottish cardiac intervention network and the appointment of Phil Hanlon. One of the best aspects of the implementation of the cancer plan is the fact that Anna Gregor and her colleagues have made the decisions about dispersal and allocations of resources utilising established and developing managed clinical networks. I am pleased that that approach appears to be envisaged for identifying priorities for new investment in cardiac services within the network. The clarification from the minister was welcome.
Crucial to all of this is proper planning, and critical to that are the collection, storage and management of relevant data. I am also pleased that there is a proper focus on discharge documentation. I took part in a recent Scottish intercollegiate guidelines network discussion on discharge documents and was amazed by the omissions and variations that clinicians and nursing staff have to deal with, not to mention the problems caused by poor handwriting. Any work to ensure that the patient's journey is enhanced by electronic discharge documentation is to be welcomed.
In his introductory remarks, I noted that the minister commits us not only to waiting times targets, but to a focus on high-quality treatment. I am interested to know whether the minister feels that there is a need for further computed tomography brain imaging equipment and radiology staff to deal with the recommendation that, by June 2003, radiology departments will provide the amount of dedicated time needed for stroke patients to have CT scans in line with the SIGN guidelines.
There are workforce and training implications in the strategy. I welcome the commitment to an additional 18 specialist registrar posts. We all remain concerned by the points raised in sections 43 and 46 of the strategy about the extra numbers of specialist nurses, allied health professionals, technicians, pharmacists, intermediate specialists, cardiologists, cardiac surgeons and stroke physicians needed to fulfil the strategy and the low numbers of suitable people to fill those posts. That is probably the key issue to be addressed if the strategy is to be successful. I hope that the deputy minister will give further information on how she envisages that matter being tackled and will say whether ministers are confident that the strategy can be delivered despite those gaps.
It is critical that proper training is given to everyone who works with patients with CHD and stroke. I am pleased that NHS Education for Scotland will be involved in training for all professionals who deal with such issues. I am keen to find out whether the information could be extended to relevant local authority staff, patients and their families.
We should never underestimate the impact that CHD and stroke have on Scottish families. I know that I never can, so I welcome the new strategy and wish it every possible success.
I welcome the tone of the minister's motion. He has accepted the many challenges that he faces, in coronary heart care in particular. He recognises the serious issues that we face in Glasgow. He is facing up to the challenges and dealing with them with the help of the action plan.
I also welcome the fact that he commends the front-line staff involved in the process. At Stobhill, front-line staff provide a first-class service hospital under the leadership of Dr Frank Dunn, a consultant at Stobhill for more than 30 years.
Dr Dunn and his team have made several innovations, one of which particularly enthused me because it is an excellent initiative. I refer to the two wards, each with 20 beds, where patients are prepared for release from hospital following intensive heart treatment. It is important that patients receive that kind of treatment during the period before release and that they are advised on ways in which they can improve their lifestyle and so ensure more effective treatment. I seek a commitment from the minister that he will ensure that similar innovations in hospitals such as Stobhill continue to be developed.
That brings me on to the acute services review decision in Glasgow. I have the luxury of representing two hospitals in my constituency—Glasgow royal infirmary and Stobhill. I genuinely foresee severe difficulties in the reprovision of services from Stobhill hospital to the royal infirmary, particularly with regard to cardiac treatment. Will the minister give me a commitment that, if there is reprovision of that service to the royal infirmary, the level of service will increase? My concern about the acute services review is that the health board has made no contractual commitments on where it will make specific improvements.
I am not an expert on the Glasgow acute services review, but does Paul Martin agree that Glasgow needs a medium-secure unit in order to release people who are inappropriately detained in Carstairs?
I do not think that it is appropriate to discuss the medium-secure unit now, although I would be more than happy to discuss it with Mary Scanlon later. What is at issue in this afternoon's debate is cardiac services in Glasgow and particularly at Stobhill.
I ask the minister to tell me exactly what improvements people can expect on the excellent service that is provided at Stobhill hospital if the reprovision proposal is implemented. If the Auditor General for Scotland discovers that reprovision would not represent value for money or lead to an improvement in services, will the minister still go ahead with the proposal?
The Parliament has produced many glossy documents, and the printers must have made a fortune out of them, but those documents must be processed into real action for front-line services. Let us ensure that the glossy documents make a difference to local services.
We live in a society where booze, fags and a sense of futility combine to kill large numbers of our people. I recall from my earlier life the rush of 300 children at school lunch time to obtain their share of the 60 meat pies in the dinner hall, and the scorn with which salad was derided as bunny food. Those children of the 1980s are now parents, if not grandparents, and I doubt whether their diets have changed much. As Nicola Sturgeon said, the first priority is prevention and, in that, there is a mountain to climb. There must be fundamental changes in lifestyles, and we all know that that cannot take place overnight.
Where do we start? It is interesting to note that the NHS boards have to come up with a programme for 2004. I hope that it will be holistic and will take in all the other agencies, pre and post-natal clinics, nursery schools and schools. There must be a shift in popular diet, entailing conspicuous fat reduction and regular exercise, and an assault on tobacco consumption and the overuse of alcohol. We must also create hope in people's lives, so that they do not write themselves off because their modest expectations seem unattainable and they then live carelessly as a result.
Also important is the early identification of people who may be susceptible to, or be in the early stages of, heart conditions. Regular, available screening is essential. I have a friend who, at the age of 35, was screened as part of a University of Glasgow and Western infirmary project on heart disease and osteoporosis in twins. He was found to be suffering from hypertrophic cardiomyopathy, is on medication for the rest of his life and is regularly subjected to medical checks. But for the fact that he was a twin and took part in the twins project, the condition would have gone unrecorded and could have killed him.
What is to be done to screen people of all ages and to encourage people to insist on a regular medical check-up? There are good examples of well-publicised cancer-screening programmes that have saved lives. Do we have the medical staff to screen everyone who wants a check-up? Should we leave things purely to individual initiative or should we embark upon a programme to encourage every citizen to have regular check-ups and screening for susceptibility to CHD and stroke? It is better to diminish such conditions by lifestyle changes or to identify people who are most susceptible or are in the early stages and take immediate steps to improve their chances of survival than to wait until they have the conditions.
The most important question is: how do we encounter the macho male attitude? I understand that a men's health clinic in Alexandria in Dunbartonshire closed, because nobody went to it. Real men do not get ill. Real men do not want to know. Are real men chicken when it comes to health? How do we crack that fundamental problem?
Such remarks might not apply only to men. I understand that Chest, Heart and Stroke Scotland had a stall at our conference last week and offered cholesterol and blood pressure checks. A person who watched the stall for a wee while thought that only the thin and fit dared to go near it and that others who thought that they might have a problem did not go anywhere near it. Each individual must take a more responsible attitude. It would be easier to reduce waiting times—which we all want to do—and the number of people who suffer from CHD and stroke through a positive prevention programme and early identification of people who are at risk.
After that, I think that I will call only the thin and fit. I will start with Murdo Fraser, who will be followed by Janis Hughes.
I am pleased to follow Colin Campbell, whose speech was well thought out. He mentioned prevention, which I would like to highlight, too. We all know that money spent on prevention is better than money spent on cures. In winding up, perhaps Mary Mulligan will respond to some points that I hope to raise.
We have a truly terrible record on CHD and stroke, with one of the highest death rates in the world. We do not need to look too far for the causes—poor diet, lack of exercise, smoking and alcohol, which Keith Raffan mentioned. I have spoken in the chamber before about women with alcohol problems. The problem is hidden at the moment, but I hope that it is starting to come to the surface.
Members may have been following the television series on Ninewells hospital, which is extremely interesting. I pay tribute to the staff at Ninewells who have taken part in the programme. A programme that I saw two weeks ago dealt with people who had been admitted with heart disease. It followed a number of patients who were stabilised, treated and visited by the consultant afterwards. The consultant gave them advice about lifestyle, diet, exercise and the need to stop smoking. That was not the first time that some patients had been given such advice—they were repeat offenders, if you like. There were encouraging signs when they all said in the hospital that they would never smoke again and that they would cut down on drinking and take exercise. The follow-up programme was interesting. At least one patient confessed that he had continued to smoke, despite the manifest risk to his health and life. Such attitudes must be overcome.
I want to discuss physical exercise, too. It is estimated that 36 per cent of men's deaths from CHD and 38 per cent of women's deaths are due to lack of physical activity. In the UK, some 9 per cent of deaths from CHD could be avoided if people who are sedentary or have a light level of physical activity progressed to a moderate level of activity.
If we are to change attitudes, we must start with the young. We should catch pupils in our schools and get them to understand the need for exercise and good diet. We have a long way to go in that respect, as obesity rates among the young are still rising steadily.
Two weeks ago, I visited Pitlochry High School and talked to the modern studies class. Coincidentally, the Scottish Rugby Union had an introduction-to-rugby day course at the same time, which went down well, as the school is small and does not have rugby on its curriculum. Talking to the teachers was interesting. They said that, that morning, there had been a sudden rash of sick notes from pupils, who all claimed that they had colds and could not participate. It was obvious that the worst offenders were girls. Perhaps they did not fancy rugby or did not feel that they wanted physical exercise. In fact, one pupil ended up being taken to hospital with a broken jaw, so perhaps they had intelligent foresight, but that is by the bye.
Girls and young women everywhere, not just girls in Pitlochry High School, seem to have a problem with physical exercise. We must encourage more activity among the young.
Health education has a role, but I am somewhat sceptical about the effect of television adverts, always battering people and saying that they must eat better and stop smoking. I wonder whether people will behave better because the state lectures to them.
A better initiative would be to place more physical education teachers in schools. The Conservatives have said in the chamber that they want a full-time equivalent PE teacher in every primary school in Scotland. That initiative would increase physical activity among the young. If we catch them young, it is to be hoped that that will set a pattern for the rest of their lives. After that, we can deal with the problem of our appalling rates of coronary heart disease and stroke throughout Scotland.
I am delighted to support the amendment in the name of my colleague Ben Wallace.
I am delighted to speak in the debate, which highlights Scotland's unenviable record of having some of the highest rates of coronary heart disease and stroke in Europe. It is a shocking fact that those diseases, along with cancer, account for 65 per cent of all deaths in Scotland. Half a million Scots suffer from coronary heart disease and 12,000 die from it every year.
Given such figures, it is vital that we take two approaches. The first approach is through treatment. We heard much about treatment from the Minister for Health and Community Care and we will hear more when the Deputy Minister for Health and Community Care sums up. Waiting times for coronary angiography have more than halved since 1999 and are now at an average of 10 weeks. Bypass surgery waiting times have also fallen. However, there is always room for improvement.
I will focus on the second strand—education. Treatment is vital, but we need to focus on prevention and public health education. Ill health is not the legacy that we want to pass on to our children. We should not accept that it is inevitable that they will inherit our bad habits. It is all too easy to say, "My mum and dad had heart problems and high blood pressure, so I will get them too." We should not encourage such a legacy for our children.
Several excellent initiatives on prevention and education have been taken. The Glasgow healthy city partnership brings together many agencies to ensure a partnership approach to health education and prevention. The starting well initiative aims to ensure that the next generation has a better start in health terms. The Braveheart campaign in Lanarkshire takes nurses into communities to offer blood pressure and cholesterol checks to help with early detection of potential problems. The partnership between primary health care and secondary health care is vital. Local health care co-operatives have a vital part to play. Camglen LHCC in my constituency lists heart disease as one of its key priorities.
Such initiatives must be built on and encouraged in all communities, so that people are more aware of the consequences of their lifestyles. As with many other health and well-being issues, education must begin early, as Murdo Fraser said. Pre-school, that can mean encouraging healthier diet choices—such as fruit instead of biscuits and sweets, as we see when we visit various nursery schools—and teaching children that exercise can be an enjoyable and fulfilling part of their everyday lives. I agree with Murdo Fraser—it is important to teach that to children at an early age, because when they are in their early teens, it is more difficult to introduce exercise. However, I disagree with Murdo Fraser on one point. There is no difference between the number of girls and young women who are sedentary and the number of boys and young men who are sedentary. The situation is equal.
The community schools programme can help to take education to the next stage. My local council, South Lanarkshire Council, has recognised the benefits of that. An holistic approach is needed—we hear much about that in the chamber, but it is important that we teach children from an early age about the benefits of lifestyle changes, compared with what they may be used to seeing at home. We must educate not only children, but parents. We must tell parents that they can make a difference to their children's future health.
Access to healthy foods in communities through initiatives such as the Cambuslang health and food initiative in my constituency, which provides cheap fruit and vegetables as well as nutritional advice, can encourage people on lower incomes to include fruit and vegetables regularly in their diet.
Although healthy eating is one way for people to improve their life chances, it is just as important for there to be a reduction in the number of smokers. I know that a number of my colleagues will squirm at this point. As Nicola Sturgeon said, a number of smoking cessation programmes exist, but we must ensure that those programmes are tailored to meet needs and that there are enough to go round. We also have to tackle the much more difficult issue of passive smoking.
I welcome the health improvement initiatives and look forward to seeing an even more dramatic improvement in the health of the country. Coronary heart disease and stroke are one family heirloom that we do not want to leave our children.
I wish that I was not taking part in the debate today because that would mean that we had begun to eradicate these terrible diseases. As a Glasgow MSP, it is with deep concern that I note that the British Heart Foundation puts Glasgow at the top of the United Kingdom league for coronary heart disease.
Other members have mentioned the research that points to the links between coronary heart disease and deprivation, physical inactivity and poor nutrition in childhood and adolescence. It is for that reason that I welcome the strategy to tackle the problem of coronary heart disease. The big question is whether the strategy will go far enough.
Deprivation has been identified as one of the key factors in creating the conditions in which heart disease and stroke flourish. The Scottish health statistics demonstrate a clear link between deprivation and the death rate from heart disease. It is unfortunate that the Scottish Parliament does not have the full powers to tackle the fundamental problem of deprivation. My colleague Nicola Sturgeon mentioned the reasons for that. The strategy mentions briefly the socially disadvantaged, but we need real action to end deprivation, which is the cause of these terrible diseases in so many areas of Scotland.
Physical inactivity has been mentioned in the debate. It is another key risk factor for heart disease. Children must be encouraged to take up sports and exercise, which have been recognised as providing protection against heart disease in middle and later life. Schools have a key role to play in increasing the amount of physical activity in which children and adolescents are involved.
However, if members examine the Executive's record, and that of previous Governments, they will see the sell-off of playing fields and the decline in the provision of community facilities. People in Glasgow are having to pay additional money to use those facilities. The Executive must address that. We must provide our children with accessible alternatives to television and computer games. We must reverse the trends that have seen the number of obese six-year-olds double and the number of obese 15-year-olds treble in the past 10 years.
Good nutrition is paramount in the fight against coronary heart disease. It is crucial to improve our children's eating habits. They need to be educated at an early stage to become knowledgeable about nutrition and the benefits of good nutrition. It is also crucial that healthy eating is promoted in schools in place of the fatty snack foods that are commonly consumed at lunch and break times. Colin Campbell mentioned that. The Executive must address and replace the so-called "fuel zones", with their menus of junk food and soft drinks.
We had an opportunity to do something about that when we considered the School Meals (Scotland) Bill. The Executive rejected a bill that could have gone some way towards instilling the practice of healthy eating among our children and so helping to prevent the development of coronary heart disease. [Interruption.] I hear Karen Gillon saying something. Does she want to intervene?
The member is in her last minute. The intervention will have to be brief.
Sandra White should remember that SNP members on the Education, Culture and Sport Committee voted not to proceed past stage 1.
Karen Gillon is very much mistaken. The bill passed its stage 1 reading. The Executive voted down the bill in the chamber. If the Executive had had the courage of its convictions, we could have had that bill. Karen Gillon should check her records.
I am the convener of the Education, Culture and Sport Committee. [Laughter.]
The issue may be a laugh for the convener, but it was the Executive that voted down the bill. She must recognise that.
The SNP welcomes the Executive strategy and the additional investment. [Interruption.]
Members must please not make any more interventions. Ms White has only 8 seconds left.
Vision and commitment are required if the problems of deprivation, poor diet and physical inactivity are to be solved. I sincerely hope that the strategy will go some way towards resolving those issues.
First, I commend the minister on one of his reforms—the establishment of the national waiting times centre in my constituency—and record that excellent progress is being made both on the number of patients who are being treated for heart disease and other conditions and on the quality of provision. It is certainly making a difference. What with the other initiatives that the minister highlighted, we are improving the quality of treatment that patients receive.
Although I welcome the strategy, I want to make a number of comments that echo concerns about the balance of the activities that are highlighted in the document. The section on prevention is the shortest and contains only one recommendation, compared with something like nine recommendations on information technology and the development and use of databases. There might be good reasons for that; for example, we might be making some progress on the issue. However, we must signal that the key issue is prevention, and that how we deal with it is important.
The section on prevention recommends that every health board should develop a strategy, which is the right approach. However, what health board in Scotland does not have a strategy for developing prevention measures or is not considering a series of active routes in that respect?
A lot is being done. For example, I have been involved for a number of years in trying to promote health improvement agendas. Janis Hughes mentioned the healthy city partnership; I was chair of the board of that partnership for a couple of years. I am aware that a number of projects in greater Glasgow are directly addressing how we improve people's health before they are stricken with heart disease. Given Glasgow's particularly poor health profile and the incidence of strokes and cancer in the city, the onus is on us to focus on prevention and to tackle the problems of particular groups. Instead of adopting a passive approach and waiting for people to get sick, we should be taking an active approach and looking for people who have hypertension, high cholesterol and other indicators of heart disease.
Would Mr McNulty be in favour of introducing in Scotland pilot schemes similar to English schemes in which 200 surgeries provide access to swimming pools and leisure centres on prescription? Would that not be a good idea, particularly in the country's most deprived areas?
A number of initiatives that provide access to leisure centres have been introduced in Glasgow. I hope that that important approach will be rolled out across Scotland, because exercise is crucial. We must also tackle diet head on. Much of the problem lies in people's habits and in the cultural eating patterns of this country.
As several members have mentioned, we must address the problem of smoking. Although some argue that smoking can be tackled by giving advice or by dealing with cigarette advertising, I believe that we should take a harder line in Scotland. We must make concrete progress and the most effective way to move forward the agenda would be to seek to restrict people's opportunities for smoking. We must make smoking an unacceptable habit—that is what the tobacco companies are most frightened of.
One of my final points is partly a criticism of the tone of the strategy document, although I am sure that the minister did not intend to create such an impression. There is a sense that we are operating within silos. For example, the strategy document is a health silo document. Instead, we need to take account of education, housing and the whole series of factors that cause ill health.
We also need to operate an evidence-based strategy and spend our money on measures that deliver the best change. Doctors, practitioners, experts and others must steer us towards what we can best do to achieve change. Politicians should be supporting them in that work, instead of suggesting their own ideas about how matters should be developed.
I will make a fairly brief speech after Des McNulty.
The minister said that health professionals are at the core of the plans. That is right and proper. I hope that a substantial proportion of the £40 million will go on professionals.
I will spend a minute or two on the challenges that are faced in relation to staffing. First, and fairly obviously, over the past six years the number of deaths from stroke has declined, although the incidence of stroke remains much the same. That increases the burden on support after a stroke, which involves a wide range of services. By the same token, the ambitious targets for bringing down angiography waiting times will increase the demand for staff.
I have before me work force statistics from the information and statistics division. I will focus on nurses, because they are an essential component of the strategy. As of August 2002, there are 1,869 vacancies for nurses generally. Intensive care has the highest percentage of vacancies: 6.8 per cent of positions are currently vacant. The next highest is paediatrics at 5.7 per cent and the third highest is theatre nurses at 5.3 per cent. That is against an overall vacancy level of about 4 per cent.
Consider some of the other statistics. Over two years, the number of cardiologists has declined by 2 per cent and the number of cardiology consultants has declined by 4 per cent. More worryingly, over a five-year period, the number of neurologists has declined by 63 per cent.
What will happen in future? A written answer to my question S1W-27665 gives the profile of retiring nurses over the next 10 years. It shows that 321 qualified nurses will retire in 2002 upon reaching normal retirement age. By 2007, that figure will have more than doubled. The number of nurses leaving the profession is accelerating due to nature. At the same time, there are real difficulties and vacancies.
As far as training is concerned, the figures are more reassuring and suggest that many people are coming through. However, the number of people in training is less than the number of nurses who will reach retirement age. On that basis, we will certainly have some problems.
I hope that Mary Mulligan, in replying to the debate, will be able to assure us that we will not only get money, but that we will be able to pay staff sufficient to attract new people into the profession. In particular, will she agree with the SNP that nurses are very much at the core of what we do in health and that they should be rewarded accordingly with substantially higher salaries than they receive at present?
Much of the debate has focused on prevention and public health education. In a sense, we got it the wrong way round. Malcolm Chisholm opened the debate by talking about treatment, managed clinical networks and so on—and I agree with much of what he said—but I think that many of us feel that not enough is being done on prevention. Several ideas have come from the chamber on that crucial issue.
There are three major causes of ill health in Scotland, not only of coronary heart disease and stroke, but of cancer, diabetes and so on. They are bad diet, smoking—tobacco, in other words—and alcohol consumption. The strategy rightly refers to life circumstances and lifestyles. Life circumstances are part of the Executive's social justice agenda.
It is important that we improve our housing stock, and that is not only about Glasgow housing estates. I was recently in a house in Scone where damp was running down the walls and there was appalling ventilation. The tenants of that council flat suffer from numerous illnesses including asthma, bronchitis and thyroid problems. It is crucial that housing is improved.
Also developing across Scotland are the so-called one-stop shops, such as Stirling Health and Wellbeing Alliance. I was at a conference in Cowdenbeath recently and learned about a similar organisation initiated by medical practice in Inverkeithing. Advice on diet and healthy living must be made available in deprived areas
It is also essential that we have healthy lifestyle education in the curriculum. I know that we have drugs, alcohol and sex education in schools, but there are many other aspects of healthy living. Health promotion is, above all, a cross-cutting issue. It is important that enhance that element of our education system. I read that, in 96 per cent of schools, there is some form of health education, but we need to get that up to a uniformly high standard in all schools.
I agree with Nicola Sturgeon, who said that the section on lifestyles in the strategy document, which makes up only two of the 50 pages, is rather short, given that lifestyle is important in relation to the causes of coronary heart disease, stroke and other illnesses.
I agree with what the minister said about national strategies and local projects and initiatives. However, if health campaigns are to have an impact and bring about culture change, they must be national. We can see the effectiveness of the national approach in Finland, which, over a 30-year period, has cut deaths from coronary heart disease by three quarters.
We have to do our utmost to reduce smoking and alcohol intake and improve diet. I do not think that the Executive's targets for a reduction in smoking are high enough, particularly given the fact that we have a smoking rate of 35 per cent in Scotland compared to 27 per cent in the UK. I want legislation to prevent smoking in public places. We are the only country in Europe that has no restriction on that.
The national plan for alcohol—and I will end with this, Presiding Officer—was launched earlier this year, somewhat bizarrely, in a pub. However, it has yet to be debated in the chamber. If the Executive is serious about health promotion, that plan must be debated soon. There are 250,000 chronic or serious alcohol misusers in Scotland compared with 35,000 injecting heroin addicts. We debate drugs in this chamber a couple of times a year, but we have yet to debate what we are going to do about alcohol abuse. To be frank, I think that that has been because we do not spend nearly enough per head on tackling alcohol misuse compared with drug misuse.
We must have a national campaign on diet. The editor of the British section of The Economist visited us in July and, over breakfast with me and other members, said, "Don't you eat fruit and vegetables up here?" One of the main things that we have to drive home is the importance of diet. We must do it in schools. I was brought up in a medical household and developed a highly sweet tooth and did not eat nearly enough fruit and vegetables. We have to start with everybody, doctors included—
There was a promise to finish a minute ago.
An improved diet is the final part of a prevention programme.
I congratulate Keith Raffan on the excellent work that he does in the Parliament on drugs and alcohol.
In the absence of other mentions of alcohol abuse, I would like to acknowledge the excellent work that is done by Alcoholics Anonymous. Scotland has 9 per cent of the UK's population and Alcoholics Anonymous provides 30 per cent of alcohol abuse support groups at no cost to the taxpayer.
I welcome the excellent work that is being done in Dumfries and Galloway towards the establishment of a managed clinical network, particularly in relation to the development of primary care standards for coronary heart disease and the Highland stroke strategy for the review of stroke services throughout the region.
The last sentence of the Executive's motion mentions
"the development of more integrated services".
There is often a feeling that coronary heart disease and stroke treatment begins and ends at acute hospitals. However, during my members' business debate last week it was acknowledged that, if the patient could be treated in primary care, they should be. I would like to emphasise prevention, which was highlighted by Des McNulty.
In a recent paper from the Scottish Association of Community Hospitals, Dr Joan Noble of Nairn discussed the completion of a successful screening programme of Nairn and Ardesier local health care co-operative's 65 to 75-year-old male patients. Unlike in Colin Campbell's area, the uptake was 93 per cent and the screening took place at the community hospital in Nairn.
As well as ultrasound screening, a vascular nurse provided a full well-man check that covered blood pressure, height, weight, urine, smoking and lifestyle issues that arose during the appointment. At the end of the MOT, patients were given a pack of specially selected health promotion leaflets.
Out of 624 patients, 24 aortic aneurysms were detected, six of which required immediate treatment. Those patients were referred to the local vascular surgeon. Four were successfully operated on, and the other two are still being assessed. The remaining patients who have smaller aneurysms are receiving continuing annual supervision.
The screening also uncovered 99 possible new hypertension patients and two new diabetics. That holistic approach in primary care—rather than a single-disease approach—not only saves the national health service money, it saves the patient time from multiple appointments and gives peace of mind.
The Nairn practice will now invite for screening all male patients over the age of 65. I use that example because men in Nairn were much keener to come to come in to the general practitioner and the community hospital. Members should compare that with the example that Colin Campbell gave of an acute hospital.
However, if the Executive really means to develop an integrated service, it needs to ensure that community hospitals, GPs and the full primary care team are fully integrated into the managed clinical networks. It must also put greater emphasis on prevention and aftercare where patients are treated as near to their homes as possible.
The Conservatives agree with and endorse the strategy. However, it is one of many strategies, glossy brochures, consultations and action plans. Will the minister now—after three and a half years of the Parliament—start to give us an update on the strategies? Will he monitor and publish what has been achieved? Will he let us know exactly what comes out of the strategies? I agree with Paul Martin and endorse his comment: let us ensure that the glossy brochures make a difference.
That showed Mr Raffan how to do it.
Thank you, Presiding Officer. [Interruption.] When Mr Raffan is finished, I will begin.
Malcolm Chisholm and others have rightly focused on managed clinical networks as an important tool in getting the best out of the resources that we have. However, for me, the theme that has come out the debate is the fact that prevention is the key to turning round our fortunes and our unenviable position of having the second-highest mortality rate for coronary heart disease in Europe.
I agree with Des McNulty that the fact that the section on prevention is the shortest in the strategy—only two pages out of 50—does not send out the right message. It is important that we send out the message that prevention is the key and that without it—without a change in lifestyle—our nation's health fortunes will not change.
I also agree with Keith Raffan that the omission of alcohol from the strategy is short-sighted, given that we know that alcohol—especially a combination of alcohol and smoking—is a key factor in the incidence of strokes and coronary heart disease. Perhaps the Executive should respond by making alcohol far more prominent.
As Nicola Sturgeon outlined, smoking cessation is key. Smoking is one of the key causes of so many of the diseases that plague Scotland. I, too, would like the Parliament to take as many measures as possible to tackle it. We need to know what will happen to the ring fencing of funding for smoking cessation. When a person wants to give up smoking, it is vital that the support is there when they require it and that the moment is seized.
As many members have said, poverty and deprivation are key aspects of our poor health record. The higher levels of coronary heart disease and strokes in deprived areas are well documented.
We need to raise the ambitions and aspirations of our people. If people do not see something to change their lifestyle for—an aspiration or a goal to aim for—why would they fundamentally change their lifestyle?
Colin Campbell's speech was well thought out and was one of the best in the debate, focusing on giving people hope. The main issue is about changing attitudes, particularly those of men, who still tend not to seek health-related assistance, which they do not see as being of any relevance to their lives. We must reverse such an attitude, which begins at an early age, so that we do not all end up with the "we've all got to die of something" attitude. We do not need to "die of something" 10, 20 or 30 years younger than when we do have to leave this earth.
People are dying far too young from preventable diseases, and they have a key role in preventing them themselves. As Murdo Fraser said, the message has to be given to people from a young age. It is crucial that we set out the diets that people should follow at a young age. If we do not, people will end up following the same poor diet over a lifetime. If we do not reverse that at an early age, it is more difficult to do so later.
At lunch time today I heard a good example of a health education project in the Whitfield area of Dundee. It was a healthy eating initiative, involving whole families, who would come together and take part in the project, enjoying simple, healthy foods. The initiative has proved so popular that there is a waiting list. That is the kind of project that we need to roll out. Such initiatives are not expensive; they are cost-effective, and display good results. Where they work, let us see more of them.
Stewart Stevenson highlighted vacancies among doctors and nurses. Filling those vacancies is critical to ensure that we have the resources that are required to provide the necessary treatment.
Sometimes we politicians can focus too much on the short-term solutions—we all have the date of the next election in mind. We must focus on the long term when it comes to changing our nation's health. That is not without risk, because it can be 10, 20 or, to take the case of Finland, even 30 years before we see results. We have to be brave enough to invest resources for the long term if our nation's health is ever to change.
We have had a valuable debate this afternoon on one of the key health issues facing the people of Scotland. The contributions have been constructive and the tone of the debate has done justice to the importance of the subject matter.
Before I deal with some of the specific points that members made, I will say a little more about health improvement. Last month, during the spending review debate, we stressed our commitment not just to Scotland's national health service, but to the national health of Scotland. Of course we want people to get the best possible services when they are ill, but we also have a duty to build a healthier nation for the future.
Our efforts will therefore be concentrated on children and young people, with more support for families during children's early years, with healthier school meals and with children being encouraged to lead more physically active lives. Murdo Fraser said that we do not take enough exercise. We live more sedentary lifestyles these days, and fewer people are involved in manual work. I accept that sport plays a valuable part in providing exercise, but I hope that Murdo will accept that we are talking not just about sport but about activity in general. Sometimes, non-sporting activities can be less off-putting for those who are less active. That might mean walking to school or to work, which can enhance people's general level of health, and which should therefore be encouraged.
When I saw Nicola Sturgeon wrinkle her nose at the idea of playing rugby, I recognised that not everyone is keen on team sports. We should tailor the availability of sports to the needs of the individual and the young people whom we are trying to involve.
Nicola Sturgeon asked what we will do once funding from the health improvement fund has ended. Last week we agreed that, through the spending review, more than £170 million will be injected into additional health improvement actions across the Scottish Executive. Coronary heart disease and stroke are clinical priorities of NHS Scotland because they can be prevented. Our target is to achieve a 50 per cent reduction in deaths from coronary heart disease and stroke of people under 75 between 1995 and 2010. We appear to be on track to meet it, but we cannot afford to let up.
Our national demonstration project, Have a Heart Paisley, recognises the wide-ranging improvements in environment, lifestyle and services that are needed to prevent coronary heart disease. The project is working closely with local communities and individuals in Paisley, as well as with a wide range of agencies.
The national coronary heart disease learning network that is being developed by the Public Health Institute of Scotland will help us to roll out the lessons that have been learned from Have a Heart Paisley and from other projects such as In Fine Fettle—the Borders primary prevention programme—and Braveheart in Lanarkshire.
Many of the risk factors for heart disease and stroke are the same as the risk factors for many other serious illnesses: smoking, poor diet, lack of physical activity, alcohol misuse and social exclusion. Our overall approach to those factors is set out in the white paper "Towards a Healthier Scotland". The paper focuses on the generic determinants of health—lifestyles and life circumstances—as well as on specific conditions. Its overarching aim is the reduction of health inequalities. That aim is particularly relevant to coronary heart disease and stroke, as the toll that they take is much greater among our most disadvantaged citizens.
We are making good progress in advancing the agenda that is set out in "Towards a Healthier Scotland". We have been helped by the decision to channel £26 million a year over the past three years from the health improvement fund.
We are progressively implementing the white paper "Smoking Kills" to step up the prevention and cessation effort on smoking. Work is in hand to address other key lifestyle determinants.
Will the minister give way?
I will give way to Keith Raffan after I have dealt with the tobacco issue.
A number of members raised the issue of smoking. We all recognise that with some key groups—especially young girls—we are not making the progress that we would like. However, cessation programmes that are under way throughout the country are having an impact. In West Lothian, treatment by a nurse at St John's hospital is supported by work with counsellors, to help people to give up the nicotine habit. That work makes a difference, because it deals with people as individuals.
We are making progress on passive smoking, which Nicola Sturgeon raised. Increasing numbers of public places are being designated as non-smoking. An increasing number of licensed premises restrict access for smokers or have non-smoking policies. Because the number of such premises is continuing to increase, we do not think that it is appropriate to legislate on the issue at this stage. However, we hope that by the end of the year legislation will be in place to ban tobacco advertising.
Is the minister aware that, since she launched the plan for action on alcohol problems much earlier this year, it has been subject to growing adverse comment? The chamber has not yet debated it. Will the minister assure us that the Executive is not complacent about that issue, which affects at least 250,000 Scots and is a primary cause of CHD and strokes?
We are not ignoring the plan for action on alcohol. At this very moment, people across Scotland are developing local plans. It is absolutely essential that we give them time to do that, because those who are working at the coalface can have the greatest effect. The plans will need to be submitted by the beginning of next year. We will then look at the resources that the Executive needs to make available to finance the plans. I can inform Keith Raffan that we are committed to making progress on that issue.
Another question that was raised was why there was not much about alcohol in the strategy. It has been raised as an issue, and if members want further information, the document that we have before us refers to the chief medical officer's top tips on how people can look after their heart.
We must acknowledge, as a number of members have mentioned, that the issue of heart disease and stroke cannot be tackled only by the health service. In the Executive, we will continue to work with our colleagues in other departments—education, culture, sport and social justice—to ensure that we have cross-cutting measures that will have a real effect on people's lifestyles. In that way, we will reduce the number of people who are affected by coronary heart disease and stroke.
The additional £170 million that we are investing in health improvement action across the Executive signifies our ambition for Scotland. We are determined to end the fatalistic and defeatist attitudes to health in this country. When we consider the human reality—the individuals whose lives have been devastated by the effects of a stroke and the families who have lost a much-loved mother or father to a heart attack—we know that we have to act.
I commend the strategy to the Parliament and ask members to endorse the Executive's motion.