The next item of business is a debate on motion S4M-11766, in the name of Neil Findlay, on the state of the national health service.
16:22
The national health service is without doubt the greatest social policy of any Government. The collective pooling of our taxes to provide healthcare for all, free at the point of need, was a revolution in healthcare, resulting in a system to which we contribute according to ability to pay and which each citizen of this country can use according to need. That is something that we should never take for granted and which all of us should work to protect.
Our NHS is under pressure like never before. From the front door of the general practice through to the social care sector, the pressures across the system are immense. In primary care in my region alone, 27 GP surgeries have full or restricted waiting lists. Workforce pressures are piling up. When a GP is off sick or retires, finding a replacement or a locum is almost impossible.
I recently met managers at two practices. Both of them told me that there were no applicants for their vacancies. Yet, rather than addressing those pressures, the Scottish Government has been cutting GP funding. The budget for general practice has been declining steadily. Next year, there is a further real-terms cut of 2.2 per cent. The Royal College of General Practitioners has raised concerns about the
“dangerous consequences for patients in the light of continued underfunding”.
Waiting times for appointments are up.
Will Neil Findlay recognise the £40 million that was announced by Alex Neil for investment in GP surgeries, particularly in more deprived communities and rural areas? Surely he will welcome that.
Of course we always welcome more money, but the issue applies across the board and over a long period, when the budget has been declining.
Waiting times for appointments are up and consultations are getting shorter, weakening the relationship between the doctor and the patient. All of that contributes to a “crisis in general practice”, in the words of the royal college. The situation is evidence of a Government failing to face up to the pressures on our local doctors and on the wider NHS.
Will the member give way?
No thanks.
Let us look at what Audit Scotland, whose report should have been a wake-up call to the Government, says about the NHS:
“The current level of focus on meeting times targets may not be sustainable when combined with additional pressures of increasing demand and tightening budgets.”
Whatever anyone thinks of targets, they are there to monitor and drive performance. The role of the Government is to ensure that the NHS is given the right level of resources to meet those targets successfully.
Will the member give way?
No, thank you.
The Government is failing not only to meet its initial targets but to meet the lower targets that it then set.
Audit Scotland also said:
“There are signs that NHS boards are facing increasing difficulty meeting their financial targets, and some are doing this in unsustainable ways. Four boards required additional funding from the Scottish Government to break even, and five continue to rely on high levels of non-recurring savings.”
Those financial constraints are undoubtedly related to the real-terms reduction in the funds allocated to the NHS. As was recently reported by the Institute for Fiscal Studies, the Scottish Government budget for the NHS in Scotland has fallen by more than the NHS budget in England. So much for the progressive credentials of this Scottish National Party Government and its promise to protect the NHS.
We have said very clearly that we are committed to a real-terms increase not just in this parliamentary session but in the next one. In the Labour leadership elections hustings debate, Neil Findlay refused to give that commitment. Will he do so now?
I will deal with the leadership election outwith the chamber; that is a different matter. Let us deal with what we are dealing with in here.
The consequences are being felt everywhere. Accident and emergency departments are full, unable to cope with increased demand and expectations. Staff tell me that they are frazzled. There is a recruitment crisis and junior doctors are under huge pressure, looking after up to 100 beds while working hours that are far too long.
I know through my family and friends how skilled our NHS workforce is; I also recognise that, when people are admitted to hospital, the vast majority of the time they receive first-class treatment. However, the number of complaints is on the rise—it is up 23 per cent—as are staff complaints about bullying and intimidation, while whistleblowing procedures remain wholly inadequate. If it was not for the dedication and commitment of NHS staff, I fear that the system would be on its knees.
One of the biggest issues facing our health and social care system is delayed discharges. In 2011, the cabinet secretary at that time took action to reduce delayed discharges when the figure reached 200,000 bed days lost and said that the matter would be resolved. Now what do we see? Last year, we saw 421,000 bed days lost and patients stuck in hospital when they could have been at home—all at a cost of £78 million. That represents an abject failure of this Government’s stated policy of shifting the balance of care.
Last week, Theresa Fyffe of the RCN said:
“The figures published today on delayed discharges are further evidence that our NHS is under pressure ... One of the worrying aspects of the figures published today is that we’ve not yet hit the winter months. If this is happening over the summer months, what’s it going to be like in between December and February, when many more patients – particularly our most elderly and vulnerable - are admitted to hospital?”
Will the member give way?
No, thank you.
Directly linked to the issue is social care, which is one of the greatest scandals of our times. Our elderly and vulnerable friends and relatives are being cared for by staff who are desperate to care but unable to do so. Council budgets have been cut by 11 per cent, with authorities shackled, unable to raise money. The norm is 15-minute care visits and the sector pays the minimum wage, with carers staying in the job only until they can find a job elsewhere.
Recently, I met a young girl who got a social care job. She received four days’ training in an office and shadowed another carer for one and a half days, after which she was sent out on her own. On her first day, she had 30 clients to visit. The first was a man with a catheter; she did not know what it was, never mind how to deal with it. The next person she went to had a personality disorder and was abusive to her. Again, she did not know what to do. Her day went on like that. She was paid until 5 pm, but only finished her day’s work at 10 pm. She was rewarded with £5.13 an hour.
That is what we are doing to our elderly loved ones and to the young carers of the future. What is the Government’s response to that situation? Last week, the First Minister week announced that an extra £5 million would be put in place to deal with delayed discharges but that councils would have to match fund the Government’s contribution.
What planet is the First Minister living on? Council budgets are being hammered by the Government, and services are closing, jobs are being lost and assets are being sold. Can the cabinet secretary give me and our councils some idea of where the money will come from? I will give way if she can tell us where it will come from.
Unlike the member, local government has been very constructive in responding to the challenges. We should remember that it is a tripartite funding agreement between local government, the health service and the Scottish Government. That is what constructive proposals are all about. Perhaps the member could give us a constructive proposal in the remainder of his speech.
We do not know where the money will come from, but local government has to find it—that is how the Scottish Government treats local government.
We have similar problems in the care home sector, where there are staff shortages and low pay, training budgets have been cut and standards are falling. Every week, there are stories in the press about neglect and the poor care of residents. Across Scotland, care home places are vacant because councils will not allocate people to them because of concern about the quality of care, yet neither the Government nor the Care Inspectorate knows the extent of the problem, because neither of them collates the information. That cannot go on. We must make social care a fairly paid, rewarding career, and we must raise standards to ensure that we genuinely shift the balance of care. That will never happen with a system that is based on a race to the bottom, as the present one is.
The two previous cabinet secretaries for health operated a denial strategy—they pretended that everything was okay when reality was staring them in the face. We now have staffing shortages across many disciplines: GPs, midwives, specialist nurses, paediatricians, psychiatrists, emergency medicine staff, anaesthetists—the list goes on. Vacancies for consultant posts have doubled, spending on locums is up by 60 per cent, spending on agency staff is up 106 per cent over the past two years and money continues to leak out of the system into the private sector. In the past few days, we have had the reports on the Vale of Leven hospital, Aberdeen royal infirmary and NHS Grampian, and there are serious issues in Fife, Lanarkshire, the Lothians and across Scotland. If ever there was a time to accept our argument for a wholesale review of our NHS and the establishment of a truly independent health regulator, that time is now. I hope that the new cabinet secretary will reject the arrogant approach of her predecessors and do exactly that.
I move,
That the Parliament commends the NHS Scotland staff who work tirelessly under increasing pressure to deliver high quality care to patients; is concerned by recent statistics that show that accident and emergency waiting time targets are being missed, the number of patients delayed over four weeks increased by 106% between October 2013 and October 2014, the number of bed days increased by 22% to 154,588 between July to September 2013 and July to September 2014 and that the BMA suggests that consultant vacancies are almost double the official figure; notes the concerns of staff regarding the ongoing scandal of 15-minute social care visits, falling standards and a race to the bottom in quality, wages and conditions, and calls on the Scottish Government to conduct a full-scale review of the NHS, as supported by the Royal College of Nursing, to address the broad range of pressures being identified in all areas of the NHS by staff and patients and to build a health service that meets the demands and needs of the 21st century.
16:32
The NHS is a fantastic institution. As the new Cabinet Secretary for Health, Wellbeing and Sport, I am grateful for the opportunity to put on record my appreciation for the effort and dedication of those NHS staff who work tirelessly day in and day out to deliver a high-quality service. This is also my first opportunity to say what a privilege it is to have responsibility for the NHS in the Scottish Government.
The NHS must always strive to seek further improvements in the delivery of care, but we should not lose sight of where we have come from and the progress that has been made. We have a clear vision and direction for our health service as part of the 2020 vision for health and social care, which has secured and will continue to secure huge benefits as we move forward with integration over the next few years.
The NHS is our top priority and we are making significant financial investment in our health service. The NHS front-line resource budget will be protected and will receive an above-inflation increase in 2015-16. Indeed, the total health budget will receive a real-terms increase in 2015-16, which will take it to more than £12 billion for the first time. I think that there should be a shift in the debate towards considering how we can better use that significant resource. My job is to ensure that we use it to achieve the things that we need to achieve.
Will the cabinet secretary reflect on the social care resource that is available?
Of course, that is why we have moved to the integration of health and social care. In his speech, Neil Findlay called for more money for health and more money for social care. We need to make sure that the £12 billion that is in the system for health and the huge resources for social care are delivering the improvements that need to be made, and that is what I will focus on doing.
As I said earlier, we have committed to ensuring that the health resource budget receives real-terms rises in each and every year of the next parliamentary session. I note that, when he was given the opportunity to make that commitment, Neil Findlay did not do so, which somewhat pulls the rug from under his argument about resources.
This Government has increased the number of NHS staff to record levels. Yesterday, members saw the workforce statistics, which showed that there are 7.6 per cent more staff working in the NHS. That translates into more than 9,600 staff. It means more doctors, dentists, allied health professionals, nurses and support staff.
The NHS is treating more people than ever before while, at the same time, reducing how long people have to wait for treatment. The number of in-patient cases has increased by more than 162,000 under this Government and day cases are up by more than 45,500. The latest statistics show that 97 per cent of new in-patient and day cases are seen within 12 weeks. There is more resource, but more people are being treated.
If the cabinet secretary believes that we are making progress, does she share my concern about the current plans to close accident and emergency departments in Lanarkshire and agree that we need urgent action to address staff shortages and a full independent review of future plans to address the many issues that affect health provision in Lanarkshire?
The member could do with a dose of self-awareness, given where we have been with the A and E departments in Lanarkshire. It was this Government that saved the A and E department at Monklands.
A recent report by the Nuffield Trust for Research and Policy Studies and Health Services into elective waiting times across the four United Kingdom countries found that Scotland had the shortest waits for nine out of 11 common procedures, including hip replacements and cataract removal.
On unscheduled care, it is clear that challenges remain, although it should be noted that performance in Scotland’s core accident and emergency departments remains the highest among all UK countries and significantly above the level that we inherited.
We could not deliver that performance without the dedicated, highly motivated and hard-working staff in the NHS. We have a clear vision for our NHS workforce and, of course, we have committed to ensuring that NHS Scotland staff are rewarded fairly for the work that they do. That is why, unlike England and Wales, we have accepted the recommendations of the independent pay review bodies on pay for 2014-15 and why we have a policy of no compulsory redundancies. We are ensuring that all NHS staff are paid at least the living wage. That will ensure that our staff are well motivated and well rewarded for the job that they do.
However, I am not complacent. I spoke earlier today about the challenges that have been identified in NHS Grampian and last week about the Vale of Leven report. The Government will not shy away from acknowledging and addressing the challenges that the NHS faces, and neither will I.
Winter planning is a key part of our unscheduled care programme. With boards and their partners, we have developed winter plans to prepare for the disruptions that winter can bring. NHS boards are also testing and communicating their business continuity plans to ensure that critical services are maintained.
I am clear that, to deal with those challenges, my focus in the next few months must be on driving forward the shift in the balance of care, driving forward health and social care integration and dealing with delayed discharge. In presenting the Government’s programme for the year ahead, the First Minister made it clear that addressing delayed discharge is one of our key priorities and it is one to which I give my personal commitment.
In 2008, the cabinet secretary said that the Government had reached Labour’s target of zero for delayed discharges. In the 24 quarters since then, the target on delayed discharges of more than six weeks has not been achieved and the Government now has a four-week target, with a two-week one coming in in April. Let us have a little bit of realism.
Cabinet secretary, you are in your last minute.
My saying that delayed discharge is my top priority gives Dr Simpson a sense of realism. Of course, when I dealt with delayed discharge, it was an inherited problem that the previous Administration left us. [Interruption.]
Order, please. [Interruption.] Order, please. The cabinet secretary is concluding.
We dealt with delayed discharge, and I will deal with it again. I did not want to leave Dr Simpson under any illusion.
In the absence of any other policies, the Labour Party continues to call for a Beveridge-style review. The Beveridge review took four years. I do not want to put the NHS on pause for four years; I want to get on and solve the problems. We know what the problems in the NHS are. We do not need a review to tell us that. We need the action to deal with the problems and ensure that the NHS continually delivers the high level of service that we expect.
I move amendment S4M-11766.3, to leave out from “is concerned” to end and insert:
“believes that, to give certainty to future health service planning, the NHS revenue budget should rise in real terms for the remainder of the current parliamentary session and the next; welcomes that the protection of the NHS budget in Scotland has seen the health workforce rise to a record high; further welcomes that, in the last year alone, NHS consultant numbers have increased by 6.6%; notes that, while delayed discharges today are significantly lower than they were in 2006, action between the Scottish Government, the NHS and local government is required to reverse recent increases; recognises that the successful integration of health and social care will be key to the delivery of the long-term sustainable solution to delayed discharge, improved patient flow and effective and coordinated care at home, and supports the Scottish Government’s aim to work with stakeholders to take forward the continued development of the 2020 vision, as it has in the past, to reflect the increasing demands from patients and the new way that services will be delivered under integration.”
16:39
I will begin, in the short time that is allotted to me, by endorsing the opening statement of Labour’s motion and by paying tribute to the staff of NHS Scotland. The vast majority of those people work in the NHS because they want to help patients, and they work tirelessly to that end. That applies right across the board, within the community and in our hospitals, from the most senior consultants to the most junior medical staff, from nurses and AHPs to the cooks, cleaners, porters and secretaries, who all play their parts in running the vast organisation that is NHS Scotland in the 21st century. Compared with many people in the private sector they are not well paid, but by and large they derive immense satisfaction from the work that they do, and they deserve our gratitude and our support.
When I think back over the near half century since I qualified in medicine, the achievements of the present-day NHS are incredible and are growing, due to the many advances in technology and medical research and the development of more and more sophisticated medicines and procedures. In 1965, hip replacements were a dream, transplants unheard of, and cancer unmentionable and virtually incurable.
The flip side of that is that more and more people are living much longer and with complex medical conditions, and of course the NHS is under pressure to provide the expected—and, sadly, often taken for granted—services. There has to be new thinking about how demand is to be met, and the silo mentality and professional empires that I grew up with have to change. That is not easy when none of us really likes to change our habits and get out of our comfort zone.
The pressures are evident in the difficulty in meeting waiting time targets, in increasing attendances at accident and emergency departments, in delayed discharges from hospitals, in maintaining the NHS estate and infrastructure and developing it for future needs, and in attracting sufficient members of staff at all levels to deal with patient demand. Those pressures are not just within the NHS in Scotland; they are present across all modern systems of healthcare. We have to learn how to cope with them.
The pinch points are well known and we all have to work together to address them. That is why I do not particularly like the inflammatory language in Labour’s motion about a “race to the bottom”, because the aim of people who are associated with the NHS is to maintain and improve quality and to do that, it is imperative that patient wellbeing is our focus and that we move forward with that in mind, using the increasing—but finite—resources that are at our disposal to try to achieve the laudable 2020 vision that is the Scottish Government’s target.
We are fortunate that the NHS budget has been protected in recent years, not least due to the Barnett consequentials from the UK Government’s health policy, which have given Scotland an extra £3 billion since 2010, with more to come every year following today’s autumn statement. However, there will always be a demand for more money, and how it is spent is clearly a matter of political choice. For example, Scottish Conservatives would pledge an extra 1,000 nurses and midwives, paid for by restoring the prescription charge—except for the young, pensioners, pregnant woman and people on low incomes, who would remain exempt, as they always have been.
I believe that new ways need to be found to make the best use of resource, rather than spending valuable time and money on a wholesale review of the NHS. To do that, our total focus must be on the best outcomes for patients who want where possible to live at home or in homely community settings. To that end, we must involve people early in their lives and instil in them the importance of taking responsibility for their own health by making appropriate lifestyle choices that help them to keep well and active for as long as possible, thereby reducing their demands on the NHS.
It is also vital that integration of health and social care moves forward apace, which will mean more emphasis being placed on primary care—
I am certainly very willing to offer Opposition members a briefing on our plans and on the progress that is being made on the integration of health and social care, as well as on winter pressures and delayed discharge, if Nanette Milne would find that helpful.
The cabinet secretary has just stolen a bit of my speech.
It is vital that integration move forward, in relation to not just doctors but to AHPs and nurses of all grades, local authorities and third sector organisations that provide much of the care within communities, so that patients can experience relatively seamless transitions between levels of care as they progress through life. To make that a reality, all interested parties will have to come together, forget their professional and cultural differences and work towards achieving a long-term effective plan to secure the future of Scotland’s NHS.
The previous health secretary was very keen to progress in that way and was particularly keen to involve politicians from all sides in moving forward—as evidenced, for example, by the Scottish Government’s welcome investment in 500 extra health visitors. That is a group of health professionals who are greatly valued by my party and we would seek to have even more of them. Therefore, I am pleased that the cabinet secretary has indicated that she will perhaps follow in the previous health secretary’s footsteps in that regard. If so, she can be assured of our support and involvement in pursuit of a sustainable and high-quality NHS for Scotland.
I move amendment S4M-11766.2, to leave out from “falling standards” to end and insert:
“; considers that, for the successful integration of health and social care, there needs to be a clear focus on primary care, including allied health professionals and the third sector, and on the interrelationships between the health and social care professionals; further notes Audit Scotland’s call for a major overhaul in the running of the NHS to cope with future needs, particularly those of an ageing population, and calls on the Scottish Government to work urgently and constructively with all parties to achieve a long-term effective plan to secure the future of Scotland’s NHS.”
We come to the open debate. We are very short of time, so speeches should be up to four minutes, although I am afraid that our last two speakers may not get four minutes.
16:44
The Labour motion identifies a number of pressures on Scotland’s NHS. However, the motion is one-sided and partial, and it gives an incomplete picture and impression of our national health service.
I appreciate that it is an Opposition’s job to oppose, but it remains my hope that on Scotland’s NHS, even despite the motion, we can still garner a good degree of consensus across political parties.
For every statistic that signals pressures on our NHS—there certainly are pressures—there is always another statistic that points to progress and improvement in patient care. That could be in waiting times: for example, by June 2014, 97.2 per cent of people were being treated within the 12-week waiting time guarantee. I remind members that in March 2007, the figure was 85 per cent for an 18-week wait. That is progress.
Progress and improvement could be in patient safety: there has been a 14.2 per cent improvement in the mortality rate. Surely that is progress. On hygiene for our elderly patients, the incidence of Clostridium difficile has fallen by nearly 82 per cent. Surely that is progress. On staffing, there is a record number of consultants in comparison with the number in 2007, representing a 36 per cent increase. Surely that is progress. There has been an increase in numbers of trained nurses and midwives. Surely that is progress. [Interruption.]
Order.
Admitting that progress exists does not mean that we deny that pressures remain. That is a key aspect of the tone of the debate: we can admit that there are pressures without denying that there has been progress. Labour’s motion signally fails to do that.
Let us look at what a root-and-branch review or a full-scale review could mean. Perhaps it could mean tackling unscheduled care, and people turning up at accident and emergency units. Yes—let us do that, and let us look at preventative action and patient flow through hospitals. Let us call it an unscheduled care action plan and put £50 million towards it. Hang on. We are already doing that.
Perhaps we should look at delayed discharge. Perhaps the Government should put in an additional £10 million, and perhaps we should work with our partners in the NHS and local authorities to provide a £20 million pot and create a delayed discharge action plan. Hang on. We are already doing that.
Perhaps we have to ensure that health and social care integration works better; indeed, perhaps we have to legislate to ensure that it happens because some local authorities were not doing it. Hang on. Once again, that is precisely what we have done.
I am trying to make the point that the NHS is an institution that is under constant review. I know that very well as deputy convener of the Health and Sport Committee, in which I work in partnership across parties to improve the NHS. One example is the £40 million new medicines fund, following our root-and-branch review of access to medicines. We did that by keeping the NHS under constant review.
Another example is the tackling of issues in regulation and care inspection of older people’s homes throughout Scotland, and making the system more robust. We already did that, through the Health and Sport Committee working in partnership with the Government.
A third example is working out whether the targets on which the NHS collects information are the appropriate ones in the appropriate place at the appropriate time. Anyone who is following the budget scrutiny in the Health and Sport Committee just now will have seen that we have already taken evidence on that.
There are undoubtedly pressures in the NHS, and I am delighted that the Scottish Government has agreed to a real-terms increase. I note that Neil Findlay would not guarantee such an increase. The NHS is under constant review; more important is that it is making constant and persistent progress and advances.
16:48
I welcome the cabinet secretary to her post, and to her first health debate. However, it is surely telling that she has in her two short weeks in post already made two statements to Parliament—both dealing with the crisis in the NHS.
The Labour motion mentions the sad state of the NHS in Scotland. The deterioration has not happened overnight: the Scottish Government has presided over it for a number of years. I wonder how bad things will get before the Government takes our advice and carries out a root and branch review of the NHS in Scotland. Is the Government’s reluctance due to its own mismanagement and the fear that a review will highlight its incompetence?
Will Rhoda Grant give way?
In response to questions on the cabinet secretary’s statement earlier today, she said that she wants to
“know where problems lie in our health service—warts and all—because only then can we take steps to address them.”
Perhaps the cabinet secretary wants to comment on that point.
That is why we have set up an independent inspectorate to do that.
Can Rhoda Grant tell us how long the review would take and whether all the things that we are doing on health and social care integration would be put on pause while the review happened? If the intention is not to stop the changes that we are making in the NHS, what is the purpose of the review and what will be its outcome?
The review would take as long as it needed to take to ensure that we have an NHS that is fit for the 21st century. Alongside the review, the Government would have to tackle the problems that occur weekly and which the cabinet secretary has to talk about in the chamber. We must not only address those problems but look at the NHS to ensure that it is fit for the 21st century. The only way of doing that is to have a review to identify the pressures and to plot the way forward. Otherwise, we will fail the patients who use the NHS and the staff who work in it. It is not good enough to depend on the good will of staff to keep the service from crumbling altogether.
In the short time that I have available, I will touch on one of the issues that impacts on the NHS: the inadequacy of healthcare in the community. The Scottish Government’s cuts to council budgets have led to choices being made between feeding old people and educating young people. That is the choice that councils face today. The Government promised to fund the council tax freeze, but it has not done so, which has left the most vulnerable people in our society paying the care tax and with little or nothing to live on. That scandalous care tax needs to end now.
Would Rhoda Grant like to tell us which budgets all that money should come from?
It is interesting that the Scottish Government is looking forward to receiving consequentials from the UK Government. Surely that could go towards ending the care tax and allowing people to live with dignity.
So, should the money not go to the NHS?
Order, Mr Doris.
I hear sedentary comments about the NHS. Surely the NHS operates in our communities as well as in hospitals. That is the nub of the issue—the Government believes that the NHS operates only in hospitals. We need to treat people in the community because, if we do not, people go into hospital. The Government policy is resulting in people going in for unscheduled care because of inadequate healthcare in the community. That leads to bed blocking. If people cannot get out into the community with adequate healthcare there, they remain in hospital, which is a dangerous place for older people. They get stuck—they become frailer and lose their strength and the ability to look after themselves, all because of inadequate care in the community.
You must come to a close, please.
We need to change the NHS, and the Government must take responsibility for that change. We need a Beveridge-style review. Sooner or later, the Government will be forced to do it. I just hope that the NHS does not go further back before that happens.
I am afraid that I do not have any time to add on for interventions, so members must take them in their own time.
16:53
It is interesting to hear Rhoda Grant calling for consequentials to go to local government when the Government has said that it will put them into health, and especially when some of her party’s members have called in The Press and Journal for consequentials to go directly to NHS Grampian.
Will Mark McDonald give way? He is misquoting me.
Labour members seem to have a very flexible attitude to the number of times we can spend the same pot of money. It is little wonder that they find themselves in opposition.
Will the member give way?
The member is not taking interventions.
It is also interesting to listen to Labour members when they are questioned about the review that the Labour Party wants to set up. The review appears to have no terms of reference, no defined timescale and no person identified to lead it. Labour members just want somebody else to do their work for them, because there is an utter policy vacuum in the health brief in the Labour Party, which has not come up with one single proactive or constructive policy initiative since Mr Findlay took on the health brief.
If that is the approach that we have to look forward to from a Neil Findlay leadership of the Labour Party, he has my full backing in the leadership contest and I look forward to him leading the party. After all, the candidate for deputy leader who is aligned to Neil Findlay has said today that any other outcome would lead to certain defeat for the Labour Party in 2016. I am sure that Mr Findlay would endorse Katy Clark’s view that Kezia Dugdale represents certain defeat for the Labour Party in 2016, given that he has aligned with Katy Clark in the campaign. [Interruption.] I hear Mr Findlay calling from a sedentary position. I know that he is an adherent of Marxist principles, but today he is a bit more Groucho than Karl. To be honest, most of us yearn for the day when he is a bit more like Harpo.
There has undoubtedly been progress in the NHS in Scotland. I offer this quotation as an example:
“we have come a long way. A decade ago, many of us who are sitting around the table were inundated with cases involving people who could not get an operation. They have disappeared in my case load ... so there have been tremendous gains.”—[Official Report, Health and Sport Committee, 4 November 2014; c 39.]
[Laughter.]
Labour members may laugh, but those words were spoken by Duncan McNeil—the convener of the Health and Sport Committee and a Labour MSP. He clearly recognises that there has been progress in the NHS. However, there are undoubtedly pressures; there have always been pressures, since the inception of the NHS. I think that Nanette Milne summed that up well by talking about the medical advances that have been made over time and which, although they have benefited the population, have increased pressures on the NHS.
That leads me to the demographic trends that we are now seeing. We need to get beyond talking about demographic trends as if they are a problem: people living longer is a good thing. What we have to do is ensure that people are living not only longer but healthier lives. That involves some of the early intervention work that this Government is focused on. The work around health and social care integration will assist greatly in that because, for too many people, there is a gap between those two silos, into which people all too often fall.
Delayed discharge is a key issue in that regard. When I was on Aberdeen City Council, delayed discharge was down to zero. However, at present, there is a real difficulty in the city in putting in place appropriate care packages for individuals. A large part of the reason for that problem is that the City of Aberdeen Council—which is Labour led, by the way—has decided to hive off social care to an arm’s-length company called Bon Accord Care, which has zero democratic oversight by local councillors.
Will the member give way?
I am in my last 40 seconds.
Bon Accord Care has zero democratic accountability, which is leading to a real difficulty for my constituents in Aberdeen, many of whom are stuck waiting for appropriate care packages so that they can go home.
Finally, I accept that there has been a long-term issue around GP surgeries. The GP surgery in Inverurie, where I was born, has never been expanded, despite the exponential growth in the population there since I was born. Too many practices have failed to benefit as a result of planning gain. That has been a failure on the parts of health boards and local authorities in the past. I have had conversations with the previous cabinet secretary for health and I would be delighted to have conversations with the new cabinet secretary about how we can use planning gain to alleviate some of the pressures on GP premises, many of which are approaching or are at capacity.
16:57
A health service under pressure, unable to recruit staff or meet targets, relying on the dedication of hard-working front-line staff to compensate for its lack of clinical assurance systems and to maintain the quality and safety of patient care—that is the picture of NHS Grampian that is portrayed in report after report published this week. It is a service that has been underfunded, against the Government’s own formula, to the tune of £158 million over five years and which has cut more than 400 nursing posts over three years just to balance the books.
Can the member say what the funding formula led to for NHS Grampian under the previous Labour Administration?
Certainly. The previous Administration put in place the national resource allocation committee, which commissioned a review of funding. The incoming SNP Government accepted the recommendations of that commission. However, the gap between what it provided and what the national resource allocation committee said that it should provide was £26.6 million in 2010, and is £29.7 million this year. It is little wonder that Ellen Hudson of the Royal College of Nursing said yesterday:
“the Scottish Government should have recognised the problems in NHS Grampian earlier and taken action to address them.”
That is not all. In addition to the challenges that are facing other health boards across Scotland, NHS Grampian has also had to deal with a small group of senior staff who have claimed to be whistleblowers while actively undermining the first principles of public service. Yesterday’s reports revealed that a small number of consultants had exhibited
“unprofessional, offensive and unacceptable behaviour”;
that they had contributed to an environment in which 40 per cent of hospital consultants have not agreed a job plan, in spite of a contractual obligation to do so; and that many staff believe that in Grampian there are “no consequences” for consultants who behave in inappropriate ways.
Niall Dickson, the chief executive of the General Medical Council, said yesterday that the body was
“extremely concerned that large numbers of consultants had no job plans”
and said that
“there was minimal evidence that clinical governance structures were working effectively.”
This is not just about the failure of NHS Grampian to get to grips with unacceptable behaviour by a handful of senior staff; the Scottish Government also has questions to answer about its role in permitting the situation to develop.
Healthcare Improvement Scotland reports:
“the minutes of the medical staff committee suggest that this group sees itself as an alternative management structure rather than as an advisory body.”
Managers told HIS that
“clinicians would tell managers what to do and threaten escalation to Scottish Government,”
and, incredibly, HIS reviewers reported that
“we heard remarks by some consultants that confirmed this.”
The arrogance of repeating such boasts in front of external reviewers answerable to ministers says it all.
Does Lewis Macdonald not accept that through HIS’s investigation all this has been exposed to the light of day and action has been taken? As soon as we became aware of those issues we took action.
I absolutely welcome that, and I welcomed it earlier this afternoon. However, we need to know why those consultants formed the view that they were “untouchable” and that they could go directly to Government if they did not get their own way. We need to know how often Government ministers entertained “escalation” outwith the proper channels, and we need to know which ministers were involved.
Above all, we need to know what ministers will now do to support NHS Grampian in addressing the issues raised by the reports, given
“the potential for patient care and safety to be further compromised”
that they show. The recommendations in these reports have been accepted; they now need to be implemented urgently.
The recommendations made by the Royal College of Surgeons have been published, but its conclusions have not. They should be published now, so that we know what it found.
The interim chief executive at NHS Grampian deserves our full support. That must include urgent additional resources to address the pressing problems of inadequate levels of nurse staffing and recruitment across the board.
Urgency, openness, resources and local confidence are all needed to allow NHS Grampian to move forward. That is the challenge for the Scottish Government.
17:01
I begin my remarks by reflecting on the work that the NHS does. Scotland’s NHS is a world leader in healthcare and a public service that is absolutely essential to the lives of everyone who lives in our country. No matter whether we are young or old, at some point in our lives we will call on the services of our NHS.
I note with interest that Neil Findlay calls for a
“full-scale review of the NHS ... to address the broad range of pressures being identified in all areas of the NHS.”
It may interest members to know that the document entitled “NHS Board Projected staff in Post changes for 2014/15”, produced by the Scottish Government, makes it clear:
“All NHS boards have been asked to develop Local Delivery Plans ... and workforce plans, as well as using workforce workload tools, in order to assess if service redesign or changes in skill mix are required to best meet the needs of their population.”
The people who know best are those at the heart of the issue: those who are involved in the delivery of our NHS at the local level. I believe that the roll-out of the local delivery plans and workforce plans is essential to identify the areas within a particular local service that need improved and those that are performing well.
Neil Findlay’s motion also asks the Government to
“address the broad range of pressures being identified in all areas of the NHS by staff and patients.”
I read with interest the latest report by NHS Scotland’s chief executive, and I noted that, as a component of its 2020 vision route map, NHS Scotland had developed its 2020 workforce vision, which concerns all NHS Scotland staff and has implications for staff across health and social care.
The document says that the vision was informed by 10,000 voices and was one of the largest qualitative exercises undertaken in NHS Scotland, in which it listened to the views of the staff and those working in healthcare. Therefore, I must say to the Labour Party that this Government has always had a commitment to engaging and discussing with and listening to staff, patients and others involved in healthcare.
I would like to look at the pressures that are raised in the motion. There can be no doubt that our national health service faces significant financial pressures. However, I am proud of the Government’s record of standing up and protecting our NHS. Our attitude towards the NHS is in stark contrast to that of those in government south of the border. To coin a phrase, a race to the bottom is taking place to privatise the NHS in England, but here in Scotland our Government’s commitment to protecting the NHS is clear.
In the draft budget 2015-16, the Government made it clear that, despite the UK Government having cut the Scottish Government’s resource budget in real terms, we have maintained our commitment that the NHS front-line resource budget will be protected and will increase at least in line with inflation.
Will the member take an intervention?
The member is in his final minute.
Our Government has a track record of protecting the NHS despite the cuts enforced by Westminster. The Labour Party would do well to remember that. Our Government is committed to engaging with and listening to all who are involved in healthcare in Scotland.
Our Government will always seek to improve, where possible. NHS Lanarkshire has improved rates for cancer patients, 95.7 per cent of whom start treatment within 62 days, which compares with 70.3 per cent in the first quarter of 2007. That is a massive improvement.
I thank all who are involved in our NHS for the outstanding work that they continue to do.
I call Jim Hume; I am afraid that I can give him only just over three minutes.
17:05
I am pleased that the Labour Party has used its time to discuss our NHS. At the outset, let me do as others have done and say that the people who make our NHS do extraordinary work. They save lives but they also improve lives. I have a veteran friend, Chris McDevitt, who will go into the care of the NHS in 14 hours, and I am sure that the staff will do their utmost to get him mobile again. Our thanks go out to the NHS.
We know that the quality of patient care is directly related to having the right people with the right skills in the right place at the right time. It is worrying therefore that the 2013 NHS Scotland staff survey showed that only 45 per cent of staff agreed that care of patients was the top priority of their health board. That is down 54 per cent from 2010. Only 32 per cent felt that they could meet all the conflicting demands on their time at work, and less than a quarter thought that there were enough staff for them to do their job properly. In the RCN members survey of 2013, 64 per cent of those who are working in NHS hospitals said that they were too busy to provide the level of care that they would like and 81 per cent recorded an increase in their workload in the previous year.
The Scottish Government’s 2020 vision simply will not be achieved unless we have meaningful change. As I said to the previous health secretary, the Government rattling off a list of where it has made investments misses the point. This is not just about one-off injections of cash; it is about ensuring that the skill mixes are right.
Will the member give way?
I am sorry, but I have only three minutes.
The cabinet secretary must recognise that the system is at breaking point. Yesterday figures showed that more NHS posts are lying vacant and for longer than was previously the case. Last week, figures revealed an alarming rise in the number of delayed discharges; fewer patients being treated within the targeted 18 weeks between referral and first treatment; 56,252 patients waiting for one of the eight key diagnostic tests—a 19 per cent increase on the 2013 figure—and waiting longer for them; and the fact that accident and emergency four-hour performance times had worsened, with 242 patients spending more than 12 hours in A and E.
A full-scale review is not the best course of action at the moment. We know what the problems are and we have a good sense of the pressures. We need solutions. With that in mind, perhaps the Labour Party could come up with some suggestions. Perhaps it has three solid policy ideas that would go some way towards alleviating the pressures on our NHS and transforming it into the service that we all want. A review will not achieve that change; it will put all on hold and slow down actions that desperately need to be addressed now.
17:08
The cabinet secretary could not have been clearer earlier this afternoon in her statement on NHS Grampian. The work done by Healthcare Improvement Scotland did not identify consistent or widespread concerns about patient safety. Aberdeen royal infirmary is not significantly different from the Scottish average.
In June 2014, NHS Grampian’s performance against the four-hour accident and emergency target was 96.1 per cent; across Scotland, the average is 93.5 per cent. We could compare that with the 91.3 per cent in April 2006 or with the figures from the Labour Administration in Wales, where the figure is 86.3 per cent. If Neil Findlay is concerned about recent statistics at accident and emergency departments, he will have to agree that Labour is not the answer to his concerns.
Where I agree with Mr Findlay is that NHS staff in Scotland are working tirelessly under pressure to deliver high-quality care to patients. Indeed, that is what the report on NHS Grampian found out.
We all know where the pressure is coming from: a lack of funding from Westminster, an ageing population and the increasing challenge of recruiting. I welcome the fact that, under this Government, the NHS budget is protected in Scotland, the health workforce is rising to a record high, and NHS consultant numbers are at a record level.
I agree with Bob Doris about the tone of the Labour motion. As far as patients’ confidence in NHS Scotland is concerned, I want to paint another picture of our public health service. “Patient opinion: every voice matters”, which is an independent online site that highlights patients’ experiences of the health service, allows patients, carers, family and friends of patients to tell their stories. Like, I am sure, other members, I also receive regular emails about what is happening in health services across the north-east.
One such story comes from an Aberdeen patient, who says:
“I was in a lot of pain ... and went to the Aberdeen Health Village where a lovely woman ... treated me. She broke the news”
about the condition
“very considerately and was a huge support, offering me lots of different treatments and advice. I was scared and upset but she made me feel so much better about the whole situation. Her kindness and sincerity is a credit to the health service offered in Aberdeen.”
There are a lot more such stories being told across the north-east.
We can all be rightly proud of the care that NHS Scotland staff deliver, day in, day out; indeed, that is why NHS staff have public support. The Government has public support because it has a vision for our nation’s public services: protecting funding for the NHS, preventing privatisation, and integrating health and social care services. There is no support in this chamber for Labour’s full-scale review, just as there is no support outside this chamber for the Labour Party itself.
We now move to closing speeches. I call Nanette Milne, who has four minutes.
17:11
It is fair to say that this has been an interesting and probably worthwhile debate, even though at times it has focused on the negative rather than the positive.
There are, of course, problems in the NHS—we need just to look at recent reports on the Vale of Leven and NHS Grampian to realise that—but there always have been such problems, and I am sure that there always will be. Nonetheless, the fact that in the 66 years of its existence our NHS has evolved and grown into the vast and complex organisation that we know today is testament to the many generations of staff and politicians who, like all of us in the chamber this afternoon, have been committed to it.
The current pressures on the NHS are proof of its success, which has resulted in our burgeoning elderly population living with multiple and complex long-term conditions and the health consequences of old age such as dementia and many of the cancers that are stretching its resources to the limit.
One of the last things that I heard Alex Neil say in this chamber in his role as health secretary was that the first person who will reach the age of 150 has already been born. That is quite a thought, and it is a clear indication that pressures on the NHS will continue well into the future.
We face huge problems with staffing levels, both in health and social care; with the management and maintenance of the NHS estate; and not least with dealing with the health inequalities that are still a blight on many lives in Scotland. The NHS and councils will also have to deal with many more people as life expectancy increases.
Neil Findlay was his usual fiery self, always pessimistic and always on the attack. I look forward to seeing his optimistic side, should he become leader of his party in Scotland later this month. The cabinet secretary gave a fair representation of her Government’s position, and I wish her well in her new and undoubtedly challenging role.
The member must know that socialists are optimists—the two things go hand in hand. I am always optimistic.
I have to say that I have never found that to be the case.
As I said in my opening speech, we on this side of the chamber are willing to work with the cabinet secretary and give her our support whenever we can, and I hope that she will accept our offer in the spirit in which it is intended.
The Scottish National Party speakers all made predictable speeches that supported Government policy and attacked their number 1 political enemy; likewise, Labour highlighted every problem that could be used to attack the SNP, although I note that Rhoda Grant emphasised significant issues about the provision of care in the community, which will no doubt be a key concern of the integration bodies at locality level. I think that it is wrong to use the NHS as a political football, and it does nothing to help the patients who depend on it.
As I have already acknowledged, there are major problems in NHS Scotland that we need to deal with, but I do not think that we should despair. We are a resilient nation; we have survived and defeated adversity over many centuries; and we have evolved into a country that we can all be proud of.
I am confident that, with appropriate leadership from Government of whatever political persuasion and by working together in the interests of patients, we can overcome our current problems and achieve a Scottish health service that will be sustainable far into the future and which will, no doubt, face and overcome even more challenges that are not yet on the horizon.
Please let us work together to improve the health and wellbeing of our fellow Scots and cut out the political point scoring that makes us so unpopular with the public whom we serve. They put us where we are, and they deserve our support. Let us try to live up to and beyond their expectations.
17:15
I have listened closely to the debate and will start by picking up a number of points that have been raised. Neil Findlay, Rhoda Grant and Lewis Macdonald would love to have us believe that the NHS is a failing basket case in Scotland. It is not. To say so is to do all NHS staff a disservice. People cannot praise the staff and then say that the NHS is failing—it cannot be both at the same time.
The resource budget is increasing in real terms, but where would the extra money that Rhoda Grant and others have asked for come from?
Will the minister take an intervention?
Just hold on a minute.
Rhoda Grant said that NHS consequentials would not go to the NHS. She also said that hospitals are dangerous places. However, healthcare-associated infection rates are down and cleanliness levels are up under the Government’s watch.
On a point of clarification, the minister has, like one of her colleagues, misrepresented my position. Healthcare happens in the community, and that is underfunded. The Government needs to fund that.
Our concerns are not made up by us. The staff who work in the NHS are telling us that the NHS has never been like it is now. That is why the RCN, alongside us, is calling for a root-and-branch review.
The Official Report will show what Rhoda Grant said about NHS consequentials.
I have asked again and again, but Rhoda Grant and other Labour members have still not said where the money would come from.
Neil Findlay mentioned delayed discharges. In October 2006, 908 patients were delayed for more than four weeks; in October 2014, the number of delayed patients was 321. That is around a third of what the figure was.
In 2011, the current First Minister said:
“I have made improved care for the elderly a personal priority. The NHS and local authorities need to work together to ensure that fewer and fewer older people are left languishing in hospital unnecessarily.”
At that point, 200,000 people were suffering from delayed discharge; now, the figure is 400,000. Is that a success for the First Minister?
Those figures are not the case, as the member well knows. [Interruption.]
Order, please.
The up-to-date figures on delayed discharges are as I said. [Interruption.]
Order, please.
We are integrating health and social care, and the budgets are moving with that. Just yesterday, I had a meeting on community planning partnerships dealing with just that sort of thing.
We are not denying that the NHS faces challenges, but the Government has a clear sense of vision and direction for our NHS and, through working with our NHS boards, we are putting in place a range of actions to support the delivery of our vision. That was highlighted by the constructive speeches that Nanette Milne and other members made. Members of the Health and Sport Committee know exactly the position on the front line and were constructive enough to point that out.
Scotland is leading the world through our Scottish patient safety programme and the person-centred collaborative, which are improving the quality of care that patients receive. We are also focusing our efforts on ensuring that the right people are available to deliver the right care in the right place at the right time. We need to make better use of workforce intelligence to support medical workforce planning within a more integrated healthcare system.
The partnership approach that we take with NHS employers and staff could be extended to Opposition members, if they would like. For example, our health and social care integration plans will help to address the challenges of delayed discharge. I hope that the Opposition will agree to address that matter in a cross-party way, as Nanette Milne indicated. We can take it forward at future cross-party meetings, as the cabinet secretary said.
I would be happy to take on ideas from Neil Findlay and others on how we could do things differently and how they could be done within the current financial settlement, but I have heard nothing about that today. There is no point in putting the NHS on pause while a review is carried out, but we are happy to meet Opposition members to talk about delayed discharge and winter resilience in the coming weeks.
We are supporting the delivery of high-quality care with significant financial investment. In addition to the investment in the resource budget, we are committed to investment in NHS capital and infrastructure that will provide the people of Scotland with world-leading hospitals, as in the new south Glasgow hospitals project, which will be completed in 2015. We will also deliver the Royal hospital for sick children in Edinburgh, a replacement for Dumfries and Galloway royal infirmary and a new maternity hospital and cancer centre in Aberdeen. We are developing much better and more robust intelligence on medical staff profiling and career choices to better inform supply and we are working with boards to boost the sustainability of the Scottish workforce.
The NHS faces challenges, but we are meeting and dealing with them on a daily basis. For all the reasons that I have given, I urge members to reject the Labour motion and support the amendment in Shona Robison’s name.
17:21
I am pleased to sum up. Regrettably, the Government has initiated only a tiny number of health debates since 2007. The short debate that we have had is wholly inadequate to explore the major issues that I think all members agree that health and social care faces.
The SNP came into government in 2007 on a false prospectus, because it encouraged the electorate to think at that time—
Is the member talking about 2011?
I am talking about 2007, when the SNP was first in government. The SNP manifesto committed the Government to not closing any acute beds, but the reality is that the Government has had to close a number of acute beds. It is also the reality that services need to be redesigned, but the SNP encouraged the electorate to think that the best way was to maintain every local service and keep every local hospital open. The SNP Government also rejected the Kerr report.
We are all signed up to the Scottish collaborative and co-operative model, which is based on managed care networks, and it is clear that it is delivering, but it requires further specialisation. The public sector model to which all five parties, including the Conservatives, are signed up is radically different from the path that the English NHS is following. As some SNP members have said, the most recent report shows that Scotland has narrowed the gap on waiting times. Long gone are the years before 1997 when patients could wait for years for hip operations and other procedures.
Labour will welcome and praise Government initiatives when they do the right thing, as in the case of the proposed major trauma units that have been announced. However, they come some years after such units were introduced in other jurisdictions and proven to be workable. That was also the case with the Healthcare Environment Inspectorate, which we welcomed, although it came in two years after England introduced a similar inspectorate.
I remind Richard Simpson that the announcement on the Healthcare Environment Inspectorate was made a year after we came into government. Does that not beg the question of what happened in the previous eight years?
In the previous eight years, we set up the HAI task force, which Shona Robison praised. The SNP Government developed that, but it still set up the new body two years later than England had set up a similar body.
That was also the case with the waiting times scandal, when the SNP took nine months to take over the matter and instigate a national inquiry, and it is currently the case on boarding out. After pressure from Labour, the Government rightly introduced a system whereby NHS boards are required to monitor boarding out. However, three years after that started, we are still unable to get information on boarding out from the boards, as we found from a recent freedom of information request that we made.
Bad boarding-out practices abound, as we have seen this week in the HIS report. Again under pressure, the Government finally agreed to set up with HIS an inspection regime for care of the elderly. Excellent. Well done. Fantastic. However, a recent FOI request by Scottish Labour showed that there is absolutely no cross-referencing between boarding out and cognitive impairment. The Government’s systems are dysfunctional.
The SNP constantly acknowledges—rightly—that there are pressures and challenges for the NHS. The NHS has always faced pressures and challenges, but never in my experience has there been a situation such as the one that Brian Keighley, chairman of the British Medical Association Scotland—to which I should declare that I belong—has called a slow car crash over the past five years. He went on to say that he felt that the situation was like rearranging the deckchairs on the Titanic. Now the Royal College of Nursing has added its weight to our call for a root-and-branch review, along with the campaign that is being run by The Herald.
Many groups—not just Labour—are saying that we need a vision of where we will be beyond 2020. We need to go on with the same work, to review what is happening now and to do service redesign, but we also need to come to an agreed decision about the position beyond 2020. We have agreed to the general principles, but we need a consensus on how we will shape health and social care and not simply to say that they will be integrated.
Will the member take an intervention?
I am sorry—I do not have time.
We have an independent inspection agency, but not one that can go in and do inspections by itself. The Government has to order it to go in, as in the case of NHS Grampian. That was right and I praise the Government for that but, nevertheless, the agency had to be authorised and told to do the inspection by the Government. HIS should be able to inspect every aspect of the health service independently and robustly and, as the Government has finally agreed for HEI, it should have enforcement powers. Such powers have been in place in England for seven years.
Will the member give way?
No, I do not have time—I am sorry.
Jim Hume made some valuable points. The Institute for Fiscal Studies has shown a cut in expenditure in Scotland against an increase in England between 2010 and 2013.
Will the member give way?
No, I am sorry—I do not have time.
Let us look at the pressures. Every board is failing on a legal guarantee that the Government chose to give. It is not just a guarantee that we would like to aspire to but which is not a legal guarantee and where, if we fail, that is a pity. This year, there are more than 10,000 Scots who have been given by the Government a legal 12-week in-patient and day-case guarantee who are not having that legal guarantee met. I am really surprised that someone has not asked for a judicial review or taken out a case against the Government.
There are also 125,000 Scots this year who will not have their 18-week referral-to-treatment guarantee met—it will be breached—and that does not include a further 100,000 about whom we have no information. The figure could be 250,000.
I know that, if he had had time, Jim Hume would have mentioned child and adolescent mental health services and the fact that 200 young people every month have not had the 26-week guarantee met. We also have an 18-week guarantee coming up that is going to have problems.
What about the cancer guarantees? Hundreds of patients are not getting their cancer guarantee met, and we are not at the 95 per cent target—[Interruption.]
Excuse me, Dr Simpson. There is far too much noise in the chamber.
Of course progress has been made. We would expect that. If it had not been made, we would have been criticising the Government far harder. Everybody would have been criticising it. However, the Government inherited double the money from Labour. We instituted the biggest increases in the health service budget that had ever been seen. The Government inherited that—it was lucky.
On the subject of money, we have learned today that Labour has refused to give a commitment to a real-terms increase and would refuse to pass on the consequentials to health. Will Richard Simpson confirm both those things?
Well, we will see, but the—[Interruption.]
Order.
We will see. The cabinet secretary has constantly repeated the lie that we would not have protected health. We would—it was in our manifesto. [Interruption.]
Order.
It was in our manifesto, Mr Swinney. In addition, we have talked repeatedly about the fact that, if the Government does not protect social care, the health service cannot cope. That is the situation.
In the final few seconds of my speech, let me look at the numbers. The Government plans to cut the number of junior doctors by 20 per cent and to cut senior training grade figures by 40 per cent. It has cut the nursing student intake by 20 per cent and the midwifery student intake by 40 per cent. That will have consequences in future years.
You need to wind up.
The Government failed to listen to what we were saying about junior doctor rotas until recently, when Alex Neil announced that he would stop junior doctors working 100 hours of night duty over seven days. However, junior doctors are still doing 65 hours over five days, and the response to our FOI request shows that not a single human resources department in the NHS is proactively asking junior doctors whether tiredness is affecting their work and their ability to journey home.
Dr Simpson, you need to wind up.
There are failings, which need to be addressed seriously. We need a root-and-branch review. We need an inspection system, with enforcement powers, which is truly independent and does not need the Government to authorise it to go in. We need change now.
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