Health Service
The next item of business is a debate on motion S4M-05088, in the name of Jackie Baillie, on Scotland’s health service.
15:49
I welcome the opportunity to debate Scotland’s health service. We are all—rightly—proud of the national health service and we are all grateful to the dedicated staff who work in it to make our experience of the NHS the best it can possibly be. However, let us be clear: they do not want just our thanks; they want and need our support and, above all, they want us to be honest about what is going on in hospitals and health centres across the country.
We in this chamber trade figures about staffing numbers and budgets. I know that there are 2,500 fewer nurses in the NHS, which has brought the nursing workforce to a level that is lower than it was when the Scottish National Party took power. I also know that the health budget has declined by £189 million in real terms and that the cost pressures on health boards are enormous. A cursory glance at any set of health board papers will tell anyone the truth of that. However, the SNP simply denies the truth. The level of complacency that it has displayed—and that its amendment shows that it continues to display—is frankly breathtaking. However, it will not be able to deny the reality as health service workers themselves report how they struggle to cope with increasing demands and even less resource.
Audit Scotland has put the NHS on an amber warning. Nine health boards had underlying deficits, and three health boards had to borrow money to break even. Health budgets have decreased in real terms from 2009-10 and are set to continue decreasing over the next three years. Savings have been deemed to be at significant risk of not being delivered, and there is a £1 billion backlog of repairs, more than half of which has a direct impact on patient care.
The SNP’s amendment might as well have come from a parallel universe. Is it really questioning what the Auditor General had to say? It was a damning report card by anybody’s definition, but what we got from the SNP at the time was a blizzard of statistics and assertion from the cabinet secretary about how everything is wonderful.
I have to say that I feel a degree of sympathy for Alex Neil. Most of the mess is not of his making. He has inherited this situation from the former Cabinet Secretary for Health, Wellbeing and Cities Strategy, Nicola Sturgeon, and he has been left holding her poisoned chalice.
Let us consider some of the challenges that Alex Neil has inherited, starting with waiting times. Others will talk more about NHS Lothian, but what is now becoming clear is that the manipulation of waiting time figures was going on well beyond NHS Lothian. It was going on in NHS Tayside and NHS Grampian, and allegations have been made about none other than NHS Greater Glasgow and Clyde.
Labour members said months ago that the practice was widespread. We even gave examples, but the former cabinet secretary was in denial and said that it was just a local problem. I even recall Mark McDonald—who is in the chamber—and Joe FitzPatrick accusing me of innuendo and of casting aspersions about NHS Tayside. That would, of course, be the same NHS Tayside that last week suspended two members of staff due to suspected manipulation of waiting times. I look forward to receiving Mark McDonald’s apology, but I will not hold my breath.
In NHS Grampian, patients get a letter saying that they should call to set up an appointment, but there are time restrictions on when they can call and the line is constantly engaged. Also in NHS Grampian, a pensioner who was approaching the 12-week time limit was offered, at short notice, treatment in Glasgow or Tayside, when there was no space available at either of those two locations. His wife kept on the case and, when she threatened publicity, she got a cancellation the next day. She tells me that she reported this matter to the former cabinet secretary’s constituency office and to her civil servants, but that she was, essentially, ignored. Did the former cabinet secretary know that the problem was widespread? Did she know about that experience in NHS Grampian? The real scandal will be if she knew and simply did nothing.
When we last debated waiting lists, we pointed out the warning signs to the then cabinet secretary. Social unavailability underwent a dramatic and unexplained rise from 4,967 in 2008 to 20,662 in June 2011, which is a fivefold increase in a few years, as people had their waiting time suspended so that the figures would look good. That was the SNP’s hidden waiting list.
In 2010, Audit Scotland produced a report that highlighted concerns about how waiting times were recorded. It said:
“The report also finds that the NHS is not accurately recording all relevant information on patient waits which makes it difficult to demonstrate that it is managing all patients correctly in line with the new guidance.”
The Government’s Information Services Division says:
“several health boards have been warned about the high levels of social unavailability”.
What did the cabinet secretary do to address those concerns? Did she even monitor what was going on? Did anything change as the result of Audit Scotland’s report in 2010 and its clear warning? I suspect not, which is why we are in the mess that we are in today.
Let us not forget that behind each and every one of those statistics of a waiting time breached is a patient—a patient with a need for treatment who might be suffering unnecessarily as health boards fiddle their figures to satisfy the SNP.
Waiting time targets are challenging—there is no doubt about that—but they are not delivered by creating a culture of fear and intimidation so that staff are forced into the position of hiding the truth. In one of the largest health boards in the country, staff are off work as long-term sick as a result of stress because of what they have been asked to do to manipulate waiting times.
A woman in my own constituency with suspected breast cancer was told that she would not be seen until the new year, breaching the waiting time target, because clinics were being cancelled for the whole of the holiday period. What happens when those targets on waiting times are missed? As we understand the system, the breach needs to be reported to the Scottish Government, but is there any monitoring of what then happens to patients who have breached the target? Are they left to languish, waiting for treatment, as the attention turns to those who are not yet in breach?
I will explain that point to the cabinet secretary. In Forth Valley, a patient waited 337 days over the 62-day target to be treated for upper gastrointestinal cancer. The overall wait was therefore more than a year. In Grampian, a patient with colorectal cancer waited 133 days over the 62-day target. In Lothian, a patient has been waiting for lung cancer treatment for 67 days over and above the 62-day target. It just seems that those who have breached the target are not treated quite so urgently. I hope that the cabinet secretary can reassure me that that is not the case and that he will investigate and monitor the situation.
Reports in The Herald identify hundreds of Scottish patients who wait too long for cancer treatment, with more than 1,000 breaches in the past two and a half years. To be clear, that was due to a shortage of staff and equipment, not because of the complexity of the cancer or the need for more diagnostic tests. The Government response is that that number of breaches is within the 5 per cent tolerance level. Can we really tolerate delays to cancer treatment of such extraordinary length when we know that early diagnosis and early treatment can save lives?
Only yesterday, damning evidence was given at the Health and Sport Committee by Scotland’s leading cancer specialists, who described the lack of access to up-to-date cancer treatment and training and the current difficulty in recruiting to specialist cancer centres. That is because Scotland’s NHS is now looked on as being “quite inferior”. The specialists’ frustration is over their inability to prescribe courses of treatment that they know will prolong life and that are routinely available in England. Their clear view that the individual patient treatment request is inadequate and simply leads to a postcode lottery must be acted on. I welcome the review that the cabinet secretary has announced, but we must ensure that any replacement system is fair and not dependent on where someone lives.
Members may also recall similar comments that one of our leading cardiologists made recently in respect of cardiac treatment about Scotland falling behind in the use of new technology and innovative treatments such as transcatheter aortic valve implantation.
I confess that I find the SNP amendment a little embarrassing. We only need to look at NHS Lothian to know that financial targets are indeed at risk. The most recent set of NHS Lothian board papers report a projected deficit of £12 million. Of course, the SNP amendment removes the line in our motion that calls on the Scottish Government
“to provide guarantees that waiting times manipulation has not spread beyond NHS Lothian”.
Now we know the truth—that manipulation has indeed been wider than NHS Lothian.
The NHS in Scotland is in danger of becoming second rate on the SNP’s watch. I implore it, genuinely, to stop and listen, to set aside the spin, and to pay heed to the chorus of voices, not from within this chamber but from health professionals and patients who are telling it that all is not well with our NHS. The more the SNP hides the truth, the more it buries its head in the sand, and the more it comes up with delusional amendments, then the more people will decide that they cannot trust the SNP with the NHS.
I move,
That the Parliament recognises that the NHS has been put on an amber warning by the Auditor General and calls on the Scottish Government to urgently act on the concerns raised; believes that reductions in staffing levels as well as financial pressures are having a negative impact on patient care and that further inaction is not an option; is concerned at reports that raise further questions about the integrity of waiting times data, and calls on the Scottish Government to provide guarantees that waiting times manipulation has not spread beyond NHS Lothian.
I call Alex Neil, who has seven minutes.
15:59
I welcome the opportunity yet again to put on record my gratitude for the dedication and commitment of NHS staff throughout Scotland and, indeed, my gratitude to the many people who work in general practitioner and dental surgeries and in many other parts of primary care who are not direct employees of the national health service.
In the three months or so that I have been the Cabinet Secretary for Health and Wellbeing, I have undertaken a series of visits, which have included three unannounced visits to front-line services so far. The dedication and professionalism of the people whom I have met is second to none.
The national health service in Scotland directly employs more than 150,000 people. It has a total budget of nearly £11.5 billion every year, and around 6.3 million consultations with hospital doctors take place every year in it. It is therefore inevitable that things will go wrong from time to time. However, let me make it absolutely clear, as I have done in the past, that if things go wrong we should find out about them and be told about them, and I will make it my job, with Michael Matheson, to sort them.
Will the minister take an intervention?
I do not have much time, so I do not have time for interruptions, unfortunately.
Let me make it absolutely clear that individual cases that need to be investigated will be investigated and that solutions or apologies, if they are appropriate, will be delivered. If there are systemic problems, we should tackle them. There has been a systemic problem with waiting lists in Lothian, which we are tackling. If there is a problem in any other board—there appears to be one in Tayside—we will deal with that, as well.
I want to deal with particular issues that Jackie Baillie’s motion raises.
First, on finances, it should be made absolutely clear that we have kept to our manifesto commitment to pass on the Barnett consequentials to the health budget in Scotland. That ensures that more than £1.1 billion of additional money will be invested over the United Kingdom comprehensive spending review period 2011-12 to 2014-15 to protect front-line services. If Labour had won the election, that figure would not have been £1.1 billion; it would have been zero, because, as Iain Gray made clear on 8 September 2010, Labour would not have ring fenced the health service budget.
The uplift for 2012-13 to the territorial boards, which provide the front-line services, was 2.9 per cent, which is above the rate of inflation of 2.7 per cent. Next year, we will provide an increase to the territorial boards of 13.3 per cent, which is above the rate of inflation of 2.5 per cent.
Will the minister take an intervention?
I do not have time, unfortunately.
I say to Jackie Baillie and other Labour members that, if we did not have to pay out £184 million for private finance initiative charges year on year, much of that money would be available for reinvestment in the national health service.
On a point of order, Presiding Officer. I wonder whether you can help. The minister says that he does not have time to take an intervention. He has seven minutes, which is more than any back bencher has in any debate, and back benchers are expected to take interventions.
Thank you, but that is not a point of order. It is for members to decide whether to take interventions.
I have so many errors to correct and so much to say that the truth is that seven minutes is not nearly enough time.
Let us deal with Audit Scotland. In the Auditor General’s report, she says:
“For the fourth year running, all NHS boards met the two financial targets of breaking even against their revenue and capital budgets at the end of the financial year ... The relatively small surpluses achieved by boards at the year end highlights the careful management of the financial position”.
Let us therefore get things in context: the reality is that, according to the Auditor General, financial management in the health boards has been sound.
Let me deal with waiting lists: 90.8 per cent of patients were seen and treated within 18 weeks from the initial referral during September 2012—the period of the latest statistics—against a target of 90 per cent. The target was therefore exceeded. We have 14 audits taking place in relation to the issue of the alleged fiddling of the figures. I made it clear yesterday in the chamber that every one of those reports will be published by the end of the financial year, and where there is fiddling we will deal with it by taking appropriate action. Where the Auditor General recommends any action in her report, we will act on that as well.
Will the cabinet secretary take an intervention?
I have only just over a minute left.
Unlike Labour, we do not have hidden waiting lists. We will not hide behind anyone. If there are problems to be solved, we will tackle them and solve them. The most recent statistics show that 97.1 per cent of patients waited less than the 12-week standard for a first out-patient consultation, which compares with waits of six months in March 2007. The statistics also show that 97.1 per cent of patients waited less than 12 weeks for in-patient and day-care treatment, which compares with the waits of eight months that we inherited five years ago.
On cancer drugs, I have initiated a review that is being undertaken by Professor Rutledge. I emphasised to him in a meeting this morning that I want him to look at the cancer drugs issue. When he reports early in 2013, I will take on board his observations and recommendations on that issue. Any issue like that will be dealt with.
Presiding Officer, my time is up, and I have so much more to say. However, no doubt I will get a second chance when I wind up for the Government in an hour’s time.
I move amendment S4M-05088.1, to leave out from “that the NHS” to end and insert:
“the remarkable work of NHS Scotland staff in caring for the nation; welcomes the recognition from Audit Scotland that the NHS’s finances have been carefully managed and that, for the fourth year running, all NHS boards have met their financial targets on revenue and capital; further welcomes that the Scottish Government has instructed the most comprehensive audit ever to be conducted into waiting times to ensure openness and transparency, and commends the decision of the Scottish Government to provide above real-terms resource funding to the territorial NHS boards to protect frontline services.”
I now call on Jackson Carlaw—five minutes, please.
16:07
Well, ever was it thus. This is depressingly like a debate that I am sure we had within the recent memory of us all. The Labour Party throws everything at the SNP and the SNP throws everything back at Labour—but, were they in reverse positions, they would do exactly the same. I know with every fibre of my being that, if I were sitting where Mr Neil is, both Labour and the SNP would do the same to me. That is because this is a perennial debate about the future of the NHS.
I support Jackie Baillie’s motion, which refers to “financial pressures”. That is not an accusation that the Government is cutting front-line health spending; it is an accusation that the choices that it is making are putting pressures on the NHS. Similarly, I have a certain sympathy with the cabinet secretary. In the previous parliamentary session, the Scottish Conservatives routinely supported the Administration in its decisions, and the way in which it progressed issues, on healthcare. However, we identified concerns that we thought were chickens that would come home to roost—and I believe they now have.
We believed that the preventative agenda was being undermined by the dissolution of the health visiting service and that financial pressures would be added to not by the principle of free prescriptions but by the progression of that policy at the moment when financial pressures were at their height.
In addition, we have pointed out that there is an ageing population crisis that has huge implications for the health service. Collectively, as a Parliament, we need to face up to and address that crisis, because it can only make the situation even more acute in every year that follows. It is no longer a problem for the next generation to deal with; it is a problem the initial stages of which are lapping at the shores of Scotland’s health service today.
It is therefore not a criticism of the NHS or the people within it to ask questions of the way in which the service is conducted today. Nicola Sturgeon and the Government were let down by NHS Lothian in the way that the figures were manipulated. However, the questions that Parliament asked at that point were on what assurances we had that that practice was not going on anywhere else and on what investigations were being undertaken in that regard.
I am not here to apologise for Jackie Baillie—she and I have had, well, almost fisticuffs on occasion—but here is what Joe FitzPatrick and the chairman of NHS Tayside had to say when she raised the issue of manipulation of waiting times in Tayside. The chairman said that he had written to Ms Baillie to insist that the health board’s waiting list data are accurate. Dundee City West MSP Joe FitzPatrick demanded an apology from Ms Baillie and claimed that she had “besmirched” the reputation of staff. He said:
“This is yet another blunder from Ms Baillie, who jumped to the wrong conclusions, hasn’t apologised and continues to leave her comments online.”
An apology is due, not from Ms Baillie but to Ms Baillie for the way in which her concerns were simply and easily dismissed.
The health secretary is not in office to get standing ovations from all concerned, as his predecessor sometimes seemed to enjoy. The health secretary is there to support the NHS and to hold the people who run it to account and ensure that they do their job on behalf of the people of Scotland. If we are to avoid a full-blown crisis, we must accept that there are huge pressures, from the ageing population, the incidence of norovirus that is overwhelming hospital wards, the reduction in the number of nurses, and the consequences of delayed discharge from wards. There is also the issue of the integrity of public confidence in waiting times.
The previous health secretary’s visits to hospitals became famous for the accompanying smell of fresh paint. Alex Neil is a practical man. He has talked about whistleblowing and he has introduced a hotline. He has talked about access to new medicines. He is visiting wards without management being present and listening to what people have to say. This is a moment when practical measures are required from him to address the issues that Scotland’s health service faces.
I will be interested to hear what emerges in the debate, and when I wind up I will say whether the amber warning that Audit Scotland placed in front of Scotland’s NHS is a warning that the Government recognises, acknowledges and is prepared to do something more practical to address than just blast it with rhetoric.
We move to the open debate, with speeches of four minutes. Time is tight this afternoon.
16:12
I offer my sincere thanks to all the NHS staff who were responsible for delivering what the NHS’s chief executive described in his recently published annual report as NHS Scotland’s “best ever performance” in key areas last year. The chief executive noted that waiting times are at their lowest ever level, patient care is safer, levels of premature mortality have reduced, and patients continue to rate the care that our NHS staff provide very positively.
We are not resting on our laurels but, despite what Labour would have us believe, the NHS delivery of patient care in Scotland is overwhelmingly a good-news story. The progress that the SNP Government has made since 2007 has been striking on all the key measures. Waiting times have been reduced through the delivery of the 18-week referral-to-treatment waiting time target. There are more qualified nurses and midwives than when the SNP came into office, and Scotland has more qualified nurses and midwives per 1,000 people than is the case anywhere else in these islands.
The Government has protected the front-line NHS budget, which will continue to rise in real terms despite the substantial cuts to the Scottish budget that have been imposed from Westminster, and it has realised more than £1 billion of efficiency savings between 2008-09 and 2011-12 to be reinvested to boost front-line care for patients.
The SNP Government has made a commitment to no compulsory redundancies in the Scottish NHS—there is no such commitment in England—while taking action to ensure that our hospitals and communities have the right number and mix of available nursing staff.
Despite the challenges that our NHS faces, that is a good record, which testifies to the Government’s commitment to ensure that our public has access to the best possible universal health service, which is free at the point of need. NHS staff have worked tirelessly to deliver those important outcomes.
The protection of Scotland’s national health service and its staff against the unprecedented cuts in public spending that the United Kingdom coalition Government has imposed is a central element of the social contract that the Government has made with the people of Scotland. It is worth stressing that only the SNP was prepared to commit to protecting NHS funding ahead of the most recent election. In government, the SNP has honoured that commitment, and the Auditor General for Scotland has been able to conclude that the overall financial performance of the NHS remains strong.
My concern is not about the commitment of NHS staff to delivering the best possible care for our citizens or about the Government’s commitment to protecting NHS funding. My concern is about the policies on the NHS that other parties in the chamber are advocating—and nowhere more so than in the case of universal benefits.
We on the SNP benches are committed to keeping prescriptions free and maintaining free eye tests. Both are central aspects of the care that we offer the citizens of Scotland, and both contribute to the social justice that lies at the core of our approach to government. More important, both promote the long-term health and welfare of our citizens and, in so doing, they reduce the future costs to our health service. That is what Campbell Christie asked us to do and that is what we are doing.
You have one minute left.
It has become clear in recent weeks that the SNP Government stands alone in giving those undertakings. We know that no area of universal entitlement to public health provision is safe from Labour’s cuts commission, and we know that Labour’s view is common to the Tories and the Liberals.
I conclude with a quote from a paper published yesterday by the Jimmy Reid Foundation, which was written by a team that includes two internationally respected experts in public policy, Professor Mike Danson and Paul Spicker. In the paper, the authors state that those who argue against universalism—one has to count the Scottish Labour Party among their number—are guilty of a serious lack of analysis of the consequences of their policies. On the system that is being championed by Labour and others, they conclude:
“A divisive, economically inefficient system which increases inequality, reduces the quality of social services, stigmatises and damages the wellbeing of the poor but benefits large corporations is being advocated without any coherent evidence-based case being made.”
You must conclude.
In conclusion, I support the amendment in Alex Neil’s name.
16:16
In the first eight years of this Parliament, Labour allocated huge increases to health, which enabled the system to recover from the previous round of Tory cuts and improved the patient experience, the quality and range of services and, crucially, the terms and conditions of NHS staff. Alex Neil has a cheek to criticise Labour, given that his predecessor refused to accept NHS Lothian’s plea for Edinburgh’s new sick kids hospital to be built through conventional spending. It will be years late and it will be funded under the non-profit-distributing model.
Last month, the cabinet secretary criticised NHS Lothian as being in the second division and Audit Scotland revealed that our NHS is on an amber warning. Today, the SNP’s amendment deletes that warning from the Labour motion. In fact, it deletes the problems that Jackie Baillie has correctly identified. The SNP cannot Tipp-Ex out those problems. Our challenge is to air them in the chamber and come up with solutions. Staff reductions have put massive pressure on the remaining staff and undermined the quality of care that patients receive. The fact that interns are now being used to supplement hard-pressed nurses is simply not acceptable.
The waiting times problem in Lothian has blown open the reality in our NHS today. The systematic fiddling of the figures that we have discussed before, the subversion of patients’ rights and the fact that the waiting lists were a complete fiction still need to be addressed. How on earth can the SNP Government assert that
“all NHS boards have met their financial targets on revenue and capital”?
What does that mean? It is completely fictitious. In NHS Lothian alone, the estimate earlier this year was that it would cost about £20 million just to address the backlog and deal with the hundreds of people who had not had their waiting times honoured. Last week, the board papers stated that the estimate of the amount needed is now more than £26 million. Those figures demonstrate that the capacity to meet the Government’s targets on waiting times is simply not there. To use the cabinet secretary’s phrase, there is a systemic problem.
I would be interested to hear the cabinet secretary’s comments about the level at which the NHS runs bed capacity in the light of this week’s report from the Dr Foster unit at Imperial College. It is stark:
“When bed occupancy tips the 85% mark the system goes into overdrive - and things start to give. For patients that means quality of care may suffer.”
How does that equate to what is happening in our hospitals in Scotland? It feels very much like what is happening in Lothian, where the problems have piled up one after another. Only last month, the board was forced to reopen the Royal Victoria hospital, which was mothballed earlier this year, to create the extra capacity to get us all through the winter. There simply are not the resources available to get older people out of our hospitals and into care that is appropriate for them when they need it. That is a current problem in the NHS.
The member is in her last minute.
The problem is not just bed capacity, but insufficient staff in key clinical areas. I could have spent my four minutes just reading out recent press headlines.
The symbolism in this chamber of the First Minister being dragged into the issue of the children’s ward at St John’s shows the mess that the SNP has created. The SNP’s promises on the NHS cannot be trusted. The previous health secretary, Nicola Sturgeon, was fully aware of the problems and it is Alex Neil’s job to sort them out. We are all waiting.
16:20
We talk a lot about choices during debates in this chamber. Recently, we have heard talk from Labour members—indeed, from the Labour leader—about the need to make tough choices, but when push comes to shove, all too often the Labour Party is found wanting. Labour members come to this chamber and criticise the choices that the Government makes, but they never offer any alternative choices that we could make instead. They never tell us how they would redirect funding to areas in the health service, or where funding would come from to pay for their priorities.
Will the member take an intervention on that point?
I will happily hear Sarah Boyack’s point in the winding-up speeches—I have only four minutes.
We need to know exactly what the Labour Party’s priorities are. I believe that generally there is a consensus about the approach to funding front-line health services through the targeting of the increases to the territorial health boards.
Will the member take an intervention on that point?
I ask Ms Baillie to leave it to the winding-up speeches; as I said, I have only four minutes.
We need an apology from you.
Order.
We need to hear the Labour Party’s priorities. The Government has set out its priorities as part of the budget process, and if the Labour Party disagrees with them, it is perfectly able to suggest alternatives. However, we never hear alternatives—all we hear are complaints.
The issue of universality, as raised by my colleague Aileen McLeod, is important, whether it is in relation to free prescriptions, free dental checks or free eye checks. Indeed, Optometry Scotland recently produced a briefing on free eye checks. I was glad to be invited to a dinner to discuss that matter further; Jackie Baillie and Duncan McNeil also attended. Optometry Scotland spoke about the savings that accrue as a result of free eye checks. It spoke about £60 million of direct savings and £440 million of indirect savings from free eye checks. Those universal services—perhaps they were what Jackson Carlaw alluded to when he spoke about
“chickens that would come home to roost”
are extremely important and a key part of the preventative spend agenda.—[Interruption.]
Order.
The Government is making efforts to more closely link health and social care. I welcome that because it will be of great benefit, particularly as we try to shift to healthcare and social care models in which people will be treated more in their own homes, rather than being admitted to hospital.
The one thing that gives me a little bit of concern, which I hope to discuss further with the cabinet secretary, is Aberdeen City Council’s recent move to make its social care department an arm’s-length trading company. NHS Grampian is concerned that that may create some difficulties regarding the health and social care agenda. I will happily speak to the cabinet secretary about that.
Finally, I will focus on NHS dentistry. When this Government came to power, thousands of people in Grampian were on waiting lists for NHS dentistry. Now, as noted in a parliamentary answer or perhaps in a letter to one of my colleagues, the Minister for Public Health has made it clear that by March 2013 virtually nobody will be on a waiting list in the NHS Grampian area. That is a strong testimony to this Government’s efforts to invest in NHS dentistry and dental clinics.
Did we hear anything from the Labour Party to welcome that? We heard not a peep. As we know, the Labour Party is only happy when it is unhappy.
Before I call Stuart McMillan, I ask for order in the chamber. I can hear conversations better than I can hear members.
16:24
We are fortunate to have a body such as the NHS. Every one of us in the chamber will have called on the NHS at some point and we know that without it Scotland would be a lot poorer. No matter how many times we thank NHS staff for their first-class work it will never be enough, but it is important that we thank them and remind them how important they are to Scottish society.
The debate so far has been typical—Jackson Carlaw’s earlier comments were quite apt. I agree that the NHS is not perfect. In fact—dare I say it—no organisation in the world is perfect, whether it is a public or private organisation. Improvements and efficiencies can always be made and support can always be improved. However, what we have heard today sounds like more of the scaremongering that has been going on for some time. Nobody should be complacent, because the NHS as a body can always be improved on, but to downplay its best-ever performance is beyond belief and is to talk down the management and staff of the NHS.
Jackie Baillie knows full well that I am prepared to campaign for services and to challenge NHS management proposals and decisions. In fact, in 2007 we were on the same side regarding maternity services. I am, therefore, disappointed that when credit is due—and in this instance it is due—she cannot give that credit but focuses merely on talking down what is clearly a positive story overall.
Will the member give way?
I am sorry, but I have got only four minutes. It was the Labour Party’s choice to have a debate in which members would get only four minutes.
With waiting times at their lowest-ever levels, care safer than it has ever been, premature mortality being further reduced and patients continuing to rate their care very positively, I wonder what it will take for the Labour Party to welcome good news. More than 90 per cent of patients were seen and treated within 18 weeks of their initial GP referral. The Patient Rights (Scotland) Act 2011 came into force in September this year, with the introduction of the treatment time guarantee, and I am confident that the NHS will continue to work hard to improve its deliverability even further to make the maximum waiting time 12 weeks from diagnosis to treatment.
A further example of what I consider a success story is the number of alcohol brief interventions delivered. In 2008-09, there were 30,310 such interventions and the number has increased steadily to a high of 97,830 in 2011-12. With alcohol misuse and its effects on individuals and wider society being debated regularly both inside and outside the chamber, that increase is proof of the determination of the Government and the NHS to work hard to help those affected. Alcohol misuse affects all levels of society, and I am sure that, across the chamber, we can all welcome the efforts that the NHS has made to help people to get their lives back.
I said earlier that improvements could be made, and the Audit Scotland report—which has been touched on and which the motion mentions—highlights a few issues. Even though the NHS in Scotland has had its best-ever performance, there can be no complacency. Knowing the cabinet secretary as we do, however, we can rest assured that there will be none. The cabinet secretary will continue the hard work and focus of his predecessor.
I am conscious of the time, Presiding Officer. I will support the amendment in the name of the cabinet secretary because I know that the NHS in Scotland is safe in the hands of the SNP Government.
16:28
It is our national health service—it does not belong to any political party—and that is what the debate, although limited in time, is about.
We recognise that, as the cabinet secretary stated, the NHS budget has been protected and health is certainly better off than some of the other portfolios, which have suffered greater cuts. However, as Jackson Carlaw pointed out, that is not the point. Significantly, the budget is not keeping pace with the increasing cost of health service inflation, which, as everyone knows, is a serious problem. It is difficult to keep pace because of the increased demand for staffing resulting in increased staffing costs and—as has been highlighted over the past few days—an increase in prescription costs. Those are all demands on our health service.
We are also well aware of the projected 67 per cent increase in the population with a disability over the next 20 years, of the fact that the number of over-85-year-olds will double over the same period and of the estimated 40 per cent increase in heart disease, stroke and dementia by 2025. It is in that context—not the context of one year to another, or of one Government to another—that we must ensure that our health service sustains and maintains its reputational value to us all.
Warning signs abound. There is a £1 billion maintenance backlog. I concede that perhaps half of that is more serious, but even half of that figure is an indication that we are unable, at this time, to maintain the fabric of hospital buildings.
There is an amber warning from Audit Scotland about financial planning. Boards are selling off the family silver to get from one year to another. We understand what will happen if that is allowed to continue. The Argyll and Clyde NHS Board is no longer here because it tried to sell off land to survive and pay its bills, which, of course, got larger and larger. Audit Scotland also points out the significant high risk relating to the efficiencies that need to be made in our health service. The risk of health boards not meeting the efficiency savings is another warning sign.
To return to Jackson Carlaw’s point, the warning signs have been well recognised and they are accepted across the board. They must be addressed. There are concerns that were not addressed as they should have been during the period of the previous cabinet secretary. We have not heeded Campbell Christie’s warning to radically change the health service strategy to one of prevention. We have not made a fast enough change in pace to integrate health and social care. We still do not have a clear understanding of how the budgets work between local government and the health boards, or of what they do and what they are expected to do. There are big gaps.
Plaudits are given to the health service staff—we have done that in all our speeches—but they are used as a shield so that no criticism can be made. Let us listen to them. The Royal College of Nursing said quite clearly that there is a difference between protecting the budget and protecting the quality of services; the British Medical Association says that we cannot go on as we are; the Scottish Council for Voluntary Organisations says that we cannot continue in the same way; Unison says that salami slicing of the budget cannot go on for ever; and RCN-BMA says that the lack of joined-up thinking in the workplace is not acceptable. Take those messages away today; listen and act, and save our national health service.
16:32
First, I refer members to my register of interests—I receive a small pension from the NHS.
I have previously stated that, prior to joining the Parliament, I worked part time for two years as a driver for the out-of-hours doctor service. I undertook five shifts each month and worked overtime, when required. During that time I saw with my own eyes the excellent NHS that Scotland has and the outstanding work that is done by all its staff. That is why I do not take kindly to the political football that the Labour Party has rolled out yet again.
To Jackson Carlaw, I say déjà vu; we last debated patient care on 19 September.
If Labour truly cared for the NHS, it would have used all its allocated time this afternoon to debate the issue, and not just fitted it in along with a debate on the police. It is Labour’s time in the chamber to allocate; it decides what it wants to discuss.
Will the member take an intervention?
No; I have only four minutes.
I agree with the Cabinet Secretary for Health and Wellbeing: the debate should have had more time allocated to it.
The NHS should remain a universal health service that is free at the point of need and true to its founding principles. It should remain a publicly funded and delivered service. We should continue to protect front-line services and ensure that NHS staff have stability and security in their employment. Only by bringing powers home to Scotland can we protect our NHS from Westminster cuts and build a better nation.
Contrary to Labour’s suggestion, staffing levels are higher than they were prior to the Scottish National Party taking office. She constantly wheels it out—[Interruption.] I apologise, Presiding Officer. I was talking about Jackie Baillie. Members of the Tory party kept saying “he” when they were talking about the First Minister last week, but I apologise to Jackie Baillie.
The Labour Party knows that there have been dramatic changes in nursing practices over the past 10 years. One fundamental change, for example, has been care in the community. Social work and NHS staff now visit clients in their own homes—and not for the 15 minutes that Jackie Baillie has suggested. Labour needs to substantiate that assertion because, by continually repeating it, it is giving the impression that that is common practice. That only undermines the hard work and dedication of care workers in Scotland. [Interruption.] Labour members do not like it when they get told the truth. Although it received fewer responses from Scottish providers than from other parts of the UK, the United Kingdom Homecare Association found in a survey that 58 per cent of visits in Scotland lasted for more than half an hour. [Interruption.]
Order, please.
This Government has defended the NHS in Scotland against cuts that have been implemented by the Tory and Liberal Government and which were caused by the Labour Party. [Interruption.]
Mr Smith!
I remember the letter that was left by the Labour minister, saying that there was no money left.
As I have said, the Labour Party needs to stop using our health service as a political football and to stop talking it down. It is time to talk it up and appreciate our staff. We have a health service to be proud of—and we should admit that. The previous health secretary should be complimented on how she looked after the NHS in her term, and I am sure that the new cabinet secretary will also look after the Scottish health service. I support the Government in what it is doing to safeguard our NHS.
I am lucky—I visit my doctor only once every 10 years and when I do he says, “Who are ye?” Other countries charge for a visit to the doctor—we do not. [Interruption.]
Order.
The Scottish NHS deserves our thanks, not a continual kicking.
We turn to the winding-up speeches. I call Jackson Carlaw. Mr Carlaw, you have four minutes.
16:36
Honestly, I just want to stand here and scream. Had I still been in business and been present at a management meeting that had received the level of contribution and response to an emerging crisis that we have heard this afternoon, I am afraid that the management team would have had to go and be replaced.
Let me start, then, by saying that I welcome all the good things that are happening in the NHS. It is wonderful news. I will pat any SNP minister on the back if they are responsible. It is wonderful what is happening in dentistry and great that there is a focus on alcohol, but none of that is a substitute for a responsible and reasonable debate on the emerging difficulties in the NHS. The repeated refrain from SNP members this afternoon was, “I’ve only got four minutes.” Frankly, anything they said could have usefully been said in two and we might then have had room for an examination of the questions that they refused to answer.
As I said earlier to Alex Neil, his predecessor’s style was to be the spider at the centre of the web, weaving, carefully controlling the figures, crisis managing—and maybe stinging with venom anyone who said anything negative about the conduct of the health service. A smell of fresh paint accompanied her on every hospital visit, and there was a sense that it was all as much about projecting the Deputy First Minister as an entity as it was about addressing the health service and its problems.
However, that is not Mr Neil’s style. He is the bull in the china shop—which is perhaps what the health service needs. I actually think that in the cabinet secretary we have a man who can make the most of the opportunities that are presented, which is why I welcome some of the initiatives that have been taken. Those practical steps are directly contradictory to his predecessor’s positions, on which she insisted vehemently until the day she demitted office.
I would therefore like the cabinet secretary to go back and look again at health visiting. In its very well-balanced and sensible proposal on the proposed children and young people bill, the RCN makes clear its belief that health visiting is central to the preventative agenda that in turn will help to reduce many of the obstacles to providing an effective health service in the future.
I would also like the cabinet secretary to dust down the report on Stracathro hospital that his predecessor consigned to the bin and which showed that the independent sector, acting exclusively for the NHS, produced a service that significantly reduced NHS waiting times at a saving of £2 million. That £2 million would, if it was extrapolated and used anywhere else, alleviate the financial pressures that the cabinet secretary is facing. I ask him to consider the prospect of walk-in centres that might relieve the pressure on GPs.
The member is in his last minute.
Was it four minutes or three?
Four minutes.
Right—sorry.
I ask the cabinet secretary to look at the responsibility agenda that we have talked about, and the need to get the public to recognise that, if we are to have a future health service that is free at the point of delivery when it is most needed, they must use the NHS responsibly.
Above all, I welcome what the cabinet secretary said about access to new medicines. However, 21,000 people have benefited from the cancer drugs fund in England, while 2,100 Scots have not. It is too little, too late to stand and preach and pray. We need practical actions from a practical man to address the problems that the health service faces today. We must, as members in the chamber, together accept that, while there is a football that will be kicked, there is an emerging problem facing Scotland’s health service that will be properly addressed only if it is addressed—beyond this debate and all the rhetoric—together.
16:41
First, I say to Jackson Carlaw that I am happy to look at the issues around health visiting and initiatives such as the family nurse partnerships. The relationship between such a service and the health visitor service is very important.
I also say to Jackson Carlaw that, inspired by a point that he made in the previous debate, I paid a back-to-the-floor visit to the Victoria hospital the other night and spoke to staff, none of whom—which was a deliberate choice on my part—was of a higher grade than staff nurse. I spoke to auxiliaries from the accident and emergency department, and to people from the medical and surgery departments. In all the visits that I have made, there is one thing on which I am clear; we must empower the people on the front line much more to take key decisions, because that is one of the ways in which we can improve the quality of the health service.
My other two visits were to the accident and emergency units at Edinburgh royal infirmary and Glasgow royal infirmary. I recommend that members make such visits, because I learned more by spending one and a half hours talking to front-line staff than six months of reading written briefings or Jackie Baillie’s speeches could ever tell me.
Duncan McNeil is right: there are three big challenges facing the national health service in the future. The first is our ageing population, which has an associated challenge in the form of multiple morbidities for older people. Secondly, there are two financial challenges: the cuts that have emanated, particularly in the capital budget, and the fact that inflation in the health service is twice the level of inflation generally. The third big challenge—which is by no means the least—relates to the inequalities in healthcare, and the consequences of inequality and poverty generally and their impacts and demands on the NHS.
I say to Jackson Carlaw in particular that the impact of the benefits reforms that are being implemented from London will, unfortunately, add to the pressure that arises from increased poverty and deprivation. I hope that he will think again about some of the proposals.
I will address some points that were raised in the debate. Sarah Boyack made a fair point about the 85 per cent occupancy rate, but the report by the Dr Foster unit to which she referred dealt with the health service in England. Just for the record, I tell members that the bed occupancy rate for Scotland in 2006-07 was 82.3 per cent, which is well below the 85 per cent trigger point. In 2011-12, the latest year for which figures are available, the bed occupancy rate was 82.2 per cent, which is very similar and within the safety level of the 85 per cent rate that the report recommended. I accept the 85 per cent figure as an indication of the right level of utilisation of bed capacity to maintain patient safety and I repeat—for the record—that we are well within that.
Like Alex Neil, I made a visit to an accident and emergency department this year, but mine was as a result of an accident rather than an official visit. A key point that was made to me was that there is a major problem with access to beds for people who come in through accident and emergency, which I think is at the root of the Royal Victoria issue. It would be good if the cabinet secretary could keep his eye on that, because the lack of alternative places to which people can go is partly what is creating major pressures on the Edinburgh royal infirmary.
The real root of the problem in the Edinburgh royal infirmary is that the plans for the hospital grossly underestimated by 20 per cent the number of beds that would be required. I am not making a party-political point, but this Administration was not responsible for that. The reason why we have to use the Royal Victoria in Edinburgh is because the Edinburgh royal infirmary should have been bigger by at least 20 per cent.
On the financial reports from the health boards, I can advise Sarah Boyack that NHS Lothian has confirmed that it forecasts that it will break even this year. Indeed, all boards are indicating that they are on track to deliver their financial targets in 2012-13.
For the record, I can also confirm that the increase to the territorial boards will be 2.9 per cent, 3.3 per cent and 3.1 per cent respectively for the three financial years from 2012 to 2015.
You are in your last minute.
We need to get the context of the debate correct. The vast bulk of things that are happening in the national health service, such as the patient safety programme, the quality programme and the family nurse partnership programme—to pick just three examples—are internationally leading edge and are recognised as such. Indeed, a recent international survey of patient safety by America’s Commonwealth Fund showed that 3 per cent of patients in Scotland felt unsafe in hospital, compared to 9 per cent in the rest of the UK. By any comparison, there is a great deal going right in our national health service.
As Jackson Carlaw and others have said, of course we must recognise that, in such a big organisation, there are things that we will have got wrong. Where we have got it wrong, we will sort it. Where there are individual cases, such as those to which Jackie Baillie referred in her speech, if members write to me about them, I will investigate them and come back with answers.
Cabinet secretary, you must conclude.
Basically, the national health service is something that we should be proud of. That is not about complacency but about ensuring that we do not throw the baby out with the bathwater.
16:47
The debate has taken a different tone in the last 10 minutes. The cabinet secretary has dealt with the debate in a much more measured tone than his stereotypical back benchers, who simply came out, parrot fashion, with a series of statements, half of which were actually rubbish.
One thing that all speakers in the debate agree on is that we continue to owe a huge debt of gratitude to the staff of the NHS. As Christmas is approaching—unless the Government breaks its habit and finally schedules a parliamentary debate on health—this will be the last debate on health this year, so it is worth saying that we owe the NHS’s staff a huge debt. Without their efforts, we would be in even more trouble.
“The NHS is continuing to perform well but there are treacherous waters ahead. There are huge risks, particularly in ensuring that quality of care does not suffer with the further financial squeeze.”
Those are not my words, but the words of Anna Dixon from the King’s Fund. The NHS is on “an amber warning”. Those are not my words, but the words of the Auditor General for Scotland, who reported that nine boards have an underlying deficit and that there is a £1 billion backlog in repairs.
The previous cabinet secretary—despite Jackson Carlaw’s caricature of her—did some things right, but she also chose repeatedly to ignore the warnings that we gave her. She dismissed them, as did one SNP member today, as “scaremongering”. That is what we are always accused of. She continued to deliver Scotland’s patient safety programme, which is a world-leading programme that was started by Labour and has been continued by the SNP. The programme has delivered significant reductions in adverse effects and, as the current cabinet secretary has just said, a feeling of patient safety that is greater than in most health services.
However, the previous cabinet secretary failed to change the culture of blaming and bullying, as is shown by the NHS National Services Scotland reports, which suggest that 60 per cent of staff have been bullied. She failed to introduce the whistleblower’s line that I campaigned for for almost two years. I compliment the current cabinet secretary for finally introducing that. It is very welcome.
In 2001 there were 3,000 delayed discharges, so we started a programme that aimed to reach zero by 2008, which was achieved. That was brilliant; the health service under SNP and Labour achieved the target. However, the SNP Government then promised that it would keep the figure at zero but, in 14 of the 17 quarters since then, the promise has been broken and the number has been higher than that. The most recent survey found 91 patients whose discharge has been delayed for more than six weeks and almost 1,000 beds still occupied by patients who had been deemed fit for discharge. There are 600 delayed discharges and 283 people with complex needs, so more than 800 beds are occupied by people who, medically, do not need to be there.
I have been attacked repeatedly on the issue of beds. However, it is a fact that the SNP promised in its 2007 manifesto not to reduce the number of beds, but the number was then reduced by 1,800. I have said that that is not necessarily a bad thing if we have good redesign, but the SNP made false promises on that.
No one has mentioned dementia, on which we face a huge challenge. The previous cabinet secretary—under pressure—finally introduced Healthcare Improvement Scotland inspections. Finally, after months of my asking, I am glad that, under the current cabinet secretary, HIS has produced a thematic report on the inspections. Again, I commend the cabinet secretary for that. However, the thematic report says that cognitive assessments are patchy and there are concerns about nutrition.
Boarding out, which the previous cabinet secretary introduced and which was also welcome, was never followed up on because we do not get reports on what happens. However, after a freedom of information request, we have found that some patients are moved up to 18 times. The royal colleges have reported that there are currently 1,600 patients whom they regard as being likely to be receiving sub-optimal care—not medical treatment—because of the pressures that the system is under.
The previous cabinet secretary left behind a slow erosion of care, an increasing level of frustration and growing anger that is getting greater by the day. Certainly, my postbag is full of those issues.
Despite the absolutely ridiculous debate about the workforce in 2007 and who had more and who had less, it is a fact that 2,300 nursing posts have been got rid of. Is anyone really saying that that can be done without putting pressure on those who remain? We have vacancies for doctors in Lanarkshire. In July, the cabinet secretary said that the issues with paediatric services in Lothian are nothing to do with money and resources—another denial—yet within the last two weeks we have learned that they are in crisis.
There has been an 8 per cent cut in the intake of Scottish medical students, but an increase in English students. Three midwifery schools were closed peremptorily by the previous cabinet secretary, with no discussion—oh, no—with the schools or with the UK, where there is an overall shortage of midwives. There has been a 20 per cent cut in the nursing student intake. No risk assessment has been carried out on the effect on the university departments involved.
In the previous session of Parliament, we raised the issue of access to medicines, and the previous cabinet secretary responded. Great. Welcome. Commendable. A new system of individual patient treatment requests was introduced. However, within months, we realised that the system was not working. Doctors told us repeatedly that it was not even worth applying, because it just does not work. This week, oncologists complained bitterly that oncology in Scotland is a second-rate service and cannot attract staff. I commend the cabinet secretary for setting up the Routledge-Scott review, which is excellent and a good response.
Several members have mentioned waiting times. When I raised the issue of waiting times in NHS Lothian, I did not know that an internal NHS Lothian report had already been produced, after a request by Naomi Hamilton. That report, which was produced well before I raised the issue, had never seen the light of day. Has the Lothian issue been put to bed? I could offer many case studies, but I will use just one.
A patient, who at the time was the sole carer for her 92-year-old mother who has a complex care package and who needs someone with her all the time, asked at her first out-patient appointment for her procedure to be delayed until mid-December, after which her brother was to return from France to help with their mother’s care. What happened? She got two phone calls from a private hospital in Glasgow offering her two appointments for 8 am, when she could not possibly attend and which totally contravened her stated wishes at her first appointment. Then she was told, “Sorry—you’ve had your two appointments, so you’re off the list. Go back to your GP to be referred again.” Her GP is livid, and she has cited to me four other cases in Lothian NHS in which the same thing has occurred.
There are waiting time problems in Grampian, and Glasgow has problems with blankets. I have an email in front of me telling me that patients are being advised to take their blankets with them to their scans and X-rays because otherwise they might not be there when they get back.
We are not saying that the health service is bad and that the cabinet secretary is not doing his best. We are saying that, unless we all face up to the fact that we face an implosion in the health service within the next two years, we will not get through the current austerity. It is time for the cabinet secretary, as the new man, to adopt reality.