Plenary, 06 Jul 2000

Meeting date: Thursday, July 6, 2000

Official Report 762KB pdf

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National Health Service

We now come to the debate on the modernisation of the national health service. Although it is not stated precisely in the business bulletin, it is intended that the debate should be interrupted at half-past 12 for a short debate on the Government Resources and Accounts Bill. The debate on the national health service will continue during the afternoon.

We live in interesting times. More important, we live in challenging times. Fifty-two years ago this week, the national health service was created. Fifty-two weeks ago, the Scottish Parliament took up its powers. It was new politics, a new system of government and a new opportunity to improve the health of the Scottish people and to address the needs of the people's health service. It was a chance to look afresh at the big picture and to address the big challenges. That is what today's debate should be about.

Let us all remember that the NHS is our biggest and most important public service. It is our country's biggest employer. It has more than 135,000 staff, 5 million patients and a £5 billion budget. That is the scale of the task and, more important, the scale of the opportunity.

There has been a lot of talk over the past week about £34 million. I will return to that later. For those who are interested in numbers, the important figure is the £5 billion—the five thousand million pounds—that is being invested in the NHS and in the health of our people in the current year. The important issue is what is being done with that investment. That is what NHS modernisation is about—matching investment with reform; not just about spending more, but about spending better. It is not just about tinkering at the margins of change, but undertaking the root-and-branch reform that is necessary to build a health service fit for the future; not by yet more restructuring, but by rethinking and reorganising services around the needs of patients.

Some of the numbers particularly interest my constituents. In Tayside, we may face six years of austerity because of a projected overspend in the Tayside University Hospitals NHS Trust. Is the minister able to give a commitment today that some of the underspend from last year will be allocated to support the trust in coming to grips with the very difficult circumstances that it faces, to guarantee that my constituents and those of my colleagues who represent Tayside and Fife are not prejudiced by a reduction in the availability of health care in Tayside?

I am pleased to say that more than £20 million in additional resources has already gone into the NHS in Tayside. It is precisely because I want that additional investment to be used effectively and to be managed wisely that I have taken action. It is why I responded to the report published last week by the task force on the management of NHS services in Tayside. It is why I will continue to act on the information that I have received to ensure that people throughout Tayside get the services they need and deserve.

People in Tayside, as in every other part of Scotland, need a modernised health service. That takes time to deliver. It takes investment, energy, commitment, determination, vision, pragmatism and principles—all in equal measure. That does not reduce to soundbites or to a single spending decision, but the results are real. The 568 extra heart bypass operations performed in the past year are real. The 50,000 more operations performed in the NHS in Scotland this year are real. The quarter of a million more contacts made by community nurses and by health visitors to people in their homes this year are real. The faster diagnosis and treatment now being delivered by more than 140 one-stop clinics across the country is real. The 62,000 more out-patient attendances at hospitals this year are real.

I can tell members what else is real: the commitment of this minister and of every minister in this Executive to invest in and to build in Scotland an NHS that is truly fit for the future.

Will the minister give way?

That is why we made clear in the programme for government our commitment to deliver substantially increased real-terms spending on the NHS; to shape a modern NHS that cares as well as it cures; to improve the patient's journey and to strengthen the voice of patients, staff and the public; and to tackle the root causes of ill health in radical and innovative ways.

Will the minister take an intervention?

In just one year of this Administration, we have made progress on all those things. I will give just some examples: the building of eight new state-of-the-art hospitals; the investment of more than £30 million in community health centres and general practices to provide modern, integrated health and social care services; the linking of GP practices and hospitals to NHS net—with pharmacies to follow—so that patients can get faster appointments, test results and prescriptions; major developments in telemedicine, which benefits rural communities in particular; investment in the Scottish NHS Direct service to provide 24-hour health and social care advice, with services to be launched later this year.

There has also been investment in staff.

Will the minister give way?

I cannot resist the temptation.

If the Minister for Health and Community Care is speaking on behalf of all her colleagues in the Executive, why did the First Minister feel it necessary to issue the no-spinning edict that seems to have been directed at her?

Once again, the SNP leader disappoints but does not surprise. I said at the beginning of my speech that this debate is about the big issues, and it is the big issues in the NHS in Scotland that we are focusing on because those are what matter.

Will the minister give way?

We are investing £6 million in a new NHS education, training and lifelong learning strategy and we are taking action to reduce junior doctors' hours. We are ensuring better pay, to recruit and retain nurses in the service, and £8.4 million was announced last week for more doctors and nurses, allocating skills and resources to the areas of greatest need, such as intensive care, accident and emergency services and our communities.

Will the minister give way?

We are placing emphasis on and providing investment in the NHS's clinical priorities of cancer, coronary heart disease and mental health, and we are providing £13.5 million for new cancer equipment.

As further evidence of our commitment to invest wisely, I am pleased to announce that we are allocating an additional £30 million for equipment for the NHS. That money, which is part of the additional resource that was received as a consequence of the chancellor's March budget, will be targeted specifically on much-needed X-ray equipment and scanners to provide better, faster diagnosis. It will also be used for sterilisation equipment, to take effective action to reduce the risk of hospital acquired infection.

Will the minister give way?

All those improvements and so many more are delivering real benefits to patients throughout the country and are rewarding the innovation and creativity that is taking place in the NHS throughout Scotland.

We are doing much more besides. The redesigning of services is delivering improved care and faster treatment, and preparations are under way for the launch in the autumn of our patients project to improve communications with patients and to strengthen their voice. In addition, we have been responsible for the learning disability review, the work of the Scottish Partnership Forum, the establishment of the Clinical Standards Board for Scotland and the Health Technology Board for Scotland, and the launch of the carers' strategy for Scotland. Much has been done over the past year, but there is much more still to do. I am not, have never been, nor will ever be complacent about that.

The NHS in Scotland delivers high quality care. In the main, it provides a service of which we can be proud. However, we all know that people are waiting too long for care and treatment and that too many people still do not get the right treatment in the right place at the right time. Today, I expect that the Opposition will yet again have much to say about problems. Instead, I would like to focus on solutions.

Money is always suggested as the solution. Of course investment is key. That is why almost £500 million more is being spent on health in Scotland this year than last, and why we have given a commitment to increase spending on health in Scotland by £400 million to £500 million in each of the next three years. That will take total spending on health in Scotland to more than £6.5 billion by 2003.

Will the minister give way?

None the less, let us nail here and now the myth that money is the only answer. New investment will not, of itself, deliver the change that our people need.

Will the minister give way?

As well as investment, we need reform in the NHS. Money will not, of itself, overcome the traditional cultural, institutional and professional barriers that have, for too long, militated against the delivery of effective patient care. Money, of itself, will not get rid of the blockages and bureaucracy, the professional demarcations or the gaps and duplication that still exist in the NHS.

Will the minister give way?

Too often, still, the way services are delivered owes more to the needs of the service than the needs of patient. That is why the NHS needs modernisation, investment and reform.

Since the turn of the year, we have been mapping out our modernisation programme for the NHS in Scotland. I want to set it out to the Parliament today. In February, at a conference of the leaders of the NHS in Scotland, I set out the three broad themes of our modernisation programme. The first is a commitment to modernise the process of policy development. The second is to modernise service delivery, to transform the way services are designed and delivered. The third is to modernise the governance of the NHS in Scotland; to clarify roles and accountabilities and ensure that local health systems operate as a partnership to deliver seamless patient care. Work is now progressing on all those areas.

Will the minister give way?

As I agreed with the service in February, we are now taking forward the development of a national health improvement programme for Scotland to provide a clear strategic framework for the development of the NHS. We are developing a more open and inclusive approach to policy development and service design, locally and nationally, involving people in important decisions about the future of their local services. Sustainable change needs real involvement of communities, staff and other interests. The local acute services reviews taking place at present are prime examples of that approach.

We have identified key target areas for action, including shortening waiting times and speeding up treatment and radically improving the links between health and social care to ensure genuinely seamless services, especially for the elderly. We are moving towards launching our first walk-in, walk-out hospitals and we are harnessing modern communications technologies to drive and facilitate new ways of working. All that progress is now being accelerated, with clear objectives and time scales that over the past few months have been agreed with every health board in Scotland. It is a significant and ambitious programme of work that we are committed to taking forward.

A modern NHS also requires changes in the way the service is managed. Attitudes, behaviours and processes left over from the internal market persist. They must be replaced with practices and accountabilities that befit a 21st century, patient-centred NHS in Scotland. That is why we are developing and improving the appointments system for NHS trust and board members. That is why we are extending the governance framework for health boards and trusts. That is why we are ensuring that corporate contracts encompass wider health and social inclusion objectives, so that health boards work much more closely with their partners outside the NHS.

Sit down.

Order

Sit down.

Are you chairing this? Mr McCabe is giving instructions to the chair.

No—are you chairing it?

We will not have members addressing one another across the chamber. Members will address the chair.

Please continue, minister.

I am grateful for your intervention, Presiding Officer. It is important that Parliament has the opportunity today to hear what the Executive is doing to drive forward modernisation and improvement in the NHS.

I have spoken about investment. I emphasise that it is being used to support and lever effective change. The £60 million of additional resources that was released to health boards last week is being linked to the delivery of specific priorities such as tackling waiting times and reducing delayed discharges from hospitals to the community.

Will the minister give way?

To drive forward this formidable programme of work, we need to have the people and processes in place. Yesterday, the first meeting of the new NHS Modernisation Board for Scotland took place. The board will help drive forward our modernisation programme. It will also build on and co-ordinate the work of our national network and project groups, which bring together people from across the service to address issues such as waiting times, winter performance, delayed discharge and capital planning.

The members of the modernisation board are talented, knowledgeable and effective individuals—champions for change. They are people who will bring a fresh perspective to our thinking on modernising services.

We also need wider involvement in our work. That is why, in the autumn, we will hold the first meeting of the new NHS modernisation forum. It will bring together a wide range of key NHS stakeholders to ensure that they have the opportunity to have meaningful involvement in shaping the future of our NHS in Scotland. Professionals, NHS staff, trade unions, patients, carers and people working in social care will all have a seat at the table.

Of course we have a long way to go—transformation on such an ambitious scale takes time and commitment from politicians, professionals and partners in the health and social care system. Already our approach to the modernisation of health services, locally and nationally, is changing people's day-to-day experience of the NHS. The transformation is already under way all over Scotland as the staff who deliver services come together to design new services in response to local needs.

Will the minister give way?

New partnership-based structures have been put in place in the NHS. Those structures are empowering our professionals and liberating their skills. That is happening throughout the NHS in Scotland.

One of the real privileges of my job is being able to see at close quarters the work that is being done in the NHS. I hope that we in this chamber can get better at celebrating and championing that work. We need to remember how much has been achieved.

Will the minister give way?

Of course more is still to be done. Of course we need to work hard to improve further people's experience of the NHS. Of course we must do more to turn around the divided and underfunded system that we inherited. I do not condone service failures and I do not condone services that build in waiting and anxiety, with the result that patients who might have benefited from early treatment are let down badly. That is not the sort of NHS that I want for my constituents and it is not the sort of NHS that I want for my family. However, neither do I condone those who would capitalise on such failures. I certainly have no truck with those who—often in a bid to win political points—only undermine patient confidence.

Will the minister give way?

Will the minister give way?

Scotland has a long history of clinical excellence that stands comparison with any other nation. We have staff throughout the NHS in Scotland who are capable of excellent work and excellent innovation. It takes courage to press on with NHS reform and it takes conviction to drive change forward, especially in an organisation as large and complex as the NHS in Scotland. There are vested interests and resistance to change, but there is also a growing demand for change and growing support for it, both among the general public and, crucially, within the NHS itself. People want practical, positive change. I want practical, positive change. This Executive wants practical, positive change. That is why we are backing that commitment with real investment.

Let me return to the debate—or, rather, the sideshow—of the past week. Let me set out the facts. Opposition members may care to listen for a moment to learn those facts.

Will the minister give way?

Will the minister give way?

In a health budget of around £5 billion, £135 million—that is, around 2.5 per cent—was carried over from last year to this. Much the same has been the case in previous years. That money is not an underspend and it is not surplus money. In the main, it is continuing spend on continuing capital projects and continuing planned expenditure by health boards on continuing local services. Of that money, £101 million is carrying over within the health budget to be spent, as planned, on committed NHS expenditure. The remaining—and much talked about—£34 million is, as the Deputy First Minister stated clearly and unequivocally this week, being set aside for health-related projects.

Will the minister give way?

This Executive wants a Scotland in which fewer people need health care because there is less illness. That is why we held a healthy Scotland convention this week, to bring ministers with different portfolios together with people with skills, expertise and perspectives from right across Scotland.

It is only by pulling together policies and resources across the Executive that we can deliver real health improvements to the Scottish people, such as action on drugs and homelessness and action for the elderly. People cannot have it both ways. They cannot call on the Executive to deliver joined-up government and then castigate us when we do.

Health improvement cannot be delivered simply by spend in the NHS, and the NHS cannot be improved simply by spend in the health service. As the Minister for Health and Community Care I am delighted that £10 million—almost one third of the much vaunted £34 million carry over from last year—is being directed towards improved community care. We have already allocated extra money to health boards for that purpose. Now the additional £10 million will help tackle the community care end of the problem. Those, quite simply, are the facts.

In closing today, I lay down a challenge to Opposition members—a challenge based perhaps more on hope than on expectation. I say to them, "Raise your game. Raise the debate. Rise to the real challenges of tomorrow rather than the cheap jibes of today." The national health service is more important than any political party. It is certainly far more important than any individual politician. The NHS is about people—the people who work in it and the people who use it. It is their interests and their future that matters.

I move,

That the Parliament recognises the Scottish Executive's commitment to the NHS in Scotland and to improving the health of the Scottish people; supports the Scottish Executive's commitment to build on the founding principles of the NHS and to providing a modern health service designed around the needs of patients; recognises that the delivery of a modern NHS requires both resources and reform; welcomes the Scottish Executive's commitment to target its record investment in the NHS to areas of greatest need and to those changes which have greatest benefits for patients, and supports the Scottish Executive's plans for the modernisation of the NHS in Scotland.

What a tired, flat performance that was from the minister. Perhaps under the circumstances it was all that could be expected.

Today I want to examine the Executive's record on health over the past year and to suggest a way forward for the long-term future of the health service in Scotland. Tired though the minister's speech was, I must say that her performance must make her a major contender for the brass neck of the year award. However, this minister has had plenty of practice when it comes to defending the indefensible. For nigh on 14 months, we have been subjected to the same old complacency—the same old self-congratulatory doublespeak.

Of course, today's debate was never meant to be like this. It was meant to be the climax to a long-planned series of announcements designed to convince the people of Scotland that the health service was indeed safe in new Labour's hands. In order to achieve that aim, the spin machine department was put on double time. All the old announcements were dusted down and the venues were selected. It was to be Deacon's fightback to public credibility. Instead, what we have witnessed is more akin to Custer's last stand.

The minister had not reckoned on her wee pal Jack coming along with a perfectly planted knife right between the shoulder blades. Just after the minister had said last week with great fanfare what she was going to do with £8.4 million, along came her colleague the Minister for Finance, who told us not only that the health budget had been underspent by £135 million, but that the Minister for Health and Community Care had agreed that 25 per cent of the underspend was to be given to him for areas other than health.

No.

Lies. Absolute nonsense.

Order.

Did the minister not realise that it was accepted practice that all underspend on health should be retained in the health budget?

Nonsense. That is not true.

Can the minister explain why she saw fit to relinquish so easily £34 million of much-needed money for the health service? Even the hastily cobbled-together compromise was made purely in the interests of Ms Deacon and Mr McConnell's careers—such as they are—rather than in the interests of Scotland's patients. As if that was not bad enough, remember that this was supposed to be a week of glorious headlines for Labour in the build-up to today's debate. The actual headlines recorded the stark reality of Scotland's health service under Ms Deacon's stewardship.

I feel constrained to speak, because the facts are being completely distorted. There has been an underspend in the NHS every year, certainly since I started in the health service. Every year, health boards used to rush to spend the money in March on all sorts of crazy things that were totally unnecessary to the service. The Finance Committee of the Parliament, in negotiations with the Minister for Finance, agreed that all spending departments—[Members: "Speech."] All spending departments—

I think that we have got the message.

The facts need to be corrected.

Order.

As I said, we have got the message—

The member allowed the intervention. Unless the Presiding Officer stops me, I have the right to conclude.

Order.

Twenty-five per cent of all spending departments—

Presiding Officer, can you stop this? The member is making a speech.

I am just asking whether the member believes—

Order. Please sit down, Dr Simpson.

The fact is that both local government and justice retained 100 per cent of their underspend. Why did Susan Deacon not fight for Scotland's health service?

After that speech from Dr Simpson, I will continue. The Tayside task force reported and revealed its concern over the standard of monitoring by Ms Deacon's department. The task force indicated that, had the management executive been doing its job effectively, the situation in Tayside could have been remedied much earlier.

Then there was the British Medical Association conference. Dr John Garner, chair of the BMA in Scotland, not only pointed out the fact that Scotland was not getting the 6.1 per cent uplift that was promised in the budget, but accused the Executive of indulging in

"sound bite politics linked to . . . a headline on the early evening news and in the morning papers."

The minister has certainly grabbed the headlines this morning.

Then came the publication of details—which have been known for some time—about the scandal of cancer patients in Scotland having to wait for up to 13 weeks for life-saving radiotherapy treatment.

Only this week, a clinical director of Lothian Primary Care NHS Trust, Dr Anna Glasier, compared conditions in her clinic to those in developing countries and said that she was ashamed to treat patients in such an environment.

Instead of today being the minister's opportunity to regain her credibility, we have a beleaguered minister. Not only has she been mugged by the Minister for Finance and shown the yellow card by the First Minister, her dismal stewardship of the health service in Scotland has been laid bare for all to see.

Let us take a look at that stewardship over the past year. We all remember the winter crisis, when we saw the classic Deacon approach. No matter that all elective surgery was cancelled and that seriously ill patients were being ferried around Scotland in search of intensive care beds, the Minister for Health and Community Care adopted what has become her standard response—deny that there is a problem, accuse the SNP of scaremongering and bang on about the new money that new Labour is putting into the health service. The truth, of course, is that the health service in Scotland was able to cope during the winter crisis only thanks to the dedication and good will of health service staff. Those staff worked extra hours, forwent days off and, in many cases, worked back-to-back shifts.

On Monday, we heard the evidence from a Unison survey that showed the increased work load for health service staff since 1995. In 1995, there was one doctor for every 92 patients; today, one doctor has to look after 110 patients. In 1995, there was one nurse for 18 patients; today, one nurse has 24 patients to care for. In 1995, there was one domestic—who are important people—for every 211 patients; today, there is one domestic for every 301 patients. And we wonder why there has been an increase in hospital-acquired infections.

Will the member give way?

No. I will be like the Minister for Health and Community Care and continue.

That is the reality of being a worker in the health service under new Labour. Even worse, those figures show the reality of the decline in patient care as a result of Miss Deacon's mismanagement of the health service in Scotland.

Will the member give way?

Will the member give way?

I will give way to Margaret Smith.

Rather than stand there attacking people, will Kay Ullrich say what the SNP would do to improve the health service in Scotland? Given that the latest figures show that SNP spending pledges so far are around £3 billion, which would be an extra 15p on income tax, and that the Executive is already spending double what the SNP promised in its manifesto, what would the SNP do to improve the health service?

I will tell the chamber one thing—if we were sitting on the amount of money that the minister is sitting on, the health service in Scotland would not be in the state that it is in today. [Interruption.] Presiding Officer, will you deal with the rabble?

I will make the chairing suggestions, thank you.

There are many examples of Miss Deacon's do-nothing approach.

Answer the question.

I have answered the question.

For example, the debacle—[Interruption.]

Order.

This is serious stuff. The people out there want to hear about it. These are the issues that people care about. For example, we had the debacle of the closure of Scotland's only heart transplant unit. Members will remember Miss Deacon's discomfort as she ducked and dived during the debate on that matter. Members will also remember that she never answered the questions that we asked that day. I will ask them again—Scotland's heart patients deserve to know.

When did the minister know of the crisis at the unit? Was it when she first took over the health portfolio 52 weeks ago? After all, the unit was nationally funded, and it had been operating with only one surgeon since 1995. Alternatively, did the minister first become aware of the crisis last summer, when the sole surgeon asked for another to be appointed? Did the minister know in January, when all transplant surgery ceased, or was it when she opened her paper on the morning of 3 May? Was it the case that, by 10 May, she realised that she must be seen to be doing something, and gave the trust a whole two days to present an action plan? Either the minister was unaware of the situation, or she knew and failed to act. Either way, the only conclusion that can be drawn is of a minister not in control of her brief. When did the minister know? I will take her intervention now.

Do not look now, Susan; he is after your job.

Last week—[Interruption.]

On a point of order, Presiding Officer. Will you control Labour and Liberal Democrat members?

I have lost three minutes because of this.

Carry on, Miss Ullrich.

Last week, we had the publication of the research study in Glasgow that highlighted the fact that cancer patients were having to wait an unacceptably long time for radiotherapy. Again, that should not have been news to the minister. In September 1999, the Royal College of Radiologists issued a report on the shortage of linear accelerators and consultant radiologists. That was followed quickly by a British Medical Journal report, which showed that the UK has fewer radiotherapists per head than Poland and fewer medical oncologists than any nation in western Europe.

I am sorry, we do not have time for another speech.

It will not be another speech.

This is serious stuff. As a doctor, Richard Simpson should understand that.

During the 3 February health debate, I raised the issue of waiting times at the Beatson oncology clinic. That day, I highlighted the plight of a patient who was diagnosed with lung cancer on 19 November last year and given a start date for radiotherapy treatment of 24 January this year. The situation at the Beatson was not news to the health minister. What was her reaction when that scandalous situation became public knowledge last week? She said that it was up to the trust to plan appropriately. No it is not. The buck does not stop with the trust; it stops with the minister.

Here we have a health minister whose modus operandi seems to be to deny, to ignore, to blame someone else and, if pushed into a corner, suddenly to appear to be taking action—more in an attempt to be seen to be doing something than actually to address a problem.

On a point of order, Presiding Officer. We are supposed to be discussing the modernisation of the national health service, not giving a tirade against Susan Deacon.

That is not a point of order. Carry on, Miss Ullrich.

I have already lost three minutes because of the behaviour of the other parties.

I will be the judge of the time, Miss Ullrich. Please carry on.

I am coming to the end-of-term report for the minister. I am afraid that the report that she must take home today will read, "Susan's coat is on a very shooglie nail." As we all know, it is not just the SNP that is saying that. The truth is that new Labour is in deep trouble over its handling of the health service. That is why we are seeing such a flurry of activity.

Money is being found from the depths of already-announced budgets—reannouncements and more reannouncements. Where, I must ask, is the long-term planning? Where is the long-term strategy for the delivery of health care in Scotland?

On a point of order, Presiding Officer.

Is it a genuine point of order, Mr Brown?

Is it in order for members to speak to a motion that calls for action and for new and imaginative methods without giving us some insight as to what those are and what the alternatives are?

That is not a point of order, Mr Brown. Miss Ullrich, please carry on. I am keeping a close watch on your time.

Every action and every announcement by the health minister is for the short-term benefit of new Labour, or Susan Deacon, or both. Last week's events provide a clear example of what a political football the health service has become, not just between political parties but, here in Scotland, between Labour ministers seeking election to what we shall call a promoted post. This short-termism must stop. Health is too important to be subject to the constraints of electoral terms of office.

There is, however, a small glimmer of hope in what the minister said today about the modernisation board. That goes some way towards embracing the SNP policy of establishing a national health care commission. The minister has failed to understand one crucial element of that SNP policy. [Interruption.] Members have been saying that they want to hear what SNP policy is, so they should now listen.

The one crucial element is to include cross-party representation of MSPs. After all, surely no one in this chamber does not want the health service in Scotland to rate alongside the best in the world. With cross-party representation on a health care commission, we could develop a long-term strategy with a consensual approach to ensure that the maximum health care benefit is achieved for the people of Scotland. Cross-party representation would allow us to move away from the current headline-grabbing, short-term approach of the Executive. Cross-party representation would also allow for a consistent approach to spending and commitments, in line with the long-term strategies developed by the commission. That would remove the tendency towards big spending rises in election years. It is no coincidence that new Labour's current panic about the health service coincides with the forthcoming Westminster election. Only a consensual approach will ensure that Scotland's health record is brought closer to European averages.

Will you wind up, please?

It is unacceptable that despite the Executive's exaggerated claims—[Interruption.]

Order.

If members listen, they will learn something.

According to World Health Organisation figures for expenditure on health as a percentage of gross domestic product, Scotland ranks below nations such as Costa Rica, Nicaragua, Honduras, Panama, Namibia and Mozambique. The minister cannot—

Will the member give way?

I am winding up.

The minister cannot seriously believe that, given the dreadful record of the her stewardship of the health service in Scotland over the past year, anyone other than the whipped masses behind her could support that self-congratulating fiction of a motion.

Susan Deacon will be glad to hear that the SNP is not calling for her resignation today. She may wish to listen to public opinion, or indeed the First Minister's opinion, and take it on herself to consider her position. However, let her be in no doubt—today the Parliament has put her on a final warning.

I move amendment S1M-1091.1, to leave out from first "Scottish" to end and insert:

"failure of the Scottish Executive to tackle the chronic problems which currently exist in the health service in Scotland; calls upon the First Minister to take immediate action to address the situation; condemns the mismanagement and inaction on the part of the Executive, and demands new and imaginative methods of ensuring that the NHS in Scotland is run on the basis of patient need and not political expediency."

We come to this debate in the fourth year of a Labour Government with a chancellor's war chest of £18 billion and a further £22.5 billion from the mobile phone auction. The Government said that it would hit the ground running; it has been running ever since. The bigger the problems, the faster it runs in the opposite direction, towards focus groups, commissions, inquiries, glossy brochures, working groups, consultation—anything that prevents it from addressing the problem. Never before have we heard daily of so many problems. Never before has the medical profession been so outspoken about those problems.

Will Mary Scanlon give way?

I have not even started. Maureen Macmillan should sit down and listen to what I have to say.

Today we are faced with a motion that does not address the crisis; it is self-congratulatory and ill deserving in the extreme. It is insulting and wholly insensitive to those working in the national health service and the patients whose lives depend upon it. The Executive will not be forgiven for its arrogance, complacency and total lack of sensitivity to NHS staff and their patients.

The motion refers to "commitment to the NHS". Would that be the commitment to the £135 million underspend, to the ever-rising financial deficits, to the 135 vacancies for consultants, or to more spin and fewer doctors?

The voice of Scotland's doctors states that the Executive is all spin and no doctors.

Will the member give way?

If I had been going to give way, I would have done so by now. [Laughter.] It is the last day of term—Hugh has had a busy year and should have a rest.

The motion refers to

"improving the health of the Scottish people"

at a time when the cure rate for lung cancer in Scotland is half that of France. Would that be the improvement in waiting lists, which have increased by 17 per cent in the past 12 months? Could it mean the Executive sitting on £135 million while cancer patients die as they wait for treatment?

The motion mentions "a modern health service". This modern health service cannot afford training and has had to slash investment in medical equipment and technology. This modern health service cannot even reply to the man who invented keyhole surgery, which is now practised throughout the world—he cannot get a reply to his letters, despite being promised funding by the previous health minister, Sam Galbraith. This modern health service cannot even give Scotland's 26 medical directors their terms and conditions of employment, despite the fact that they have been in post for 16 months. At a time when the aim is to change the way in which clinicians practise, who better than the medical directors to bring about that change? When they move, the doctors move, and, until the doctors move, no one moves.

The motion says that the Parliament

"welcomes the Scottish Executive's commitment to target its . . . investment . . . to areas of greatest need".

How would Susan Deacon know the areas of greatest need? She does not even talk to the British Medical Association. John Garner said at the BMA's national conference:

"We currently have no significant involvement in the development and direction of health policy."

While the minister talked of partnership, John Garner went on to say that

"the BMA in Scotland has had no dialogue at all with the Executive over the new monies . . . But we are not alone, the other health professions and indeed the public are equally frozen out from the process."

As for targeting resources, the minister called the members of the Health and Community Care Committee numpties when they dared to disagree with her over the Arbuthnott report. It would seem that the modernisation board can propose anything so long as Susan agrees.

On a point of order.

I hope that it is a genuine point of order, Mrs Smith.

I think that Mrs Scanlon will find that she has made an error in saying—[Interruption.]

Order. If members will allow me to hear Mrs Smith's point of order, I will be able to make a judgment on it. Mrs Smith, do you wish to continue with your point of order?

I think that Mrs Scanlon will find that the minister did not call committee members that name.

That is an intervention, not a point of order, Mrs Smith. Carry on please, Mrs Scanlon.

The spin-doctors have to apologise for that, as it was published throughout Scotland.

There is not even a pharmacist on the modernisation board, despite the fact that Scotland's pharmacists see 600,000 people every day. What are the modernisation plans? Is there a plan? Is there a vision? Is there a strategy? Or is it the case, as John Garner of the BMA said, that everything is being done by

"a new army of special advisors, civil servants and spin-doctors"?

The BMA is the voice of Scotland's doctors. John Garner went on to say:

"We believe it is vital that the Executive understands that those who work in the service, those who pay for the service and most importantly, those who use the service, are central to modernising the service. Scotland needs a long-term strategic plan of expansion and modernisation involving meaningful and constructive dialogue".

One would not have thought that the Executive needed to be told that.

Will Mrs Scanlon give way?

John Garner went on to say that, rather than sound-bite politics—

Will Mrs Scanlon give way?

Hugh Henry is so persistent that I shall give way.

I am grateful to Mary Scanlon; she is always the lady.

Mary Scanlon mentioned paying for the service. Does she agree with Ann Widdecombe, who stated that, if someone wants to pay to see their GP, they should be encouraged to do so? If she agrees, what advice does she have for those who cannot pay?

I am delighted to say that William Hague has given us carte blanche to make health policy in Scotland to suit Scotland's needs and Scotland's patients. Ann Widdecombe is not the health minister; the next time that Hugh stands up with his wee interventions he should remember that. We are talking about something called devolution. I know that it is difficult for Tony Blair to understand, but that is what it is called.

All the shortcomings that John Garner described come from an Executive in which one is sacked for leaking but keeps one's job for incompetence. If the minister had discussed with the professionals how best to use the money for Scotland's health, she might have used £80 million to invest in and modernise the aging diagnostic equipment to bring it up to satisfactory minimum standards. A written answer to a question from Kenny Gibson confirmed the huge reduction in investment in medical equipment. How can trusts invest when they have to transfer capital to revenue budgets to meet political, rather than clinical, targets?

Money could have been invested in training, by revitalising the study-leave budgets that, over the past five years, have continually decreased in real terms. Even £50,000—a drop in the ocean—could fund a Scottish course to train tutors of lip-reading, which would benefit 370,000 hearing-impaired adults in Scotland.

Surely, as a management consultant, the minister must recognise that change must be managed. However, the clinical director of Tayside University Hospitals NHS Trust, who quit after 40 years of service, described

"the stress of trying to run clinical services when instructions from the centre, particularly the Health Minister, are incompatible with running that service".

When the minister wants to talk about partnership, I suggest that she starts by looking for a dictionary definition and then works on that.

The £135 million underspend is a result of sheer hard work by staff in the NHS who, as Kay Ullrich said, were under the illusion that it would be ploughed back into the health service. Many of those staff worked 16-hour shifts to get the NHS through the winter. It is hardly surprising that good will and trust has now been broken and that morale is seriously dented. Is it any wonder that staff in the NHS are feeling let down, angry and frustrated? This should be about clinical priorities, not political priorities. Let the health service get on with managing. Let NHS staff get on with treating the patient—they know what needs to be done.

The £135 million underspend did not just appear on 31 March. When did the minister know of the potential underspend? Was it when patients in Inverness were being offered the nearest intensive care bed in Birmingham? Did she know of the underspend when the cancer patients in Tayside and Glasgow found out that their tumours had grown too big to be treated? Did she know of the £135 million underspend when services were cut at Stracathro month by month? Why was it that justice, local government, the Parliament and administration all negotiated to keep the full underspend with no clawback? Previous practice was that the health service retained 100 per cent of any underspend, not 75 per cent. Why did the budget rules change this year? Why did the minister agree to a £34 million loss to the core services of the NHS? Did the civil servants not tell her about common practice, or is Jack McConnell a little bit too smart for her? If she cannot fight to retain £34 million in its rightful place in our NHS, how can she be trusted to represent Scotland's interests in negotiating the Barnett formula for our funding from Westminster?

However, the Minister for Health and Community Care has a contingency plan. When things go wrong, she blames the managers. If that does not work, she threatens to sack them and to dock their pay. If that does not work, she threatens to cull them. If that does not work, she blames the doctors and consultants. If that does not work, she blames the GPs. If that does not work, she blames the patient. If that does not work, she blames Jack McConnell.

Those policies sound like the rhyme "Solomon Grundy". They are born on a Monday, leaked on a Tuesday, spun on a Wednesday, denied on a Thursday, rejected on a Friday, dead on a Saturday, buried on a Sunday. That is not the end of Solomon Grundy, however, because it is all reannounced the following Monday. Surely the time has come for the Executive to put Scotland's patients before ministers' career prospects.

I move amendment S1M-1091.2, to leave out from first "the Scottish" to end and insert:

"that the delivery of a modern NHS requires both resources and reform; calls upon the Scottish Executive to abandon those policies which foster a spirit of divisiveness, to adopt policies which will restore the morale of the health service workers at all levels and to work with medical professionals and relevant authorities to address the need for investment in equipment and training and ensure that the £135 million underspend is fully committed to benefit patient care, and further calls for the development of a new approach to long-term and community care through unified health and social work budgets."

The motion asks us to note

"that the delivery of a modern NHS requires both resources and reform."

I reiterate what I have said on every possible occasion since I was elected. I say yes to resources, yes to reform, but please do not reorganise the NHS. Leave the structure alone and let us and the NHS staff concentrate on what is important, which is service delivery.

What are the essential elements of a modernised NHS? I have come up with three. It must be carefully and consciously people-centred, it must be equitable and its resources must be used effectively. I say people-centred rather than patient-centred because it should be a health service, not a treatment for ill health service. We say that prevention is better than cure, but the phrase is so familiar that we sometimes ignore the truth of it. I will say more about that when I speak about the effective use of resources.

Being people-centred demands a willingness to consult people about their needs and wants, to listen to what they say, to take that seriously and to act in accordance with people's wishes rather than one's own. That can be difficult for any professional, medical or otherwise. It is much easier to take a nanny-knows-best attitude than to take the time and trouble to find out what a patient wants or—often more pertinently—what the patient does not want. As part of that exercise, a patient must be given the information that he or she requires to make an informed decision. Barriers to understanding should be recognised and overcome. How often are our health professionals given the time with patients and, where necessary, the support of translation or patient advocacy services to consult patients properly? Perhaps they are sometimes, but certainly not always.

Feedback from those who have been through the system highlights time and again that people want to be kept informed and to be involved in decisions about their care. It would be good to involve people in decisions about what care should be available, but it is notoriously difficult to persuade the public to enter into a dialogue about setting priorities. They are only too happy to leave such difficult debates to others.

The public interrelate with the health service via the local health council. In 1975, there were 48 local health councils, but several years ago that number was reduced to 15—one in each health board area. There is a strong case for increasing the number of members in each local health council. In that way—as used to be the case—each community is more likely to have a local health council member living in it, who is better known to people in the community. The public could have more direct influence through directly elected health boards.

Being people-centred means delivering services in a way that is convenient for people. Considerable effort has been made in recent years to move service delivery as near as possible to people's homes. That raises issues that have to be addressed. Resources—funding and personnel—have to be moved from large centralised hospitals to general practices, which requires the rationalisation of hospital services. It is necessary to preserve critical mass to maintain skills levels in different techniques.

As more services are moved away from hospitals and into the community, health professionals will need to be trained differently. If minor surgery is to be carried out by general practitioners, hospital surgeons' time will be freed up, but that means that only the more difficult and complex surgery will be done in hospitals. Implications arise from that because the balance of the work load will change. Also, a nurse who treats patients in their homes needs a different set of skills from a nurse who works in a large hospital.

By moving health service delivery into the community, we highlight the importance of relating health to all the factors that affect well-being, which emphasises how important it is that all the professionals whose services affect people's lives co-operate with one another. The most obvious partners are health and social work and much joint working is being developed. Grampian Health Board and Grampian Regional Council were producing a joint community care plan about 10 years ago. Although the north-east was well ahead of the game at that time, such joint planning is now happening more widely. It is easy to list numerous local authority responsibilities that impact on health—responsibilities that relate to environmental health, leisure and recreation, education and housing. Co-operation in those areas reinforces the benefits of each and enhances people's well-being.

As well as the increase in work that is done with outside professionals, a welcome start has been made on breaking down divisions between health professionals. The old, blinkered attitude that doctors were the only health professionals has given way to greater recognition of the professions that are allied to medicine, such as physiotherapy, chiropody, speech and language therapy, occupational therapy, dietetics and so on. Pharmacists play a greater role in advising doctors on prescribing. Increasingly, the value of the amount of contact that community pharmacists have with the public and the way in which that can be used to disseminate health information and advice is being recognised. Nurses are being given more responsibility and their skills are being given higher status.

I want to mention one or two staffing issues. One of the strengths—or weaknesses—of the health service is the status of doctors as self-employed contractors. That situation arose for reasons that are history, but the issue has been skirted around for many years. It is, perhaps, time to grasp the nettle and have a debate about whether that is the best or only option.

In recent months there have been instances when it has proved impossible to fill vacancies at specialist and consultant level, which suggests a supply shortfall. It is necessary to reconsider how the number of training places is calculated, because the gender balance in medicine has shifted dramatically. More than half of medical students are female, so provision for maternity leave and career breaks to raise families must be factored into the calculation of the number of trainees that is required to ensure an adequate number of consultants and specialists.

Continuing professional development for doctors is reasonably well organised and funded, but a lot more needs to be done to afford other health professionals similar opportunities. It might be of interest to members to know that student nurses from Napier University are in the gallery. I hope that they find today's proceedings edifying. We wish them well in their future careers in the new, modern NHS.

The second essential element of a modernised NHS is that it is equitable. I will start with the allocation of resources to health boards. The Scottish health authorities revenue equalisation—SHARE—system dates from the late 1970s and was ready for an overhaul. Professor Sir John Arbuthnott was asked to chair a committee to review resource allocation and produce recommendations on methods of allocating resources that were as objective and needs-based as the available data and techniques permitted. He did that, but in the light of the difficulties it faced in completing its work, the review committee identified the need for considerably more research to improve understanding of the causes of the clear inequalities in health care, between affluent and deprived and between urban and rural communities. The review also identified the need to find effective and cost-effective policies to tackle such inequalities.

Good decision making depends on good information. Much more information is needed on who falls through the net and why and on how to facilitate access to services for those who may be barred by lack of information, lack of language skills, disability, poverty, disaffection, remoteness, or even the attitudes of the professionals whose services they need.

Effective use of resources is also helped by good information. A lot of work has gone into moving towards evidence-based medicine, whereby drug treatments and procedures are evaluated much more critically. It takes time to do such investigations and every drug and procedure cannot be covered just like that. Even when the evidence has been gathered, the task of disseminating the information and persuading practitioners to take cognisance of it is lengthy and difficult. Through the work of the Scottish intercollegiate guidelines network and the clinical outturns group, the process has begun well and should gather momentum.

Clinical governance is very much to the fore these days and can be assisted by the ease of statistical comparison in the computer age. In recent weeks, the effectiveness of clinical governance mechanisms has been demonstrated by the acute hospital trust that serves my area, where problems that can be dealt with now were identified.

There is currently a belt-and-braces approach to medical competence—the General Medical Council is embarking on a revalidation initiative to provide regular and robust evidence of fitness to practise throughout a doctor's career.

A more contentious area, in which there is scope for more effective use of resources, is organ donation. There have been dramatic advances in transplantation in recent years, but thousands of people still die from conditions that could be overcome by the transplant of a donor organ. The BMA's medical ethics committee recently published a report entitled "Organ Donation in the 21st Century: Time for a consolidated approach", with which it hopes to stimulate debate and encourage action.

In time, transplants might be rendered obsolete by gene modification, either to eliminate congenital conditions or to clone spare parts from animals. Realistically, however, that is years away. In the meantime, there is groundwork to be done in educating the public.

At a recent Aberdeen University graduation ceremony, Professor Neil Gow of the department of molecular and cell biology is reported as saying:

"Scientists must help society understand technological advances so the public does not reject them out of fear"

and that

"it was ironic that scientists and doctors had become the object of suspicion and lack of trust."

He also said:

"Genetic engineering, GM foods, human genetics, genetically manipulated micro-organisms are just some of the controversial scientific realities that face a society in which too few of its citizens are comfortable or capable of making the kind of informed decisions that our technological advances demand of us."

Please wind up.

He also said:

"It is a tremendous irony that, in an era where science and medicine are yielding so many advances, that scientists and doctors have become for some the objects of unprecedented suspicion and perhaps even lack of trust. Education has therefore become of paramount importance in framing and explaining the issue."

The other contentious debate is on fluoridation of water to improve dental health, but I mention that without rehearsing the pros and cons.

When we talk of effective use of resources, we should not forget the enormous part that is played by the voluntary sector.

Please come to a close.

The voluntary sector can range from large organisations, such as Macmillan Cancer Relief—which provides highly trained specialist nursing care—to the local volunteer who drives visitors to hospital.

In recent years there have been increasing pressures on health budgets and local authority budgets, so funding for the voluntary sector has been badly squeezed. It is a trend that must be reversed because the returns on a relatively small investment are absolutely huge. We should also be conscious—particularly if we are to be as people-centred as we would like to think—that we might depend too heavily on volunteers.

Please close now.

Sorry?

Please bring your speech to a close.

I thought that I had 18 minutes.

No, you have 12 minutes.

We need to do more for carers. Early intervention makes sense—money spent on that saves money later. We should support parents in establishing healthy eating habits in young children. Sensible health education in schools prevents unplanned pregnancies and helps to prevent young people from taking up smoking or being persuaded into drug or alcohol abuse. Helping people to stop smoking, eat better and to take more exercise is an effective use of resources.

When health services become more integrated into the community, develop stronger co-operation with other agencies, involve people more in their own health care and take a more holistic view of health, we will arrive at a modernised health service and, more important, we will have a healthier population.

We move to the open part of the debate. The time limit for speeches is four minutes.

This is a serious debate and the fact that so many members have attended it is an indication of the importance that we attach to the health service. We must remember that we are speaking not only among ourselves, but to the people of Scotland who are looking to us to deliver the national health service. I have worked in politics for many years—sometimes more years than I care to remember—and have seen many changes enacted by various Westminster Governments. Some of those changes have been for the better and some have been for the worse. One of the Scottish Parliament's greatest challenges was to ensure that the national health service in Scotland was put in the safe hands of the 129 members who serve here. Our constituents want us to deal with the complexities of the NHS and to deliver its services efficiently and competently.

As Kay Ullrich pointed out, members should ensure that Scotland has a health service that is a success—a world-beater. Some of the changes that have taken place over the years seem to have been carried out merely for the sake of change and so that the Government is seen to be doing something. We must instil a sense of confidence in the Scottish public about how Parliament is dealing with issues.

Despite my intention to be constructive in my speech, I am sorry to say that during the past week, the most sympathetic observers and kindest critics of the Executive cannot have seen anything other than a week of utter confusion over the NHS. It has been almost like "The Paul Daniels Magic Show"—now you see it, now you don't; now you need it, now you don't. I therefore want to emphasise the crucial points for those outside the chamber who are genuinely concerned, because politics is about people.

To whom do we turn first when we are not feeling well? Kids usually turn to their parents, who are full of homespun remedies, but the first real port of call for us all is our general practitioner and the surgery in our local community. GPs do not want to be seen as Dr Finlays and Dr Camerons any more than nurses want to be described as angels. GPs and the ancillary staff who work with them, such as practice nurses, midwives, district nurses, health visitors, ambulance services and psychiatric nurses are vital to all of us. Those front-line people comfort, counsel and—if necessary—refer us to hospital for care.

Too often, our debates centre on hospitals and consultants and we do not talk about the daily work that is done so willingly by surgery staff. Every member in the chamber should display a great deal of support for the front-line troops in the health service.

GP co-operatives represent an important structural change and are vital to our communities, particularly in rural areas. There should be more emphasis on local practices and I ask the minister to consider the possibility of developing schemes to train more triage nurses to co-ordinate administration for GPs, especially for important out-of-hours services.

Wind up, please.?

I have lots to say. However, unlike Nora Radcliffe, I did not think that I was getting 18 minutes. I will miss out some of my speech—I can always write to the minister, as I do from time to time, although I am still waiting for replies to some of my letters

I tried to intervene in the minister's speech on the issue of mental health. I noticed that she gave way only twice during her speech, despite the fact that there were about 20 other attempts to intervene. I want to pay tribute to the Deputy Minister for Community Care, Iain Gray, who brings genuine commitment to mental health—a very complex area in which we share an interest. As Nora Radcliffe is asking an oral question this afternoon on the crisis in the mental health service, I will not pre-empt the issue. However, is not it possible for Iain Gray and Susan Deacon—if they can stop their private conversation for a moment—to thaw the freeze on the Mental Welfare Commission's budget and the mental illness specific grant? Money needs to be spent on that important area; it should not be seen as a cinderella service.

I will start with a declaration of interests, as I believe that one must do so. I am a member of the British Medical Association, the Royal College of General Practitioners and the Scottish Association for Mental Health and I am a fellow of the Royal College of Psychiatrists. I perform occasional consultancy work for pharmaceutical companies. I have directorships of Nursing Home Management, which has nursing home beds in England and of the Forth valley primary care research group.

Today's debate has been a good example of Dr Jekyll and Miss or Mrs Hyde. In the Health and Community Care Committee, Kay Ullrich and Mary Scanlon are co-operative and acknowledge the changes that the Executive is attempting to make. When we come into the chamber, everything they say is negative and regressive. They do not mention the eight new hospitals that have been commenced or the health centres that have been built. Four of the 10 health centres in my constituency are being renewed and another two are planned. They do not mention the advances in cancer treatment or the new intensive treatment unit beds that we will open and the staff who will support them. They do not mention the investment that was made last September in a linear accelerator, which cannot be created in a few months. They want all that to have been done yesterday. They acknowledge none of what has been done—all they do is attack.

The unprecedented boost in funding for the NHS over the next three years provides a unique opportunity to modernise the service for the benefit of patients. That was not taken up by Mary Scanlon or Kay Ullrich. A partnership between patients, carers, health professionals and management is being forged through the forum that was announced by the minister, the board of which met the other day. That forum has a heavy responsibility to challenge and improve accepted practice. If it fails to meet that challenge, there is unlikely to be another chance to improve practice in the foreseeable future.

The easy route would be to throw money at acute trusts, such as the Tayside primary care NHS trust, which has shown ineptitude and an inability to live within its budget that is almost unique. Such an approach would be perverse and must be avoided.

Does the member acknowledge that, although some responsibility for the case that he mentions must lie with the local managers, the interim report also criticised the management executive, for which the Minister for Health and Community Care is responsible, for its handling of the situation in Tayside?

The Minister for Health and Community Care announced the establishment of a task force within a few months of taking office. Again, that was not acknowledged by the Opposition. The task force has taken a few months to establish what is going on, which shows how poor the reporting systems in that trust were. That is made absolutely clear in the report.

As Nora Radcliffe said, the process of modernisation must begin with the journey that a patient is required to make. Patients should not have to struggle to find the appropriate route to services. The Scottish version of NHS Direct—which we have not introduced rapidly, but have taken time to examine in a considered way—will provide a single point of access to the primary and emergency services. Too many professionals find themselves overwhelmed by demands. The Scottish NHS Direct will provide expert advice and could ensure that only those who need to see a health professional will do so.

I call upon the member's professional expertise. In a letter to The Herald on 9 June, Andrew Muirhead, a consultant orthopaedic surgeon at Ayr Hospital, referring to a 67 per cent cut in the funding for nursing homes in his unit, said:

"I would like to record a vote of ‘No Confidence' in the present Labour administration, which has undermined the NHS in our area."

The minister would not comment on that. Will Dr Simpson?

There has not been a cut in funding. If a cut in resources has been reported by that surgeon, that health board must be called to account.

The patient should be able to obtain the highest standard of care from the right professional, as close to home as is practical. Across Scotland and the UK, there are many examples of good practice. Those examples need to be spread across the whole of the service. In Lothian, some patients have almost immediate access to minor surgery of the highest quality, provided by GPs in their local health centre. Elsewhere in Scotland, patients have to travel many miles to hospital for the same service, unnecessarily taking up the time of people such as the surgeon whom Christine Grahame mentioned. Many problems can be dealt with easily if we get the case mix and the skill mix right. That has to be managed locally.

Will the member give way?

No—I have taken quite a few interventions. I might give way if I get more time, but I doubt whether that will happen.

In Liverpool and Bradford, a variety of endoscopic procedures are carried out on patients safely and to the highest standards in a local health centre, while other patients must wait for months for a hospital appointment in the same cities, because the hospital will not consider developing the skills that are required.

This country has a unique primary care system, yet its potential to provide a high-quality service has been completely, or largely, unfulfilled. If we do not grasp the opportunity now, we will be in real trouble.

Please come to a close.

Every survey of public opinion shows a high level of regard for doctors and nurses, but patients who need medical advice need more than seven minutes for a consultation. We must release our professionals to deal with the real and serious problems—that is as true for hospital staff as it is for primary care staff.

It is absolutely imperative that we tackle again the amount of bureaucracy and paperwork, which was being reduced but which is beginning to grow again and which plagues the system.

The Labour party's vision for the renewal of the NHS in Scotland places the user at the centre of services. We will encourage a partnership between health professionals and the patient that provides as quickly as possible the highest quality of service close to the patient's home.

Yes, there are problems, and yes, the service is not perfect. However, at least we have a vision of the future. Our vision is achievable if we grasp the opportunity now.

Margaret Ewing's and Dr Richard Simpson's speeches were a welcome contrast to that of Kay Ullrich and the negativity and vitriol that went with it. The challenge of government is to control the direction of events, to remedy the problems and to use the instruments of public policy to deliver something better. Behind all the clamour of the chattering classes and the SNP's vitriol, that is exactly what the Scottish Parliament and the Scottish Executive are beginning to do.

Foremost among the radical changes is the raft of measures to improve public health, which was a major demand of the Liberal Democrats at the election and which is coming through in increasing measure in decision after decision from the minister.

Will the member give way?

I want to get started before members begin to intervene.

Among those public health promotion measures are the minister's recent announcement of the establishment of the public health institute; the health promotion fund, which is backed by some of the funds from the hypothecated tobacco tax—also called for by Liberal Democrats at the election—the national free fruit scheme for Scottish schoolchildren, which is a major innovatory initiative; and support for the reduction in smoking addiction, not least through the prescription of new drugs. When 35 people a day die in Scotland as a result of smoking, to my mind, it is offensive in the extreme that the most public contribution of the Conservative party should be the cigarettes and alcohol party that was hosted by the Conservative education spokesman: some spokesman; some education.

Is not the Minister for Health and Community Care dependent on smokers continuing to smoke at the same rate, so that the Government can claw back the tobacco tax to put into the health service?

The short answer is no. There is a linkage; I am trying to stress the present investment in changes for the better in Scotland's health.

Major changes are taking place that will revolutionise the NHS. Richard Simpson touched on some of them. There are shifts and balances between the primary and secondary care sectors, as well as the issues of tackling the drugs budget to get more out of it, better health spending and husbandry of resources and so on. However, no magic wand can make those changes happen overnight, by tomorrow or by the end of the parliamentary recess. The changes will take time, perseverance and leadership.

I offer one piece of advice to the Scottish Executive and to the Minister for Health and Community Care: trust the people on this issue. Far more damaging to the credibility of the NHS and the Government is the perception that health board consultations are a sham, and that they result in preordained decisions taken by the great and the good. The Scottish Executive must insist that effective ways are found to bring to bear the force of informed public opinion in developing options and in the ownership of the consultation process—what a friend of mine calls the democracy of complex decisions.

Mr Brown referred to leadership in the NHS. Is he content with the leadership that our current health minister is giving to the NHS?

We all have to make our contribution.

I was talking about the situation at the level of the local trust and trust board. There is a consultation in south Glasgow on the acute services review. There are lots of pamphlets and public meetings—a much more sophisticated campaign than those that health boards have usually conducted.

That is soured by the perception that the decision appears to have been taken by the health board before the consultation, rather than as a result of it, and that all the effort is going not towards consulting the public, but towards persuading the public, which is the wrong way to go about it. I suggest to the minister that the proper way to proceed is by an approach in which the public are partners in this great enterprise of the NHS, not spectators on the sidelines at some arcane, occult ceremony.

What does the SNP have to offer on health spending? A fanfare of negativity, abuse, mismanagement, inaction and all the rest of it. We are still waiting to hear a call for new, imaginative methods, and the SNP will certainly need them to pay for its spending pledges, which currently stand at £3.6 billion, which is equivalent, as Margaret Smith said, to 15p on income tax.

The statistics show that the Scottish Executive and the Scottish Parliament are delivering on health spending. We have to make sure that the money is well spent and does the trick in its results. This is not an issue for spin doctors and counter-spin doctors; it is about what happens with regard to ill health and to the health of the people of this country, not least in my constituency of Glasgow.

Will Robert Brown give way?

Will Robert Brown take an intervention?

No, I am finishing.

Let us ensure that the efforts of every member of the Scottish Parliament are directed towards success, rather than towards point scoring on the great and liberating enterprise that is the national health service in Scotland. Let some people take some lessons from that approach.

It would be very easy for the debate to degenerate into a rant against the Executive, but we in the Conservative party wish to move the debate forward.

The Labour party has succeeded in doing certain things. Over the past three years, it has managed to convince the people of Scotland that they no longer have a health service that they can trust. It has destroyed the confidence and morale of medical staff at all levels, and it has systematically undermined the work of professional managers in the service by interference and bullying.

Most of the modernisation initiatives are either a continuation of Conservative policies or part of the natural progression, spun with more momentum than a candy floss machine. It is an insult to hard-working, dedicated staff such as Dr Simpson to suggest that improvements, changes and development have been taking place only since Tony Blair ascended to the throne in 1997. The staff in the NHS, if allowed freedom to manage, will always move to modernise the service.

Let us examine the facts at the root of modernisation. Ms Deacon likes facts. Fact 1: of the eight hospitals being built, seven were approved in 1998 or before. The four major private finance initiative proposals were all well under way when Labour came to power, and required only the signature of the secretary of state.

Fact 2: the business case for the Royal infirmary of Edinburgh was approved by Ian Lang in 1994, and the invitation to tender was approved in 1996.

Will Nick Johnston take an intervention?

In a minute.

Fact 3: the outline business case for Hairmyres hospital in East Kilbride was approved by Ian Lang in March 1994, and the tender was approved by Michael Forsyth in August 1995.

Fact 4: the outline business case for Law hospital in Wishaw was approved by Ian Lang in March 1994, and the tender was approved by Michael Forsyth in 1995.

Fact 5: Michael Forsyth signed off the business case for East Ayrshire community hospital in 1995—Donald Dewar simply signed the contract.

Will Nick Johnston give way?

Will it move the debate on?

Nick Johnston is boasting about the PFI, another Tory policy adopted by new Labour. Lothian University Hospitals NHS Trust has pointed out, with regard to the Royal infirmary of Edinburgh, that the additional cost of such funding, over traditional funding, is equivalent to the cost of 19 consultants. Is that something to boast about?

It is certainly something that we have to take into account. We also have to take into account the fact that we would not be getting those hospitals if it were not for public-private partnership.

Let us consider service delivery. I want to be a little parochial, and discuss the situation in Tayside. Against the background of management incompetence, overspending, sacking and resignations, the acute services review is a shambles. We now read that consultation has been put back until early 2001, that doctors are at odds over the proposals, and that the review has angered medical professionals, patient groups, GPs, health visitors and local authorities. Dr Foster, a consultant anaesthetist, was quoted thus in The Courier and Advertiser, on 27 June:

"Unfortunately there is no sound evidence which will allow us to reassure the public of Perth and Kinross and Angus that they will not be placed at increased risk by centralisation of maternity services."

If that is improved service delivery, I do not know where we are going.

There has been no decision on that yet.

That is a proposal, as Richard Simpson knows.

The Executive's forward planning consists of switching resources from patient care to trees, but people in my region are faced with the prospect of swingeing cuts in services to fund the incompetence of the Executive in monitoring public health budgets.

I have two more brief points to make. First, a modern health service must take alternative medicine more seriously, as 10 per cent of the health service budget is spent on drugs. Why are GPs who want to train in alternative medicine neither funded nor paid to administer such treatment? Secondly, will the minister tell us when she intends to fulfil the stated aim to introduce price controls for generic drugs?

The NHS is now at risk from the Executive, which is being short-changed by a minister who promises but cannot deliver, and who appears to have lost the faith of her colleagues. It is hampered by a minister who wants to interfere in the provision of services but will not take responsibility for them. Surely the people of Scotland deserve recognition of the fact that the Executive has a first-class staff running a second-class health service. Perhaps ministers should consider their position and paraphrase the words of Henry—not Hugh Henry, but Henry II: "Will no one rid us of this turbulent Deacon?"

I am pleased that the final Executive debate before the recess is on an issue that is of great importance to the people of Scotland. I welcome the fact that, despite the sniping of the Opposition parties, the Scottish people will benefit from record levels of investment in the national health service over the next few years and a hospital building programme that is unprecedented in this country's history.

My colleagues have covered many of the organisational, structural and technological improvements that are taking place in the NHS. The NHS is becoming more responsive to the needs of patients and is taking active steps to consult its users. The abolition of the internal market was a key move towards designing a truly patient-centred health service. Other initiatives, such as the establishment of one-stop clinics, the extension of out-of-hours services and the ending of mixed-sex wards are reshaping the NHS, so that it is fit for the 21st century.

However, today I would like to touch on another important aspect of our modernisation programme—the need to improve our nation's health. Modernising the NHS is not only about building new hospitals, purchasing new equipment and employing more staff. Improving the health of Scots is probably the single most important step that we can take towards truly modernising our health service.

The people from Scotland's most deprived communities suffer the worst health and are significantly more likely to suffer from coronary heart disease, strokes, cancer and mental illness than people from more affluent areas. The rate of mortality from coronary heart disease among those from the most deprived areas is more than 2.5 times that among people from the least deprived areas.

As Karen Whitefield is especially concerned about Lanarkshire, she will know that there are concerns about coronary heart disease in the mining communities of West Lothian, which borders on Lanarkshire. Does she agree with me, and with many members, that the Arbuthnott report desperately needs to be re-examined so that the rates of cancer and coronary heart disease that she is talking about in Lanarkshire can be addressed in other deprived areas such as West Lothian? The problem is that they are not being addressed, and the Executive's initial proposals on the Arbuthnott report are consequently failing Scotland.

Not surprisingly, I disagree with Miss Hyslop. The Scottish Executive is tackling heart disease with projects such as "Heart of Scotland".

More than 13,000 Scots die from smoking each year, and thousands more are hospitalised. The cost to the NHS of smoking is estimated at £140 million spent on hospital treatment for diseases caused by tobacco use. If we have an impact on those figures, we will not only improve the health of Scots, but we will free up vast sums to use elsewhere in the health service.

I welcome the policy document "Towards a Healthier Scotland", which sets out a comprehensive programme of action to improve the health of Scotland. A network of healthy living centres will target some of Scotland's poorest communities, promoting healthy eating and challenging life-threatening habits such as smoking and alcohol abuse. The Executive's commitment to tackling poverty and improving the living conditions of all Scots will have a profound effect on the health of the nation.

Truly modernising the NHS is about ensuring a cross-departmental and cross-ministerial approach. Health boards are already working hard to improve public health. My local health board in Lanarkshire is developing innovative ways to encourage healthy living, working in partnership with agencies such as Central Scotland Countryside Trust to promote walking in the woods around Torbothie and Eastfield, which as members of the press and insiders will be aware, are some of the important surrounding villages in my constituency.

Predictably, we have heard scare stories from the Opposition parties: that the Executive is not spending enough, or spending in the right place, or, most ironically, that it is not managing its budget. We do not need lectures from the nationalists and Conservatives; we are in the process of truly modernising our health service, ensuring that it remains true to its founding principles and relevant to the needs of the new millennium.

The debate could be better entitled "Saving the NHS" if The Courier and Advertiser headlines are anything to go by: "Tayside patients face six years of ‘austerity'"; "Another Tayside health chief goes"; "Health crisis: enough is enough, Deacon told"; "Don't blame me, says Minister". "Don't blame me" sums up the minister's attitude to the situation in Tayside. For months, she told concerned local MSPs from all parties that we were scaremongering. Pleas for her intervention were ignored as we were told time and again that it was a problem for local health managers to sort out. It was a case of, "Crisis? What crisis?"

Finally after nine months—nine months, I tell Richard Simpson—of speculation and anxiety from patients and staff, the minister announced that a task force would be sent in to sort out the problems. At last the minister acknowledged that the £11 million deficit in Tayside's acute hospitals was "clear cause for concern". Why did it take nine months to realise that? Why did she not act sooner? Why did she accuse local members of scaremongering when they were telling the truth and raising local concerns?

We now have the interim report of the Tayside task force, which confirms what we knew already: that there was a lack of effective financial control, an absence of leadership, a lack of team work and poor communication. The report states:

"many members of staff are disillusioned and dispirited, expressing a sense of frustration and anger at the lack of proper information and consultation."

Really. What a revelation. It has been clear to everyone in Tayside that staff morale has been at an all-time low for some time. What I cannot understand—and perhaps the minister will explain it—is what, given that the situation was so bad in Tayside, with a failure of the acute trust and the health board on most counts, the NHS management executive and the minister were doing during that time. Did they know about the deep-rooted problems in Tayside? If not, why not? If they did, why did they not act sooner? Heads have rolled locally. Perhaps it is time for other heads to roll.

The so-called recovery plan has done little to alleviate concerns. Tayside people now face six years of austerity to pay back the projected £19 million deficit. I have talked to clinicians many times over the past few months. If the minister did so, they would tell her that it was totally unrealistic to say that that £19 million would be paid off within two years—unless there were swingeing cuts. Swingeing cuts, I tell the minister. She has claimed time and again that patient care in Tayside will not be affected. However, the recovery plan is based on a 15 per cent cut in hospital admissions in key areas. That means a cut of at least 1,000 referrals for accident and emergency, and a cut of 133 referrals for plastic surgery and treatment of burns injuries. Cuts are also planned in neurosurgery and general and respiratory medicine.

Is the minister really trying to tell us that a 15 per cent cut will not lead to a reduction in patient care? Staff, patients and local politicians know that it will; is she the only one who says that it will not? Robin Hunter of Unison has said that it is not possible to achieve a 15 per cent reduction in activity without affecting service users and losing jobs. Is the minister the only one who thinks otherwise? The people of Tayside should not be punished for the mistakes of others.

Will the member give way?

I am sorry.

As I said earlier, local heads have rolled. However, we cannot just change the people at the top, give them the same leaky bucket to carry, and expect all to be well. The continuation of the huge deficit in Tayside means that people in a new team would be starting with their hands tied behind their backs.

The health minister could have given Tayside a fresh start by writing off the deficit. Tayside's per capita share of the £135 million underspend in the minister's budget would amount to £11 million, which is almost exactly the amount that is required to pay off the current deficit. Instead, the people of Tayside are expected to accept six years of austerity. What a missed opportunity.

The NHS needs a fundamental reappraisal. Some big questions lie before us. Some of those questions are to do with long-term health trends—for example, the development of new treatments, and new demands for health and related services. It is a disappointment that we are not having that debate. We must have that debate—it will not go away just because we do not have it today. There are fundamental issues that we must address.

The most important issue is probably the way in which the health service engages with broader society. In the past, the health service has essentially been a closed system, dominated by the idea of patients getting treatment. That is obviously an important dimension of the health service, but in future the health service will have to contribute towards—not provide on its own, but contribute towards—lifelong health care support for people with an increasingly diverse range of demands. The health service will have to reappraise what it does. It is no longer only about acute hospitals, or people going into general practitioners' surgeries. It is about how we support people to protect their health, and about how society can provide resources, mechanisms and skills, not just for doctors, nurses and managers, but for the general population.

Does the member think that the closed system to which he refers can be opened up by the minister's refusing to enter into dialogue with the British Medical Association?

Mary Scanlon has been doing well as the mouthpiece for the BMA over the past wee while. I counted the number of times that she mentioned Dr Garner, and I am sure that she is relaying his views effectively.

We need a step change in the debate. The debate should not be about only shortages and problems; it should be about the way in which we think about the health service. The health service needs to be thought about in a fundamentally different way. Is it sensible any more for GPs to act as gatekeepers for all kinds of health treatment? Is it not the case that we ought to be finding ways of enabling people to access health information and resources for themselves? Can we short-circuit the way in which we do things and have done them in the past, so that people can get the health resources that they require?

Perhaps there is a problem with the acoustics, but we did not hear the answer to the question about the BMA. When the BMA says:

"In fact the BMA in Scotland has had no dialogue at all with the Executive over the new monies",

is it right or wrong?

The member will have to ask the BMA what dialogue it has had with the Executive. I am sure that it is passing on information. The question should be addressed to the minister, rather than to me.

My contribution to the debate concerns how we change the way in which we do things. Duncan Hamilton may not be interested in that; he may want instead to make small political points. However, I want to examine how we can work smart in the way in which we deliver health services.

We need to assist nurses and doctors to examine people's broad health requirements. Housing and education affect the way in which people's health is protected. One interesting way in which the Government is approaching its task is through the development of full-service schools, which integrate health service support with education in local communities. Health is no longer confined to hospitals or GP surgeries, but is being integrated with other things that people do. That is the way forward.

If we want to make a fundamental change in the way in which people's health is safeguarded in Scotland—I come from the west of Scotland and am a former member of Greater Glasgow Health Board—we need to think differently about how we go about that. We cannot confine ourselves to debates about hospitals and resources. Resources are important—they are fundamental to improving health—but we cannot think just about health service resources. We must think about how we use other resources in a way that promotes health. There should be a health audit of Scottish Executive expenditure across the board, to ensure that we get greater benefit from that money. That would be an important step forward in the debate on health modernisation.

I am afraid that Susan Deacon's approach to facts does not work for me. When I go home and tell my wife that I have cut the grass, I do not find that the fact that I have said that—and I say it again and again—makes it true. Saying something repeatedly does not make it true.

When I asked to speak in this debate, I had hoped that there would be some discussion of what I regard as the modernisation of the health service—making better use of new technology. It is quite clear that that will happen only if the minister gives the necessary leadership. Although this morning she said the words, she did not provide the energy and leadership that is required.

Will the member give way?

As Richard Simpson has intervened during everyone else's speech, I regard it as an honour that he should intervene during mine.

I have intervened only once.

It seems like more.

Is the member aware that, as part of the modernisation strategy, there is a specific group dealing with information management and technology? I should have thought that he would have welcomed that.

I welcome it, but I welcome action over words. I do not think that enough is being done and that there are enough concrete examples across the country of information technology in use in the health service. The proper use and deployment of IT and telemedicine could save hundreds of millions of pounds that could be better invested in patient care. The minister should be making a priority the building of effective databases on patients and their requirements.

Karen Whitefield, with her website, is a great promoter of IT. I look forward to downloading Karen's speech from her site later. We heard from her about the need to promote health care, but I was amazed to find that in GP practices or health board areas no patient data are kept that can be properly used for the purposes of preventive medicine. It is not possible to find out how many high-risk patients, perhaps men over 50 who are liable to have a heart attack, live in a specific area and to start to target resources. Despite all the talk, that is not joined up. Information technology is in an excellent position to do that.

The second great role that IT can play is in changing the relationship between GPs or consultants and patients. In particular, I would like to see much more video-linking from GP surgeries—with the GP and the patient present—to allow discussions to take place directly with consultants. That would have great scope not only for cutting down the bureaucracy, but for providing a much better service for the patient.

Thirdly, there is enormous scope for IT in the whole system for appointments and timings. I know no system in the health service other than that by which when an appointment is made, someone writes down the date on a little piece of card. There must be enormous scope for moving to a much more sophisticated way of deploying—

We have.

In that case, will the minister tell us about it when he sums up? He could give us the facts—details of places where that is happening and the patients who are benefiting—rather than just headline-grabbing statements. I do not see patients benefiting from electronic stuff. I see people with little cards.

We must put IT, and its use, at the heart of our health service. The ministers must demonstrate that they are committed not just to the soundbites that come with IT, but to the practice of it. At the moment, I see no evidence of that. I just hear the soundbites.

May I remind the chamber that this is Labour's debate on the health service? Only about a dozen Labour members are here. I was glad to hear from our old friend from the surrounding villages—at least Karen Whitefield is flying the flag for Labour. Only a dozen of them are here, for a health debate that they initiated. It looks as if most of them are off for the recess already, but the recess does not begin until tonight.

Recesses can be very useful for contemplation, not just for constituency work. Someone once said that politicians are like a heap of manure. Heaped together, they can be pretty obnoxious, but in the recess, if the heap is spread out to fertilise the country, they might do a little good. [Laughter.]

I suggest that the Scottish Government spends some of the recess contemplating that defining moment in Blairism when it decided to grab £34 million from the health budget to spend on trees and fancy buildings instead of on sick people. That was Blairism at its worst—utterly immoral, as Mr Follett has said. Spinning followed. In London, Mr Follett, who is one of Mr Blair's ex-friends, called spinners the rent boys of politics. In Scotland, I protest and say, "What an insult that was—to rent boys."

However, yet another U-turn has been forced upon the Government. Thank goodness. Here, the public sees the value of a strong Opposition. It was only because of thunderous opposition from us that that £34 has gone back into the health service. At question time today, the Executive could not face another pasting.

Those of us who come from Glasgow sometimes feel that when we approach the Executive we are approaching a royal court that has been taking arrogance tips from King Louis XVI at Versailles. We know what happened to him and his worse half Marie-Antoinette. What was Jack the Rip-off thinking: let them look at trees, instead of getting their cancer fixed faster; let them admire baroque gargoyles, while the cardiac transport unit closes in Glasgow? It is utterly shameful that this Executive underspent £135 million on health. How many lives have been lost through that money being hoarded?

Radical action, not tiny droplets of money, is needed to break the link between poverty and bad health. In Glasgow, lung cancer patients wait an average of 13 weeks between their first hospital visit and the commencement of their treatment. One in five of those patients is beyond help by the time they receive their first treatment.

In Glasgow, a successful modernising idea is the back pain service at Glasgow royal infirmary, but the funding for its noble task of alleviating the pain of thousands is uncertain. Physiotherapists there have been so successful that only five back patients out of 1,000 need surgery, but the money runs out in January.

Glasgow is officially the worst place in Britain for infant mortality—

Will the member give way?

I do not get many chances to speak, so I will carry on.

Glasgow is the worst place in Britain for infant mortality, chronic illness and early death, which are linked to high unemployment and appalling housing. Last year, Phil Hanlon, professor of public health at the University of Glasgow, said that life expectancy in central Scotland was comparable to that in the former East Germany. Is that something to be proud of? Yet this Executive would have denied Glasgow, the sickest city in Britain, any crumbs from the £34 million. That is shameful. Morality must come into decisions on health budgets. With Blairism there is no moral concern for ordinary people. Labour must contemplate on that, with shame, during the recess.

Forgive me if I rub my nose. In the best traditions of method acting, I have brought a cold to the health debate. I look forward to the debates on alcoholism after the recess.

At the time of the Scottish Parliament referendum we said—although I am not sure how true it was—that there had been only one hour of debate at Westminster on Scottish health issues in the previous session. Now we have many debates, but a lot of them are confrontational and aggressive. There is a culture of blame, accusation and counter-accusation. We need to be more constructive, and look positively at the way ahead. While I appreciate that the SNP is the Opposition, negative motions such as its motion today throw doubt on the value of our chamber debates.

Those debates contrast with the work that is done in committee. For example, Margaret Smith, Malcolm Chisholm and Dorothy-Grace Elder spread themselves about the Borders the other day and found out about the problems that exist in the health service there. That, rather than the shouting and aggressive debate that we have today, has laid the groundwork for cross-party agreement in committee on how to tackle the issue properly. That is the Scottish Parliament doing things that the old dispensation would not have done. The opportunity is there for us to do things better.

There are two important groups to consider in terms of the health service modernisation agenda. The health service, like the education service, is basically about people. I will start with the workers, three groups of whom have contacted me recently on constituency matters. Modernisation of the health service should not be something that happens to them; it should happen with them.

Ancillary workers genuinely feel themselves to be forgotten people in the health service. Their pay is low, their hours have been cut and there is more pressure on them. They play an important part and keep the service going. Laboratory staff, including people with honours degrees, have salaries that are not competitive. A modern health service depends absolutely on the excellence of laboratory test results and their quick and efficient delivery. We must pay attention to that staff grade. We must also continue to work to get the hours of junior hospital doctors down to the levels that we promised. Staff matters must be addressed early in the modernisation programme. Before we get on to all the other bits about structures, we must make the staff feel more comfortable and more valued.

Users of the service—patients and their relatives—want a service that provides appropriate, high-quality, accessible treatment. People want their health provision to be as close to them as possible. In communities like the Borders, we want GPs to have access to beds in community hospitals, so that patients do not have to be shipped inappropriately and unnecessarily to the district general hospital. Similarly, we want people to have a full range of high-quality services in the district general hospitals.

We worry about the erosion of services that might occur because there is a problem—I accept that—about the critical mass that is needed for certain specialities. There must be ways of keeping those kinds of services in the Borders so that folk from Hawick are not taken 50 or 60 miles up to Edinburgh when, with a wee bit of management and skill, the services could stay where they are now. People, of course, want access to centres of excellence and to specialist tertiary care when necessary and appropriate.

I welcome the minister's aims and objectives, and I genuinely welcome many of the initiatives. I also welcome her commitment to the consultation of both professionals and users. As Robert Brown said, we must ensure that the consultation is genuine. I am sure that the results of the consultation will demonstrate the need for improvements in staff salaries and conditions and a genuine wish for services to be delivered as close to patients as possible. I urge the minister to address those needs as early as possible in the modernisation process.

Ian Jenkins's opening comments were very helpful. I welcome the opportunity to speak about Scotland's health and Scotland's Parliament. Many aspects of the health service have been covered in today's debate, but I would like to address my comments to the health promotion agenda—the opportunity for practical, positive change.

It would be easy to believe that that is a less important part of the service, because it is not demand led in the same way as other statutory provision. However, proper health promotion can not only reduce the incidence of ill health, it can save lives. We must not be deterred from that core message by the fact that health promotion is a long-term prospect and that we will not see the results in this year or next. The Health and Community Care Committee has learned that that is a radical agenda that can change the health of our nation.

Healthy living centres afford the opportunity for the community-based delivery of the message that prevention is better than cure. Community food initiatives and the Wester Hailes snack attack are innovative pilot projects. Their worth will not, however, be proven in one year or two. We will reap the benefits in future generations and that is why, on this agenda, we must move forward on faith.

We have evidence that the approach works. The Finnish experience, which the Health and Community Care Committee has been considering, merits mention and is an excellent example of what can be achieved. Finland has had similar health problems in the past, but it has begun to find the right solutions. Key to its approach are the principles that non-communicable disease can be prevented and that public health should focus on the entire population, rather than high-risk elements. That fits in with what Nora Radcliffe was saying about a people-centred, not just a patient-centred, service.

Will Irene Oldfather accept that much of Finland's success is down to its consensual, cross-party approach? If she accepts that, will she back our call that the modernisation board should have cross-party representation?

The Health and Community Care Committee has demonstrated cross-party working. We are all willing to support that and take it forward.

One major strand of health policy in Finland has been a drive for better nutrition. In 1986, Finland's long-term health policy promoted a unified food policy programme. Since then, dietary and catering guidelines have been published for sections of the population: from young to old and from patients to pensioners. Health food in school and other public sector canteens is heavily subsidised. Salad is often provided free.

The results have been striking. For men under 65, cardiovascular deaths are down by 68 per cent, lung cancer is down by 73 per cent and the death rate is down by 45 per cent. The Finnish experience has given the lie to those who condemn health promotion measures as no more than nanny state interference. It shows the real changes that can be made through co-ordinated effort.

The debate is not only about money; it is about how we spend money to ensure that the NHS remains responsive to the needs and the expectations of the Scottish people. In 1980, the Black report outlined how improvements in lifestyle and a commitment to the public health agenda could improve health. Unfortunately, the Government of the time did not act upon that. This Government is acting on public health.

I support the motion.

I agree with Irene Oldfather when she points out that if we are to tackle health problems in this country, we have to take a broad, strategic approach and consider poor housing and poverty, and the related problems of deprivation and unemployment.

Today's debate focuses on the role of the national health service in tackling poor health in Scotland. I wish to make three points. First, everyone in the chamber should understand the level of frustration and anger in Scotland about the state of our health service. For the past 20 years, we have seen the health service get a lot of lip service but not the level of resources required to deal with the problems in our society.

We had 18 years under the Tories. For the first two or three years under new Labour, the health service was denied the level of resources required while big tax cuts were handed out to people throughout the country who did not need them. People do not understand why, on the one hand, politicians say that the health service is a top priority while, on the other hand, it has been starved of the resources required to do the job properly.

Will the member give way?

No, I do not have enough time.

We must put the debate in the context of 20 years of starvation of the resources required to deal with the problems of the health service. That brings me to the latest crisis of the past seven to 10 days. I do not care if there is a big battle between Jack McConnell—now known in Edinburgh's financial circles as the fiddler on the hoof—and Maiden Deacon on the leadership of the Labour party in Scotland and who succeeds Donald. That, quite frankly, does not matter.

What matters is that, throughout last year, there was £135 million in the kitty, while the Minister for Health and Community Care was telling people over 65 that they could not get a free flu jag because the money was not there. There was £135 million in the kitty, yet we are told that we are so short of radiotherapy units that people are dying of cancer unnecessarily in our country. That was the report from the oncology unit—

I do not have time to accept interventions. There was £135 million, yet we are short of—

Will Alex Neil give way?

Very well, I shall give way to Mary Scanlon.

Would the financial wizard from the SNP condone or condemn Jack McConnell, who started the year with a zero budget and now has £435 million?

I will never condone Jack McConnell's economics. In fact, as the Finance Committee pointed out after reading his budget, he makes Houdini look positively arthritic. None of us would agree with Jack.

The fact is that £135 million was ready to be spent, yet all these crises were going on and people were being denied the treatment they required. The money was in the kitty all the time. That was bad enough, but handing over £34 million of it for trees was absolutely ridiculous. It is no wonder that people in Scotland are angry—angry at new Labour, angry at the Executive and angry at the Minister for Health and Community Care and the Minister for Finance. Even the First Minister is angry with them and ready to sack them. Unfortunately, he said that he would sack Susan Deacon only for disloyalty. I would have thought that the incompetence that she has demonstrated would already have justified her sacking.

Ministers keep telling us that we are getting lots of extra money for the health service in Scotland. If that is the case, how is it that the ratio of staff to patients is getting worse and our cancer survival rates and waiting times for heart surgery are among the worst in Europe? If all that extra money is going in and the performance of the health service is so poor, there can be only one explanation—that the person in charge of the health service in Scotland is mismanaging the resources and letting down the people of Scotland.

I urge the Minister for Health and Community Care to use the recess to get on top of the job and ensure that the people of Scotland are never again denied expenditure on their health while she sits on £135 million.

In health debates, it is always easy to criticise and hard to make progress. We have seen that once again from the Opposition parties this morning. The killer question came from Margaret Smith, who asked what the SNP would do. Answer came there none. It was exactly the same from the Conservative front bench, notwithstanding a witty speech from Mary Scanlon.

I am proud of many achievements of the Executive and the Labour Government at Westminster, none more so than the national health service. One of the most important things that Labour and the partnership Administration have done is reassert the founding principles of the national health service. In no other area have the partnership parties been more radical. One of the most radical ideas of the partnership Executive and the Westminster Labour Government has been to say that the NHS cannot be improved simply by spending on health. The connection between health and social conditions is at the heart of the modernisation of health policy in Scotland. I am therefore delighted that the £34 million is going to be spent on health-related projects. I have yet to hear one Opposition party welcome that fact.

Notwithstanding all the debate and argument about the £34 million, let us remember that it was only an addendum to the big health programme. Can we hear more about the main programme and less about the addendum? We have not heard a welcome from one Opposition member this morning for the £30 million for X-ray equipment, scanners and sterilisation equipment, which was the key announcement in the minister's speech. Why has the Opposition not welcomed that massive advance that we have had this morning? That leads into the issue of funding, which no doubt Andrew Wilson will raise.

I am unspeakably grateful to Mr Chisholm for giving way. In this spirit of shoring up the Executive, does he hold to his statement on "Holyrood" on Sunday this week that the Executive has made major mistakes over the past week? Has it made major mistakes—or not?

Andrew Wilson has tried to make the most of this. I certainly did not use the word major. In fact, the following morning, when I was on "Good Morning Scotland" with Andrew Wilson, I said that it was a small mistake.

We should concentrate on the big picture today, which is exactly what the SNP refuses to do. Money is part of the modernisation agenda; I repeat that never before in the history of the health service have we had such a big increase in health expenditure over a five-year period. However, let us not only deal with money this morning; we should also deal with what the money is being used for.

Three points that we want to emphasise—there are many others—are: improvements in the patient's journey through the health service, which Richard Simpson and others have dealt with; strengthening the patient's voice; and the new element that I would like to talk about, although Susan Deacon referred to it, which is the new quality agenda.

On establishing exactly what Malcolm Chisholm said, he has been quoted as saying:

"It was quite clearly a presentational disaster."

Was it? Who was to blame?

That typifies the SNP's approach. We are concerned with the substance of policy. The public are far more interested in that than whether presentational mistakes are sometimes made. It is the fact that the £34 million is now being spent on health-related projects that matters.

We have introduced massive new initiatives—of which Opposition parties seem to be unaware—on clinical governance, the Clinical Standards Board for Scotland and the new emphasis on patient focus. One of the most important announcements was that the patients project, which is to be launched in the autumn, will be given even greater importance. That has been widely welcomed by the health council movement and all who are concerned with the patient voice in the health service.

Those two agendas cross over. Clinical governance is about trusts being responsible for standards of clinical care, which did not happen before 1997. In the guidance on that, we include an emphasis on patient information and involvement as a key component. There is also public involvement in the auditing process on the Clinical Standards Board and all standards of clinical care are being systematically audited. There is also an emphasis on patient focus in the generic standards of the Clinical Standards Board.

Some people do not want to hear about this wider agenda of the health service, but it is very important. I will pick up on what Dorothy-Grace Elder said. If we have a mission over the summer, perhaps we should all ensure that the public understand all these major new initiatives so that they are given reassurance. We will always be able to find things that are going wrong with individual patients or more generally; the difference is that with this Executive those problems are being addressed. Let us concentrate more on the solutions and less on the problems, which we will always be able to find.

That brings this morning's part of that debate to a close. It will continue after question time this afternoon.