National Health Service Reform (Scotland) Bill
The next item of business is a debate on motion S2M-1095, in the name of Malcolm Chisholm, that the National Health Service Reform (Scotland) Bill be passed, and one amendment to that motion.
The passage through Parliament of the National Health Service Reform (Scotland) Bill has been assisted by a great many people and I would like to thank those who have been involved in its progress. That includes the broad range of groups that have taken the time to give evidence to the committees and have represented the views of the national health service, staff, local authorities and the public. I am grateful to the members of the Health Committee, the Finance Committee and the Subordinate Legislation Committee who have debated and scrutinised the bill. Finally, I thank the clerks of those committees and my officials.
The National Health Service Reform (Scotland) Bill contains an important series of measures that will accelerate the development of NHS Scotland into a modern service that responds to and involves patients, that cares for its staff, is free to innovate and is not hindered by bureaucracy.
Having a patient-centred NHS means giving patients and the wider public a voice and an ability to express their views directly to the NHS rather than through a handful of individuals. That is why the bill will make it a legal requirement for health boards to take action to ensure that the public are directly involved in the planning and development of health services, as well as in significant decisions that affect those services. That is not a meaningless duty, but one that will be backed up by a robust public involvement structure that is able to act independently and ensure that health boards perform their duty of public involvement properly.
The key objectives of the bill are to make the planning and delivery of health care more responsive to the needs of local populations; to develop more services in primary care settings; and to break down the traditional barriers between social care, primary care and specialist health services. That is why we are establishing community health partnerships as a key part of our distinctive Scottish health reform agenda. Those partnerships will enable local health care professionals, local authorities, the voluntary sector and communities to work together to improve the health of their local area. They will deliver services to the community in the community where it is safe and sustainable to do so.
The NHS needs to respond to the needs of a diverse Scottish society. That is why the bill also places a duty on the NHS to encourage equal opportunities and I am pleased that the Parliament has agreed to extend that duty to all functions, not just those that are contained in the principal National Health Service (Scotland) Act 1978.
Staff are the core of the NHS and must be properly managed. The bill imposes a duty in relation to the governance of staff that will require boards to have in place arrangements for improving the management of staff and for work force planning.
The bill will provide boards with the freedom to innovate through the duty to co-operate. While we will try to deliver as many services as close to the patient as possible, there are some services that can be delivered safely and sustainably only from highly skilled and specially resourced centres. I want boards to look beyond their boundaries more and to work together to ensure that there is greater and more effective regional planning.
The NHS needs to be able to operate free from unnecessary bureaucracy and barriers. That is why I have dissolved the trusts and will remove the power to create trusts. Primary and secondary care need to be more joined up and that is best achieved through single-system working. Single-system working will allow front-line staff to work together more effectively and, through the schemes of delegation, will empower staff to take decisions on the provision of health care.
When things go wrong, it is important to have effective means of intervening to correct service failure. The health service is a massive and diverse organisation. It would be impossible to prescribe every scenario in which an intervention might take place. However, it is important that intervention takes place only as a last resort and the measure that is contained in the bill will achieve that.
For too long, the NHS has been seen as a reactive health organisation that responds when people are suffering or injured. The NHS, with its partners, needs to be more proactive in promoting health and the new duty of health improvement will achieve that. It will also give boards the powers that they need to do that.
Tom McCabe will cover the details of Shona Robison's amendment to the motion in his speech and, while I look forward to hearing what Shona will say, I fear that I have heard it all before. The NHS is receiving unprecedented levels of funding and the costs of the bill can and will be absorbed by that. It is certainly not right that more of the finite resources that are available should be spent on administrative costs rather than front-line services. The costs associated with the bill are not significant. The bill is about reforming and redesigning existing methods and practice to make them more appropriate for the national health service of the new century.
I am pleased that the Parliament supported the general principles of the bill at stage 1. The bill was improved at stage 2 to include some important new features and I hope that the Scottish Parliament will now approve the bill, which will allow the NHS to develop and continue to be a source of national pride.
I move,
That the Parliament agrees that the National Health Service Reform (Scotland) Bill be passed.
I thank all those who gave evidence during the passage of the bill. I also thank the Health Committee clerks, who did a great deal of work in getting us to the stage 3 debate.
I welcome the main thrust of the bill. As I have said throughout the process, the Scottish National Party has been keen for a long time to abolish trusts, because we want to remove the artificial barriers that exist between primary and secondary care and which have hindered the delivery of an integrated system of health care across Scotland, and because we want to simplify the system and get rid of the bureaucracy in the NHS that has been a major barrier to change and progress.
However, structural changes alone will not be enough. As I said when I spoke about my amendment 12, on direct elections, we have not seen enough of the real reform that is needed if the public are to be empowered. However, that will have to wait for another day. We need to address the fundamental issues in the NHS, such as capacity and financing, which I will deal with later.
As the minister said, the bill has many positive aspects, such as regional working and community health partnerships, which must be dynamic organisations responding to local needs. I do not believe that they represent in any way a cheap option, as was suggested by some during the evidence-taking sessions. I agree with the NHS Confederation in Scotland, which said:
The creation of new bodies almost inevitably has additional costs attached ... and Ministers should be aware of this.
Public involvement is another important element of the bill and we all support the idea. However, as I have said, we need to have real public involvement through direct elections. As the NHS Confederation in Scotland said,
continuous public involvement is not cheap, as NHS organisations have found through experience.
We have had a debate around the independence of the Scottish health council and the abolition of local health councils. My concern about those two aspects remains and, although I will support the motion, I want that concern to be on the record.
On finance, I was interested to hear the minister say that he has heard it all before. I think that he is going to hear even more about the issue. I am sure that he is aware that, according to senior civil servants, three health boards are in dire financial straits at the moment and seven others could go either way. The minister will hear a lot more about the financial problems that are facing health boards. Legislators have a responsibility not to make the situation even worse by passing legislation without ensuring that the resources will follow.
Health boards will have to find the money from somewhere to fund the public involvement elements of the bill—such as community health partnerships—the powers of intervention, the duty of co-operation and the duty to promote health. I do not believe that there will be no overall additional expenditure as a result of those provisions, and I do not think that many health boards will believe it. The money will have to come from somewhere, but from where? Given that all the new responsibilities will have to be funded, the money will inevitably have to come from services and patient care. Surely we all want to avoid that situation.
The purpose of my amendment is to say that we remain concerned that the financial provisions in the bill are inadequate; I hope that members who share those concerns will support the amendment.
I move amendment S2M-1095.1, to insert at end:
"but, in so doing, remains concerned about the lack of detail in the Financial Memorandum regarding potential additional costs arising from the Bill."
I join Shona Robison in thanking the clerks and those who gave evidence to the Health Committee; we were well supported during the scrutiny of the bill.
I am, once again, afraid that we have come back to a situation in which the minister runs everything from his desk and all is controlled from the centre. Today, he has—[Interruption.] I heard that. For the record, Tom McCabe said, "If only." That is the ideology of the ministerial team and probably of the Executive and those in the chamber who support it.
I regret the passing of the trusts, because they were a change in bringing forward health care in Scotland. Obviously, they were due for review but, as I have said before, I would have got rid of the health boards, if anything. In fact, many health board chiefs are beginning to think that there will be rapid moves either to amalgamate boards or to examine the roll-out of the managed clinical networks, which are strategic bodies that examine health care in the wider regional aspect, so I suspect that the changes that are made by ministers will not end here.
I do not, from what the minister has said, understand why the opportunity that exists in other parts of the country to use foundation trusts—such trusts are mutual bodies, so they do not represent privatisation—is to be denied in Scotland, where hospitals want to work in that way. I always thought that the minister was keen on public-private partnerships, but that gets spun into the idea that the only good job is a job that is done in the public sector. That is a load of nonsense—the health service was founded on a public-private partnership and many of the professionals who operate in our health service come from the private or voluntary sectors.
Shona Robison mentioned funding, and the minister said that an increasing amount of money is pouring into the health service, but we are not getting an increasing amount of outcomes from all that money. Since the Scottish Executive came to power, the growth in the number of administrative staff has far exceeded the increase in staff who deliver care in the health service. People might be fed up with my talking about the patient journey, but the patient should be the centre of the health service. The patient is what the service is all about, and we should facilitate patients receiving good care at the right time. That should be based not on a general practitioner saying, "This is my friend from the golf club and I want this to be done for him," as the minister thinks, but on a clinical basis—we should trust our professionals.
In a situation in which there are so many points of failure, we must allow the patient to move and we must ensure that health boards that are in trouble do not have to fund care for other health boards without additional funding being offered. That is the basis of the comments that I made earlier today.
There are aspects of the bill that will lead to improvement. There are many good things about the community health partnerships and I welcome the fact that the voluntary sector—which provides an enormous amount of unpaid support in health care in Scotland—will be represented on them. However, it is also important to ask when we are going to deal with local authorities and health boards working together on patient care, where they have shared responsibility. I still do not understand why the minister refuses to move to a situation in which the budgets are simply brought together and the local authority staff who work on delivering medical care move to the health board. We would then have single patient assessment, a single budget and single management of every case. The twin-track approach is not working in some areas, and I know that one or two councils are looking to take the joint future agenda down the route that I mentioned. There was an opportunity to do that in the bill, but the minister failed to take it.
Once again, we reach the end of passage of a bill that is riven with Scottish socialist tendencies, although there have been flashes of understanding from the socialists in some respects. I say to the minister that I do not think he will survive the journey for long because, to be quite frank, the people of Scotland expect delivery of health care and not just another big bill.
The bill will fundamentally reform the organisation and management of the NHS in Scotland. It will abolish the last traces of the Tories' discredited internal market by dissolving the NHS trusts. The reforms will also devolve decision making and resources to front-line staff through the establishment of community health partnerships. The bill will also give ministers greater powers to intervene when the health service is deemed to be failing. The principle that prevention is better than cure is an obvious one, and the bill places a duty on health boards and ministers to promote health improvement, which is a long-standing Liberal Democrat commitment. Community health partnerships will delegate existing resources to the front line.
One of the biggest improvements that the bill will introduce is the duty to encourage public involvement; I am pleased that I managed to say something about that while the bill was being amended. The bill will make a remarkable difference in addressing the problems that people throughout Scotland face with so-called public consultation. People will have to be consulted not only on planning and development, but on decisions
"to be made"—
those three words are extremely important—
"by the body significantly affecting the operation, of those services".
That is a radical improvement, and I am pleased that it will be enshrined in law, assuming that we pass the bill at decision time.
The Lib Dems will not support the SNP amendment, which says that we should be
"concerned about the lack of detail in the Financial Memorandum regarding potential additional costs arising from the Bill."
As Shona Robison will recall, evidence was given on the issue by one of the smallest health boards in Scotland and it told us about what it had saved by streamlining its organisation. Throughout Scotland, that saving should run into millions, so I will not support Shona Robison's amendment.
I turn to the Conservatives' contribution to the debate. People are often turned off politics, and they say—mistakenly, of course—"You lot are all the same." I take this opportunity to thank the Conservatives publicly for tackling that issue as far as health is concerned, because they are indeed being different. They are championing the cause of the private patient at the expense of our national health service. In Parliament, there are real differences between what the Executive parties offer and the ideological approach that is taken by the Conservatives. We are in favour of reforming and improving the national health service in Scotland but—it seems to me—the Conservatives are interested in undermining it in favour of private practice.
Mike Rumbles is missing this point: if there is health service failure, does not the patient have the right to go elsewhere? We should make the health service as efficient and as well managed as possible. We are not in favour of privatising the health service. We need to give to choice to the patient, and if care can be delivered by other sources, why should it be denied them?
Mr Rumbles, you must wind up now.
I want to respond to David Davidson. He is quite right to say that patients have rights when the service fails, and that is why the power of ministerial intervention is included in the bill. However, the problem will not be solved by his proposal to undermine the national health service by taking public money away from the public health service and giving it to a private health service. We must have a thriving public health service—in which that money makes a difference—and a separate private health service. We cannot subsidise one at the expense of the other. I obviously have to end at that point.
I thank the clerks and other Parliament staff who have helped in the process of bringing the bill to this stage and I thank those who gave evidence as part of that process.
The National Health Service Reform (Scotland) Bill contains much that is to be welcomed, so I am pleased to be able to support it. One of the main principles that underpins the bill is the removal of unnecessary barriers and bureaucracy from the national health service. The bill will devolve more power so that services can be delivered in communities. The NHS should not be a one-size-fits-all service.
The bill will facilitate much more local decision making. In part, that will be achieved by the creation of community health partnerships. CHPs—which will replace the current local health care co-operatives—will require the establishment of joint working with local authorities and other partnership agencies as part of the community planning process. They will have budgetary control and dedicated staff to allow the development of services that best meet local needs in communities and that can be integrated with social care and other local services.
Another important aspect of the bill concerns public involvement in decisions that affect service development and delivery. We have already heard much about public involvement today. In recent years there have throughout Scotland been major changes in the way health care is delivered. For many reasons—too many to go into today—change is necessary, but it is often not without pain, and consultation methods have varied greatly among health boards. Although the Executive has produced guidelines in the form of policy documents, those have not always led to meaningful consultation. The bill will enshrine the need to secure the public's involvement in the planning and development of their health services.
In addition, the bill will place a duty on health boards to co-operate with other health boards and other agencies in planning and providing services. In recent months, there has been much criticism of the lack of regional planning of services. Health boards have taken in isolation decisions that have had effects on neighbouring boards. Although I welcome the measures in the bill, I would like further guidance from the Executive on the consultation process. I hope that the minister can give some assurances on that when he sums up.
One aspect of the bill that I welcome particularly is the promotion of health improvement. As I have said before in the chamber, health improvement has for too long been the Cinderella of the health service. Often, it is the first area to be targeted when money is short. The bill will impose a duty on ministers and health boards to promote improvement of the physical and mental health of the Scottish public. I very much welcome that and I hope that we will in the near future see more details on how that will be done, especially on how boards will work with key partners, such as those in the voluntary sector.
During the Health Committee's evidence-taking meetings on the bill, the British Medical Association, the Royal College of Nursing, Ayrshire and Arran Primary Care NHS Trust and others highlighted the fact that staff governance had been omitted from the bill. The Health Committee raised that issue with the minister at stage 1. I am pleased that the minister took our comments on board and that the duty for staff governance will, after today, be enshrined in legislation.
In conclusion, the bill contains much that is to be welcomed. It brings together a number of recent health care policy developments, such as the joint future agenda, "Designed to Care" and "Partnership for Care". It also addresses a number of concerns that we have had about issues such as consultation and regional planning. I believe that the bill will do much to improve our health service and I will be pleased to support it today.
In the interests of brevity, I will speak only in support of the SNP amendment.
As my colleague Shona Robison pointed out, the budgets of three health boards are currently in extremis and the budgets of another seven are on the cusp of being so. From the evidence that the Health Committee received on the budget, we are aware that the increase in expenditure for Greater Glasgow NHS Board will cover only inflation, the increased staffing costs arising from the new contracts and the costs of complying with European directives. Therefore, any clinical initiatives that the minister wishes to prioritise will require cuts in other clinical services. Another example of such a situation is provided by Argyll and Clyde NHS Board. The Auditor General's report states:
"The auditor considers that NHS Argyll and Clyde's cumulative deficit could reach £60-70 million by 2007/08 and may be irrecoverable."
That is the background against which the Scottish National Party challenges the assertions in the financial memorandum to the bill. Our position is corroborated and supported by the Finance Committee's report. The financial memorandum pretty much states that the major changes—which we support—to the structure of the NHS will be cost neutral. Paragraph 41 of the financial memorandum states:
"The Executive is of the view that there will be no impact on other aspects of public expenditure, including local authorities, or on the costs of the voluntary or private sectors or individuals, as a result of the provisions in the Bill."
Perhaps the minister should address that point when he sums up.
My comments on the financial memorandum are based mainly on the Finance Committee's report, which makes very interesting reading. The report from that secondary committee provided our committee with important and helpful support for our findings. Indeed, I associate myself with the remarks that the deputy convener and my other colleagues on the Health Committee have made about the evidence that was given by witnesses and about the hard work of the clerks.
Paragraph 13 of the Finance Committee's report makes an important point:
"The Committee questioned whether the Scottish Executive could have provided a clearer financial assessment of the costs and savings associated with abolishing NHS Trusts, especially in the initial phases, rather than assuming that they would offset each other."
At paragraph 17, the report states:
"The Committee also received evidence highlighting concerns that until details on the structure, number and scope of CHPs are determined, it is difficult to state whether or not the Financial Memorandum of the Bill is correct."
When members introduce members' bills in the Parliament, they need to ensure that their financial memoranda are correct: it seems to me that there is one rule for members' bills and another for Executive bills, because it is still not clear that those questions have been answered.
Paragraph 29 of the Finance Committee's report deals with the costs of intervention. The minister said that he would address that issue perhaps by spreading the cost across health boards, but that still does not answer all the questions that the Finance Committee report asks. Paragraph 29 states:
"The Committee remains unconvinced that the estimated average cost"—
not liability—
"associated with the power on intervention is reasonable based on the evidence it received."
The Health Committee also pointed out that no assessment has been made of the cost implications of the recommendations that a health board will have to implement following an intervention. Will those costs be paid by the health board in question or will they be spread throughout Scotland? What are the cost implications?
Finally, paragraph 43 of the Finance Committee report deals with public consultation, on which the minister has given us some undertakings. The report states:
"The Committee would recommend that the Health Committee further pursue whether the funding provided at present is adequate for carrying out public consultation as detailed in the Bill."
The health boards that were mentioned are quite small health boards, but other health boards cover large areas and have major deficits. My party is not convinced that the bill is financially neutral.
The Executive is either burying its head in the sand or wilfully under-resourcing the NHS. To suggest that the bill has no financial implications and that NHS boards will be able to absorb the changes flies in the face of the evidence. That is why I will support the amendment in the name of Shona Robison.
Let me quote from a letter that was recently issued to a division of one NHS board. The letter ably demonstrates the sort of pressures that boards face and the drastic measures that they are considering in order to bring themselves into financial balance.
Under the heading "Benchmarking acute services and identifying potential to reduce capacity", the letter suggests that the division will have to review its
"homeopathic service … All ‘standalone' rehabilitation hospitals … Dermatology inpatient beds"
and
"Conversions to five day wards".
It will also have to
"Reduce continuing care beds"
and
"Close beds to reflect reduced cross boundary flow".
On prescribing, the letter states that the division will have to
"Restrict introduction of new drugs"
and implement an
"Aggressive cost reduction programme".
On pay, it says that the division will have to
"Manage introduction of Agenda for Change within funding available".
That means tinkering with the agenda for change, which was supposed to be an independent evaluation of people's roles.
The recommendations go on. The division will have to
"Reduce agency cost …Identify potential for reduced and reshaped workforce"
—which means job losses—and
"Identify potential to reduce mental health beds".
I could go on. The letter contains 14 separate recommendations for cuts and many of the recommendations are broken down into further subsections. That letter describes reality.
Although we will support the bill, we have serious reservations about the impact that it will have on costs to NHS boards and the ensuing impacts on services to patients. I remain concerned about a number of the details. The jury is still out and continuous scrutiny will be required.
I will not repeat all the points that were made earlier in relation to the amendments on health councils. There is a serious lack of democracy and accountability in the provision of health services, which the bill does not address in any way. The bill deals with delivery of health and social care, which was previously part of the joint future agenda, but it does not address unequal terms and conditions, roles, responsibilities and training. The question of accountability of staff—who their employer is and how their status is monitored—is also not addressed. There are difficult issues on the ground.
There will not be enough trade union and clinical input into the composition of community health partnerships and the BMA has told us that there will not be enough input from GPs, for example. However, there will be an increase in the participation and influence of private business. I have deep concerns about that.
The bill provided us with an opportunity to introduce national collective bargaining for NHS staff in Scotland. That opportunity has been missed, which is unfortunate.
I challenge the Executive to be realistic about, to justify and to indicate what it will do about the current financial situation. It should justify the introduction of legislation that will place a burden on NHS boards, which workers must deliver and boards must manage. Where will the funding come from? The reality is that services are being cut left, right and centre.
The problem with the NHS in Scotland today is not funding, but that it is driven from the centre and has constantly to respond to centrally set priorities and targets, each of which puts more pressure on the system and results in more administrative costs, harassed staff and frustrated patients waiting to access the system.
The National Health Service Reform (Scotland) Bill was a golden opportunity to put things right—to turn the system around and truly to devolve decision making in the health service from politicians to professionals and patients. If there were a focus on the needs of the patient and funding went with the patient, choice would open up for them and the service would soon respond. Sadly, that opportunity has been lost.
The removal of NHS trusts apparently involves the removal of a layer of bureaucracy, but we see it as a move away from the patient towards centralisation because—essentially—the trusts have been subsumed as operating divisions of health boards, which are one step further away from patients.
There is merit in much of the bill, but we still have many concerns about it. The development of managed clinical networks deriving from regional co-operation between health boards is a step in the right direction, but it falls far short of our proposals to allow patients the option of receiving their treatment from any NHS provider or from the voluntary, not-for-profit and independent sectors if they choose, based on a national tariff system that would define set costs for specific procedures, as explained by David Davidson.
I will respond to the criticisms of our policies. As I have said often in the chamber, I am and always have been a passionate believer in the NHS. My family has more reason than many to be grateful to it, following my son's successful liver transplant 12 years ago. However, as Jean Turner did, I point out that many private patients are only private patients because they cannot timeously get the treatment that they need from the public service. I know many elderly people who are by no means wealthy and who have given their life savings to procure the treatment that they need. There is no reason why those people, who have contributed to the NHS all their lives through taxation, should not take a part of the cost of their treatment with them, which would free up space in the service for those who are still waiting to gain access to it.
The development of local health care co-operatives into community health partnerships has merit and will give local stakeholders and front-line staff a role in decision making on the delivery of local health care services, which must be in the interests of the patient. However, there is still much work to be done on the statutory guidance for CHPs—on their remit, role, membership, number and cost. It is extremely important that the Health Committee has the opportunity prior to their introduction to scrutinise the guidance and regulations relating to the operation of CHPs.
The duty on health boards to ensure public involvement is a positive step but, as the BMA stated, if the proposed Scottish health council and CHPs together are to engage the public and encourage them to play a meaningful role in community planning, it is essential that that work receive appropriate funding. We still have doubts about whether the proposed Scottish health council can be truly independent as part of NHS Quality Improvement Scotland and we do not agree with the proposal.
We also have serious concerns about the cost of the provisions in the bill, particularly in relation to intervention, CHPs and the Scottish health council.
Will the member take an intervention?
The member is winding up.
We question the Executive's claim that the bill will be cost neutral. It is a particular concern that health boards could incur the costs of intervention at the very time when they are facing serious financial difficulties.
We see merit in some of the proposals in the bill but we have serious concerns about others. Above all, we see the bill as a missed opportunity for true reform of the NHS in Scotland—to put the patient and health professionals at the very core of the service. Sadly we cannot, therefore, give the bill our support.
This has been an important debate for the future of the NHS in Scotland. I express my thanks to those who have been involved in the passage of the bill.
The bill that we are being asked to pass today will update the principal act that governs the national health service—the National Health Service (Scotland) Act 1978. It will ensure that the right legislative framework is in place to enable the NHS to move forward, to modernise and to adapt to the needs of a 21st century health service.
However, the founding principles—that health services should be free to all at the point of delivery and that health professionals should be able to work together without barriers to deliver the best possible care—remain as valid today as they were in 1948. Those principles are widely shared by the people of Scotland and by many of the people who gave evidence on the bill.
It is disappointing, though not surprising, that the Conservatives have fundamentally misunderstood what the bill is about. The bill is about decentralising as much as possible down to front-line staff. It is remarkable that David Davidson and his colleagues harp on about centralisation when, week after week, they ask for specific funding for particular conditions or for their pet project of the month. Week after week, they ask for central direction from the Executive, but in this debate they have harped on about their claim that the bill is about centralisation. It is not. The bill is about health boards becoming single bodies and about community health partnerships delivering services locally with local authorities and other partners and pursuing safe, sustainable services. It is about our being able to take action to ensure that local and regional services are provided to an adequate standard. That is the reform agenda that is right for Scotland and which will provide high-quality health services right across the country.
As members know only too well, the Government is injecting record amounts of money into the national health service, but the money pot is not bottomless. Tough choices need to be made, especially in relation to specialised services, and the public need to be meaningfully involved in those decisions. In some cases, the status quo is not an option if we are to continue to provide safe high-quality services. No one group can opt out of making choices—not the Executive, not health boards and not the public. The duty of public involvement is just that—a duty to involve the public in decisions. It is not a duty to avoid making decisions.
As the Health Committee recommended in its stage 1 report, safeguards will be put in place to ensure that the proposed Scottish health council and its local advisory councils are able to act at arm's length from the bodies that they monitor. That will be achieved through the regulations that will establish the health council—regulations that the Health Committee will be able to scrutinise.
The National Health Service Reform (Scotland) Bill will also address the balance in the NHS between health treatment and health improvement. That is important to our vision of what a health service should be—a service that actively promotes health improvement, rather than just a service to which people turn when their health is failing. A focus on health improvement will lead to a healthier population, which is better for the NHS and better for our country.
Finally, I want to address Shona Robison's concerns about the financial memorandum that accompanied the bill. As Malcolm Chisholm said in the short debate on the financial resolution at stage 1, it is no surprise that the SNP's only substantive contribution is—yet again—to call for more resources.
The bill that we pass today will lead to some additional costs. That has always been clear, but there will be additional savings which, together with the redistribution and better management of resources, will more than make up for the additional costs.
Will the minister give way?
No—he must conclude.
Okay.
I will give the example of the dissolution of trusts. We know that Dumfries and Galloway NHS Board saved £500,000 in one year after its move to single-system working and that Borders NHS Board saved a similar amount, albeit over a longer time. However, the move to single-system working is not about cutting costs; it is about improving health care for patients through greater co-operation and collaboration. If savings can be made, I expect them to be reinvested in the front line.
The new duty of health improvement is designed to make it easier for boards and ministers to spend existing money more effectively on promoting health improvement. We already spend large sums of money on promotion of health improvement. Examples include the extra £173 million that was announced in "Building a Better Scotland", on top of the £134 million that is already being spent between 2003 and 2006.
As Malcolm Chisholm said in his opening speech, we have seen record levels of investment in the NHS in Scotland. Those resources can and must be used more effectively and that is what the bill is all about. I urge members to reject the SNP amendment.
Today, we are being asked to pass an important bill that will reform the NHS so that it continues to deliver quality health services to the people of Scotland. To do that we need to reduce bureaucracy, increase collaboration, delegate functions that can be delivered locally to community health partnerships, support staff and intervene effectively when necessary. The bill will achieve that and more. I strongly urge every member to support it.