Engagements
To ask the First Minister what engagements he has planned for the rest of the day. (S4F-02074)
Engagements to take forward the Government’s programme for Scotland.
Last year, the Scottish Government again missed its accident and emergency target, meaning that thousands of Scots had to wait more than four hours for treatment. The First Minister’s response was to lower the target. According to Audit Scotland this week, the Scottish Government is not just missing the original target; it is now missing the new, easier-to-reach target as well. More patients are suffering.
Last year, the First Minister promised action. This year, we learn that the number of those who are waiting more than four hours for treatment has tripled on his watch. When will his actions start to prove effective?
Of course, Audit Scotland was referring to the statistics for 2012-13, which is also the year that Johann Lamont is talking about. Let me first say what we are doing about the situation, because that is the real issue.
I do not know whether Johann Lamont heard Dr Martin McKechnie, the vice-chair of the Scottish board of the College of Emergency Medicine, on the radio this morning. Dr McKechnie said:
“We have had a lot of support and investment in the last 18 months from the Government and we are beginning, I hope, to feel and to see the effects of some of these changes.”
The year 2012-13 was a hugely tough one for the emergency services of the national health service in Scotland. We had a substantial number of ward closures because of norovirus. However, the emergency action plan that was announced by the Cabinet Secretary for Health and Wellbeing has been welcomed by the profession, as indeed has the substantial increase in the number of consultants, staff and facilities around Scotland. Working together, we will bring about the improvement that Scotland requires and which the patients of Scotland deserve. That improvement is happening in the statistics already and, if Johann Lamont was fair about it, she would note that Audit Scotland remarked on the substantial improvement since the yearly statistics to the end of financial year 2012-13.
Yes, but Audit Scotland pointed out that the improvement was against the worst ever statistics in this area.
I know that the First Minister will have plenty of facts and figures to prove that there is not really a problem, but we know that there is a problem in our hospitals because healthcare workers are telling us so. Let us hear what patients think. Margaret Watt, chairwoman of the Scottish Patients Association, said:
“People have died as they couldn’t get into hospital because they were kept waiting in A&E. The distress it causes patients and families is huge but the situation seems to get worse year on year. I have never known it as bad as this and our national treasure, the NHS, is becoming a nightmare for patients.”
Last year alone, more than 100,000 people had to wait for more than four hours—that is more than half a working day. Nearly 1,500 people waited more than 12 hours for treatment. The First Minister has been in office for seven years—why have waiting times trebled on his watch?
I do not know how familiar Johann Lamont is with the statistics but, as she said that the waiting times were the worst ever in A and E, I will just correct her. I will give her the exact statistics and then I hope that she will be able to admit how wrong she was.
Johann Lamont was right in quoting the statistics for 2012-13: 103,782 people waited more than four hours. That is exactly the situation that we are trying to tackle. That is out of total attendances at A and E of 1,618,610. We are seeking to tackle those figures and bring them down to what we believe are more acceptable levels.
However, Johann Lamont said that those were the worst figures ever. I will give her the figures for 2006-07, when she was a minister. In that year, there were 1,342,737 attendances—some 300,000 fewer than there were in 2012-13—and the number of people waiting more than four hours was 125,753.
Now that Johann Lamont has heard those figures, will she withdraw the suggestion that 2012-13 was the worst ever year, as clearly it was not? Will she acknowledge that, although we are trying to improve performance, it is substantially better than it was when she was a minister? Will she agree to concentrate on the action plan that will serve the people and patients of our community in the best possible way?
The degree of complacency in that response is staggering—let us go back to our comfort zone in which a politician makes a debating point, rather than responding to what patients, staff and Audit Scotland are saying. The reality is that the First Minister does not seem to understand or care about the problem.
We have a social care crisis, which is fuelling an A and E crisis. People attending A and E need beds, but they cannot get them because patients are being parked in inappropriate wards, waiting to be discharged but with nowhere to go. Hard-working nurses and doctors are not to blame; they are doing their best. Is the First Minister going to get serious about the crisis, or is he just going to fiddle with the target again?
Johann Lamont should accept that it is rather more than a debating point to point out that she is fundamentally mistaken in her claim that 2012-13 was the worst year ever. I am afraid that 125,753 is a much bigger figure than the one that she cited.
Johann Lamont accuses me of complacency, but I reject that totally. The health secretary has set out the action plan, which has been widely welcomed by health professionals. This Government, unlike the Labour Government, pledged to protect real spending in the national health service and we have done so.
The figure for patients seen within four hours increased last December, in the heart of winter, to 93 per cent. We want to get that figure higher, to the interim target of 95 per cent and then on to 98 per cent. If Johann Lamont wants to hear about complacency, perhaps she should recall that, when she was a minister and Andy Kerr was health minister—it is quite recent history—the figure was 87.5 per cent.
Take some responsibility.
Mr Findlay!
The figure of 87.5 per cent was hailed by Andy Kerr as showing
“that the vast majority of A & E departments are meeting the four hour target ... Investment ... in the NHS is paying off”.
For her party’s credibility and her own, Johann Lamont should explain why, if 87.5 per cent was wonderful when she was a minister, 93 per cent under the current Government is such a disaster. Will she accept that, thanks to the hard-working professionals in the national health service, there is an improvement, which we intend to drive up further, thanks to the investment plan? Will she acknowledge that, when she comes to the chamber and makes up figures because she cannot substantiate her points, she and her party are fundamentally lacking in any credibility on the national health service? [Applause.]
The fact that the Scottish National Party back benchers respond so warmly to that answer tells us everything about the problem that we face. Dr Nikki Thompson, chair of the British Medical Association Scottish consultants committee, said:
“medical staff are working under considerable strain to try to maintain high quality care in an overstretched system; clearly this is not sustainable.”
However, with an unsustainable NHS, what we get is a First Minister coming up with unsustainable answers.
Let us be honest about what is happening here and what the Scottish Government’s approach is. It is revealed in the following line in the Audit Scotland report:
“The Scottish Government has indicated it will review the 95 per cent interim target after September 2014.”
What could possibly be happening in September 2014 that matters more? We are not prepared to wait for his referendum before we make sure that the ill and the injured do not have to wait for treatment. Is it not the case that the First Minister cares more about the constitution of our country than the health of our people?
In dealing with the situation, we have announced the £50 million emergency care plan, and we are reviewing the 95 per cent figure towards the end of the year because we want to drive it upwards towards 98 per cent.
I have been critical of the Labour Party on the health service because neither in 2007 nor in the run-up to the 2011 elections would it commit to protecting the health service budget in real terms. I remember Lord McConnell saying that every other service, including the health service, would have to cut its cloth because he was going to put all the consequentials into education.
Another Administration in these islands—a Labour Administration—decided, because of the pressure of spending cuts from Westminster, that it could not protect the health service in real terms. I have the figures for emergency care in Wales. Not on a single occasion over the past few months has even 90 per cent been reached there, never mind 93 per cent. Labour has failed every time.
In contrast, we have a rising number of staff in the national health service in Scotland. We had 127,000 in September 2006, before we took office, and we had 135,000 at the end of 2013. We have a rising number of medical staff—the number has gone up from 9,600 to 11,438. We have rising numbers of staff in nursing and midwifery. That has all been made possible because we have protected the health service in real terms. If the Labour record in office in this place was so lamentable, and if its current record in Wales is so much worse than that of this Administration, how on earth can Labour have any credibility on the national health service?
Why not welcome the investment that has been put in to drive up the figures for emergency care? That has been welcomed by the health professionals. Labour should get behind the action plan and it should stop trying to rewrite the dismal history of its Administration or the present practice in Wales.
Prime Minister (Meetings)
To ask the First Minister when he will next meet the Prime Minister. (S4F-02072)
I have no plans to meet the Prime Minister in the near future.
At First Minister’s questions on 27 March, Ruth Davidson asked me about the implementation of a Scottish Clare’s law, which involves information being provided on issues of domestic abuse. I can tell the Parliament that the Scottish Government is carefully considering this morning’s proposals from the Solicitor General for a new offence of domestic abuse. Ruth Davidson and the Parliament will also wish to note that the chief constable has today proposed a multi-agency group to set up and develop a pilot on a Clare’s law disclosure scheme in Scotland. I know that Ruth Davidson will welcome those initiatives, and I can assure her that they will be carefully considered as they unfold.
I thank the First Minister and welcome the pilot of Clare’s law, a matter that I indeed raised with the First Minister on 27 March. While the First Minister is in a listening mood, I ask him to reconsider my repeated calls for a full public inquiry into the baby ashes scandal.
The First Minister seemed awfully keen a few moments ago to talk about Wales, but slightly less keen to talk about his own record in Scotland. We have heard an awful lot of statistics today. The First Minister cannot get away from the facts. He missed his target for treating people in accident and emergency, so he lowered his target. Then, he missed it again. This is not just about the thousands of people waiting for more than four hours in A and E, and it is not just about the 1,000 people waiting for more than 12 hours; it is about everybody expecting to wait almost half an hour longer than they did just five years ago.
The First Minister likes to blame almost anyone else when things go wrong, but is it not the case that the Scottish National Party Government has overseen the national health service in Scotland for the past seven years? Does not this failure land squarely on the First Minister’s desk? Will he start to take some responsibility for it?
The responsibility that we have taken for it was to announce the emergency healthcare action plan. That £50 million is making a substantial difference. I have already read out this morning’s quotation from Martin McKechnie, the vice-chair of the Scottish board of the College of Emergency Medicine. He welcomes the action plan that is being unveiled across Scotland and the close working relationship with the Cabinet Secretary for Health and Wellbeing. Furthermore, there are proposals in the Audit Scotland report that the Government will adopt and implement, as they are entirely sensible. The matter is being treated with the utmost seriousness.
It is reasonable to put forward the situation as it was when we took office. It is reasonable to put forward the position that there are more staff, more nurses and more doctors in the national health service. The number of consultants who are working in accident and emergency units is more than double the number that there was when we took office, and far more people are being treated in A and E. It is entirely reasonable to put forward those points because all of them are true.
When the Government announces its action plan, which is welcomed across the national health service, and there are already signs—as detailed in the Audit Scotland report—of an improved position, that is a Government that is looking at an issue and a serious problem for many patients across Scotland and taking affirmative action to do something about it.
We know that more people are being treated, and we know that the NHS is under pressure. That is why the Conservatives are committed to delivering an extra 1,000 nurses for Scotland. However, that does not get us away from the record that the SNP Government is creating. A and E targets are being missed, nursing numbers are down from their peak and bed numbers have been slashed by more than 20 per cent in one of the fastest declines in hospital beds anywhere in the western world. Last week, the Cabinet Secretary for Finance, Employment and Sustainable Growth, John Swinney, said that the Government had absolute control over the NHS. He said:
“we have control to decide what type of national health service we want, what direction we want it to take and what reforms we want it to undertake.”—[Official Report, 30 April 2014; c 30343.]
Given that complete control over the NHS, are all the cuts by SNP design or has the First Minister been so busy with the referendum that they have just happened by accident?
The health service budget has been protected in real terms. That was the right decision to make, and I will defend that decision to anyone at any time. That has not been easy to do because of the cutbacks at Westminster, as Ruth Davidson well knows. Nonetheless, the health service budget has been protected. It is entirely reasonable to point out that the fact that the staff numbers in the NHS are higher than when we came to office, as I mentioned, is a virtue of that investment. It is also true to say that the non-profit-distributing programme that exists across the national health service is producing great results and we look forward to direct investment in the new south Glasgow hospitals. Those things are improving healthcare radically across Scotland, which is a substantial achievement given the cutbacks elsewhere.
I do not like to talk about Wales, although the Prime Minister talks about little else when he speaks of the national health service at Westminster. Although we face a major challenge in accident and emergency services in some of our health boards in Scotland, which we are meeting, none of our health boards anywhere in Scotland is registering the figures of 81.7 per cent, 85.6 per cent and 86 per cent—which is the figure in Southend—that are being registered by health boards that are under pressure south of the border.
One of the reasons why people have confidence in the health service in Scotland is the unbending commitment of this Government to fund it in real terms. We are also committed not to fragment and privatise it, as has happened south of the border. That a Tory politician can come to this or any other chamber and ignore the dismay that has been caused in the health service across England by the policies of their Government almost beggars belief. Our health service will be kept in public hands. We will respond to crisis by investing more and we will meet challenges as they come, but it will be a public national health service for the people of Scotland.
Tavish Scott has a constituency question.
The First Minister will know that European structural funds for the Highlands and Islands are important for the delivery of economic growth. Can he confirm that the £172 million from the new structural fund will all be spent in the Highlands and Islands and that decisions on which projects are to be supported will be made locally instead of that function being removed to Edinburgh, which is what Shetland Islands Council and others fear will happen?
Those matters are under discussion. I am sure that Tavish Scott will look carefully at some of the recent substantial investments that have been made in Shetland, not least in the airport and other things that I could list. He will know of the Government’s substantial commitment to Shetland and the other island communities. The decisions are under discussion at the moment.
Cabinet (Meetings)
To ask the First Minister what issues will be discussed at the next meeting of the Cabinet. (S4F-02068)
Matters of importance to the people of Scotland.
Audit Scotland has reported that a lack of hospital beds is a major problem for accident and emergency. The number of hospital beds is at a record low, but last week the Cabinet Secretary for Health and Wellbeing said that there is not a strategic shortage of beds. Is it not the case that the Government woke up to the problem only two years ago? The First Minister mentioned Dr Martin McKechnie from the College of Emergency Medicine, and that is exactly what he said this morning. Does the First Minister not think that we are in this position because he failed to act early enough?
We are in a position where accident and emergency waiting times are improving; our accident and emergency staff all over the country are treating more patients than ever before; we are implementing lessons where best practice is ensuring very substantial results, as is the case in Tayside and elsewhere; and we are seeking changes to the health service’s infrastructure to bring about facilities such as the emergency care centre in Aberdeen, which is managing patient flow superbly. All those things are happening.
The new facilities have not been planned over the past 18 months; rather, there has been a continuing investment in the national health service over the past few years. It is absolutely right that the Cabinet Secretary for Health and Wellbeing, together with health professionals, put together the action plan to deal with the pressures on the national health service. However, there should be some acknowledgement that the national health service is treating more patients than ever before, and that the public have fantastic confidence in our national health service and nothing but admiration for the staff, the doctors and the nurses who are performing to such an exceptional level.
The First Minister mentioned keeping the NHS in public hands. That is exactly the point that I want to tackle him on—charging people for continuing care. Last Friday, the Government announced that it was ending the principle that people who need continuing care can get it free in their community. The only way that people can avoid hundreds of pounds of charges is to stay in hospital. Will that not increase the pressure on bed numbers and make the waiting times problem worse?
The First Minister has one half of his Government trying to get people out of hospital, while the other half is giving them all the financial incentives to stay in hospital. That does not make sense, does it?
The Cabinet Secretary for Health and Wellbeing will make a statement on continuing care in which he will explain the exact proposals and not the version that Willie Rennie presented. I am sure that Mr Rennie will want to participate in that discussion.
We are committed to the success of free personal and nursing care. That would have been enhanced substantially if the then Labour Westminster Government had not withheld the attendance allowance, which would have been an extraordinary help financially.
One of the most significant and continuing financial pressures on the national health service, which we cannot unfortunately do anything about, is the disaster of the private finance initiative. In key hospitals and hospital boards, that is resulting in continuing payments of eight to 10 times the cost of hospitals because of the disastrous contracts that Willie Rennie and his colleagues signed when they were in government. Our commitment to a public national health service is not just to protect the funding, but to have a public health service not paying over the odds to private contractors.
Population Increase
To ask the First Minister what the Scottish Government’s position is on the increase in Scotland’s population. (S4F-02076)
We are very pleased that Scotland’s population is at its highest ever level. Healthy population growth is vital to future economic growth, and the continuing increase in our population is welcome news.
It is very encouraging that our population is at its highest ever level but, like other countries, Scotland faces demographic challenges. Does the First Minister share my regret that Westminster’s United Kingdom Independence Party-driven agenda completely ignores Scotland’s needs and that only the powers offered by a yes vote will enable us to optimise our population and build a fairer and more prosperous society?
I agree. One of the signs—not just over only a few years but over a century—of the failure of Westminster control of the Scottish economy was the lack of population growth in Scotland. Over 100 years, the 10 per cent population growth in Scotland compared with around 60 per cent growth in England. Thankfully, since the advent of this Parliament and particularly over the past few years, those trends are reversing and they will reverse even further in an independent Scotland.
I cannot think of anything dafter as a policy, whether UKIP driven or not, than to educate students up to a high degree of human capital in our fine universities and then to deprive them of the opportunity to work and contribute to our economy. What could be a dafter policy than the one that the Liberal-Tory Administration at Westminster is pursuing?
We should welcome the fact that the new statistics show a substantial increase in population. In the space of one year, that increase seems to be substantially higher than the estimates used in November 2013 by the Institute for Fiscal Studies. We should accept that, if we pursue the right policies, we can get a population growth that is beneficial to economic growth in Scotland.
Free Personal Care
To ask the First Minister, in light of the reported 162 per cent increase since 2004 in the cost of providing free personal care, what action the Scottish Government is taking to ensure that local authority social work budgets can meet demand. (S4F-02071)
The Scottish Government is proud of the fact that free personal care improves the lives of more than 77,000 older people in Scotland. We are fully committed to the policy and I hope that, when the Labour cuts review eventually sees the light of day, Sarah Boyack will have been successful in defending free personal care from the cuts commission set up by Johann Lamont.
As Sarah Boyack will be aware, we protected the local government budget in relative terms and, in 2015-16, it will stand at £10.6 billion. In addition, since 2008, payments for free personal and nursing care have risen in line with inflation. The Scottish Government is also providing an additional £5 million to local authorities in 2014-15 for care of older people.
Given the view of the Convention of Scottish Local Authorities spokesperson Scottish National Party councillor Peter Johnston that
“Councils’ social work budgets are under huge pressure, with some ... nearly at breaking point”,
what will the Scottish Government do to address the fact that local government revenue spending has had a real-terms cut of 1.2 per cent while costs have risen 10 per cent since 2007? With demand for care services growing and more older people living longer, is it not time for the Scottish Government to sort out the squeeze in local government funding?
I do not know whether Sarah Boyack has woken up to the fact that there is a squeeze on public spending in Scotland because of the squeeze being administered by the Westminster Government. That is the reality.
Various aspects of public spending are being protected. The chief one to be protected has been the health service for the reasons that we have already specified. Labour, of course, did not commit to that.
Second only to the health service in the protection of public spending has been local government. In 2006-07, when the Labour Party was in office and Johann Lamont and others were ministers in the Administration, as a percentage local government funding was 34.7 per cent; in 2014-15, it is 36.7 per cent.
Yes, times are tough. How could they be otherwise as a result of the financial crisis induced by Alistair Darling and the Labour Government and the austerity policies that the Tory Government has pursued? However, local government spending has risen since the Labour Party was in power so, whatever the squeeze and difficulty, we know that it would have been a lot worse if Sarah Boyack and her colleagues had continued in office.
As the First Minister alluded to earlier, Westminster retained attendance allowance when we introduced free personal care. To date, that amounts to around £300 million. Surely the whole Parliament would agree that that should be returned to Scotland.
Do you have a question, Ms Grahame?
Even the Labour Party, when in power here, asked the Labour Government at Westminster for that and was refused. It should surely be returned now to help with our elderly.
The withdrawal of attendance allowance is a hugely important issue. If I remember rightly, Henry McLeish, as First Minister, said that it was unfair that, as a result of a Scottish Government policy, attendance allowance should be withdrawn from Scotland. I think that I am right in saying that it was Jim Murphy who, as the Westminster minister, said, “No, we’re going to keep the attendance allowance money.” Over the years since, it amounts to more than £300 million.
That tells us two things. First, would it not be a grand idea if we considered and controlled all aspects of policy—not only spending but revenue and social security? Secondly, how useful would that £300 million now be in helping to fund the things that the Labour Party says it cares about but for which, when in office, it withdrew funding from Scotland?
Alcohol Minimum Pricing
To ask the First Minister what the Scottish Government’s position is on the minimum pricing plan for alcohol being referred to the European Court of Justice. (S4F-02077)
We look forward to making the case before the European Court of Justice for that vital public health tool, which will help to rebalance Scotland’s relationship with alcohol.
Each week, on average, alcohol misuse is responsible for more than 20 deaths and almost 700 hospital admissions in Scotland. Minimum pricing would save lives within months of its introduction. The Scottish Government remains committed to implementing it as part of the concerted package of measures that has already been rolled out to reduce alcohol-related harm.
Scotland is leading the way on the issue: I understand that the Governments of Ireland and Estonia have outlined that they would like to move to their own minimum unit pricing systems.
Does the First Minister recall the wise words of the European Commissioner for Health, Tonio Borg, who said that he was in favour of minimum pricing in principle? Along with the empirical evidence from Canada, and the support of each of the United Kingdom’s chief medical officers, does that not further demonstrate that minimum pricing is essential if we are to reduce alcohol-related harm, cut violent crime and save lives in Scotland?
We welcome the commissioner’s backing in principle for minimum unit pricing. As the member points out, that adds to the substantial weight of support for the policy, particularly from those who work daily with the effects of alcohol misuse and abuse.
Minimum unit pricing was introduced in Canada and has resulted in reductions in alcohol-related harm. A 10 per cent increase in minimum price has led to an estimated 32 per cent reduction in wholly alcohol-attributable deaths.
As I said, I welcome the referral to the European Court. I look forward to implementing minimum unit pricing—a policy that, the evidence shows, will save lives.
Previous
General Question TimeNext
Skin Cancer