National Health Service Reform (Scotland) Bill: Stage 3
We now move on to the stage 3 proceedings for the National Health Service Reform (Scotland) Bill. As members know, they should have the bill as amended at stage 2—that is, SP Bill 6A; the marshalled list, which contains all amendments that have been selected for debate; and the groupings.
I will allow a voting period of two minutes for the first division this morning. Thereafter, I will allow a voting period of one minute for the first division after a debate on a group. The voting period for all other divisions will be 30 seconds.
Section 2—Community health partnerships
Amendment 1, in the name of Malcolm Chisholm, is grouped with amendment 6.
Amendment 1 is a minor technical amendment, or perhaps I should say a very minor technical amendment, as the words that it deletes are reinserted, albeit in a different place.
The error that amendment 1 corrects occurred in the printing of the marshalled list of amendments at stage 2. The amendment affects subsection (2)(a) of proposed new section 4A of the National Health Service (Scotland) Act 1978. That paragraph provides for the general community health partnership function of co-ordinating the planning, development and provision of certain services. In turn, the relevant services are set out in subparagraphs. The effect of the error is that the words
"with a view to improving those services"
are currently attached to subsection (2)(a)(ii), although the intention is that they should apply to all the functions that subsection (2)(a) covers. Amendment 1 ensures that the bill reflects the original policy intention.
I can appreciate what Duncan McNeil is trying to do with amendment 6, and I pay tribute to all the work that he has done on patient information. It is clearly very important that patients and the public should know about the services that they can expect the national health service to deliver and the targets that we have set for the provision of those services. We are committed to ensuring that that information is made available at national and local levels so that patients are comprehensively informed.
We consulted last year on the document "Patient Rights and Responsibilities: A draft for consultation", which sets out what patients can expect from the NHS, and we are currently working with the Scottish Consumer Council to finalise the document. It will be produced as a national document that states what the NHS is committed to deliver to the people of Scotland. We will require each health board to publish a local version of the document, which will show how those rights and responsibilities will be delivered locally. We are already working on, and are committed to, ensuring that patients have information on the services that they can expect to receive. When that local information is issued, we will ensure that it gives the full information that is necessary to inform the public of their rights as well as specific local services and provision that are available. We will also ensure that NHS boards disseminate that information widely in different forms so that it is available to the largest possible number of people locally.
Amendment 6 is not the best way to achieve what we are determined to do, and there are a number of reasons for that. For example, it covers all health services, whereas CHPs' remit will not extend to all health services. If any such duty were to be placed on a body, it would need to be placed on NHS boards, and, as I have already stated, we shall require boards to provide information.
We are committed to reducing waiting times in general and specific waiting times in some key areas of treatment, such as heart surgery. We fully agree that the public need to know which services are subject to waiting times guarantees and how they can ensure that their health board can fulfil those guarantees. The purpose of having a guarantee is to impose a requirement on NHS boards to ensure that the guarantee is fulfilled. If a board cannot itself offer treatment to fulfil a guarantee, it is required to arrange and fund treatment through another health board or through an alternative public or private provider in the United Kingdom or elsewhere. That reflects our absolute commitment to ensuring that guarantees are fulfilled.
If patients have any difficulty in obtaining access to treatment that should be available under a waiting times guarantee, that will be followed up in the first instance with their local health boards and then with the national waiting times unit in the Health Department, which is working with the NHS in Scotland to reduce delays for patients through more efficient use of capacity within and outwith the NHS and to help to ensure that waiting times guarantee commitments are fulfilled. The national waiting times unit will then ensure that a provider that is able to offer treatment is identified and that the necessary arrangements for treatment are completed through the local health board.
I am happy to provide the assurance that the commitments to waiting times guarantees will be set out in the patient information documents that we will issue nationally and locally and that that will include information on what patients should do if they feel that they are not receiving treatment within the guaranteed waiting times. Duncan McNeil might say that that has not happened yet, but I remind members that the guarantees started only this January, and I give another guarantee that the information that I have described will be disseminated nationally and locally in the near future. That is the most effective way to ensure that patients know which treatments are subject to targets and the rights that they have to ensure that those targets are hit.
I move amendment 1.
I will make some brief statements of fact. The more socially disadvantaged and less well-educated members of our communities have the poorest health and shortest life expectancy. Our constituents, especially the more socially disadvantaged and less well educated, are not conversant with their rights to NHS treatment. It is not possible for somebody to exercise a right if they do not know that it exists, and a right that cannot be exercised is no right at all.
Amendment 6 seeks to put right that situation by placing a statutory duty on community health partnerships to take active steps to make the public aware of what they are entitled to, the timescale within which that should be provided and which alternative sources of treatment they can access in the event that the service cannot be delivered within the timescales. The amendment would also place a duty on CHPs to ensure that access to that information is as wide as possible. It would require that the information be made available in a range of formats—for example, Braille and languages other than English.
With amendment 6, I am determined to improve the health record of our most deprived communities and to close the opportunity gap, and so I am sure that I can count on Executive support for such a modest move.
I accept the minister's explanation of amendment 1 and I have great sympathy with what Duncan McNeil is trying to do with amendment 6. It is important that we stress at the beginning of the debate that the patient should be at the centre of the health service, not added on to it. We should do anything that we can to provide patients with the right information. We hear a lot of groups talking about patient empowerment, and I have great sympathy with what Duncan McNeil has said, so I do not understand why the minister wants to produce expensive, glossy documents for national distribution given that when people have difficulties, they seek local health care in their communities. I beg the minister to change his mind about Duncan McNeil's amendment 6, which I will certainly support.
I am generally sympathetic to Duncan McNeil's amendment 6, because it is essential that patients should know what they are entitled to. I welcome the minister's comments, which are a step forward from the position at stage 2, but I would like more information from him about what he proposes and how he will ensure that that will reach the targets—the kind of people about whom Duncan McNeil is talking—and will not be just another glossy pamphlet that reaches only those who already know their entitlement, stand up for their rights and ensure that they get their treatment within the waiting times guarantees. How will he ensure that the people whom we are trying to target—those who have the worst health records and who might not read a glossy pamphlet—know what they are entitled to, what they should do to obtain that entitlement and the steps that they can take if a health board stands in the way of their accessing the health care that we in the Labour Party were committed to in our manifesto and are beginning to deliver?
I support Duncan McNeil's amendment 6. General practitioners are used to giving patients information and to making patient leaflets that are updated with changes and contain maps. GPs' staff also help them to convey information.
Glossy leaflets are not enough. They are often found lying around health centres, where people may walk on them. They are just waste paper to gather at the edges of fences.
The Health Department frequently employs much cash to convey information to the public. Sometimes, £85,000 is not considered too much to spend on one publication.
Providing information is health boards' responsibility, as they are supposed to interact with the public and communicate information. If they are to place more responsibility on general practitioners, they must think about the money and time that will be spent on producing materials, such as posters and leaflets, in addition to postage and staff costs.
Given the new regulations that will mean that not all practices have to provide the same service, it is essential that patients have knowledge. A patient's own general practice is a good place of contact. Greater use of health visitors would also enable information to circulate in the community.
Duncan McNeil's objective is good and perfectly achievable. The only question is whether it should appear in the bill. We are establishing community health partnerships by giving them aims and objectives and specifying the practices that they must undertake. Duncan McNeil is arguing for good practice—it is good practice that patients should receive such information. However, I am not convinced that it is necessary to put that in legislation and I urge him not to move amendment 6, because it would not be helpful to make such provision when we have not yet established the CHPs.
I support Duncan McNeil's amendment 6, which is reasonable. I remind members that it says that "all reasonable steps" should be taken
"to provide information, in such formats as may be reasonably requested … about … the health services to which"
people
"are entitled … the timescales within which such services will be provided, and … any alternative sources of treatment which they are entitled to access in the event that such a service cannot be delivered within such a timescale".
I do not understand why the minister is reluctant to accept the amendment. People should be fully informed and should receive information in a format that they understand. That is not too much to ask from our health service.
In answer to Mike Rumbles's question, the reason for putting the provision in the bill is simple: it would state from the start the principle of what we expect from the new bodies that are being established. That would send out the right message about what we expect from community health partnerships. I hope that the minister will reflect on that and accept Duncan McNeil's amendment.
I agree with almost everything that has been said, but I do not draw the conclusion that it is therefore appropriate to put in the bill a duty on community health partnerships, which are new bodies that will already have massive responsibilities and challenges.
My fundamental point is the same as that which Jean Turner made. She said that she supported Duncan McNeil's amendment 6 but that providing information was the health boards' responsibility, which is the fundamental point that I made. Community health partnerships are committees of boards, so they will obviously have a key role to play, but the fundamental duty is on health boards. As I described in detail, we shall ensure that boards fulfil that responsibility.
I agree entirely with Duncan McNeil that people cannot exercise rights if they do not know that those rights exist. That is precisely why we are working with the Scottish Consumer Council on finalising a statement of patient rights and responsibilities. I assure him that that will be available in a range of formats.
Of course I agree with David Davidson that patients should be at the centre of the health service, but I am again astounded that he should imply that we think otherwise. As he thinks in stereotypes about the Executive's health policy and does not pay attention to what we are doing, he talked about national distribution and blotted out all my remarks about the information that would be available locally. The thrust of what I said was that information would be in local formats.
I agree with Karen Gillon that it is essential that patients should know their rights. She asked how we would ensure that the target was hit. To do that, we will not only produce the new document to which I referred, but ensure that boards disseminate that information, as I outlined. The reality is that the way in which we will ensure that that happens will not be fundamentally different from the way in which Duncan McNeil's amendment would be enforced. If his amendment were agreed to, we would have to ensure that community health partnerships provided information, just as we will ensure that boards fulfil that responsibility. In many cases, boards will act through community health partnerships to do that.
I dealt with Jean Turner's comments and I thank her for saying that providing information is the health boards' responsibility. I do not disagree with Shona Robison that all reasonable steps should be taken to provide information. I certainly agree that that should be done—I might even want to state it more strongly than that.
I implore members to accept that the primary responsibility must be on the health boards. Community health partnerships could be the most exciting part of the bill. They have enormous challenges. To place on them alone the duty to provide information, which would have quite a lot of ramifications, and to do so without consultation—although a massive consultation document on the partnerships was issued—would be received extremely negatively by those who are involved in the partnerships. It is not that they do not want to be part of fulfilling the responsibility, but I repeat that the primary responsibility rests with health boards. We shall ensure that they discharge it.
Amendment 1 agreed to.
Amendment 6 moved—[Mr Duncan McNeil].
The question is, that amendment 6 be agreed to. Are we agreed?
No.
There will be a division.
For
Aitken, Bill (Glasgow) (Con)
Baird, Shiona (North East Scotland) (Green)
Ballance, Chris (South of Scotland) (Green)
Ballard, Mark (Lothians) (Green)
Brocklebank, Mr Ted (Mid Scotland and Fife) (Con)
Canavan, Dennis (Falkirk West) (Ind)
Crawford, Bruce (Mid Scotland and Fife) (SNP)
Davidson, Mr David (North East Scotland) (Con)
Douglas-Hamilton, Lord James (Lothians) (Con)
Ewing, Mrs Margaret (Moray) (SNP)
Fabiani, Linda (Central Scotland) (SNP)
Fergusson, Alex (Galloway and Upper Nithsdale) (Con)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallie, Phil (South of Scotland) (Con)
Gibson, Rob (Highlands and Islands) (SNP)
Gillon, Karen (Clydesdale) (Lab)
Goldie, Miss Annabel (West of Scotland) (Con)
Grahame, Christine (South of Scotland) (SNP)
Harvie, Patrick (Glasgow) (Green)
Hyslop, Fiona (Lothians) (SNP)
Johnstone, Alex (North East Scotland) (Con)
Lochhead, Richard (North East Scotland) (SNP)
MacAskill, Mr Kenny (Lothians) (SNP)
Mather, Jim (Highlands and Islands) (SNP)
Maxwell, Mr Stewart (West of Scotland) (SNP)
McNeil, Mr Duncan (Greenock and Inverclyde) (Lab)
McNeill, Pauline (Glasgow Kelvin) (Lab)
Milne, Mrs Nanette (North East Scotland) (Con)
Mitchell, Margaret (Central Scotland) (Con)
Muldoon, Bristow (Livingston) (Lab)
Neil, Alex (Central Scotland) (SNP)
Robison, Shona (Dundee East) (SNP)
Scanlon, Mary (Highlands and Islands) (Con)
Scott, Eleanor (Highlands and Islands) (Green)
Scott, John (Ayr) (Con)
Stevenson, Stewart (Banff and Buchan) (SNP)
Swinburne, John (Central Scotland) (SSCUP)
Turner, Dr Jean (Strathkelvin and Bearsden) (Ind)
Against
Alexander, Ms Wendy (Paisley North) (Lab)
Baillie, Jackie (Dumbarton) (Lab)
Barrie, Scott (Dunfermline West) (Lab)
Boyack, Sarah (Edinburgh Central) (Lab)
Brankin, Rhona (Midlothian) (Lab)
Brown, Robert (Glasgow) (LD)
Butler, Bill (Glasgow Anniesland) (Lab)
Chisholm, Malcolm (Edinburgh North and Leith) (Lab)
Craigie, Cathie (Cumbernauld and Kilsyth) (Lab)
Curran, Ms Margaret (Glasgow Baillieston) (Lab)
Deacon, Susan (Edinburgh East and Musselburgh) (Lab)
Eadie, Helen (Dunfermline East) (Lab)
Ferguson, Patricia (Glasgow Maryhill) (Lab)
Finnie, Ross (West of Scotland) (LD)
Glen, Marlyn (North East Scotland) (Lab)
Godman, Trish (West Renfrewshire) (Lab)
Henry, Hugh (Paisley South) (Lab)
Home Robertson, Mr John (East Lothian) (Lab)
Hughes, Janis (Glasgow Rutherglen) (Lab)
Jackson, Dr Sylvia (Stirling) (Lab)
Jackson, Gordon (Glasgow Govan) (Lab)
Jamieson, Cathy (Carrick, Cumnock and Doon Valley) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Kerr, Mr Andy (East Kilbride) (Lab)
Lamont, Johann (Glasgow Pollok) (Lab)
Lyon, George (Argyll and Bute) (LD)
Macdonald, Lewis (Aberdeen Central) (Lab)
Macintosh, Mr Kenneth (Eastwood) (Lab)
Maclean, Kate (Dundee West) (Lab)
Macmillan, Maureen (Highlands and Islands) (Lab)
Martin, Paul (Glasgow Springburn) (Lab)
May, Christine (Central Fife) (Lab)
McAveety, Mr Frank (Glasgow Shettleston) (Lab)
McCabe, Mr Tom (Hamilton South) (Lab)
McMahon, Michael (Hamilton North and Bellshill) (Lab)
McNulty, Des (Clydebank and Milngavie) (Lab)
Morrison, Mr Alasdair (Western Isles) (Lab)
Mulligan, Mrs Mary (Linlithgow) (Lab)
Munro, John Farquhar (Ross, Skye and Inverness West) (LD)
Murray, Dr Elaine (Dumfries) (Lab)
Oldfather, Irene (Cunninghame South) (Lab)
Peattie, Cathy (Falkirk East) (Lab)
Pringle, Mike (Edinburgh South) (LD)
Purvis, Jeremy (Tweeddale, Ettrick and Lauderdale) (LD)
Radcliffe, Nora (Gordon) (LD)
Raffan, Mr Keith (Mid Scotland and Fife) (LD)
Rumbles, Mike (West Aberdeenshire and Kincardine) (LD)
Scott, Tavish (Shetland) (LD)
Smith, Elaine (Coatbridge and Chryston) (Lab)
Smith, Iain (North East Fife) (LD)
Smith, Margaret (Edinburgh West) (LD)
Stephen, Nicol (Aberdeen South) (LD)
Stone, Mr Jamie (Caithness, Sutherland and Easter Ross) (LD)
Wallace, Mr Jim (Orkney) (LD)
Watson, Mike (Glasgow Cathcart) (Lab)
Whitefield, Karen (Airdrie and Shotts) (Lab)
Wilson, Allan (Cunninghame North) (Lab)
Abstentions
Byrne, Ms Rosemary (South of Scotland) (SSP)
Fox, Colin (Lothians) (SSP)
Kane, Rosie (Glasgow) (SSP)
Leckie, Carolyn (Central Scotland) (SSP)
Sheridan, Tommy (Glasgow) (SSP)
The result of the division is: For 38, Against 57, Abstentions 5.
Amendment 6 disagreed to.
Section 2B—Equal opportunities
Group 2 is on equal opportunities. Amendment 2, in the name of Malcolm Chisholm, is grouped with amendment 5.
At stage 2, the Executive lodged an amendment to provide a legal underpinning to the existing policy of encouraging health boards, special health boards and the Common Services Agency to discharge their functions in a manner that encourages equal opportunities. The duty, as introduced at stage 2, will require those bodies to encourage equal opportunities and to observe equal opportunities requirements that are contained in existing legislation pertaining to equal opportunities. The duty applies to the functions of those bodies that arise from the National Health Service (Scotland) Act 1978.
The amendments extend the duty to promote equal opportunities to all health board, special health board and Common Services Agency functions, not only those that are listed in the 1978 act. Amendment 2 will extend the range of functions to which the duty to promote equal opportunities applies. Amendment 5 is a consequence of amendment 2 and will repeal the duty to promote equal opportunities in the Mental Health (Care and Treatment) (Scotland) Act 2003. That is required in order to avoid unnecessary and potentially confusing duplication.
The issue has been discussed in the NHS, patient bodies and equality bodies and the measures are widely welcomed and supported.
I move amendment 2.
Amendment 2 agreed to.
After section 2B
Group 3 is on waiting times, the duty to provide goods and services and national tariffs. Amendment 9, in the name of Duncan McNeil, is grouped with amendments 10, 21, 22 and 11. There will be a slight pause until Mr McNeil is ready.
I apologise for the delay, Presiding Officer.
The partnership agreement pledges that the interests of the patient "will always come first". Sadly, I am not sure whether our communities agree that that happens. When health bosses sit down to consider the most controversial issue that faces the national health service in Scotland—service redesign—they have certain legally binding obligations. There are, for example, the European working time regulations and the new consultant contract. In fact, there is some sort of statutory protection for everyone's interests, except those of the patient. The interests of the patient get a look in only when the four corners of the debate, as defined by law, are agreed, and that cannot be correct.
Amendments 9, 10 and 11 seek to redress the balance and give patients' interests parity with professionals' interests. Amendment 9 would give ministers the right, through regulations, to set legally binding guarantees for patients on maximum waiting times for certain services. Amendment 10 would give health boards, in partnership, a duty to ensure adherence to those waiting times guarantees throughout Scotland, and amendment 11 would mean that the powers of intervention in the bill would apply to bodies that, or persons who, do not comply with the waiting time regulations. I do not pretend that the amendments in themselves will put patients at the heart of the national health service, or even the decision-making process—they would simply give patients' interests the same status as those of the professionals.
I know from our discussions on the matter that the minister argues that what we currently have is better than what the amendments would deliver and that making maximum waiting times legally enforceable would lead to less ambitious targets being set. However, I do not follow that logic. If we really are already delivering on our tough targets, does the sanction for failure make a great deal of difference? If health boards are not meeting the guarantees, however, the option of recourse to the legal system would put the power to take action in the hands of the patient rather than in the hands of the bureaucrats at the national waiting times unit.
On the other hand, boards may have been relying on the public's lack of knowledge in order to meet their targets and they would be under real pressure if more patients knew their rights—as amendment 6 would have ensured—and were better able to exercise them. Whatever the case, I cannot see how what is proposed would be detrimental to the people whom I was elected to represent.
I move amendments 9 and 10.
For the purposes of the Official Report, I advise that, for procedural reasons, although Mr McNeil has spoken to amendments 10 and 11, he can move only amendment 9.
Yes. I am sorry.
Throughout the discussion on regulations, the minister talked a lot about the duties of boards. However, we hear time and again about individuals who cannot get treatment locally at an appropriate stage and about their clinical advisers—whether they are out-patient consultants or GPs—wanting them to receive, on time, treatment that is suitable and which meets the needs of their particular case. In other words, a clinical decision is involved. If the local health board cannot supply a service at a time that the physician recommends, the system should be allowed to change to ensure that the health board facilitates the patient being taken to another health board area—or another source—to receive treatment.
The Minister for Health and Community Care already said at stage 2 that he will put a duty of care on boards to look after other boards' patients. Quite a mix-up is involved in the fund flows and in the understanding of the matter out there. With amendment 21, I seek to put clear reasons in the bill for that approach and to give support to patients in their patient journey, to which the minister frequently refers.
One issue that health boards have raised time and again is that when they have co-operated with another health board, they often get their own operation into financial difficulties—whether through the Arbuthnott formula or something else. They find that they must pay for treatment that has been provided by another board, although the funds do not necessarily follow. To avoid any connivance, in a sense, whereby a board thinks that it can get a service cheaper elsewhere, amendment 22 seeks to set up a national tariff system for NHS treatments that would be set in place by regulation and which could be updated quite simply in the same way that, in pharmaceutical supply, the drug tariff is updated on a weekly to monthly basis.
We must ensure that money timeously follows the patient and does not cause any hold-up in or damage to the system. We should have a national health service, and patients should have the right to transfer within that service. If, as the minister has said, the health service cannot supply a service, the patient should be able to obtain it elsewhere, whether in the independent sector, the voluntary sector or the not-for-profit sector.
All that I seek to do is to put in the bill the rights of patients to have their treatment at the appropriate time wherever their clinicians think that they should have it and wherever it can be dealt with accurately, properly and safely. I want funding to follow the patient. The patient is the core of the health service and every patient journey must have such rights attached to it.
Mr McNeil's proposals are unnecessary. I do not want yet more administrative effort and duties to be placed on health boards when they should be seeking to provide the best possible service at the earliest possible opportunity. The proposals would simply mean a cumbersome administrative exercise.
I move amendments 21 and 22.
Mr Davidson can only speak to amendments 21 and 22; the opportunity to move or not to move them will come later.
I support amendment 9, in the name of Duncan McNeil. We should be prepared to take the step that he proposes for a number of reasons, the most important of which is that, currently, a number of health boards are under considerable financial pressure. We are concerned that that could lead to an erosion of the waiting times guarantee. We know that health boards are under pressure and that, in some areas, waiting times will be impacted on. Giving patients the right to recourse if health boards fail to meet the waiting times guarantee would prevent that from happening.
Duncan McNeil made a strong case when he spoke about the patients' interests being protected in the same way that others' are. At present, the public and patients feel that the health service is not always run in their interests and that is a perception that we all want to change.
Accepting amendment 9 would send out a strong message to health boards that failure to fulfil their duty to patients would empower the patient to use the law to get what they should be getting from the health board in their area. I am happy to support Duncan McNeil's amendment 9.
I will not comment on the dispute between Duncan McNeil and the minister about Duncan McNeil's amendments; I will stick strictly to David Davidson's amendments.
David Davidson gives the appearance of being the patients' champion in the national health service, but he is the champion of the private patient. Liberal Democrats believe that it is healthy to have an alternative to the state-provided health service, but we believe vehemently that the public health service should not be used to subsidise private health care. Amendment 22 would be a passport out of the national health service.
David Davidson has lodged a substantial amendment that strikes at the very principles of the national health service and at the principles of the bill. He did not lodge the amendment at stage 2 in committee—in fact, David Davidson signed up to the Health Committee's stage 1 report. It was only when that report was debated in the chamber at stage 1 that David Davidson turned about to oppose it.
It is disappointing that amendment 22 has been lodged in such a way because the point of the process of passing laws in the Scottish Parliament, which is so different from the process in Westminster, is that we involve the public. We involve everybody in the consultation process and take evidence as we go through the process. Lodging amendment 22 at the last possible moment represents Conservative party political principles—it is not appropriate at this stage. I do not question David Davidson's right to do that—he is perfectly entitled to lodge amendments in that way—but it is a little disingenuous of him to pose as the champion of the patient when he is the champion of the private patient.
I do not disagree that Duncan McNeil has the patient's interests at heart. He spoke about reorganisations in health boards and their lack of accountability, but his amendments do not address that point.
The experience of medical secretaries, for example, is that the management of waiting times distorts clinical priorities and wastes their time in some areas because it takes them away from being able to deliver patient care. Legislating on the matter would be a simplification of the delivery of health care and would risk distorting clinical priorities.
I support Shona Robison's proposed measures to keep health councils and thereby the democratic accountability of health boards. I hope that Duncan McNeil will support those measures because they would provide a way of holding health boards to account for organisations that the public do not support.
I concur with Mike Rumbles on David Davidson's amendments. Instead of allowing the bill to abolish the internal market and trusts, amendment 22 would have the effect of making the internal market that wee bit bigger and it would offer up opportunities for the proliferation of the private sector. David Davidson's amendments are a bit sneaky—I say well done for trying, but we will not support them.
I will not support David Davidson's amendments. It is good to have somebody like David Davidson in the Scottish Parliament because it reminds me of why I am in the Labour Party, why the Tories are the Tories and why we must do everything that we can to prevent them from getting into power at the next general election.
I support Duncan McNeil's amendments. If the waiting times guarantee is to be meaningful, it must be enforceable. I am interested to know why the minister opposed those amendments and why he does not think that a patient should have the right to enforce the guarantee if it is not met by the health board. That was a key plank of our manifesto and many people voted for us on that basis, so I would be grateful to know why they should not have that right.
There will be pressures on health boards and, in my area, we have been made aware of a couple of pressures in relation to how the consultant contract will impact on elective surgery. I would be grateful to know from the minister how we can continue to meet those guarantees without giving patients the right to recourse when we fail to meet them.
I rise in support of Duncan McNeil's amendments and against David Davidson's amendments. Many of the arguments have already been made; I simply endorse Duncan McNeil's amendments. We are not dealing with a simple matter of providing information—it is also about having equality throughout Scotland. The key is that we want to embody the waiting times guarantee in regulations to make it legally enforceable. That is what the minister does not want to face—he does not want to deal with litigation based on the regulations. However, it is important to have them because there is no point in having a waiting times guarantee if it is just a piece of paper that one can do nothing about.
Much has been said about David Davidson's amendments. I say more kindly than Miss Leckie, with whom I agree entirely, that the amendments represent an unsubtle attempt to take us incrementally down the road of Tory privatisation. We know that some health services have already been purchased outside the NHS, but the Scottish National Party does not want to see that increase—we would like to see a return to a much more public service. David Davidson's amendments are unsubtle and will be rejected by the Scottish National Party.
I have the joy of being an independent member and I do not feel obliged to vote one way or the other on the amendments—I agree with them all. I agree with Duncan McNeil because what he said was important.
I know what happens to patients and when I looked at David Davidson's amendments, I thought about the passports that everybody is afraid of. I hate to think that the national health service would ever be privatised, but I tell members that, in Glasgow, there are three different prices for orthopaedic operations. There is a price for the health board, there is a different price for the Golden Jubilee hospital, which might be the cheapest, and there is another price for the private sector. So many people out there are in desperate need of a hip replacement operation to keep them mobile that, as I have said before in the chamber, they have had to spend their hard-earned savings on having perhaps two hip replacements. They receive no tax rebate although they have paid into the national health service, which cannot provide.
One of my constituents would love to go anywhere in Scotland to have his hip replaced, but he has not been able to have that sorted out. I had a patient at the Glasgow royal infirmary, but when his consultant was transferred to the Golden Jubilee hospital, the whole waiting list did not move with that orthopaedic surgeon to the new hospital. My patient was deprived of having his operation in time. I should have said "constituent" rather than "patient"—I still forget that I am no longer a general practitioner. That poor chap would dearly have loved to go private because there was no other way for him to have his operation in time. He would have scraped up the money—his family would have provided the finances—but he was not fit to have his operation done in the private sector. We should remember that it is not always easy to choose to use the private sector. It might be imperative to stay in the NHS and in an NHS general hospital because of one's other medical conditions.
I read David Davidson's amendments carefully and, if he has some ulterior motive, I am sorry about that. I agree with what he says, however, because I would like equality and I would like patients to have their treatment now.
Far too many people are having to wait. For example, I know someone who has to wait 72 weeks for her first orthopaedic appointment in an NHS hospital. The NHS is not working. The waiting times are dreadful. In fact, consultants do not know the real extent of the waiting lists; instead, they are given what they are told is their waiting list, although they know that the rest of their list is sitting in some other part of the hospital. As a result, any suggestions on how we can keep an eye on waiting times would be valuable. Targets are another matter: I would ban them. In any case, I agree with all the members who have spoken.
I remind members—
Briefly, please.
I will be very brief. I remind members that people in the outer Hebrides are able to receive physiotherapy the next day, the day after that or the next week whereas people in Glasgow have to wait 13 weeks for the same treatment. As patients within the health service do not have an equal opportunity, I support all the amendments that have been lodged in this group. Lucky me.
In many cases, we are talking about pain. Someone who is in pain will take any steps to alleviate it. I am a great supporter of and believer in the NHS. As the service already allows consultants to carry out private work, I do not see that there is a great deal of difference between David Davidson's proposals and the Executive's position.
I do not believe in private medicine, but neither do I believe in private pain. I was forced to have an operation privately, because I could not suffer the pain of my arthritic hips for another year. My heart goes out to anyone who is still waiting in that queue for treatment.
I support the amendments lodged by Duncan McNeil and David Davidson. As Jean Turner said, they are both right, and consensus on this matter would help everyone.
I appreciate the intention behind amendments 9, 10 and 11 and assure Duncan McNeil and Karen Gillon that the patient guarantees will be met. That said, I am not convinced that those three amendments will achieve the desired outcome or be in patients' interests.
To date, we have made some good progress in working with health boards to reduce waiting times and to ensure that the guarantee is delivered. I should remind members that the guarantee itself kicked in only this year. I accept Dr Jean Turner's comments about out-patient waiting times, which were left for too long in Scotland. However, we are very much making up for that now by introducing a major programme of work on reducing out-patient waits. Indeed, I am speaking tomorrow at a major out-patient event for one of the areas affected—ear, nose and throat—and will announce some money and ensure that action is taken to reduce those waits.
Progress has been helped by the work of the centre for change and innovation and the waiting times unit and by making available the resources of the Golden Jubilee national hospital to NHS patients across Scotland. I believe that that collaborative approach has achieved results and is more constructive than the legal approach that is proposed in amendments 9, 10 and 11. As I pointed out in relation to amendment 6, steps are being taken to ensure that patients are well aware of the waiting time guarantees, what the waiting times are; and what they should do if they feel that the guarantee has not been met in their case.
I have three general objections to the idea of enshrining maximum waiting times in primary legislation.
Will the minister give way?
I will take an intervention after I make my three points.
First, creating legal duties in relation to services that are subject to a waiting times guarantee—including elective surgery such as hernia repairs and cataract removal—would give rise to a perverse situation in which those services could become a priority over other more clinically urgent services, such as emergency services, that are not enshrined in legislation in such a way. Indeed, I think that Carolyn Leckie made the same point. It would mean that boards would be under express legal duties in relation to services covered by the waiting times guarantee, but not under similar duties for other services such as emergency care.
Secondly, as waiting times are integral to the quality of the services provided, I do not think that it is appropriate to single out in legislation the particular issue of waiting times from other crucial aspects of quality.
Thirdly, our firm guarantees already go beyond what applies in the rest of the UK. Turning those guarantees into a legal duty could be counterproductive in creating pressure to soften targets and guarantees as a result of the potential for expensive legal challenges against boards. Even if Duncan McNeil does not accept that that might be a possibility, I hope that he thinks it reasonable to give the guarantees some time to prove themselves. After all, as I have said, they were introduced only in January.
I think that the minister has already answered my question. However, for the sake of clarity, is he saying that the waiting times guarantee is not legally enforceable and that, if it were not met in my case, I could not take him, his department or any board to court?
That is a statement of fact. However, I have already assured members that the guarantees will be met and there are many ways of ensuring that that happens short of putting them in primary legislation. I certainly think that many staff members and patients would be horrified at the idea that someone in such a situation should be taken to court. My point is that, if we push this provision beyond a guarantee, we will create a perverse situation in which minor elective procedures, which would then be legally binding, would have to be put before emergency care, which would not be. Such a situation would be neither clinically acceptable nor in patients' interests.
The other duties set out in amendments 9 and 10 do not add anything to the current arrangements. As the duty in section 12H of the National Health Service (Scotland) Act 1978 currently requires arrangements for monitoring and improving the quality of health care to be in place, it already applies to waiting times because that aspect of a service is an integral part of the service's quality. As a result, systems already exist for monitoring and reducing waiting times. For example, boards make regular submissions to the department's waiting times unit on how they are performing against the waiting times targets. Given that the 1978 act contains such an equivalent duty, amendment 9 is therefore unnecessary.
Amendment 10 seeks to affect the duty of co-operation. However, as currently drafted, the bill already requires boards to
"co-operate … with a view to securing and advancing the health of the people of Scotland".
That wording already covers co-operation to reduce waiting times as that itself would advance
"the health of the people of Scotland".
Boards will continue to co-operate with the Golden Jubilee hospital on reducing waiting times and will also work with other health boards in a national effort to reduce them.
On amendment 11, I agree that if a board is systematically failing to meet waiting times targets it might be necessary as a last resort to use the new power of intervention. That is partly a response to Christine Grahame's earlier point. Such boards would clearly be failing to provide the service to a standard that Scottish ministers find acceptable.
That does not mean that I support amendment 11. It is unnecessary because, as drafted, the power of intervention already allows ministers to intervene when an adequate service is not being provided. I have said before that we will not be able to prescribe every circumstance in which Scottish ministers should intervene and waiting times should not be singled out over and above other issues such as quality. That matter will no doubt arise when we discuss the next group of amendments.
Moving on to David Davidson's amendments, I have to say that amendment 21 is quite unusual in how it takes the good aspects of the current service and makes them worse. At present, a patient has a consultation with a medical practitioner, who then decides on the treatment that the patient needs. Taking into account the seriousness or urgency of the patient's condition and the availability of services, the medical practitioner will then consider where the patient can receive that treatment and make a referral for specialist services on that basis.
The national waiting times database has been available to all GPs since December 2002 and to the public since October 2003. It is designed to help and support patient choice and to inform decision making for the patient, the primary care practitioner and hospital services. If the patient and general practitioner want a referral to a clinic in another board area, that can already happen.
The minister mentioned patient choice. I am trying to ensure that such choice can be delivered on the ground and that there are clearer duties in that respect. It should not simply be put into the melting pot of waiting times. Recently, a constituent of mine had a lump in her breast and was panic stricken. She went to her general practitioner and he asked for an immediate investigation, but the health board said that it did not have the capacity to do that within two months. She went for private treatment. She did not have health insurance but she and her family scraped the money together. Is it not right that, if a health board cannot provide the service, a patient can be referred elsewhere? We are certainly not proposing the privatisation of the health service, but if the health service fails, there should be provision for other services to provide the treatment. It is concern for the treatment of the patient that lies behind amendments 21 and 22.
The reality is that, under the arrangements that I have just described, that constituent could have been referred to another board if the waiting time had been shorter there. The problem with amendment 21 is that it would seriously distort priorities at health board level because decisions on the timing of treatment would rest solely with individual medical practitioners, as stated in the proposed new subsection (2C). If anyone is thinking of supporting amendment 21, I ask them to read the proposed subsection (2C) within it, which makes it clear that a letter from a GP would supersede not only the targets and the waiting times guarantee but clinical priority as well.
Amendment 21 says that a medical practitioner could insist on the precise time of treatment. That could lead to a scenario in which a GP demanded that a minor surgical procedure be performed quickly, with the result that a far more serious operation had to wait longer. Different practitioners would make different professional judgments in situations that might seem similar to us. However, amendment 21 would place a legal duty on a health board to do whatever an individual doctor said that it must do. The board would have to ensure that a service was provided to the individual patient by a date dictated by the doctor. The health board would not be able to consider the disruption to other treatment, to consider wider priorities, or to consider other strategic matters. I fail to see how that would be good for patients or the NHS.
I turn now to amendment 22. The tariff idea is interesting. David Davidson has lifted it from Labour in England—albeit with a deadly Tory twist. The idea of having a uniform cost for a particular treatment is one in which I am interested. I have asked my department to give it detailed consideration. However, it would be quite wrong to agree to amendment 22 on the hoof without such detailed consideration and without consultation. For example, one of the downsides to the idea may be that treatments cost different amounts in different hospitals for quite legitimate reasons. It may well be that small hospitals would lose out under such a system.
The Tories support this idea as a Trojan horse for their unfair and divisive patient passport, whereby each patient would automatically receive a tariff—or "part of the tariff", to use the very words of the proposed section 17J(c)(ii) in amendment 22—in order that those who can afford it can supplement their own private payment and access health care on the basis of income rather than on the basis of clinical priority.
Minister, we have only nine minutes in which to get through both this group of amendments and the next group, before the knife falls at 10:31.
That is utterly unacceptable and is—[Laughter.]
I mean, David Davidson's amendment 22 is utterly unacceptable. [Laughter.] No, actually, I meant that the Tory twist was utterly unacceptable. [Laughter.] In itself, that twist is sufficient reason to reject amendment 22.
Mr McNeil, do you wish to wind up briefly?
No. I have heard what the minister said and I am happy with that.
Are you pressing amendment 9?
No, I am not.
Amendment 9, by agreement, withdrawn.
Section 3—Health Boards: duty of
co-operation
Amendment 10 not moved.
Amendment 21 moved—[Mr David Davidson].
The question is, that amendment 21 be agreed to. Are we agreed?
No.
There will be a division.
For
Aitken, Bill (Glasgow) (Con)
Davidson, Mr David (North East Scotland) (Con)
Douglas-Hamilton, Lord James (Lothians) (Con)
Fergusson, Alex (Galloway and Upper Nithsdale) (Con)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallie, Phil (South of Scotland) (Con)
Johnstone, Alex (North East Scotland) (Con)
McGrigor, Mr Jamie (Highlands and Islands) (Con)
Milne, Mrs Nanette (North East Scotland) (Con)
Mitchell, Margaret (Central Scotland) (Con)
Monteith, Mr Brian (Mid Scotland and Fife) (Con)
Scanlon, Mary (Highlands and Islands) (Con)
Scott, John (Ayr) (Con)
Swinburne, John (Central Scotland) (SSCUP)
Turner, Dr Jean (Strathkelvin and Bearsden) (Ind)
Against
Alexander, Ms Wendy (Paisley North) (Lab)
Baillie, Jackie (Dumbarton) (Lab)
Baird, Shiona (North East Scotland) (Green)
Ballance, Chris (South of Scotland) (Green)
Ballard, Mark (Lothians) (Green)
Barrie, Scott (Dunfermline West) (Lab)
Boyack, Sarah (Edinburgh Central) (Lab)
Brankin, Rhona (Midlothian) (Lab)
Brown, Robert (Glasgow) (LD)
Butler, Bill (Glasgow Anniesland) (Lab)
Byrne, Ms Rosemary (South of Scotland) (SSP)
Canavan, Dennis (Falkirk West) (Ind)
Chisholm, Malcolm (Edinburgh North and Leith) (Lab)
Craigie, Cathie (Cumbernauld and Kilsyth) (Lab)
Crawford, Bruce (Mid Scotland and Fife) (SNP)
Curran, Frances (West of Scotland) (SSP)
Curran, Ms Margaret (Glasgow Baillieston) (Lab)
Deacon, Susan (Edinburgh East and Musselburgh) (Lab)
Eadie, Helen (Dunfermline East) (Lab)
Ewing, Mrs Margaret (Moray) (SNP)
Fabiani, Linda (Central Scotland) (SNP)
Ferguson, Patricia (Glasgow Maryhill) (Lab)
Finnie, Ross (West of Scotland) (LD)
Fox, Colin (Lothians) (SSP)
Gibson, Rob (Highlands and Islands) (SNP)
Gillon, Karen (Clydesdale) (Lab)
Glen, Marlyn (North East Scotland) (Lab)
Godman, Trish (West Renfrewshire) (Lab)
Grahame, Christine (South of Scotland) (SNP)
Harvie, Patrick (Glasgow) (Green)
Henry, Hugh (Paisley South) (Lab)
Home Robertson, Mr John (East Lothian) (Lab)
Hughes, Janis (Glasgow Rutherglen) (Lab)
Hyslop, Fiona (Lothians) (SNP)
Ingram, Mr Adam (South of Scotland) (SNP)
Jackson, Dr Sylvia (Stirling) (Lab)
Jackson, Gordon (Glasgow Govan) (Lab)
Jamieson, Cathy (Carrick, Cumnock and Doon Valley) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Kane, Rosie (Glasgow) (SSP)
Kerr, Mr Andy (East Kilbride) (Lab)
Lamont, Johann (Glasgow Pollok) (Lab)
Leckie, Carolyn (Central Scotland) (SSP)
Lochhead, Richard (North East Scotland) (SNP)
Lyon, George (Argyll and Bute) (LD)
MacAskill, Mr Kenny (Lothians) (SNP)
Macdonald, Lewis (Aberdeen Central) (Lab)
Macintosh, Mr Kenneth (Eastwood) (Lab)
Maclean, Kate (Dundee West) (Lab)
Macmillan, Maureen (Highlands and Islands) (Lab)
Martin, Paul (Glasgow Springburn) (Lab)
Mather, Jim (Highlands and Islands) (SNP)
Maxwell, Mr Stewart (West of Scotland) (SNP)
May, Christine (Central Fife) (Lab)
McAveety, Mr Frank (Glasgow Shettleston) (Lab)
McCabe, Mr Tom (Hamilton South) (Lab)
McFee, Mr Bruce (West of Scotland) (SNP)
McMahon, Michael (Hamilton North and Bellshill) (Lab)
McNeil, Mr Duncan (Greenock and Inverclyde) (Lab)
McNeill, Pauline (Glasgow Kelvin) (Lab)
McNulty, Des (Clydebank and Milngavie) (Lab)
Morrison, Mr Alasdair (Western Isles) (Lab)
Muldoon, Bristow (Livingston) (Lab)
Mulligan, Mrs Mary (Linlithgow) (Lab)
Munro, John Farquhar (Ross, Skye and Inverness West) (LD)
Murray, Dr Elaine (Dumfries) (Lab)
Neil, Alex (Central Scotland) (SNP)
Oldfather, Irene (Cunninghame South) (Lab)
Peattie, Cathy (Falkirk East) (Lab)
Pringle, Mike (Edinburgh South) (LD)
Purvis, Jeremy (Tweeddale, Ettrick and Lauderdale) (LD)
Radcliffe, Nora (Gordon) (LD)
Raffan, Mr Keith (Mid Scotland and Fife) (LD)
Robison, Shona (Dundee East) (SNP)
Rumbles, Mike (West Aberdeenshire and Kincardine) (LD)
Ruskell, Mr Mark (Mid Scotland and Fife) (Green)
Scott, Eleanor (Highlands and Islands) (Green)
Scott, Tavish (Shetland) (LD)
Sheridan, Tommy (Glasgow) (SSP)
Smith, Elaine (Coatbridge and Chryston) (Lab)
Smith, Iain (North East Fife) (LD)
Smith, Margaret (Edinburgh West) (LD)
Stephen, Nicol (Aberdeen South) (LD)
Stevenson, Stewart (Banff and Buchan) (SNP)
Stone, Mr Jamie (Caithness, Sutherland and Easter Ross) (LD)
Wallace, Mr Jim (Orkney) (LD)
Watson, Mike (Glasgow Cathcart) (Lab)
Whitefield, Karen (Airdrie and Shotts) (Lab)
Wilson, Allan (Cunninghame North) (Lab)
The result of the division is: For 15, Against 89, Abstentions 0.
Amendment 21 disagreed to.
After section 3
Amendment 22 moved—[Mr David Davidson].
The question is, that amendment 22 be agreed to. Are we agreed?
No.
There will be a division.
For
Aitken, Bill (Glasgow) (Con)
Davidson, Mr David (North East Scotland) (Con)
Douglas-Hamilton, Lord James (Lothians) (Con)
Fergusson, Alex (Galloway and Upper Nithsdale) (Con)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallie, Phil (South of Scotland) (Con)
Goldie, Miss Annabel (West of Scotland) (Con)
Johnstone, Alex (North East Scotland) (Con)
McGrigor, Mr Jamie (Highlands and Islands) (Con)
Milne, Mrs Nanette (North East Scotland) (Con)
Mitchell, Margaret (Central Scotland) (Con)
Monteith, Mr Brian (Mid Scotland and Fife) (Con)
Scanlon, Mary (Highlands and Islands) (Con)
Scott, John (Ayr) (Con)
Swinburne, John (Central Scotland) (SSCUP)
Turner, Dr Jean (Strathkelvin and Bearsden) (Ind)
Against
Alexander, Ms Wendy (Paisley North) (Lab)
Baillie, Jackie (Dumbarton) (Lab)
Baird, Shiona (North East Scotland) (Green)
Ballance, Chris (South of Scotland) (Green)
Ballard, Mark (Lothians) (Green)
Barrie, Scott (Dunfermline West) (Lab)
Boyack, Sarah (Edinburgh Central) (Lab)
Brankin, Rhona (Midlothian) (Lab)
Brown, Robert (Glasgow) (LD)
Butler, Bill (Glasgow Anniesland) (Lab)
Byrne, Ms Rosemary (South of Scotland) (SSP)
Canavan, Dennis (Falkirk West) (Ind)
Chisholm, Malcolm (Edinburgh North and Leith) (Lab)
Craigie, Cathie (Cumbernauld and Kilsyth) (Lab)
Crawford, Bruce (Mid Scotland and Fife) (SNP)
Curran, Frances (West of Scotland) (SSP)
Curran, Ms Margaret (Glasgow Baillieston) (Lab)
Deacon, Susan (Edinburgh East and Musselburgh) (Lab)
Eadie, Helen (Dunfermline East) (Lab)
Ewing, Mrs Margaret (Moray) (SNP)
Fabiani, Linda (Central Scotland) (SNP)
Ferguson, Patricia (Glasgow Maryhill) (Lab)
Finnie, Ross (West of Scotland) (LD)
Fox, Colin (Lothians) (SSP)
Gibson, Rob (Highlands and Islands) (SNP)
Gillon, Karen (Clydesdale) (Lab)
Glen, Marlyn (North East Scotland) (Lab)
Godman, Trish (West Renfrewshire) (Lab)
Grahame, Christine (South of Scotland) (SNP)
Harvie, Patrick (Glasgow) (Green)
Henry, Hugh (Paisley South) (Lab)
Home Robertson, Mr John (East Lothian) (Lab)
Hughes, Janis (Glasgow Rutherglen) (Lab)
Hyslop, Fiona (Lothians) (SNP)
Ingram, Mr Adam (South of Scotland) (SNP)
Jackson, Dr Sylvia (Stirling) (Lab)
Jackson, Gordon (Glasgow Govan) (Lab)
Jamieson, Cathy (Carrick, Cumnock and Doon Valley) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Kane, Rosie (Glasgow) (SSP)
Kerr, Mr Andy (East Kilbride) (Lab)
Lamont, Johann (Glasgow Pollok) (Lab)
Leckie, Carolyn (Central Scotland) (SSP)
Lochhead, Richard (North East Scotland) (SNP)
Lyon, George (Argyll and Bute) (LD)
MacAskill, Mr Kenny (Lothians) (SNP)
Macdonald, Lewis (Aberdeen Central) (Lab)
Macintosh, Mr Kenneth (Eastwood) (Lab)
Maclean, Kate (Dundee West) (Lab)
Macmillan, Maureen (Highlands and Islands) (Lab)
Martin, Paul (Glasgow Springburn) (Lab)
Mather, Jim (Highlands and Islands) (SNP)
Maxwell, Mr Stewart (West of Scotland) (SNP)
May, Christine (Central Fife) (Lab)
McAveety, Mr Frank (Glasgow Shettleston) (Lab)
McCabe, Mr Tom (Hamilton South) (Lab)
McFee, Mr Bruce (West of Scotland) (SNP)
McMahon, Michael (Hamilton North and Bellshill) (Lab)
McNeil, Mr Duncan (Greenock and Inverclyde) (Lab)
McNeill, Pauline (Glasgow Kelvin) (Lab)
McNulty, Des (Clydebank and Milngavie) (Lab)
Morrison, Mr Alasdair (Western Isles) (Lab)
Muldoon, Bristow (Livingston) (Lab)
Mulligan, Mrs Mary (Linlithgow) (Lab)
Munro, John Farquhar (Ross, Skye and Inverness West) (LD)
Murray, Dr Elaine (Dumfries) (Lab)
Neil, Alex (Central Scotland) (SNP)
Oldfather, Irene (Cunninghame South) (Lab)
Peattie, Cathy (Falkirk East) (Lab)
Pringle, Mike (Edinburgh South) (LD)
Purvis, Jeremy (Tweeddale, Ettrick and Lauderdale) (LD)
Radcliffe, Nora (Gordon) (LD)
Raffan, Mr Keith (Mid Scotland and Fife) (LD)
Rumbles, Mike (West Aberdeenshire and Kincardine) (LD)
Ruskell, Mr Mark (Mid Scotland and Fife) (Green)
Scott, Eleanor (Highlands and Islands) (Green)
Scott, Tavish (Shetland) (LD)
Sheridan, Tommy (Glasgow) (SSP)
Smith, Elaine (Coatbridge and Chryston) (Lab)
Smith, Iain (North East Fife) (LD)
Smith, Margaret (Edinburgh West) (LD)
Stephen, Nicol (Aberdeen South) (LD)
Stevenson, Stewart (Banff and Buchan) (SNP)
Stone, Mr Jamie (Caithness, Sutherland and Easter Ross) (LD)
Wallace, Mr Jim (Orkney) (LD)
Watson, Mike (Glasgow Cathcart) (Lab)
Whitefield, Karen (Airdrie and Shotts) (Lab)
Wilson, Allan (Cunninghame North) (Lab)
The result of the division is: For 16, Against 88, Abstentions 0.
Amendment 22 disagreed to.
Section 4—Powers of intervention in case of service failure
Amendment 11 not moved.
Amendment 3, in the name of Malcolm Chisholm, is in a group on its own.
Amendment 3 serves two main purposes. The first relates to the range of individuals who may be included within an intervention team that is to be sent into a health board to bring a failing service back to an acceptable standard. The bill currently restricts the individuals who are eligible for an intervention team to employees from health boards, special health boards, the Common Services Agency and the Scottish Executive. It is considered that local authority employees could usefully be added to this list, thereby broadening the pool of expertise and experience that Scottish Ministers could draw from. The first part of the amendment gives effect to that policy.
The second reason for amendment 3 is to clarify that the actings of the appointed person are to be treated as actings of the relevant body that is subject to the intervention. As I said during stage 1, the general principle to which we are working is that boards that are responsible for a failing service should be responsible for the costs of intervention to remedy the failure. The alternative would be for costs to fall on the entire Scottish NHS budget and therefore on boards as a whole. We believe that it would be wrong to penalise other boards for the costs of correcting the failings of one board.
However, the amendment also enables Scottish ministers to assist with the costs of the intervention if they choose to do so. For example, if ministers were to take the view that the costs were such that, if the board was to meet them, it would result in a material reduction in services in that board area, they could decide that it would be appropriate for the Executive to contribute to, or bear, the costs of remedying the failure. The effect of doing so would, of course, be to spread the costs across the whole of Scotland.
Amendment 3 also makes it clear that third parties do not have to distinguish between acts of the relevant board and those of the appointed person in the unlikely event that they suffer any loss during the course of an intervention.
I hope that I have provided the necessary clarification that the Health Committee requested at stage 1.
I move amendment 3.
We have very little time. I call Shona Robison.
The minister will be aware that there have been concerns about who meets the costs of interventions. The Health Committee had a lot to say about that because we are talking about health boards that are already under severe financial stress. I am pleased that the minister has said that, when the costs would lead to a material reduction in services, the Executive could help to meet those costs. That is to be welcomed. However, we require a bit more information about what would constitute a material reduction in services. At what level would that be measured? How would it be assessed whether services had been reduced to that extent? It would be helpful to have more information on that.
I apologise to the two members whom I cannot call.
It is clear that the Executive would want to take action to ensure that there was a comprehensive assessment of the situation in any area. The criterion is that, regardless of what has occasioned the failure of a service within a board, whatever actions we take should not have a detrimental effect on the other services within that area. The Scottish Executive, aided and abetted by the officials who serve us, would conduct a comprehensive assessment to ensure that we did not take any action that would have further detrimental effects on the people who depended on the services in that area.
Amendment 3 agreed to.
Before section 5
Group 5 is on the membership of health boards. Amendment 12, in the name of Shona Robison, is in a group on its own.
Amendment 12 is necessary because we cannot have a debate on NHS reform without talking about one of the most important reforms that could and should take place in the health service, which is to redress the balance by tackling the lack of public say in and power over the decisions that are made locally about people's health services. We know from all our patches that the public in constituencies throughout Scotland feel dislocated from the decisions that are made by health boards. In Caithness, the west of Scotland, Glasgow or wherever, there are feelings of disempowerment and a sense that the health boards will do what they want to do in spite of the public's opposition.
If we are to address that concern, the public will be able to regain their trust in health boards only if they are given a direct say in the decisions that health boards make. In my opinion, the only way in which to do that is to have direct elections for at least half the places on health boards. I am aware that Bill Butler has made a proposal for a bill on the subject and I look forward to hearing about what is happening on that front and what the timescales are for the bill's introduction. We cannot afford to wait for such change for ever. The time is now right to send out a signal to the public that we recognise their disillusionment with the decisions that have been made and so we are prepared to take real action to address the imbalance of power.
I move amendment 12.
We will not be supporting amendment 12, for the reasons that I stated during stage 2 consideration. The proposal has a huge cost implication and we have far too many elections in Scotland as it is. Frankly, the introduction of elections for health boards would open up the boards to the risk of being taken over by single-issue campaign groups, which could bring nothing but disruption to the running of the boards.
We must seek ways of incorporating health patients' views to a greater extent in the health system. I felt that local health councils played a valuable role in that regard, before the bill came along. There is a big skills gap among the general public about how health boards are run. It is one thing to talk about patients' input and getting their voices heard—I have some sympathy with what Shona Robison said about the needs of communities in relation to consultation on changes such as the centralisation of maternity services—but I do not believe that having an electoral process, which could be repeated time and again during a session of Parliament, to deal with a single issue would be in the interests of the health service's efficiency.
I do not think that Shona Robison seriously expects the Parliament to support her amendments today. I will make the same comment that I made on David Davidson's amendments 21 and 22, which I said would change the NHS's entire principles.
Shona Robison has already referred to Bill Butler's proposal for a member's bill. I am sympathetic towards the principle behind amendment 12, which also lies behind Bill Butler's proposed bill. However, there are two ways of ensuring health boards' accountability to patients and the public. The first is through ministerial powers of intervention and the other is through direct elections. I am sympathetic towards direct elections because, when the National Parks (Scotland) Bill was considered by the Rural Affairs Committee in the first parliamentary session, I lodged 15 amendments on the subject. They were successful—the Parliament agreed to them—and 20 per cent of all the members of the national parks boards are now directly elected by the people within the national park boundaries. That is a good thing and, from speaking to the people who are involved, I believe that the system works extremely well.
I am supportive of the principle, but I return to the point that I have just made. There are two public accountability options—direct elections and ministerial intervention. Although I am supportive of the Executive's decision to go down the route of ministerial intervention, it presents me with a difficulty. How compatible with direct elections is giving the minister powers to intervene to ensure the public interest, if that means that the people who are directly elected are then subject to ministerial intervention? That is the crux of the matter. Members of all parties who want health boards to have more public accountability face a real dilemma.
On amendment 12 specifically, I do not think that now is the moment for the Parliament to take on board Shona Robison's proposal without a thorough investigation. We must give due attention to Bill Butler's proposed bill.
I support the spirit of amendment 12, which is the same as an amendment that Shona Robison lodged at stage 2. I accept that the proposal forms an important part of reform of the NHS and links in with a number of other areas that are dealt with in the bill, such as consultation.
I fully agree that the public should have a say, through consultation, in how services are delivered in their area, but I also believe that they should have a say on the question of direct elections to health boards. That is why I think that it is premature to lodge such an amendment. Mention has already been made of making policy on the hoof and I think that that is what we would be doing by including in the bill provision for direct elections to health boards.
I have given my support to Bill Butler's proposed member's bill and I think that the way forward is through full consultation, which I understand will be happening in the near future. Through such consultation, we should give the public the opportunity to comment on how they view direct elections to health boards. For that reason, I will oppose amendment 12.
I support amendment 12, having lodged a similar amendment. It is unfortunate that such a measure was not contained in the consultation on the bill, as that would have provided the opportunity for it to be discussed fully. I, too, would like there to be a lot more debate about the composition of, and elections to, health boards. I have already indicated my support for Bill Butler's proposed bill.
I will explain why direct elections to health boards are necessary. Up and down the country—from Wick to the Borders and from the Highlands and Islands to Glasgow—there is a lack of confidence in the democracy and accountability of health boards. That is a constant theme in the petitions that are submitted to the Public Petitions Committee. Nearly every reorganisation results in the public being up in arms and reaching conclusions that are the opposite of those reached by the health board. That is unacceptable; the situation is untenable.
Let us consider what is happening now. The issue is not just the public's inability to hold health boards democratically to account; it is the composition of boards. By my reckoning, 41 appointees to NHS boards are ex-Labour candidates or councillors, nine are Liberal Democrats, nine are independent, four are members of the Scottish National Party and four are Tories. That represents a clear imbalance if we consider the proportion of the population that is made up by activists of or candidates for the Labour Party and other parties. Two thirds of the appointees who have disclosed political affiliations are members of the parties of the Scottish Executive and only seven appointees—less than 10 per cent—have affiliations with non-Executive parties. There might be even more appointees with Labour affiliations, because only people who have stood as candidates in the past five years are required to disclose their party background. For example, Bill Speirs, the general secretary of the Scottish Trades Union Congress, is an appointee who does not have to declare his Labour Party affiliations, so he is not included in the figures that I have given.
If we are to address the public's suspicions, there must be greater openness and transparency, direct accountability and direct democracy. A secret report—although it is not secret, because we all know about it—expresses great suspicion about accountability, the number of quangos, the performance of the Scottish Parliament and so on. We could restore public confidence and deal with the quango issue by introducing direct elections to health boards. Quangos could be turned into democratically and publicly accountable bodies if we replaced the appointed members of NHS boards with directly elected members who would be answerable to local communities, rather than to the political party in which they are active.
Shona Robison mentioned me in dispatches, so I will place a few matters on the record.
It is my intention to issue before the summer recess a consultation paper on my proposal for a member's bill on direct elections to health boards. I give my word on that to Parliament. I sincerely believe that that is the appropriate approach to what would be a far-reaching reform with profound ramifications. To tack on to the bill an amendment, without consultation, would not be an appropriate way of introducing a much-needed reform, as I think that the Health Committee decided at stage 2.
If the results of the consultation are positive, as I think they will be, I hope that the ministerial team will give my proposal a fair wind. I will be interested to hear what ministers say about that later in the debate.
I was surprised that Shona Robison lodged amendment 12, after a similar amendment was withdrawn at stage 2. I understood that at that stage she thought that further consultation was needed and that Bill Butler's proposal offered an appropriate approach. I do not think that much has materially changed since stage 2, but we must consider the amendment nevertheless.
Bill Butler has indicated that he has every intention of introducing his member's bill and that there will be an opportunity for proper consultation on the proposals that his bill contains. I am not persuaded that we should legislate in advance of such a consultation and I hope that members want to wait for the outcome of the consultation before they consider whether and how to take forward legislation on such an important issue.
We should remember that the Executive has already taken steps to increase the public accountability of health boards throughout Scotland. The creation of 15 unified NHS boards in September 2001 extended the range of key stakeholders by including local authority councillors. The formal presence of elected councillors as full members of boards was specifically intended to strengthen local accountability, responsiveness to community issues and joint working between health boards and local authorities.
The Executive is also working to improve patient and public involvement throughout the NHS. That is demonstrated by other provisions in the bill. Community health partnerships, for example, will include at least one member of the public partnership forum, who will represent the public's interests. The new duty of public involvement will ensure that boards consult the public on plans and decisions that significantly affect the operation of services. We want to create mechanisms that allow interested members of the public to influence what happens in their health board area and I believe that we are doing that.
This is not the time to introduce the provisions in amendment 12 and I urge members to reject it.
I will be brief. I thought that it was important to keep the issue of direct elections to health boards on the agenda, so I lodged amendment 12 as a probing amendment, to find out what was happening about Bill Butler's proposed member's bill. I am grateful to Bill Butler for his commitment to proceed with the consultation before the summer recess and I look forward to that process. I am sure that there will be a large response from people throughout Scotland and we will certainly encourage people to respond. Given Bill Butler's commitment, I will seek to withdraw amendment 12.
Amendment 12, by agreement, withdrawn.
After section 5
Group 6 is on health councils. Amendment 13, in the name of David Davidson, is grouped with amendments 14 to 20.
The Health Committee took a lot of evidence about the proposed new Scottish health council and discussed the matter fully. I find it strange that although the Executive has spun the fact that the council is to be established and will be an important body, the bill does not refer to it. That is staggering given that the minister has regularly stated in public that the health council represents a vital part of the modernisation of one aspect of health care in Scotland.
Amendment 13 would include the Scottish health council in the bill and would reinforce the fact that the council should be an independent body and not merely a department of NHS Quality Improvement Scotland or a body that is subject to joint management. The Scottish health council should stand alone.
Local health councils are keen to be linked into a proper national body—neither they nor I object to that proposal—but they want that body to be truly independent. In the past, they worked closely with but were funded by the health boards. However, the Scottish health council should be a truly independent body that considers NHS performance from the point of view of patients and staff and visits the different health establishments in which local health councils have been active and welcome in the past. Currently, one or two local councils do not have the resources or the manning to enable them to be efficient. Amendment 13 would clarify the position. I think that the minister is sympathetic to that aspect of the matter and I ask him to accept that the Scottish health council should be covered in the bill. It is vital that we give the public confidence that independent bodies are there for them and that they can turn to such bodies to investigate any failure in the system. NHS QIS measures quality standards in health service performance on a technical basis; it does not consider that aspect.
I have some sympathy for the member's position, but amendment 13 states:
"The general duties of the Scottish Health Council shall be to … co-ordinate the work of the local health councils on a national basis".
However, local health councils will be dissolved under section 6. I do not see the point of co-ordinating the work of bodies that will be dissolved.
The minister seeks to set up local advisory councils. The local health councils want those to come together in a national body that would support and help them. If the bill is passed, local advisory councils will replace local health councils, as the discussions in the Health Committee acknowledged.
I am sympathetic to Shona Robison's amendment 14 and I will listen carefully to what she says. If amendment 13 is not agreed to, we might support amendment 14.
I move amendment 13.
I call Christine Grahame, to be followed by Carolyn Leckie.
I support amendment 13—
I beg your pardon. I made an error; I should have first called Shona Robison to speak to the amendments in her name.
I seek the retention of local health councils, but that does not mean that I do not recognise the importance of the new national body, the Scottish health council. The two are not mutually exclusive—they have distinct roles. I will say a bit about the independence of the Scottish health council in a minute.
Throughout the passage of the bill, I have expressed concern about the dissolution of local health councils and the loss of their important role, particularly their advocacy work. The councils help some of our most vulnerable people to complain or to find their way round the health service. People have given years of service to their local health council, but the local expertise that has been built up is, unfortunately, in danger of being lost. I have spoken to a number of people who have been involved in local health councils, and they are disappointed and feel that they have been cast aside because their services are no longer required. Although the intention is to try to involve some of those people in the new local advisory councils, those councils will not have the same role, and so a number of people will choose not to be involved.
As I have said throughout the process, I cannot understand why the establishment of the Scottish health council should lead directly to the dissolution of local health councils. It is unfortunate that the Executive has linked those two measures. The Scottish health council and local health councils would have distinct roles. I urge members not to throw the baby out with the bath water and to retain the role of local health councils.
I share David Davidson's concerns about the independence of the new Scottish health council. It would be unfortunate if the message that the public received was that the council was not fully independent or able fully to protect their interests. It is difficult to argue that the council will be independent when it is to be located within NHS Quality Improvement Scotland, which is an NHS body. There are arguments for establishing a different structure to guarantee the new council's independence. I am happy to support David Davidson's amendment 13 to achieve that end.
Since I started Christine Grahame, I will allow her to finish.
My colleague has addressed David Davidson's amendment 13. It is important that the new Scottish health council is put on a statutory basis for the reasons that David Davidson expressed. In evidence to the Health Committee, a recurring theme was the strongly expressed concerns about the independence of such an organisation. The Executive appears to be going for a symbiotic relationship with NHS QIS, but the evidence to the committee shows that there is a strongly perceived conflict of interest, if not an actual one, in relation to the proposal.
Dennis Canavan is right. Mr Davidson's amendment 13 states:
"The general duties of the Scottish Health Council shall be to … co-ordinate the work of the local health councils on a national basis."
Mr Davidson is trapped by his amendment: he has no option but to support Ms Robison's amendment 14.
I concur with that point and I hope that Mr Davidson will support amendment 14.
I want to place the debate in context. I hoped that the Executive would listen to the views of organisations such as the Transport and General Workers Union, Unison and the Royal College of Nursing on the proposed abolition of local health councils, which is a serious assault on the independence of the system. A non-statutory body that is located within NHS QIS will be nowhere near a replacement for the rigorous work of local health councils, whose work could be improved further, because there is always room for improvement.
I support David Davidson's amendment 13, which would create a national body to oversee the work of the local health councils—I presume that he supports amendment 14. Amendment 13 would not introduce enough democracy, but it is better than nothing. To give a wee bit of political history, in England, proposals that were similar to the Executive's were at first removed because of opposition by the Tories, Labour back benchers and the Liberal Democrats, but Tony Blair, in his no-reverse-gear mode, insisted on reintroducing them. I hoped that that attitude would not be reflected in the Executive's bill, but unfortunately it is. However, it is never too late—we should stick up for health councils today.
I seek clarification on the policy and intentions of the Lib Dems. When Nora Radcliffe was the health spokesperson for the Lib Dems, she had a members' business debate on 4 October 2000 to celebrate the success of local health councils. I understand that it is published Liberal Democrat policy to support health councils and to oppose their abolition. Perhaps the Lib Dems will let us know what they are doing. We have an opportunity to reach a consensus through which we could retain health councils and introduce an independent national health council.
I am delighted to respond to Carolyn Leckie. I cannot help thinking that if the Executive had proposed another quango, Carolyn Leckie, Shona Robison and David Davidson would have argued how terrible that was. As the Health Committee realised, a number of different options could have been chosen.
What has been missing from the debate so far is a focus on the bill, rather than the amendments. The problem is solved in section 5, which for the first time will introduce in legislation a duty to encourage public involvement. Section 5 states:
"It is the duty of every body to which this section applies"
to consult the public, not only on "planning and development" but, importantly, on "decisions to be made". As the Health Committee knows, people throughout Scotland are dissatisfied with the public involvement and consultation processes of the 15 health boards in Scotland. I am pleased that the Executive is taking action through the bill to ensure that we have real consultations, not consultations after decisions have been made. The bill turns round the situation by talking about "decisions to be made".
We all agree about the importance of public involvement, but we are talking about the abolition of local health councils and the independence of the new Scottish health council. As Carolyn Leckie said, the previous incumbent of Mike Rumbles's post as health spokesperson had strong views on the retention of local health councils. What is his view on their abolition?
Thank you very much for that. I am trying to put across the point that the National Health Service Reform (Scotland) Bill will radically change public involvement in the health service in Scotland. I hope that SNP members will support the bill at decision time. They would be mad not to accept that the Labour Party and the Liberal Democrats are radically changing the situation, which has moved on in the past four years.
The key issue is the duty to involve the public. As the Liberal Democrat spokesperson on health and community care, I am satisfied that we have the right approach and that the bill will introduce significant changes in public involvement. Therefore I am relatively relaxed about not creating another so-called independent, non-accountable body, which is what David Davidson would like. It is not at all necessary. The whole raison d'être has changed, so placing the Scottish health council within NHS QIS is perfectly acceptable.
The beauty of debate is that one is able to change one's mind. Bills go through fairly quickly; as a new member of Parliament, I have found that the process can be difficult, because there is so much to take on board and one changes one's mind many times. I have always felt that it would be a great pity to dissolve the local health councils. Many changes happen in the health service and the most disadvantaged are always penalised. It would have been a great idea to leave the Scottish health council in the bill. In committee, I was persuaded in the end by the minister's assurance that the intention was that the Scottish health council would be independent, under the NHS QIS banner. On reflection, and on reading what has been said in the past, I think that such an important body should have been included in the bill. I go along with everything that has been said.
Mr Davidson said something that made me stop and think. If the Scottish health council comes under NHS QIS but is not included in the bill, it will be subject to regulations. If everybody's intentions are honourable at present, everything will go well. However, if people change, regulations could change, and the whole idea, as it is set up at the moment, might change. Since I am independent, I will vote for amendments 13 and 14. I would have loved it if the Scottish health council had been included in the bill. Throughout the evidence, people's fear that the Scottish health council would not be independent was a constant theme. In the light of the public's mistrust of health boards and the Government, it was a mistake not to put the Scottish health council in the bill.
I will explain why amendment 13 and amendments 14 to 20 should be rejected, just as they were rejected by the Health Committee. Amendment 13 seeks to establish the Scottish health council as a separate, independent body—or, should I say, a supposedly independent body; as Dennis Canavan rightly pointed out, the amendment would ensure that a Scottish health council would be composed of local health council representatives. The key point is that local health councils are appointed by local health boards. David Davidson, Shona Robison and Carolyn Leckie should all remember that point when they applaud the independence of local health councils.
The Executive has proposed that the Scottish health council should be established as a body with its own distinct role and status within NHS Quality Improvement Scotland. That is because the Executive regards patient focus and public involvement as an essential part of securing quality in the NHS. As I say repeatedly, the experience of every patient is the starting point for improving quality in health. In the Executive's view, improving quality should be about developing services that are more focused on patient experience and meeting what patients want through service redesign, managed clinical networks and other initiatives. The review and monitoring functions of NHS QIS will be strengthened by that body being able to draw directly on the expertise and patient networks of the Scottish health council. NHS QIS is at the heart of improving quality in the NHS. It operates separately from ministers and other boards. I am sure that anyone who knows the chair, Naren Patel, will understand what I mean when I say that.
I have written to the Health Committee setting out the Executive's proposals for ensuring the independence of the Scottish health council within NHS QIS, and I reiterate those proposals now. The council will be created through regulations as a committee of the board of NHS QIS. The chair will be appointed through the public appointments process. Members will be appointed through an open process by NHS QIS, and up to three members will be appointed from the local advisory councils to ensure strong local links.
Establishment of the Scottish health council through regulations will mean that there is parliamentary involvement in the process. The Scottish health council cannot be created by primary legislation, because NHS QIS was not created by primary legislation. Establishment through regulations will also mean that there will be a clear, legislative basis for the Scottish health council's work. It will ensure that the council's continuing existence is not just a matter for ministers and the Health Department, and that the council cannot be changed or abolished without parliamentary approval. The council's local advisory structure will mean that it is not a remote or centralising body. By creating a Scottish health council, we will be able to bring more professionalism and expertise to patient focus and public involvement in Scotland. At the same time, the existence of the local advisory councils will mean that there is local input from patients and the public, thus ensuring that the health boards communicate with and listen to patients and local people.
On community health partnerships, there will be the new public partnership forums, which will be important in ensuring that there is strong communication and engagement with the public and, crucially, feedback on key issues and policies.
The minister said that the Scottish health council could not be included in primary legislation because NHS QIS is not included in primary legislation. I do not understand the rationale for that, because amendment 13 makes no reference to NHS QIS. With respect, the argument is not logical.
Christine Grahame may not agree with the argument, but the Scottish health council will be set up as a part of NHS QIS and it is not possible to have a part of a body in primary legislation when the body itself is not in primary legislation.
Shona Robison's amendments 14 to 20, which are almost identical to those that the Health Committee rejected at stage 2, seek to preserve the status quo. A lot of good work has come out of local health councils—I pay tribute to all the people who have been involved in that—but everybody accepts that that work has been uneven. It is time to build on that good work and to move on. Preserving the status quo would be inadequate for the better public involvement that we want. Mike Rumbles got straight to the heart of the debate when he said that the new structure is all about ensuring better public involvement and better patient focus.
The bill's provisions for a new duty of public involvement and for dissolving local health councils are designed to support and underpin patient focus and public involvement. The Executive wishes to put greater responsibility on NHS boards to communicate with and involve patients and the public, and to encourage patients and community and voluntary organisations to represent their views directly to boards, rather than to have local health councils substituting, as it were, for the public and for those groups. I want to involve the public directly in the planning and design of health services, and not to have their views filtered through an outside body. The Scottish health council will monitor and quality assure that process, and that will do more to help to achieve a more responsive and patient-focused NHS than would be the case if we kept the current system.
I know of the dissatisfaction among members about the way in which public involvement has been facilitated in the past. The Scottish health council's new role will be crucial to guaranteeing better public involvement. For example, all the service change proposals that come to me for approval at present, partly on the ground that there has been good public involvement, will all be considered by the Scottish health council. The council will report on that, and it will give annual reports on the extent to which boards are improving their work on public involvement. That is crucial to an objective that all members share.
From listening to Shona Robison today, and at stage 2, I know that she wants to maintain local health councils' discrete role in relation to advocacy. The Executive sees local advisory councils as having an important role in ensuring that health boards hear, understand and act upon the views, concerns and experiences of patients, carers, patients, organisations and communities. That is a wider role than advocacy in the traditional sense, which is about supporting individuals and helping them to speak for themselves in their relationship with health services. When a local advisory council feels that the patient's viewpoint is not being adequately considered, or when there is not an appropriate patient support group, the local advisory councils will be able to put forward the views of patients and ensure that appropriate action is taken. I made that point at stage 2, and I have written directly to Greater Glasgow Health Council on the matter.
We want to encourage health boards to engage much more directly with patients and with local opinion; at the same time, we will ensure that strong feedback arrangements are in place where the patient's voice, for whatever reason, is not being properly expressed or heard.
We are not disregarding existing interests and expertise. Those people who are currently on local health councils will have an opportunity to be represented on the local advisory councils. They will be the local presence of the Scottish health council; in many cases, those who are currently on local health councils will be the ideal people to fulfil that role and I hope that many of them will choose to do so. They have played a valuable role so far, and they can do more in their new roles in the future. That would have far more value than staying where we are. Accordingly, I encourage members to follow the example of the Health Committee and reject the amendments in this group.
In fact, it was the whipped ranks of the partnership parties in the Health Committee that voted down my amendment at stage 2, not the committee at large—although we have to accept the numbers game.
Will the member take an intervention?
No, not at this time. I will come to Mr Rumbles eventually.
This has been an interesting debate, but I do not think that the minister has grasped the significance of my amendment 13. I do not think that he understands the public's worry about the matter or the perception about having a health council that is not regulated, other than through ministers' directions. That is an example of the minister's desire to control all aspects of health in Scotland from his desk. The public are getting very concerned about that centralising approach.
I appreciate the support that I have had on this matter from the other side of the chamber, particularly the points that were made by Shona Robison and Carolyn Leckie. It is important to have a statutory body that can be clearly identified by all members of Scottish society and which acts not just at the behest of the minister, but in a clear, independent manner.
I thought that I heard Mr Rumbles talking about public involvement, and I think that the minister got round to speaking about that, too. What is wrong with public involvement? This is about how we deliver our public services, for goodness' sake. If the public do not have a right to say something, what rights do they have left? If NHS QIS is not enshrined in primary legislation, that is a fact of life. That is why we need to include the Scottish health council in primary legislation, as a distinctly separate, independent body, which is perceived to be independent and to act in the best interests of the patients. That is what the health service is there to do.
Once again, we have seen a Liberal Democrat squirm out of policy commitments from the past, just because there has been a new agreement. I find that very strange, and I think that the Liberal Democrats should be more honest about that.
Will the member take an intervention?
In a moment.
He will not do so, will he?
I am just trying to warm him up, Presiding Officer.
I refer to some of Jean Turner's comments. As a former practising medic in the community, she understands very well the public perception of the situation. Her route to Parliament demonstrated the public's desire for input.
In the interests of democracy, I will allow Mr Rumbles to intervene.
I would have preferred it if the intervention had come from Nora Radcliffe, because she could have put Mr Davidson right on some facts. My point is that our policy has not veered one iota in four years. Is it not rather odd to suggest that committee members from an Executive party should be willing to vote against a policy that they are advocating?
That says it all, really.
I beg the minister to reconsider the Executive's position on this matter. The proposal in amendment 13 would be an important step forward. If the minister believes in democratic input, as I think he does, deep down, he should get away from wanting to do everything by regulation. He should have some courage and include the new body, the Scottish health council, in the bill, so that it can actively work for patient care throughout Scotland and build on the good work that has been done. Everybody who is involved seeks a properly resourced national body that is independent enough to work where it wishes in the NHS.
The question is, that amendment 13 be agreed to. Are we agreed?
No.
There will be a division.
For
Aitken, Bill (Glasgow) (Con)
Baird, Shiona (North East Scotland) (Green)
Ballance, Chris (South of Scotland) (Green)
Ballard, Mark (Lothians) (Green)
Brocklebank, Mr Ted (Mid Scotland and Fife) (Con)
Byrne, Ms Rosemary (South of Scotland) (SSP)
Crawford, Bruce (Mid Scotland and Fife) (SNP)
Curran, Frances (West of Scotland) (SSP)
Davidson, Mr David (North East Scotland) (Con)
Douglas-Hamilton, Lord James (Lothians) (Con)
Ewing, Mrs Margaret (Moray) (SNP)
Fabiani, Linda (Central Scotland) (SNP)
Fergusson, Alex (Galloway and Upper Nithsdale) (Con)
Fox, Colin (Lothians) (SSP)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallie, Phil (South of Scotland) (Con)
Gibson, Rob (Highlands and Islands) (SNP)
Grahame, Christine (South of Scotland) (SNP)
Harper, Robin (Lothians) (Green)
Harvie, Patrick (Glasgow) (Green)
Hyslop, Fiona (Lothians) (SNP)
Ingram, Mr Adam (South of Scotland) (SNP)
Johnstone, Alex (North East Scotland) (Con)
Kane, Rosie (Glasgow) (SSP)
Leckie, Carolyn (Central Scotland) (SSP)
Lochhead, Richard (North East Scotland) (SNP)
MacAskill, Mr Kenny (Lothians) (SNP)
Martin, Campbell (West of Scotland) (SNP)
Mather, Jim (Highlands and Islands) (SNP)
Maxwell, Mr Stewart (West of Scotland) (SNP)
McFee, Mr Bruce (West of Scotland) (SNP)
McGrigor, Mr Jamie (Highlands and Islands) (Con)
Milne, Mrs Nanette (North East Scotland) (Con)
Mitchell, Margaret (Central Scotland) (Con)
Monteith, Mr Brian (Mid Scotland and Fife) (Con)
Neil, Alex (Central Scotland) (SNP)
Robison, Shona (Dundee East) (SNP)
Ruskell, Mr Mark (Mid Scotland and Fife) (Green)
Scanlon, Mary (Highlands and Islands) (Con)
Scott, Eleanor (Highlands and Islands) (Green)
Scott, John (Ayr) (Con)
Sheridan, Tommy (Glasgow) (SSP)
Stevenson, Stewart (Banff and Buchan) (SNP)
Sturgeon, Nicola (Glasgow) (SNP)
Swinburne, John (Central Scotland) (SSCUP)
Turner, Dr Jean (Strathkelvin and Bearsden) (Ind)
Welsh, Mr Andrew (Angus) (SNP)
White, Ms Sandra (Glasgow) (SNP)
Against
Alexander, Ms Wendy (Paisley North) (Lab)
Baillie, Jackie (Dumbarton) (Lab)
Barrie, Scott (Dunfermline West) (Lab)
Boyack, Sarah (Edinburgh Central) (Lab)
Brankin, Rhona (Midlothian) (Lab)
Brown, Robert (Glasgow) (LD)
Butler, Bill (Glasgow Anniesland) (Lab)
Canavan, Dennis (Falkirk West) (Ind)
Chisholm, Malcolm (Edinburgh North and Leith) (Lab)
Craigie, Cathie (Cumbernauld and Kilsyth) (Lab)
Curran, Ms Margaret (Glasgow Baillieston) (Lab)
Deacon, Susan (Edinburgh East and Musselburgh) (Lab)
Eadie, Helen (Dunfermline East) (Lab)
Ferguson, Patricia (Glasgow Maryhill) (Lab)
Finnie, Ross (West of Scotland) (LD)
Gillon, Karen (Clydesdale) (Lab)
Glen, Marlyn (North East Scotland) (Lab)
Henry, Hugh (Paisley South) (Lab)
Home Robertson, Mr John (East Lothian) (Lab)
Hughes, Janis (Glasgow Rutherglen) (Lab)
Jackson, Dr Sylvia (Stirling) (Lab)
Jackson, Gordon (Glasgow Govan) (Lab)
Jamieson, Cathy (Carrick, Cumnock and Doon Valley) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Kerr, Mr Andy (East Kilbride) (Lab)
Lamont, Johann (Glasgow Pollok) (Lab)
Lyon, George (Argyll and Bute) (LD)
Macdonald, Lewis (Aberdeen Central) (Lab)
Macintosh, Mr Kenneth (Eastwood) (Lab)
Maclean, Kate (Dundee West) (Lab)
Macmillan, Maureen (Highlands and Islands) (Lab)
Martin, Paul (Glasgow Springburn) (Lab)
May, Christine (Central Fife) (Lab)
McAveety, Mr Frank (Glasgow Shettleston) (Lab)
McCabe, Mr Tom (Hamilton South) (Lab)
McMahon, Michael (Hamilton North and Bellshill) (Lab)
McNeil, Mr Duncan (Greenock and Inverclyde) (Lab)
McNeill, Pauline (Glasgow Kelvin) (Lab)
McNulty, Des (Clydebank and Milngavie) (Lab)
Morrison, Mr Alasdair (Western Isles) (Lab)
Muldoon, Bristow (Livingston) (Lab)
Mulligan, Mrs Mary (Linlithgow) (Lab)
Munro, John Farquhar (Ross, Skye and Inverness West) (LD)
Murray, Dr Elaine (Dumfries) (Lab)
Oldfather, Irene (Cunninghame South) (Lab)
Peattie, Cathy (Falkirk East) (Lab)
Pringle, Mike (Edinburgh South) (LD)
Purvis, Jeremy (Tweeddale, Ettrick and Lauderdale) (LD)
Radcliffe, Nora (Gordon) (LD)
Raffan, Mr Keith (Mid Scotland and Fife) (LD)
Rumbles, Mike (West Aberdeenshire and Kincardine) (LD)
Scott, Tavish (Shetland) (LD)
Smith, Elaine (Coatbridge and Chryston) (Lab)
Smith, Iain (North East Fife) (LD)
Smith, Margaret (Edinburgh West) (LD)
Stephen, Nicol (Aberdeen South) (LD)
Stone, Mr Jamie (Caithness, Sutherland and Easter Ross) (LD)
Wallace, Mr Jim (Orkney) (LD)
Watson, Mike (Glasgow Cathcart) (Lab)
Whitefield, Karen (Airdrie and Shotts) (Lab)
Wilson, Allan (Cunninghame North) (Lab)
The result of the division is: For 48, Against 61, Abstentions 0.
Amendment 13 disagreed to.
Section 6—Dissolution of local health councils
Amendment 14 moved—[Shona Robison].
The question is, that amendment 14 be agreed to. Are we agreed?
No.
There will be a division.
For
Aitken, Bill (Glasgow) (Con)
Ballance, Chris (South of Scotland) (Green)
Ballard, Mark (Lothians) (Green)
Brocklebank, Mr Ted (Mid Scotland and Fife) (Con)
Byrne, Ms Rosemary (South of Scotland) (SSP)
Curran, Frances (West of Scotland) (SSP)
Davidson, Mr David (North East Scotland) (Con)
Douglas-Hamilton, Lord James (Lothians) (Con)
Ewing, Mrs Margaret (Moray) (SNP)
Fabiani, Linda (Central Scotland) (SNP)
Fergusson, Alex (Galloway and Upper Nithsdale) (Con)
Fox, Colin (Lothians) (SSP)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallie, Phil (South of Scotland) (Con)
Gibson, Rob (Highlands and Islands) (SNP)
Grahame, Christine (South of Scotland) (SNP)
Harvie, Patrick (Glasgow) (Green)
Hyslop, Fiona (Lothians) (SNP)
Ingram, Mr Adam (South of Scotland) (SNP)
Johnstone, Alex (North East Scotland) (Con)
Kane, Rosie (Glasgow) (SSP)
Leckie, Carolyn (Central Scotland) (SSP)
Lochhead, Richard (North East Scotland) (SNP)
MacAskill, Mr Kenny (Lothians) (SNP)
Martin, Campbell (West of Scotland) (SNP)
Mather, Jim (Highlands and Islands) (SNP)
Maxwell, Mr Stewart (West of Scotland) (SNP)
McFee, Mr Bruce (West of Scotland) (SNP)
Milne, Mrs Nanette (North East Scotland) (Con)
Mitchell, Margaret (Central Scotland) (Con)
Monteith, Mr Brian (Mid Scotland and Fife) (Con)
Neil, Alex (Central Scotland) (SNP)
Robison, Shona (Dundee East) (SNP)
Ruskell, Mr Mark (Mid Scotland and Fife) (Green)
Scanlon, Mary (Highlands and Islands) (Con)
Scott, Eleanor (Highlands and Islands) (Green)
Scott, John (Ayr) (Con)
Sheridan, Tommy (Glasgow) (SSP)
Stevenson, Stewart (Banff and Buchan) (SNP)
Swinburne, John (Central Scotland) (SSCUP)
Turner, Dr Jean (Strathkelvin and Bearsden) (Ind)
Welsh, Mr Andrew (Angus) (SNP)
White, Ms Sandra (Glasgow) (SNP)
Against
Alexander, Ms Wendy (Paisley North) (Lab)
Baillie, Jackie (Dumbarton) (Lab)
Barrie, Scott (Dunfermline West) (Lab)
Boyack, Sarah (Edinburgh Central) (Lab)
Brankin, Rhona (Midlothian) (Lab)
Brown, Robert (Glasgow) (LD)
Butler, Bill (Glasgow Anniesland) (Lab)
Canavan, Dennis (Falkirk West) (Ind)
Chisholm, Malcolm (Edinburgh North and Leith) (Lab)
Craigie, Cathie (Cumbernauld and Kilsyth) (Lab)
Curran, Ms Margaret (Glasgow Baillieston) (Lab)
Deacon, Susan (Edinburgh East and Musselburgh) (Lab)
Eadie, Helen (Dunfermline East) (Lab)
Ferguson, Patricia (Glasgow Maryhill) (Lab)
Finnie, Ross (West of Scotland) (LD)
Gillon, Karen (Clydesdale) (Lab)
Glen, Marlyn (North East Scotland) (Lab)
Henry, Hugh (Paisley South) (Lab)
Home Robertson, Mr John (East Lothian) (Lab)
Hughes, Janis (Glasgow Rutherglen) (Lab)
Jackson, Dr Sylvia (Stirling) (Lab)
Jackson, Gordon (Glasgow Govan) (Lab)
Jamieson, Cathy (Carrick, Cumnock and Doon Valley) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Kerr, Mr Andy (East Kilbride) (Lab)
Lamont, Johann (Glasgow Pollok) (Lab)
Lyon, George (Argyll and Bute) (LD)
Macdonald, Lewis (Aberdeen Central) (Lab)
Macintosh, Mr Kenneth (Eastwood) (Lab)
Maclean, Kate (Dundee West) (Lab)
Macmillan, Maureen (Highlands and Islands) (Lab)
Martin, Paul (Glasgow Springburn) (Lab)
May, Christine (Central Fife) (Lab)
McAveety, Mr Frank (Glasgow Shettleston) (Lab)
McCabe, Mr Tom (Hamilton South) (Lab)
McMahon, Michael (Hamilton North and Bellshill) (Lab)
McNeil, Mr Duncan (Greenock and Inverclyde) (Lab)
McNeill, Pauline (Glasgow Kelvin) (Lab)
McNulty, Des (Clydebank and Milngavie) (Lab)
Morrison, Mr Alasdair (Western Isles) (Lab)
Muldoon, Bristow (Livingston) (Lab)
Mulligan, Mrs Mary (Linlithgow) (Lab)
Munro, John Farquhar (Ross, Skye and Inverness West) (LD)
Murray, Dr Elaine (Dumfries) (Lab)
Oldfather, Irene (Cunninghame South) (Lab)
Peattie, Cathy (Falkirk East) (Lab)
Pringle, Mike (Edinburgh South) (LD)
Purvis, Jeremy (Tweeddale, Ettrick and Lauderdale) (LD)
Radcliffe, Nora (Gordon) (LD)
Raffan, Mr Keith (Mid Scotland and Fife) (LD)
Rumbles, Mike (West Aberdeenshire and Kincardine) (LD)
Scott, Tavish (Shetland) (LD)
Smith, Elaine (Coatbridge and Chryston) (Lab)
Smith, Iain (North East Fife) (LD)
Smith, Margaret (Edinburgh West) (LD)
Stephen, Nicol (Aberdeen South) (LD)
Stone, Mr Jamie (Caithness, Sutherland and Easter Ross) (LD)
Wallace, Mr Jim (Orkney) (LD)
Watson, Mike (Glasgow Cathcart) (Lab)
Whitefield, Karen (Airdrie and Shotts) (Lab)
Wilson, Allan (Cunninghame North) (Lab)
The result of the division is: For 43, Against 61, Abstentions 0.
Amendment 14 disagreed to.
Schedule 1
Minor and consequential amendments
Group 7 is on the naming of health boards and special health boards. Amendment 4, in the name of the minister, is in a group on its own.
Amendment 4 is a minor amendment to schedule 1. It removes the existing requirement under the National Health Service (Scotland) Act 1978 that the formal names of health boards should contain the words "Health Board". Under the 1978 act, ministers have a power to name health boards and special health boards by order but, by stipulating that the words "Health Board" appear in all health boards' formal titles, the act limits ministers' discretion on names.
The order that names the various health boards does so according to their geographical location, followed by the words "Health Board"; for example, we have Grampian Health Board and Lothian Health Board. Since 1999, the NHS brand has been developed across the health service in Scotland. Following representations from health boards, I agree that their official names should reflect their names under the NHS brand and their responsibilities for delivering the full range of NHS services, following the dissolution of the trusts.
Amendment 4 allows for the updating of health boards' names to reflect that branding, as has already been done for the special health boards with national coverage. The obligation to use the formulation "Health Board" will be removed. Members will know from their own areas that boards might already be using their new names; for example, NHS Highland and NHS Lothian are doing so. We want to make that possible as far as the legal use of such titles is concerned. I hope that members will support the proposal.
I move amendment 4.
Amendment 4 agreed to.
Schedule 2
Repeals
Amendments 15 to 20 not moved.
Amendment 5 moved—[Malcolm Chisholm]—and agreed to.