Plenary, 06 Jul 2000

Meeting date: Thursday, July 6, 2000

Official Report 762KB pdf

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National Health Service

Resumed debate.

We now return to the debate that was interrupted this morning, on motion S1M-1091, in the name of Susan Deacon, on modernisation of the national health service, and two amendments to that motion.

On a point of order, Presiding Officer. On 21 June, I raised a point of order about the language that Andrew Wilson used about the Chancellor of the Exchequer. Have you had an opportunity to reflect on that point of order since then?

Yes. I refer members to the ruling that I gave on this matter on 16 March. We do not allow references in the chamber to lying when they apply to other members in the chamber. There was an example of that yesterday, which I regret, but the instance to which you refer did not apply to a member in the chamber.

On a point of order, Presiding Officer. Could you clarify what would be acceptable to the Presiding Officer in the event of a "terminological inexactitude" being deployed in the chamber?

I am surprised that Ms MacDonald should echo Churchillian phrases from another chamber. Such a phrase has not been used, but I will ponder on that point.

The next speaker in the debate is Andrew Wilson.

I assure members that I will be a harbinger of truth in all matters.

On Wednesday last week, I emerged from my much-needed beauty slumber to hear the Minister for Health and Community Care talking on the radio about £8 million of new funding for nurses and doctors. That was the beginning of a wonderful week for Susan Deacon, who, I see, is engaged in deep discussions with Cabinet colleagues, which I hope are convivial. Perhaps she will reflect on what was the most difficult week for Government health policy. No sooner had we emerged from our breakfasts than the Executive was preparing another announcement, saying that four times that amount was to be taken from the health budget, as we heard that afternoon.

So began a week of disgraceful Executive behaviour. On the next day, Susan Deacon stood up from the seat in which she is now sitting to tell the chamber that there was no problem and that the £34 million was merely an example of good financial management.

It is odd, then, that the next day, in The Courier and Advertiser in Dundee, Malcolm Chisholm, perhaps one of the most respected Labour members, said that

"mistakes had been made in the way the cash was moved".

He said:

"It was quite clearly a presentational disaster."

He went on to say:

"Some modifications are needed for the arrangements we have for underspends."

The first question that I hope the minister will address in summing up is about what modifications are planned to meet the demands of Labour back benchers.

We were told that financial management had been good and that there was no problem, but then we emerged into the weekend. We got up on Sunday morning to find that Susan Deacon had briefed the Sunday papers. The headline in the Sunday Herald was, "Deacon: give the NHS back £34m". The article stated that Ms Deacon was

"believed to have secured backing from cabinet colleagues and the wider party in a power play expected to leave McConnell isolated, after he blundered over cuts in health spending."

We are supposed to trust the Executive with the NHS, yet people are at war within the Cabinet, using our NHS—our doctors, nurses and hospitals—as a political football in an internal wrangle and unseemly battle to replace Donald Dewar before he has moved on from his position.

Did the Minister for Health and Community Care, or anyone in her employ, brief the Sunday Herald and, if not, has she complained to the Press Complaints Commission or written a letter to the newspaper's editor to complain about the article, which clearly outlines an attack on the £34 million being taken from the health service?

Rising at 7 am on Sunday morning—as I always do—not only did I read the article but, minutes later, I turned on Radio Scotland to find that the Executive's position had changed again. Donald Dewar, the First Minister, dismissed Ms Deacon's statements and said that the money would remain in the contingency fund. We should not be surprised, of course, because today, on what is perhaps the most important day of Ms Deacon's parliamentary career to date—an important full-day debate on the health service—what has Mr Dewar authorised his spin-doctor to do? He has authorised him to produce a headline, which says, "Furious Dewar threatens to sack Deacon for disloyalty".

If Mr Dewar cannot trust his health minister in the most important parliamentary debate of her career, how can anyone in Scotland trust Labour with the NHS? It is a scandalous week, which has left Ms Deacon with absolutely no credibility.

In today's edition of The Scotsman, a senior Labour figure is quoted—I assume that Susan Deacon will correct this if it is wrong—as saying:

"The slap down wasn't being delivered to the group because the group is united, it was made quite clear the First Minister was cracking the whip with his cabinet – and it was obviously aimed at Susan."

What did the health minister do to require such a slap down from the First Minister? At question time it was clear that Jim Wallace was unwilling to tell us, but if people are to bring ministers to account, they are entitled to know exactly what has been going on during the past week. I have outlined the story—the context in which this health debate is taking place. People are entitled to know what has gone on. Has the minister been slapped down or not? If not, who has been? It is time the truth was told about this very sorry episode.

I will direct my comments to the work being undertaken within the health service in Scotland.

I welcome the opportunity to participate in today's debate, which allows me to share with members the positive effects of the Executive's modernisation of the national health service, in particular in Ayrshire and Arran.

Last Friday, my colleague Cathy Jamieson and I observed presentations by representatives of all the local health care co-operatives in Ayrshire and Arran. The changes taking place now and in the near future are a breath of fresh air—and that comes from someone who has always been somewhat sceptical of general practitioners. The central theme of the presentations overturned any previously held views of the GP as God, directing patients around the various services—those were the words of the GPs from the local health care co-operatives, not mine.

The new emphasis is on the patient having access to all in the primary care team, all of whom are equal partners, working in partnership for the benefit of patients. It is worth noting that the General Medical Council's recent publication, "Changing times, changing culture", states:

"we are not prepared to accept attitudes to service which seem to favour doctors more than patients."

I urge other professions to take off the blinkers and lift the barriers, to focus on patients. However, I hope that those professions do not take the amount of time that the GMC took before waking up and promoting patient-centred care in our communities. It is not enough that those at the coal face embrace the modernisation of the national health service. In some cases, the attitude and level of competence of trustees on trust boards and health boards are a barrier to delivering the modernisation programme. I urge the minister to consider urgently the commitment of those trustees. It is unfair to burden executive trustees on their own with that responsibility.

It is unfortunate that some members fail to accept the many changes that have taken place in the delivery of health care in Scotland—the advances in technology, the new drug regimes and the greater expectations of patients. Many trusts have redesigned services for the benefit of patients. Ayrshire and Arran Acute Hospitals Trust has recently been awarded the Association of Health Care Human Resources Management partnership in health care award 2000 for the Ayrshire cataract service. I hope that members will join me in congratulating the trust and its staff on achieving such national recognition and in encouraging others in the service to consider the process of health care delivery from all perspectives. The improvements to patients are immense: fewer journeys to hospital; fewer members of staff encountered by the patient; waiting time subsequently reduced and the time that patients spend in hospital reduced from days to hours. Buildings and beds were not high on the agenda of the patients who helped to redesign services in Ayrshire and Arran.

The Scottish people expect their health service to reflect their needs and expectations. It is our responsibility to ensure that they receive quality service with positive outcomes, meeting needs and expectations, in a modern health service.

On a point of order. How will we ensure a balance in the debate, given that no Liberal Democrats are present for the opening speeches?

I assure Mrs Ewing that the Presiding Officer takes such matters into consideration when calling members to speak.

I welcome Donald Gorrie, who has just returned to the chamber.

In the 1997 election, Labour promised to hit the ground running. However, in respect of the health service, Labour has been running either on the spot or backwards ever since.

Today, I want to make some points about health service provision for the elderly—or the lack of it. Many elderly people feel neglected by the health service. At the very time when they most need it, the people who have worked all their lives to build it, pay for it and make it what it is today fear that it is not there for them. Elderly people feel that there is an agist culture in the NHS and that agism is replacing racism as a social evil. They feel—with good reason—that the system discriminates against them. Medicines are rationed, services are poorer and "do not resuscitate"—DNR—is being found on medical notes. Indeed, Age Concern is calling on the Government to investigate those specific issues—I echo that call.

Beds are blocked—I know that that is not the right usage. There are almost 2,400 blocked beds in Scotland; that number rises as surely as night follows day and has risen hugely since Labour came to power.

I accept that, as the minister pointed out at question time, £10 million has been given to address the problem. Will that be enough or will it be too little, too late? Let us face it: that money was given grudgingly. After all, before last week, it had not been Ms Deacon's intention to spend it on delayed discharge. One has to ask whether it will solve the problem. The real problem is that health boards and social work departments cannot get their acts together; the underlying problem will remain and once the £10 million is used up, the problem will recur. As Age Concern points out, the Government must accept that there are different standards of treatment for the elderly.

The Government must accept the principles of the Sutherland report, which have already been adopted by the Tories, and produce a single health and social work budget so that we can start to address those issues.

Given the late but welcome conversion of the Tories to Sir Stewart Sutherland's report, will they now support my proposed Alzheimer's and dementia care bill, which has Sir Stewart's support and completely implements his recommendation to make payment for personal care illegal to ensure that dementia sufferers are treated like every other sufferer?

I am advised by Mary Scanlon on my left that we will certainly consider Christine Grahame's bill.

Will the member take an intervention?

Indeed. [Interruption.] Well, I do want to finish.

I have a genuine point.

I am sorry. I am advised that I should not take the intervention.

With regard to the Sutherland report—

On a point of order, Presiding Officer. Is not it for individual members to make up their own mind whether they will take interventions, or do they have to look to their health spokespersons to do so?

I presume that Mr Scott was making up his own mind. Mr Scott, will you proceed?

I will proceed, if I may.

It has already been mentioned this morning that waiting lists and waiting times are another problem. Many elderly people suspect that they are being put to the back of the queue in the hospital's hope that if they wait long enough, they will no longer be a problem. Perhaps they are not being put to the end of the queue; perhaps it is just that the queue is too long in the first place. However, the fact is that many routine operations that affect the elderly are simply not being performed in Ayrshire, as Christine Grahame pointed out this morning, and indeed throughout the country.

For those reasons and others that time does not allow me to address, it is little wonder that the elderly feel that the so-called modernisation of the health service has passed them by. Our society will have failed if we neglect our elderly; and this society, this generation and this Government are currently failing for that reason.

Will the member give way?

No, I cannot.

I urge members to treat the Executive's self-congratulatory motion with the contempt that it deserves and to reject it.

I will certainly support the SNP amendment, because the Executive motion is far too self-congratulatory and does not recognise the major problems that still exist within the health service in Scotland.

However, before making my main points, I should say that I will not take any lectures from the Tories about neglecting the elderly. I remind John Scott that, in 1980, a previous Tory Government led by Mrs Thatcher implemented one of the most damaging pieces of legislation when it disgracefully broke the link between pensions and earnings, with the result that single pensioners are now worse off by £27 a week, and pensioner couples by £35 a week. I hope that the member will consider that point.

I acknowledge Tommy Sheridan's point, and should point out that even new Labour has been unable to restore that link. How would Tommy fund the link between earnings and pensions if it were reinstated?

I could be here all day giving Ben Wallace ideas. However, first of all, I would impose a wealth tax so that the friends whom the Tory Government buttered up would pay appropriate and fair taxes instead of getting away with blue murder.

In this morning's debate, several members were unfairly criticised because they raised some of the British Medical Association's very genuine criticisms about the lack of consultation on the Executive's proposals and the preponderance of spin over substance in the announcement of new moneys for the health service. Those criticisms deserve to be taken on board, and I hope that the minister will refer to them.

I want to raise other criticisms, and no doubt I will be criticised for repeating the criticisms of Unison. However, those criticisms are also genuine. That union does not think that it is being consulted and does not feel that it is part of a partnership, although it is the largest union for health workers in Scotland.

We were asked this morning to welcome the fact that the £34 million that is at the core of today's debate is at least going to health-based projects. I will not welcome that, because those health-based projects are receiving that money at the expense of mainstream expenditure that is required in the health service to address some of the most serious problems that it faces: staffing levels and staff-to-patient ratios.

This week, Unison released figures that show that, between 1985 and 1999, staff-to-patient ratios reached totally unacceptable levels. The doctor-to-patient ration fell from 1:70 in 1985 to 1:110 in 1999. The nurse-to-patient ratio fell from 1:13 to 1:24. Worst of all is the ratio for cleaning staff to patients. In 1985, it was 1:60; in 1999, it was 1:301. No wonder there are increasing complaints about cleanliness in hospitals and no wonder people contract diseases in our hospitals. There is a clear lack of domestic and cleaning staff. We need those resources to be mainstreamed if we are to retain staff and recruit essential new staff. Most of all, we need the minister to announce that he and Susan Deacon will set minimum standards and levels of staffing in every hospital, department and health discipline. I hope that he will assure us that he will do so.

Unison's Scottish organiser for health said that the figures that I have just mentioned

"should place into focus the debate that is presently taking place in the Scottish Executive about the £34 million that was taken away from Health last week. This money needs to be returned as a matter of urgency to the Health Service and minimum staffing levels for every ward, department and discipline should be established throughout Scotland."

I ask the minister to announce today that the Executive will establish minimum staffing levels in all those areas.

I am disappointed that, yet again, we are talking about one of the buzzwords from Labour's lexicon. Today's buzzword is modernisation. I do not know what is meant by that word in relation to the matter that we are discussing, which shows the devaluation of language that is typical of this Administration.

I see that, just as the junior partners in the coalition did not have the courtesy to be present at the start of the debate, the Deputy Minister for Community Care does not want to listen. Perhaps he does not like what we are saying.

I ask Mr Adam to withdraw that remark, which was patently untrue. I did not leave the chamber and I was listening to every word that he said.

I am pleased that the minister has returned to his chair.

I draw the minister's attention to the word modernisation. Some of us remember the council housing that was built in the 1960s and 1970s, much of which is no longer here. When it was built, it was thought to be wonderful and modern. It might have been modern, but it was not wonderful and it was not much of an improvement. I suggest that many of the things that the Executive thinks to be modern will not be judged to have been much of an improvement.

I want to raise a point about clinical governance that Malcolm Chisholm has raised previously. There have been a series of failures of clinical performance recently. Many of them have come to light as a result of clinical governance and audit. While it may be sad, or unfortunate, that those problems have been highlighted, including a number in Grampian, where we have had problems with the radiology service, cardiac surgery and some of the dental services, at least clinical governance and clinical audit have picked them up. I ask the minister to address the question how we are to turn round those situations, when senior members of staff often end up either not practising or suspended for long periods. The consequence is deterioration of services, and that part of the problem has yet to be addressed.

Tayside has seen a significant result of such practices. The clinical performance of two senior members of staff was called into question and they are no longer practising, with the result that acute services at Stracathro hospital have been grossly undermined. That is part and parcel of the overall problem that exists in Tayside, but I ask the minister to put his mind to the question how we are to turn round such situations more quickly, with the provision of appropriate retraining and support. That would prevent the deterioration of services as a result of the inevitable discovery of poor performance through clinical audit and clinical governance, in a way that need not impinge on the quality of services or the length of waiting times.

I have taken up enough time.

As a Labour MSP for Glasgow, which, health statistics show, is suffering, I welcome the debate as an opportunity to speak on the important issue of the modernisation of the national health service.

It is quite right for members of Opposition parties to question the Government, which, with ministers, should be accountable. Opposition members want answers to many of the questions that have been raised today, but it is about time that we heard some answers from those members about what they would do if they were in Iain Gray's position. What would they do to advance the NHS agenda? We need a clear answer to that. Perhaps the world debating champion, Duncan Hamilton, wishes to intervene with an answer to that question—I would be happy to give way to him if he wished to provide that answer.

I thank Paul Martin for the build-up.

On our specific proposals, perhaps Paul Martin did not hear Kay Ullrich's opening speech, which dealt with the idea of taking the debate on the health service out of party politics and towards a cross-party approach.

If Paul Martin, like Irene Oldfather, supports that approach, he should say that he does. If so, can we count on his support, as a member of an Executive party, in our attempt to persuade the minister to take on board all the SNP's ideas, not just some of them?

Duncan Hamilton should discuss that with his colleague, Andrew Wilson, whose four-minute speech was based on the gossip columns of Scotland. These are serious issues, and this is serious politics. People in Scotland want us to propose genuine ideas for a constructive way forward.

Will the member give way?

I will not take any more interventions, but I thank Shona Robison for her attempt.

I want to make a constructive suggestion that came about as a result of consulting local GP practices and consultants. David Mundell made a constructive point about the information technology systems that are in place in the national health service. When I, with colleagues, met Greater Glasgow Health Board recently, we were concerned to learn that it takes a pretty fragmented approach to the IT systems that are available throughout the health board area. For example, many of the trusts have implemented individual IT systems, and there is no cohesive approach towards that work. It is important for the minister to take on board that issue, to ensure that a cohesive approach is taken towards the procuring and building of an IT system to serve the health board area.

We should also consider another issue that David Mundell touched on: videoconferencing, which would give GPs the opportunity of conveying information to consultants without having to go through an appointments system that does not serve the public at the moment.

The existing management structure of the health boards and trusts is complicated. In Glasgow, there is Greater Glasgow Health Board, the local hospital trusts, the primary care trust and many other health care organisations. We must consider whether those organisations are actually serving local communities. I call on the minister to consider the possibility of a study being carried out—

On a point of order, Presiding Officer. What is the procedure for calling for a quorum count in the chamber? There are, I think, 11 representatives of the Executive parties out of 71, which I think is very few for a debate of this seriousness.

I can assure you that there is a quorum: the quorum for a meeting of the Parliament is three.

I would welcome consideration of an independent study on whether those management structures—the local health boards, the trusts and other organisations—are serving local communities properly, with what must be described as the substantial additional resources that have been made available to them.

I welcome the debate. If we are genuinely to move forward, we will have to work together for the betterment of the national health service in Scotland.

I will first explain to you, Presiding Officer, and to the rest of the chamber, the reason why the Liberal Democrats were away from the chamber for a short time. It was the only opportunity in the day that could be found for us to give a presentation to Jim Wallace in recognition of his very good performance as acting First Minister. It may interest Brian Adam, who took us to task on the subject, that the presentation took the form of the original of a newspaper cartoon showing Jim Wallace as a gladiator, thoroughly defeating Mr Alex Salmond in the arena of the coliseum in Rome.

I will just make an introductory remark about the overall issue of the funding of the national health service, and of how that has been dealt with. I was one of those who did not vote for the formation of the coalition. Since the coalition was formed, I have been a loyal but critical supporter of it, to the extent of performing my first-ever karaoke last night—and the ineptitude obviously showed. However, the spirit was willing, with the help of an excellent Labour MSP, Sylvia Jackson.

I think that I am in a position to say, politely, that some of the Labour ministers should learn to control their ambitions and refrain from spinning in a way that harms the work of the coalition Government. The spinning of some Labour ministers during the negotiations on student fees and during the section 2A disputations did not help greatly; neither did the spinning about the health money. The Executive has a much better story to tell than that. It has made an honest attempt to deal with the very great problems of health. It has produced some more money and it has some very good plans and intentions, which I am happy to support.

Regarding the karaoke, was one of the songs "Things Can Only Get Better"?

No, our song was "True Love". It was very symbolic, and was carefully chosen.

I will now make a few specific points, some of which have been alluded to by other speakers.

First, one way to improve the health service is to reduce the amount of bureaucracy and paperwork that floods into it, and into all other departments of our activity. I have already volunteered to be a bumf tsar and to help to reduce the paperwork. I am sure that somebody else could do it better, but it must be done.

Secondly, we should properly consider the efficiency of the health service. When visiting councils, I often get the impression that councillors and council officials feel that councils have been under the spotlight of much more scrutiny for many years than has the health service, and that savings could be made in the health service without compromising standards. We must get stuck into that.

Finally—and although this is a point that I always make, it is important—we should consider the preventive or community medicine argument. Medicine is still dominated by the influence of skilled people in hospitals who demand the latest expensive equipment. We must certainly do what we can in that direction, but much more money needs to be put into our communities, especially the poorer ones. Our children are becoming couch potatoes; they do not play enough sport. We do not provide enough backing for voluntary organisations that support people suffering from stress in deprived areas. Much more money, thought, help and co-operation must go into communities and into helping people to be healthier. The current plans contain some intention to do that, but they should be much more focused, to combat the understandable enthusiasm of the specialists for all their expensive equipment.

I am happy to support the good intentions of the Minister for Health and Community Care and the Deputy Minister for Community Care. I wish them success in the future. We will support them and keep an eagle eye on them.

Paul Martin called this a serious debate. It is very serious for Scotland's ill when the attendance of Executive members is such as we have this afternoon. I want to raise serious issues concerning the older people in Scotland.

On 17 December, I asked in a written parliamentary question whether the Executive had evidence of age discrimination in the NHS, and whether it would initiate a full and comprehensive investigation. Susan Deacon answered:

"There is no evidence to suggest that elderly people are being refused NHS care solely on the grounds of age."—[Official Report, Written Answers, 17 December 1999; Vol 3, p 302.]

I have here some evidence of such discrimination, which I shall present in the format that is used by the Minister for Health and Community Care. Fact 1: more than three quarters of family doctors believe that the NHS discriminates against elderly people. Fact 2: two thirds of family doctors support an inquiry into agism in the NHS. Fact 3: 43 per cent of GPs would be worried if a frail and elderly relative went into hospital.

I also have quotations to support that evidence. Dr Brian Williams, the president of the British Geriatrics Society, says:

"There is good evidence to say that the NHS harbours institutionalised ageism which is morally indefensible."

Dr Bill O'Neill, the Scottish secretary of the British Medical Association, says:

"There is ageism in the society and the NHS is not immune from it."

Here is more evidence. Fact 1: breast cancer screening is rarely offered to the over-65s, although more than two thirds of the mortalities from breast cancer are within that age group. Fact 2: one third of coronary care units refuse to admit over-65s who are referred to them by GPs, thus forcing them into general wards. Fact 3: elderly people are routinely excluded from drug trials, although the drugs that are being tested may help them. I ask members to remember Jill Baker, aged 67, who read in her case notes—for the first time—that she was not to be resuscitated in the event of her having a stroke. That was written by a junior doctor who never met her.

I shall now speak on long-term care for the elderly. In March, Dr Williams and the heads of the Royal College of Physicians in Edinburgh, Glasgow and London branded long-term care of the elderly a national disgrace. Sir Stewart Sutherland's report gathers dust. The truth is that, if someone has Alzheimer's, they are subjected to the worst age discrimination of all—paying for nursing that is free to people suffering from all other illnesses. People who have Alzheimer's are compelled to sell their homes to pay for nursing care or—what a choice—confined to a hospital bed because there is no money in the social work budget to pay for their care costs. The only treatment someone suffering from Alzheimer's can be guaranteed is to be treated as a non-person.

Of course there is rationing. The Dundonald GP who spoke so frankly at the recent BMA conference was saying what we already know to be the case. If there is to be rationing because of medical progress and limited resources, let it be on the basis of assessed individual ability to benefit, not on the basis of age any more than it would be on the basis of skin colour.

My speech is bursting at the seams with evidence and I have only a minute and a bit to go. The cure for the ailment is for older people to be seen by politicians and society as the individuals that they are and that we see ourselves as. I have a poem for the minister, for the holidays. It is on individual rights and called "Warning".

When I am an old woman I shall wear purple
With a red hat which doesn't go, and doesn't suit me,
And I shall spend my pension on brandy and summer gloves
And satin sandals, and say we've no money for butter.

I shall sit down on the pavement when I'm tired
And gobble up samples in shops and press alarm bells
And run my stick along the public railings
And make up for the sobriety of my youth.

I shall go out in my slippers in the rain
And pick the flowers in other people's gardens
And learn to spit.

I very much appreciate what Christine Grahame said about the elderly. As the second-oldest member of the Parliament I thank her. However, I have never been a patient in hospital, although members of my family and colleagues have. According to a recent ICM poll, some 63 per cent of those questioned ranked the NHS as the most valuable institution in this country. Around two thirds of them believed that the health service needed to be improved "quite a lot". In February an Angus Reid poll of 17 countries showed that the UK was unique in that a majority was in favour of paying higher taxes to ensure better public services, particularly a better NHS.

Recently five parliamentarians—Lord McColl of Dulwich, a Tory peer and a surgeon before he entered the House of Lords, Alan Milburn MP, the Secretary of State for Health, Liam Fox MP, the health spokesman for the Tories at Westminster and a medical practitioner, Nick Harvey MP, the Liberal Democrat spokesman on health, and Frank Field MP—put forward a series of proposals for the modernisation of the NHS. Despite diverse political views, their shared priorities were new ways of providing treatment, an examination of funding and patient guarantees. Those three points are crucial to modernisation of the NHS.

Let us look at funding. As we have heard, cash is available if Gordon Brown releases it. We know about the £18 billion. A further £22.5 billion is supposed to be coming the way of the NHS following the recent auction of mobile phone licences. I have never understood why the lottery funding rules are not changed to allow a considerable sum of money from the lottery to go into the NHS. I hope that the rules are changed. Other countries permit that.

Unison, which is one of the biggest unions in this country, has always expressed concern about private finance initiatives or public-private partnerships. Why does it not take some of its massive assets and invest in some of the hospital projects? That would give it a stakeholder's presence.

Will the minister give way? [Laughter.]

Tommy.

Because I have known John for a long time I think he is a minister. Would he agree with me that given the current budget surplus of £18 billion and the additional £22 billion, rather than Unison investing its money it would be better for new Labour to invest money?

I welcome money from any sphere. My point was that it would give Unison a stakeholding.

Will the member give way?

I am sorry. I am very limited for time.

Unfortunately, Dr Richard Simpson and I did not manage to complete our conversation outside on the pavement at lunchtime, but I had time to mention to him that a German former colleague of mine had said that, in the likes of Duisburg, which is in an industrial area where the population is heavily concentrated, general purpose surgeries were established many years ago. Not only was there a physician, there was a lung expert, a urologist, and a person dealing with heart disease. They were all in the one surgery. In addition, when it was feasible, the surgeries got the necessary equipment, although that is not to say that they had the equipment that a hospital would have.

When in doctors' surgeries, I have often thought that they lack something. I feel that some senior nursing sisters have more experience than some junior practitioners. Why is it not possible to see them rather than waiting to see the doctor? At the moment in my area, it takes between one and a half and two weeks before a patient can see a doctor. Problems such as that should be considered.

Will you wind up now, Mr Young?

Frank Field has talked about a little-known European Union provision that Dr Simpson, Sam Galbraith and some others will no doubt know about. The E112 form allows United Kingdom citizens to have certain operations within the EU. In this day and age, greater movement could take place within the union on that basis.

We know that we need equipment and we know that the elderly population is increasing. The site of Canniesburn hospital is being sold and we are told that its value is £21 million. All profits from such sales must be reinvested in necessary NHS equipment.

I have one final point for Iain Gray.

You must come to a close, Mr Young.

The most deprived area in Scotland is the south side of Glasgow and parts of east Renfrewshire. Apart from the maternity hospital in Rutherglen, which lasted only 20 years until it was closed, we have not had a new hospital built since Queen Victoria was on the throne. The last time that a hospital was built in the south side of Glasgow was in 1890, and it serves a population catchment area of 430,000. I hope that Iain Gray will pass that on to Susan Deacon.

We have all been surprised in this debate. Despite the barrage of criticism aimed at the Labour front bench, all that we have received have been the usual sour looks, the usual lectures and the usual implications that everybody is out of step except our Susan and, of course, our Iain.

And she is not here.

And she is not here. She must have got tired of it.

The real verdict on the health services in Scotland does not come from this chamber; it comes from the people we meet on the street, it comes from our own experiences and it comes from anecdotal evidence that we might get when talking to people at a party or in the pub.

During the Ayr by-election, which Mr Scott won, it was not possible to walk down Ayr High Street without someone wanting to stop and talk. Three subjects came up. One was the Carrick Street day centre, which we all remember and which is responsible for Mr Scott's being here, so he has a lot to thank a Labour local authority for. Pensions was another subject for discussion, but the one that people were really concerned about was their personal treatment in the NHS. They did not speak with resentment or anger, because they knew that they were getting the best service that they were allowed to get by whatever Government was in power.

In Susan Deacon's opening remarks this morning, I was horrified to hear an accusation that the SNP and the Conservatives were, in some sense, talking down the staff, or talking down the patients, or scaremongering. Those are weak and silly arguments. Iain Gray was nodding his head—he seems to agree with those arguments. However, the leadership of the NHS in Scotland, as represented by the front bench, thinks that that is the right way in which to conduct the debate—telling everybody who criticises: "Oh, no. Those are weak and silly arguments. We know best."

We have heard the arguments, and we have heard the single transferable spending announcement that dots around the chamber. Richard Simpson is shaking his head—he also knows best. I like Richard Simpson, but it is that arrogant manner that people in Scotland resent. It is that arrogant manner in which the health service is being run. I shall make no comment on any minister who may happen to be entering the chamber as I speak.

The problem is that there is a lack of trust in the political leadership. We could go through a raft of statistics, or the way in which announcements are made. The other day I was looking into something called the waiting times support force. I am no expert in these matters. However, apparently the minister is not either, because the waiting times support force is a mythical concept that is pulled out from time to time when she has nothing else to announce.

On 14 September 1999 the minister said in a press release:

"when this national review is completed, we will set public targets for speeding treatment and reducing waiting times before the end of December."

On 6 October she stated:

"I will announce action based on this work before the end of this year."

On 21 October she repeated that there would be an announcement

"by the end of the year."

On 4 November she said:

"By the end of December we will set public targets".

However, on 16 December—so close to the deadline, with the Executive about to go off on its holidays—she announced:

"Agreed maximum waiting times in key clinical priorities will become one of the key planks of the Executive's agenda to speed treatment."

We have never heard another announcement about the waiting times support force. The more people hear that type of spin and single transferable spending announcements, the less they trust what they hear. The important point is that people have lost faith in the leadership of the health service in Scotland. That leadership sits on the Executive benches. Until the people have faith in politicians and what they can achieve, things will just get worse.

I was amused by Mr Russell's point of order a couple of minutes ago, in which he drew attention to the number of members present on the Labour benches. I recall that at one point during yesterday afternoon's debate the number of members on the SNP benches had fallen to four, and that Mr Russell was not one of them, after having argued for extra time.

On a couple of occasions members have referred to criticism of the minister by the British Medical Association. I happen to have to hand a copy of Michael Foot's biography of Aneurin Bevan, an excellent book that I would recommend to people. At one point Aneurin Bevan reflected:

"it can hardly be suggested that conflict between the British Medical Association and the Minister of the day is a consequence of any deficiencies that I possess, because we have never been able yet to appoint a Minister of Health with whom the B.M.A. agreed."—[Official Report, House of Commons, 9 February 1948; Vol 447, c 36.]

I do not think that much has changed on that score in the past 50 years.

Will the member give way?

I have only three and a half minutes.

Today was an opportunity for us to focus on the modernisation and improvement of the national health service, but to a large extent that opportunity has been missed, particularly by the Opposition parties. It is widely accepted that the national health service is not perfect. Ministers accept that there is a need for us to improve and modernise the NHS. Opposition parties have an opportunity to engage in that process, but they have singularly failed to do so.

Will Bristow Muldoon take an intervention from a member of an Opposition party?

I will have to pass, as I have only another minute and a half.

I tried all morning—

The member is not giving way.

I want to highlight a few of the areas where positive developments are taking place in the health service, as well as a couple of issues that we still need to address.

In my constituency we are seeing the benefits of the extra investment that is going into the national health service. A large chunk of the extra money that was allocated to accident and emergency services has gone to the accident and emergency unit at St John's Hospital in Livingston, to take account of the fact that usage of the unit is now at twice the level for which it was designed. Another £400,000 has been invested in a new resource centre in Broxburn. That is bringing together best practice by bringing the national health service, West Lothian Council, GPs and voluntary organisations under one roof and encouraging greater joint working. We are investing in a new partnership across Lothian called the healthy respect initiative, which is aimed at bringing together the national health service, local authorities, schools, GPs and voluntary organisations in a programme aimed at reducing the incidence of teenage pregnancies and sexually transmitted diseases among young people. Those are all good, positive developments in the health service.

In the last 30 seconds of my speech, I will throw in a few issues on which we still need to move forward. Some parts of the health service still reflect the compromise that was made at the time of its establishment. We need to re-examine the way in which consultants work—the way in which some consultants are able to move between NHS practice and private practice. I am sure that all members have had constituents bring that issue to their attention. GPs needed to be brought into the system more and to be made more accountable. The ability of GPs to strike people off their lists without having to explain that or to account for it to anyone is a problem that I have come across in the past.

Many members have mentioned delayed discharge. The money that has gone into dealing with that problem is welcome, but again we need to focus on how to solve the problem—how to ensure that the health service and local authorities work much more closely together to deal with the problem—in the long term.

There is opportunity for everyone to engage constructively in the debate. I think if the Opposition parties were ever to take that opportunity, that would be very much welcomed by the Minister for Health and Community Care.

My apologies to Margo MacDonald, who was in the last position on the SNP speaking list. In consequence, she drops off the list.

If we are to have a truly modern health service, we must resource it properly. That is fundamental. We must also reform it with imagination and commitment. The minister outlined today some of the many ways in which the Executive is trying to do just that. She also acknowledged that there was a long way to go. I think we would all agree with that. Certainly I think that all members, like John Young, would agree that the health service remains our most important, and probably our best-loved, institution.

This has been a turbulent and petulant week. As convener of the Health and Community Care Committee, I wrote to the minister to express concerns, shared by many others, about the consequences of last year's underspend. Richard Simpson was right to say that there is always an underspend. The minister's speedy response to my letter makes it clear that the underspend is caused by a range of factors, including slippage in capital programmes.

In the past, that underspend would have been returned to the UK Treasury. We now have a new system and it may well be that, as a result of what has happened this year, we will look again at how we deal with the underspend in future years. The new system allows us to make decisions about what we wish to do with the £135 million underspend. I think that we are sending a clear message: the people of Scotland, and members of all parties in the chamber, have said that they want health underspends to be spent on health.

I welcome the fact that the £34 million will be spent on health-related initiatives such as community care, drugs programmes and tackling homelessness. No one in the chamber doubts that health outcomes can, and must be, delivered by a range of departments, not just by health. Meanwhile, it is prudent to hold some of the reserves to deal with health-related situations such as winter pressures that develop during any year.

I will turn to the motion. At the heart of the modernisation process must be a willingness to move services closer to patients and clients through new walk-in-walk-out hospitals, one-stop clinics, NHS Direct or healthy living centres. We are starting on that process. That means providing services closer to where people live and giving people best access. It also means that we must make best use of our staff's talents. Tommy Sheridan and others mentioned the staff in the health service; modernisation will put an incredible burden on those staff. Consider the difference in the role of nurses, for example, over the past decade. We are asking more and more from our nurses and from other members of staff.

I was in the Borders recently, at Borders general hospital, and the plight of the domestics there was made very clear to me, not only by members of the domestic staff but by the chief geriatric consultant at the hospital. Staff at the hospital know the difficulties that are faced in their wards if there are not enough domestics to cover requirements in terms of the spread of infection and so on.

We must put the patient at the heart of the process, but it is also important that we put the staff at the heart of the process. That means not just paying lip service to them. Neither patients nor staff can be taken on board if we do not take them on board from the beginning of any process that involves modernisation and change. I agree with Margaret Ewing that we should not embark on change for change's sake, but as a way of improving the quality of care that patients receive. The Executive's role is to ensure that there is constant monitoring of that care.

We are now into the second year of structural change involving local health care co-operatives and others. We know that some of the LHCCs are doing good work; we also know that in other parts of the country they have not been taken up, for whatever reason. Although we have ended the internal market, quite rightly, we should be ensuring that we find ways of giving GPs and practices some incentives. That might mean ensuring that the joint investment fund, for example, has some money in it. If we want to change the way that services are provided, we must look seriously at double funding of services while the period of change is being managed.

Across Scotland, a number of consultation exercises are going on. Robert Brown pointed out that when the Health and Community Care Committee examined the issue of consultation, it found that the present system is flawed. Managers need to be given the resources, tools, training and guidance to inform, engage and consult the public on the necessary service changes that the modernisation agenda brings.

Direct elections to health boards might go some way toward increasing public confidence in the decisions that are taken by them. However, we all have to play our part. Even I am wedded sometimes to the idea of bricks and mortar, but we should be wedded to the idea of the best place in which to deliver patient care. Sometimes that will be in a general practitioner's practice; sometimes that will be in an out-patient clinic; sometimes that will be in a community hospital; and sometimes that will be in an acute bed.

We heard from Christine Grahame and others about instances in which people are being treated inappropriately in the acute sector when they ought to be in the community. I welcome the £10 million. I welcome £10 million from wherever it comes and in whatever circumstances. If it is more money for community care and more money to tackle the problem of delayed discharge, I welcome it. I hope that, in the coming weeks, we will have an announcement that the Sutherland report will be implemented in full.

We have heard a mixed debate today. A number of members have made good speeches. I would like to address Paul Martin's point. Modernising the service also means modernising the equipment. One of the key equipment areas is information technology. We have to ensure not only that health boards, authorities and the Executive talk to each other through their computer systems, but that a link is made with social work. We can do that.

I hate to finish on a sour note—it is not my normal practice—but Kay Ullrich's performance today was negative and sour. No one party has all the answers to all the questions on the delivery of health care. I asked the question earlier and I am still awaiting an answer: what would the SNP do that would be any better?

Before I call the next speaker, I have a point of rectification to make about the point of order that Michael Russell raised about the quorum for a meeting of the Parliament. The Presiding Officer said that the quorum is three. For the record, that figure relates to committee meetings. There is no quorum for a meeting of Parliament.

I call Ben Wallace to wind up for the Scottish Conservatives. You have seven minutes.

Last week, I attended the NHS Confederation conference in Glasgow, as did the Minister for Health and Community Care. It was full of people with new ideas about modernising the NHS. I listened to the minister's speech. In it—she alluded to it today—she talked about two anniversaries: the anniversary of the Scottish Parliament and how we have all done terribly well and the 52nd anniversary of the founding of the NHS. There was a third anniversary, which she left out—it was not last year that Labour came to power and started to make changes in the NHS, but more than three years ago. To be precise, it was three years plus the 48 hours before the general election, because at that time it was said that there were 48 hours to save the NHS.

What have we got as a result? For all the promises, we see waiting list targets failing. We see that 7 per cent of staffed beds are inappropriately blocked. We see that the number of people who are waiting more than 18 weeks following a referral by their GP is up by 60 per cent. We see that 135 consultant posts are unfilled. We have seen spending crises, bed crises and even winter crises. In fact, it has been crisis after crisis.

It was not under a Tory Government that halls in Perthshire—and now in the Forth valley and Angus—were packed with people who felt unconsulted and unsure about the future of the health service. It was not under a Tory Government that tabloids in Scotland ran campaigns to save the NHS.

Will the member give way?

No, I will not.

For all the spin, the truth is that the situation has got worse, not better. Of course, the minister will look for blame elsewhere, but if it is not resources and it is not policy what else can it be? There is only one suspect, but it is easier for her and back benchers to blame the Tories. Let us consider that. On record investment, Labour has increased health spending by 23.7 per cent since it came to power, but from 1992 to 1996 we increased health spending by 23.3 per cent.

While we welcome the extra spending, let us not pretend that the magic wand of billions and billions is any more out of context than the increase in spending line on line. To answer the charge that we had no modernisation programme, I point out that we had a thing called the patients charter. Its aims were almost identical to Labour's alliance for patients. Almost every aim is the same, except that Labour's aims have failed more quickly than the patients charter.

Perhaps we should blame the doctors. Dr Simpson made a Jekyll and Hyde comment, so let us ask him, as a member of the British Medical Association, whether he speaks in accordance with the BMA or as a Labour MSP. If he supports the BMA, he will agree with Dr Garner.

Will the member give way?

No.

Order. Mr Wallace, if you are challenging Dr Simpson and inviting him to reply you should afford him the chance to intervene briefly.

The difference is—

I have not given way.

Mr Wallace, I cannot force you to give way, but I suggest that if you put questions to Dr Simpson you should allow him to respond.

I have not finished my question, Presiding Officer.

Will Dr Simpson support Dr Garner's statement that

"Unlike in England, we have no intensive dialogue with politicians over how the money should be invested. In fact the BMA in Scotland has no dialogue at all over the investment of new monies"?

Does Dr Simpson support that statement, yes or no?

My response must be slightly longer than yes or no.

It is an intervention, not a speech.

Mr Wallace asked me a question; I will answer it. The answer is that the BMA will be consulted as part of the modernisation forum. It is represented there. John Garner is expressing sour grapes—and I say that even though I am a member of the BMA—because he is not on the modernisation board. There are doctors on that board, however, and the BMA is being consulted. Dr Garner is wrong.

That is an example of professional courtesy at its extreme.

There is the word going, as in going to be consulted. Going. We have had more than three years to consult the BMA, but we are going to do it. Unison, hardly a friend of the Tories, says that the Executive pay deals will not work and that morale is at its lowest for many years.

Perhaps we should blame the patients. In Tayside, the reduction of referrals by the arbitrary level of 14 per cent sends the message that under Labour people should not be ill, should not go to the doctor and should not go to hospital.

The minister will say that reform takes time. Do not forget that Labour was in opposition for 18 years and has been in power for three. If it cannot come up with a decent proposal in 21 years, it should go back into opposition.

The Sutherland report has been sitting there since March 1999. The Conservative party took its time, looked at how the report's recommendations could be funded, and has agreed to adopt it. I hope that the Executive will adopt it as soon as it possibly can.

The other person to blame is Jack—big, old evil Jack McConnell. The minister was part of that Cabinet decision. She cannot pretend that she was not because she was in Cabinet, part of the collective Cabinet decision, when those rules were agreed to. She was so unaware of her budget that when I caught her after her speech at the NHS Confederation, she was briefing about her new money being spent on staffing levels. At the same time, Jack McConnell was deciding how to spend it elsewhere.

In one year, the minister has driven a wedge between patients, the professionals and the public. She rarely answers questions directly. She attacks challenges arrogantly. For example, she claimed that the BMA was talking nonsense. She should know; Dr Garner has worked in the health service all his life and she is a management consultant. There we are: there is the professionalism in it. Susan Deacon is a bit like the school girl who comes home with a report card at the end of term that says E5 and tells her mother that E means excellent and that 5 means that she is fifth from top. She asks what the teachers know anyhow and says that she is being bullied by Jack, the playground bully.

In summary, the minister is too weak to get her £34 million back into direct NHS spend. All she could eventually achieve in the climb-down was health-related spending. That will not buy the equipment that is so desperately needed in Glasgow. Nor will health-related topics bail out budget deficits in health boards across Scotland. That spending will relate very little to the actual, direct needs of the NHS right now.

New Labour promised so much to so many people in such a short period of time more than three years ago. The Executive cannot pretend that it did not make medicine into a political football. It comes here with its high morals and pretends that we should all grow up, but it politicised the issue. It promised 48 hours to save the NHS. Now, it has to reap the results.

How long will it be before the people of Scotland realise that the spin of the Labour party is actually about explaining away bad management, bad leadership and bad policy? At the end of the day, not much has changed for the people on the ground in the NHS. In fact, it has got worse, not better.

It is not a particular pleasure to close the debate because it has been quite ugly, but I am delighted to see the minister back from her sojourn—we were so lonely without her. It was suggested that predictions in The Scotsman had come true at half time in the debate.

There has been some suggestion that the modernisation process, which is the subject of the motion, has nothing to do with funding and managerial competence. I wish to make clear from the start the link between the two. For all the talk of modernisation—and there has not been a great deal of substantial talk from the Executive on what it thinks modernisation means—and all the alleged action, without the funding and without managerial competence at the heart of government, it will be for nothing.

Will Mr Hamilton give way?

No thanks.

That is why we are trying to tie the two together at this stage.

On the minister's speech—

Will Mr Hamilton give way?

No thanks.

The essence of the speech was "Aren't we doing well?" That is an odd attitude for the minister to take, given that it flies in the face of all the facts that have been presented throughout the day. If the minister were doing so well and were to be paid a glowing tribute by her boss, I would suggest a bunch of flowers, a box of chocolates or even a bonus. If I was doing a fantastic job and was universally regarded as a rip-roaring success, I would not expect to wake up to headlines in The Scotsman suggesting that I was about to be sacked. It suggests that the minister is not doing as well as she pretends.

I am sorry for coming back to it, but Malcolm Chisholm commented on "Holyrood" that one of the lessons of politics is never to defend the indefensible. That is exactly what the minister tried to do in her speech this morning. Of all the programmes that she would not miss, I would have thought that "Holyrood" is one of them.

If we consider funding, the Executive's real crisis in the past week due to a division in the Cabinet, the backbiting and the treatment of the NHS as a political football, this has been more about naked political ambition than about moving on the debate on the national health service.

Despite what the minister has—or has not—said today, questions that the Scottish National Party and the Conservatives have been pushing remain unanswered. When was the minister aware that the underspend existed? I will give the minister time to think and will let her in on that. As Scottish health minister, why did she not fight to retain 100 per cent of the NHS budget? Is it not the job of the Scottish health minister to ensure that, like local government and the department of justice, her department keeps 100 per cent, to push forward the basis of Scottish health?

The fact that the minister has no intention of standing up and justifying that position speaks volumes for the fact that she knows she has been found out.

Will Mr Hamilton give way?

No thanks.

To anyone listening to the debate, the matter of the £34 million displays managerial incompetence. I am loth to take suggestions from the Daily Record, but it was suggested by a Labour "insider" that there has been a cock-up rather than a conspiracy. Well, great—is that supposed to put our minds at rest that there is no great conspiracy in the Executive; it is just that it cannot do its job? Is that meant to make everybody relax? Is that meant to give everybody confidence in the health team? Whether it is a cock-up or a conspiracy, it is not sustainable or defensible and the minister owes the Parliament an apology.

This debate has been more about Labour splits—the split between the front bench and the back bench—than about the national health service. Malcolm Chisholm said that the matter was a major mistake and a presentational disaster—until he was rapped across the knuckles and changed that to a small mistake and a presentational blip.

Then there was a split between the ministers. Jack McConnell, who was here earlier to give ocular proof of the close connection between himself and Susan Deacon, has decided to leg it for this afternoon's debate. There is a split in the Cabinet between health and finance, and the First Minister, who is meant to be convalescing, has had his convalescence period interrupted because he has had to come back to resolve that internal Labour party squabble.

I suggest that that tells us quite a lot about the role and status of the acting First Minister. He did not have the authority or the remit—and he certainly did not have the ear of his Cabinet colleagues—to resolve the dispute. We are always told that the acting First Minister acts like a First Minister and that deputies deputise, but Jim Wallace was incapable of deputising. Perhaps his Liberal colleagues, when giving him awards this afternoon, might want to reflect on the fact that he was incapable of resolving this central Cabinet dispute.

I want to reflect on the useful point that Margaret Ewing made. She tried to move us away from the idea that the debate is about party politics—and the central thrust of Kay Ullrich's speech this morning was about the importance of having a cross-party alliance. I welcome the support that some members on the Labour back benches have expressed for the idea. Let me give an example of why it might work. The reason education has progressed in Ireland is that—

We are supposed to be talking about health.

I know we are; if the member bears with me he will understand my example. The reason for progress was that, on a cross-party basis and regardless of changes in Government, successive parties and Governments in Ireland decided that education was to be a No 1 priority. That is a model for what we can achieve in health. If we have cross-party consensus, we can take health out of the party political arena and put it on to the national agenda.

In the cacophony of self-congratulation, the minister must be aware of some of the examples of real failure in the health service that have been mentioned in the debate. It should be a matter for regret, at the very least, that we have heard of cancer patients who are not getting treatment in time, which impacts on their lives and well-being.

Will Mr Hamilton give way?

If Mr Kerr wants to defend that situation, he can have a go.

I had the privilege of attending a Lanarkshire Health Board meeting at which members of the board were discussing how to spend an extra £2 million. As I looked out of the window, I could see the new Hairmyres hospital, which is already six months ahead of schedule. Seventy-five per cent of the equipment that goes into that hospital will be brand new. That is what is happening in the NHS—not the drivel that Duncan Hamilton has been giving us.

With that kind of biting logic, what chance do I have? Is Mr Kerr seriously suggesting that he is happy with the current position in the health service?

Will Duncan Hamilton accept an intervention?

If it will help.

I think it might. I did not attend a meeting of Lanarkshire Health Board this morning; I spent the whole morning having a bone scan at Edinburgh royal infirmary. If we are considering the modernisation of radiology, ultrasound and nuclear medicine facilities in Edinburgh, I plead with the minister to give consultants, nurses and patients the resources that they know are required.

I was treated in time because there was no trauma. The moment there is a trauma and the one computed tomography scanner or the one magnetic resonance imaging scanner is knocked out of use, patients like me are left waiting in the corridors and wards. I plead with the Executive to modernise and provide two scanners to the new hospital.

I thank Margo MacDonald for that contribution, which takes us back to the reality of the health service in Scotland. Her comments also give me the opportunity to move on to the modernising agenda. There has been a great deal of talk about the suggestion that the SNP has nothing to bring to this debate. We are the only party in the debate that has brought forward a constructive proposal, saying that we want to make health a cross-party issue. We support the idea of the modernisation board, but it could be made even better by going the whole hog and having cross-party support so that funding decisions can be taken on the correct basis.

The central part of any modernising process must be consultation. Quite frankly, it demeaned Dr Simpson to say what he said about the British Medical Association, and particularly about John Garner. There is no place for such comments in a debate such as this. The idea that the British Medical Association is just slightly out of sorts because one of its members has not been able to contribute to the debate simply does not wash.

We must take this debate away from one politician shouting at another. I would like to finish by quoting to the minister what real people in real organisations have said. One is from Paul Leslie:

"Health Minister Susan Deacon is simply not up to the job, and it is she who has failed to show true leadership or understanding of what is required to modernise the NHS."

Another is from Dr Hepworth:

"It is time the people of Scotland laid the blame where it belongs, and for the health minister, Susan Deacon, to accept responsibility for the crisis in the NHS in Scotland".

I suggest that the minister has lost the confidence of the people and what we are voting on today is whether she has also lost the confidence of the chamber.

In the first meeting of Parliament after the summer recess last year we debated health and we are debating health in the last meeting of Parliament before this summer recess. Health has been the top and hem of this Parliament's first year. We have debated it on many occasions; it has featured heavily in question time and in members' business.

There has often been a sense of déjà vu or, as Duncan Hamilton would say, déjà entendu. Unfortunately he has never yet reached the stage of déjà compris. He understands nothing more now than he did a year ago.

In the past year, what has the health service been doing while we talk? It has carried out 50,000 more operations than it did the year before. It has carried out 13 per cent more heart bypasses, more hip operations and started pancreas transplants. Accident and emergency departments have seen 43,500 more people; consultant clinics have carried out 62,000 more appointments and there have been 50,000 more at out-patient clinics. Mental health teams—as Susan Deacon said—made 85,000 more visits and community nurses and health visitors made an astonishing 277,000 more visits. More dentists are practising in Scotland than a year ago and fewer consultant posts are vacant than were a year ago.

Every day the NHS is serving our people and serving them well. It is not complacent to recognise that; it is right. I have to say it must be worth a prize if it gets us accused of arrogance by Mike Russell.

In the light of the £135 million underspend, does the minister understand the anger and frustration felt by members of the rural communities surrounding Dalmally in Argyll and Bute, whose doctor resigned because she could not get a part-time partner, which would have cost about £20,000? Will he give a reason as to why that happened?

There is no underspend. There is a rollover; 100 per cent of it is spent in the NHS. The problem with understanding is the lack of understanding of the Opposition.

Understanding is going to—

Order.

As I said, every day the NHS serves our people, but it can serve them better and it wants to serve them better. That is why, in the past year, we have acted where the service needs it. As Richard Simpson said, £13.2 million has been invested in linear accelerators for cancer care. Mary Scanlon talked about intensive care and high-dependency wards; £6.8 million has been invested in that. Recently, £60 million was invested to reduce waiting times and reduce delayed discharge, which Christine Grahame mentioned.

We recently agreed £4.5 million of incentive payments for GPs as incentives for flu vaccination for next year. That was negotiated directly with the BMA. Another matter that we are addressing with the professions is that raised by Brian Adam: what happens following suspension of members of staff. There may be an opportunity to talk in more detail about that at another time.

Margo MacDonald mentioned investment in diagnostic equipment. This morning, Susan Deacon announced that £30 million would be invested in diagnostic equipment such as CT scanners.

Statutory controls on generic drugs have been mentioned. At 12 noon today, Lord Hunt announced that statutory controls will be imposed on generic drugs. In a full year, that will save the Scottish health service as much as £20 million.

We have lifted NHS spending to an unprecedented £5.42 billion. However, the NHS can and wants to serve better. That is why in the past year we have begun the reforms that will allow it to do that. Margaret Jamieson reminded us of the redesign of cataract services in Ayrshire, which is underpinned by the changing attitudes in the profession.

David Mundell and Paul Martin talked about the need to use IT. As an example of telemedicine, there is the teleradiology link to the Garrick hospital in Stranraer, in David Mundell's constituency, which he will be able to see for himself within the year. If he goes to any GP surgery, he will see the IT equipment that has been provided since the Labour Government was elected in 1997.

Other reforms include the introduction of joint appointments such as that of child health manager of Highland Health Board and Highland Council, and the other examples in Lothian to which Bristow Muldoon referred. There is a new national cervical screening programme. I could go on. Anyone who tries to dismiss those improvements as soundbites simply insults those who make them work, day in and day out.

Will the minister give way?

No.

This is long-term improvement and it now has the leadership of the modernisation board and the engine of the modernisation forum, which includes the BMA, to drive it forward in partnership with those who make our service what it is.

What about minimum staffing levels?

I am coming to that.

Ian Jenkins and Tommy Sheridan talked about the need to take staff with us. That is one of the primary things that we have to do. That is why the modernisation board was preceded by the Scottish partnership forum, which had Unison at its heart and which discussed exactly the issues that Tommy Sheridan raised, such as staffing.

There has been much talk about a positive approach and giving alternatives. When I saw that the SNP amendment talked about "new and imaginative methods" for the NHS, I thought that perhaps the SNP shared our vision for the NHS. I listened for new and imaginative ideas from Kay Ullrich, and I heard one. If I understood it, it was to put her on the modernisation board. We have discussed it and, I am sorry, the answer is no.

Mind you, that was an idea. Andrew Wilson and Duncan Hamilton managed two whole speeches with barely a mention of the health service at all, never mind a new idea.

Will the minister give way?

No, I do not have time.

This week, there was a chance to engage in the building of a healthier Scotland. On Monday, we held the first healthier Scotland convention. In many ways, it was an inspiring day, which had at its heart a vision of what is possible for our people if we have the will. Kay Ullrich, Duncan Hamilton, Mary Scanlon and Ben Wallace were invited, but they could not make it.

It is true that the notice that was given was short, but it was the same for everyone. Five ministers and 150 leaders from the NHS, local authorities and the voluntary sector were there. Some Health and Community Care Committee members were on committee business in the Borders, but Kay Ullrich, Duncan Hamilton and Mary Scanlon were not. What was it that they were so busy doing?

On a point of order, Presiding Officer. It was my understanding of a previous ruling that you gave today that when a member is mentioned by name in the chamber, that member has the right to respond.

I did not say that a member had the right to respond. In the specific case of Dr Simpson, I suggested that it would be helpful to the debate if he were allowed to intervene.

We know what they were doing, because we could read the quotations they gave that evening and the following day. Their priority is not health, but headlines.

Will the minister give way?

No, I do not have time.

Will the minister give way?

No.

It is perfectly clear that the minister is winding up. I will give him about another two and a half minutes.

There has been much talk of the £34 million. I can see why it is an important sum of money for the SNP; in its 1997 manifesto, it is all the additional money the SNP would have allocated to the health service. Compare that with the almost £0.5 billion that we provide. As for the Tories, they would either use the money for tax cuts, as David McLetchie said last Thursday, or give it back to the Treasury, as he was suggesting by Sunday. Perhaps the Tories would use it to subsidise private health insurance so that they can charge for hip replacements and cataract operations, which is what Liam Fox was talking about in Glasgow last week.

I will give way to Mary Scanlon. I ask her please to tell us what she was saying.

Can I say something?

No. I will give way to Mrs Scanlon if she wants me to.

I thank the minister.

With respect, minister, you should not give way to anyone. We are over time. I ask the minister to conclude.

Mrs Scanlon, health may be devolved, but regulation of the insurance sector is not. The real reason—[Interruption.]

Order. Members should allow the minister to finish.

The real reason the SNP talks so much about the £34 million is that it is a conjuring trick. It gets people to look at the £34 million on the one hand in the hope that they will not notice the £5.4 billion on the other.

The Tories have a conjuring trick too. Theirs is the one where you put the watch—the NHS—in the hankie and smash it to bits. They would smash the health boards, the primary care trusts and the local health co-operatives, but the people know that the Tories are the Tommy Coopers of politics—when they give the hankie back, the watch is still smashed.

Will the minister take an intervention?

I am winding up.

On a point of order.

Oh.

Order. I want to hear the point of order.

When this Parliament was set up a year ago, it was supposed to be different from Westminster. Is not the rabble on the Labour benches reminiscent of scenes at Westminster?

That is not a point of order. [Interruption.] Order. The chamber must come to order. We are past the time for decision time. I want the minister to conclude. There is other business to deal with before we come to decision time.

Those who made it to the health summit would have heard Professor Phil Hanlon talk about an important factor in life expectancy—hope and optimism. I was reminded of a Chinese saying, not from Mao Tse Tung—I will leave that to Keith Raffan—but from Confucius, who said that a leader must deal in hope. The Opposition fails that test.

The SNP deals in despondency—it says that there is crisis and chaos and catastrophe. There is not. The Tories deal in despair. They tell us that we will have to go private, that the public NHS cannot cope and cannot handle it. Well, it can. The NHS was born in the hope of a better society. Every day, our people use it with the hope of better lives. This Executive—this partnership—deals in hope in the certainty that we can have a better NHS. We will not be deflected.

On a point of order.

Points of order at this stage only delay proceedings further.

With the greatest respect, Presiding Officer, at 17:01 it was announced that there would be two minutes until the end of the minister's speech. It is now 17:04:40. The minister rose in time to complete his speech within time. He received four minutes extra. Will you clarify how the rules apply?

I understand that the minister was interrupted quite a lot during his speech and I made allowances for that.

On a point of order. Is it in order for members to tap their microphones during a speech? Presiding Officer, will you rule whether that conduct is becoming of members of the Scottish Parliament and whether such conduct demeans the Parliament and detracts from the serious subject under debate?

Tapping microphones has little effect—the only live microphone is that of the member who is speaking.