Health
Good morning. The first item of business is a debate on motion S2M-2931, in the name of David McLetchie, on health issues, with specific reference to the Kerr report.
The Scottish Conservatives are pleased to make our time in the Parliament available to members to debate the Kerr report and the state of the national health service in Scotland. It is a matter of regret that the Scottish Executive refused to do so in its time prior to the recess, given the importance of the subject.
Almost every survey of public opinion shows that health is the issue of greatest concern to people in Scotland, and it is, I submit, the biggest challenge facing this Parliament and the Executive. We need to engage in a genuine debate about the future direction of our health service. Professor Kerr's report is an important contribution to that debate. We need to start by looking at where we are today in a calm and rational manner, if at all possible. Too often, discussions on health in this chamber are reduced to a war of words over the key statistical indicators and whether they are getting better or worse. That is fine and valid, as long as we also make time for less fevered debates in which we consider the broader issue of how we improve our health care system. That is the purpose of today's debate and the purpose behind the Kerr report.
I have said on numerous occasions in this chamber that I am happy to acknowledge the additional funding that has gone into the health service since 1997. That funding has been substantial. Since that time, spending has increased by 55 per cent in real terms. However, that is not a break with the past, but simply an acceleration of a trend established under the last Conservative Government. Far from starving the health service of resources, the same spending figures indicate that spending in Scotland rose by 55 per cent in real terms during the period of our Administration. Those who call for a mature debate about the health service in Scotland should have the grace to acknowledge that fact.
Equally, I acknowledge some specific improvements that have taken place in recent years. For example, real progress has been made in dealing with premature death from coronary heart disease, with a 38 per cent drop in rates since 1995. Survival rates for most types of cancer are also up, with death rates down by 8.5 per cent since 1996. Those improvements are welcome. I fully accept that it is not all doom and gloom. However, honesty also requires that we not only give fair credit for improvements, but recognise failings and shortcomings. In many respects, the key indicators are worse. The extra money going into the health service has not been matched by corresponding increases in productivity, hence the increase in waiting lists and waiting times for in-patients and out-patients, which means that our patients are not receiving the level of service that they demand and deserve and for which they are paying through their taxes.
The problem of demand outstripping supply in the health service is not new—it is as old as the NHS itself, and politicians of all parties have wrestled with it since the NHS's inception in 1948. One assumption on which the NHS was based was that once the backlog of ill health had been treated, demand and expenditure would reduce. However, as we all know, the reverse has been the case, as a result of the demography of our population, rising public expectations and advances in medical research and health technology. Thus, we have the on-going political problem of dealing with potentially limitless demand on the one hand and finite resources on the other.
Does David McLetchie agree that the premise underlying the NHS and Bevan's vision that demand would decrease was based on there being anti-poverty measures and the eradication of poverty, which is the major cause of ill health? That is what Governments have failed to do, including his.
I agree that there is a multidimensional aspect to it, and that we have to deal with issues relating to poverty, but if Carolyn Leckie examines the standard of living of people in all classes in this country since 1948, she will see that it has improved immeasurably under both Labour and Conservative Governments.
The outward signs of the health service struggling to cope are obvious: patients languishing on long waiting lists, unacceptable waiting times, proposals to close local hospital services—against the wishes of local communities—in the cause of rationalisation, and the slow adoption of new technologies and drugs in the NHS compared with other European health care systems, as identified by the Wanless report that was commissioned by the United Kingdom Government. However, despite all those perfectly justifiable causes of complaint, as Professor Kerr points out, the NHS
"is still seen as Government's greatest gift to its citizens".
I contend that that underlying support is based on the founding principle of the NHS—with which we all agree—which aims to guarantee health care for all, according to need and irrespective of ability to pay. The challenge for us in this Parliament is how we sustain that principle while recognising that the structure of the NHS needs to be updated to make it fit for the 21st century.
I put it to the chamber that the main reason for the failure of the NHS to meet public expectations lies in its structure as a centrally-run state monopoly. As Alan Milburn said:
"The system seems to work for its own convenience not the patient's—a frustration that is shared between staff and patients alike. The whole thing is monolithic and bureaucratic. It is run like an old style nationalised industry".
The problems associated with central planning do not change. No matter how well intentioned or intelligent the people doing the planning, without the necessary information they will find it impossible to meet the needs of patients. In such a system, patients have no way of indicating how much they would like spent on health care or where that spending should be directed. It is therefore no surprise that those doing the planning often get it wrong.
There is limited spare capacity within the NHS, so waiting lists become the means of rationing access to health care to meet demand. Such shortfalls can be in different parts of the country or in particular specialist services. That is what leads the planners to advocate the rationalisation and centralisation of services, which we all know is deeply unpopular with people who see their valued local hospital services under threat of closure. That is exactly where we find ourselves today—the only way for people to register their support for their local services is not through the personal health care decisions that they make, but through political protest.
The Executive's response to the unpopularity of rationalisation, which many see as a euphemism for closure, was to commission—some might say hide behind—Professor Kerr's report. Of course, that did not stop political pressure being brought to bear in the interim to reverse unpopular decisions, such as those taken in relation to St John's hospital in Livingston—a fine hospital built, of course, by the Conservative Government. Such politicisation is an inevitable consequence of the way we run our health service. It is deeply unsatisfactory, which is why we need fundamental reform.
Many of the objectives set out in Professor Kerr's report are eminently sensible. For instance, the aim of delivering health care predominantly in local communities is clearly in tune with public feeling. However, we should remember that we were moving in precisely the opposite direction as regards hospital services until the strength of opposition made its voice heard throughout Scotland.
How do we ensure that the Kerr report is more than just a temporary halt in that centralisation process? I submit that that will happen only if we are prepared to adopt a genuine change of approach. If I may say so, the weakness of the Kerr report is that, while it recognises the need for change, it advocates leaving in place the central features of the system that got us into the present situation in the first place. In that system, change comes about only at the behest of those who run the service—the politicians and their health board appointees—and the service develops according to the edicts, directives and targets that are set by the men from the ministry.
The alternative is to let patients' choices determine how the service develops. In that way, change would become evolutionary and gradual and we would not have the periodic and disruptive shifts in approach that characterise the current system. The central feature of the NHS of the 21st century must be its determination to put patients' needs first. Many fine words have been spoken about that, but it is time to turn them into reality. We will achieve a fairer system that guarantees access for all and that prevents political distortion of health care provision only if we give power directly to patients. That means putting funding into the hands of patients and enabling them, in conjunction with their general practitioners, to purchase health care from the provider of their choice.
Mr Purvis was first.
I ask Mr McLetchie to clarify two points. First, am I correct that the Conservative policies for greater devolution to individual hospitals and for a passport for patients will, as a Conservative policy paper states, result in
"large cost differences between hospitals"
being "eradicated"? In other words, there is to be a national cost basis for all treatment in the NHS.
Secondly, figures from the Department of Health show that in England in 1994, 19,800 people were on the in-patient waiting list for 15 months, whereas in 2004-05 the figure was reduced to 12,538. However, in Scotland, the most recent figure was zero. How does Mr McLetchie explain that?
That is a bit of a statistical blizzard from Mr Purvis; I am not sure that I can explain the matter in the time that is available to me. However, on his first point about costs, it is extremely important that we establish the cost of services in our hospitals, because we will get better value for money for the taxpayer from NHS treatment if that information is transparently available and if we use a multiplicity of providers to treat patients in the NHS. There is no point in having a tariff system unless we are prepared to use it.
We must make a fundamental change in the Government's role in relation to the NHS, so that it becomes a funder and a guarantor of access for all, according to need. In recent months, there have been signs that the Scottish Executive is trying to move in that direction. We understand that a tariff system is to be introduced that will provide a standard price for NHS treatments. That is an essential first step in creating a modern health service, as we have seen in Sweden, where such a reform was the catalyst for the creation of a level playing field on which public and independent providers could compete for patients. However, the Scottish Executive's announcement of the change was so sotto voce as to be almost imperceptible. As I pointed out at First Minister's question time two weeks ago, there was nothing about the change in the NHS plan that was published in December and nothing about it in the statement that the Minister for Health and Community Care, Mr Andy Kerr, made to the Parliament on the NHS plan. What is the minister so afraid of, that he has a policy that dare not speak its name?
Of course, it is never comfortable to admit that one was wrong. Further, the wholesale adoption of Conservative solutions would no doubt cause uproar among the health service unions and, by all accounts, Mr Rumbles and the Liberal Democrats, too. However, we should make no mistake: we are seeing Labour men and women and Tory measures. It is about time that the Minister for Health and Community Care admitted the truth about the policy.
Sorry, but I think that Mr Ewing was first.
On the topic of admitting when one was wrong, were the Tories wrong to introduce trusts and boards in to the NHS?
Most certainly not. I inform Mr Ewing that, if we still had a trust in Caithness, we would not have the absurd situation in which women in Wick are sent 100 miles to have their babies. The Executive has vandalised and savaged the local control of our health service, which has sent the service down precisely the wrong road.
If there is to be a new dawn for the health service in Scotland, people in Scotland have a right to know about that and the Minister for Health and Community Care should stop hiding behind obscure language. The potential benefits of the policy are there for all to see. In England, a similar reform has enabled the independent sector to increase greatly the available capacity to treat NHS patients and the overall productivity of the service. For example, independent sector treatment centres that specialise in cataract operations can treat eight times more patients per day than the NHS has traditionally managed. Reform of that kind would lead to exactly the benefits that the Kerr report wishes for the health service in Scotland: standards would rise and patients would be treated more quickly; new ways of meeting patient needs would be developed, with faster adoption of new medical techniques and drugs; and there would be better value for money, as costs would be driven down by the most efficient providers.
Are the Scottish Executive and the ministers serious about genuine reform or, as in many other cases, are they just paying lip service to change and making a few token gestures but otherwise carrying on business as usual? If the ministers are serious about genuine reform, the Conservatives will support them. They should not be held back by the fickle Liberal Democrats, the fearties in the Labour Party or the Scottish National Party dinosaurs, whose thinking about the NHS is still stuck in the time warp of 1948. If the Scottish Executive has the courage to grasp the nettle, it will do the NHS and our people a great service.
I move,
That the Parliament welcomes the Kerr report as an important contribution to the debate on the future structure of the NHS in Scotland and its objective of ensuring that most health services continue to be provided at a local level in response to patient needs and demands; notes, however, continuing public concern over the extent of the proposed centralisation of hospital services across Scotland and the effectiveness of NHS 24 and the out-of-hours service; further notes that, despite a substantial increase in funding for the NHS in Scotland, the waiting list is longer and waiting times are higher than they were in 1997; believes that a truly patient-centred NHS will be possible only if purchasing power is put in the hands of patients so that their choices determine the development of the service and healthcare providers are given far greater freedom to respond to those demands, and, to that end, calls for the establishment of foundation hospitals within NHSScotland and an increase in the capacity available to treat NHS patients by extending the use of the independent sector.
Although we received the Kerr report only two weeks ago, I was somewhat encouraged that the Conservatives wished to discuss it, because I thought that they might attempt to build on the welcome consensus among all parties that was displayed on 25 May. Mr McLetchie probably intended at the beginning of his speech to show some consensus. However, the Conservative party motion makes it clear that today's debate is not intended to be consensual and the rest of Mr McLetchie's speech bore that out.
As the Kerr report clearly points out, the NHS in Scotland must change to meet the challenges that it faces in the 21st century. Those challenges—the aging population, the emergence of chronic disease as the main issue facing the health service and the growth in emergency admissions—are significant, but surmountable. To bring about the necessary changes successfully, the Parliament must play its part, which means mature debate about how to improve the service and implement reform. We should not apportion blame or make unnecessary criticisms, because it is genuinely important that members act responsibly and consider what is best for the NHS. However, I will be pleased to tell my UK colleagues of the Scottish Conservative party's continuing support for the Labour Government's reform of the English health service. I am not sure that Mr McLetchie's colleagues down south will be so pleased, as they opposed foundation hospitals the last time I heard.
Will the minister take an intervention?
Let me finish my introduction.
Let me be clear that the Executive parties are pro-reform, pro-diversity of provision and pro-patient choice, but we are not about importing models from elsewhere in the UK with no consideration of their suitability in the Scottish context. As for the views on out-of-hours care that are expressed in the motion, I fear that the Tories are still living in the world of "Dr Finlay", perhaps around 1995, which was probably the last time the Conservative party had a majority.
The Scottish Executive is committed to a distinctly Scottish health care model that is based on collaboration and integration, and Professor David Kerr explicitly supported that model in his report. However, we are also willing to make the necessary reforms. By implementing single system working in NHS Scotland, for example, we have already removed many barriers to local decision making and innovation. The Golden Jubilee national hospital and the developing regional treatment centre at Stracathro are two further examples of the innovation that there has been in NHS Scotland in recent years.
I turn to the motion's criticisms of NHS Scotland. Members are aware of the findings in the NHS 24 review group's interim report. We established that review to identify where performance could be improved and to realise the full potential of an innovative and crucial part of NHS Scotland. That was the right step for the Executive to take. The review group's interim report makes a number of recommendations, and I welcome the public commitment of NHS 24 to implement those recommendations as soon as possible. Are the Conservatives seriously saying that we can do without a telephone triage system?
The Kerr report makes a number of innovative suggestions about the integration of out-of-hours services with other parts of the NHS, including in multidisciplinary community casualty units. We will look at those proposals closely over the summer.
Page 30 of the Kerr report states:
"as a rule of thumb each current hospital offering A&E services should be able to sustain services for urgent care".
Will the minister give us a view on Fife NHS Board's proposal to move accident and emergency services from Queen Margaret hospital to Victoria hospital in Kirkcaldy in the long term? Does she still support that move, or does she support what Kerr says?
Fife NHS Board will not revisit decisions that have been taken on the basis of consultation. What is exciting about the Kerr report is that it contains the concept of community casualty units in which people can be treated as close to home as possible, although they might have to move to other centres if very specialist treatment is required. The concept of community casualty units is hugely exciting and we look forward to examining the proposals closely over the summer months.
On waiting times, we continue to deliver improvements against the standards that have been set. In March 2005, no patient waited longer than our guarantees for in-patient, day-case or heart treatment. The number of patients who waited for more than six months with a guarantee for in-patient or day-case treatment, or for out-patient appointments, significantly reduced, which leaves us well placed to deliver our maximum waiting time standards of 26 weeks at December 2005 and 18 weeks at December 2007.
I turn to the positive opportunity that the Kerr report offers for developing NHS Scotland. The report calls for the NHS to identify patients who are most at risk of hospitalisation so that better care can be provided to keep them out of hospital. We should not wait until an emergency develops before we provide appropriate care. Patients are better served by co-ordinated care in the home or community that is aimed at preventing crises from happening.
The report highlights the work that is still to be done on health inequalities and makes valuable recommendations in that area. Evidence has been presented of persistent underutilisation of health services in our disadvantaged communities, and that has an associated impact on health outcomes. Therefore, we welcome the recommendation that resources should be targeted at enhancing primary care capacity in deprived areas—and the recommendation that at-risk patients in those areas should be actively sought out—to provide appropriate health advice and treatment.
Does the minister recognise that providing such facilities at local level may require investment decisions that will mean that difficult decisions will have to be taken? Is the Executive committed to making those decisions and to ensuring that such facilities are provided in places such as Glenrothes, where there is currently a severe shortage of facilities?
I recognise the need to invest in areas in which services have been underutilised. There will be an announcement on the modernisation of primary care premises shortly; I am sure that members will welcome that.
We remain absolutely committed to the proposition that a person's place of birth should not determine how long they are expected to live.
I commend the report's focus on unpaid carers, who provide a high proportion of health-related care. Their role is often insufficiently acknowledged and supported, and I welcome the report's stress on providing unpaid carers with the information, training and support that they need. They are invaluable partners in the provision of care.
We welcome Professor Kerr's finding that the majority of unscheduled care can be provided in multidisciplinary community casualty units and accept his conclusion that not every hospital will provide the whole range of complex emergency work. We expect boards to consider the range of options that the report gives for sustaining local unscheduled care services. Ministers also support Professor Kerr's recommendations on the separation of planned and unscheduled care.
The Minister for Health and Community Care has made clear the Executive's intention to have a full debate on the Kerr report soon after the summer recess. That will give members time to consider the report, which is more than 250 pages long; more than 1,000 pages of supporting text are also available. It will also give time for all parts of the health service to consider and discuss the report. Earlier this week, the minister met the board of NHS Highland to discuss the implications and implementation of the Kerr report. I encourage all members to engage constructively with their local boards.
I finish by emphasising my opposition to the Conservative party's calls for the introduction of foundation hospitals within NHS Scotland; pointing out the evidence of steady improvement in out-of-hours services and waiting times; and emphasising the opportunity that the Kerr report provides to focus on the future of NHS Scotland. We should not squander that opportunity by dwelling on the past.
I move amendment S2M-2931.3, to leave out from "welcomes" to end and insert:
"commends the Kerr report, Building a Health Service Fit for the Future, and its emphasis on sustainable and safe local services and preventative care for the most vulnerable, which supports the Scottish Executive's goal of delivering care that is as local as possible and as specialised as necessary; welcomes the interim report of the NHS 24 review team and the public commitment of NHS 24 to implement the key recommendations as quickly as possible for the benefit of the people using the service, and is encouraged by the positive progress on waiting times and waiting lists."
I begin by apologising on behalf of Shona Robison for her absence. She was keen to be here, but, unfortunately, has been taken unwell.
I welcome the opportunity to debate the Kerr report. However, it was incumbent on the Executive to have a debate at the earliest opportunity in Executive time, rather than put off a debate until some time later in the year.
I oppose the Tories' attempt to turn the debate into a political opportunity to try to promote the private health sector at the expense of the NHS. On that point, Professor Kerr's report states:
"Patient choice is important, but the people of Scotland sent us a strong message that certainty carries greater weight".
On the member's reference to the Tories supporting the privatisation of the NHS, will he explain why the Scottish National Party members of the Health Committee do not support my amendments that attempt to halt the privatisation of the NHS?
The Scottish Socialist Party's dogmatic approach is well known, but we do not take its approach. There is a role for the private health sector, where appropriate, but the Government's primary activity should be to support the NHS in Scotland and to ensure that that is the priority. The Tories' false choice would rob the NHS of both the certainty that was mentioned in the report and, of course, much-needed funding. That funding would be handed over to the private health sector.
Will the member take an intervention?
Not at the moment. The member should give me a chance to get started.
By having NHS patients treated in the private sector, we would actually often pay more to have the same patients treated in the same hospital by same doctor. The NHS would slowly become a second-rate provider. That is not choice for all, but choice for the few. The Tories' plans would give to the few who can afford to pay at the expense of the many who cannot.
One of the most important issues that the report identifies is the potential for improvement that can be achieved through the separation of elective and non-elective work. The patient journey can often be haphazard, as I found out last year when I was required to go into hospital for an operation. I was relieved to have my operation, and I praise all the staff who were involved, particularly those in ward 5 of the Victoria infirmary in Glasgow, who were part of a highly professional and dedicated team. I appreciate the care that I received. However, when I was first diagnosed, I was told that I would have to wait between two and six months for an operation. After two months, I was informed that the operation would be at least another six months away. However, after two months and one week, I received a phone call during which I was asked whether I could take a cancellation a few days later. I was extremely grateful for that cancellation but, as my personal experience shows, it is crucial to separate out elective procedures to ensure that, as Professor Kerr says,
"if we make a commitment to see or treat a patient on a specific date, we must honour this, and ensure the quality of care delivered."
Professor Kerr suggests that to do that, NHS boards will have to fulfil several tasks. Those include ensuring that diagnostics and theatre facilities are actively utilised during a more flexible working day to allow more patients to be treated. That is an excellent idea and it is long overdue. Boards should also introduce pre-admission clinics led by nurses and allied health professionals so that certain tests can be carried out prior to elective surgery. Such clinics would also manage variations in the length of patients' stay through admission on the day of surgery and active discharge planning. Along with the other recommendations, that would contribute greatly to the smoother running of elective procedures.
We in the Scottish National Party are very pleased that Professor Kerr agrees with our policy of introducing a network of diagnostic and treatment centres. I agree with David McLetchie that there is ample evidence from England that diagnostic and treatment centres have a vital role in bringing down the length of waiting times for treatment. In England, the statistics show that, between 2002 and 2004, the percentage of in-patients admitted within six months rose from 77 per cent to 91 per cent. However, that was not because of the private sector diagnostic and treatment centres. As of March 2004, there were only two private treatment centres in use in England. Most of the increase in the percentage of patients being treated and the cuts in waiting times were down to the use of centres within the NHS.
I agree with the Kerr report when it states that we should look to the NHS first. I also agree with the report when it goes on to say:
"If this action does not sufficiently meet the supply side pressures, NHSScotland should continue to explore options for targeted partnerships with private sector providers".
However, the Executive decided to go straight to the private sector rather than use the NHS first. The NHS in England achieved great results through using diagnostic and treatment centres within the NHS, so is the minister able to explain why the NHS in Scotland could not do likewise?
I turn to the issue of staffing. If there is an expansion of the private health sector in Scotland, the big unanswered question—the Tories have never come up with a proper answer to it—is: where will the staff come from? I do not usually agree with Robin Cook, but I did when he recently said:
"As a former health spokesman, I find the least appetising passage in the manifesto to be its curious belief that the capacity of the NHS can be expanded by increased use of the private sector—or, as it is delicately described in the text, ‘the independent sector'. The reality is that the private sector does not add capacity to the NHS but competes with it for the time of its consultants. My local health board gave the game away recently by advertising a new post for a consultant to work three days a week in the NHS and two days a week in a private hospital at NHS expense. The danger with increasing private provision is that its commercial culture undermines the very public-service ethos that makes the NHS popular."
Does the Minister for Health and Community Care agree with his Labour Party colleague, Robin Cook? I do not think so, because, frankly, the minister's assurances that private health companies involved in NHS work would be prevented from poaching NHS staff are not worth the paper they are written on. The self-same assurances were given in England and they have proved to be absolutely worthless. As Unison pointed out,
"The treatment centres will be allowed to employ seconded NHS staff, contrary to the earlier assurances by the government that ‘the medical staff from these units will be from overseas and additional to the existing NHS workforce.' Now, according to the BMA, overseas companies would be allowed to second up to 70% of their staff from the NHS."
The minister briefly mentioned health inequalities, and I have one comment to make on that. Health inequalities in Scotland are appalling, and they are getting worse, not better. Successive Tory and Labour Governments have made the difference between the life expectancy and healthy life expectancy of the richest and poorest in our society worse rather than better.
I welcome the Kerr report and its support for the many policies that the SNP has been advocating for some time, particularly the use of diagnostic and treatment centres primarily within the NHS to avoid the many pitfalls that would result from attempting to go down the Tory route of expanding the private health sector at the expense of the NHS.
I move amendment S2M-2931.1, to leave out from "believes" to end and insert:
"commends the staff within the NHS for their hard work and dedication; believes that, to tackle waiting times more quickly, there is a need to set up fast-track diagnostic and treatment centres within the NHS, and welcomes the Kerr report's emphasis on addressing health inequalities in order to close the health gap that currently exists in Scotland."
I am grateful that my amendment was selected.
The new document "Building A Health Service Fit For The Future Volume 2: A guide for the NHS" is a big document, and there are lots of points for discussion in it. However, frankly, I am extremely disappointed at the level of the discussion and debate so far. The Tories want to reduce everything to the question of foundation hospitals. Despite the fact that the document has just been published and has not yet been distributed to NHS professionals, the Labour amendment shows that Labour is quite happy to commend it. The SNP wants to reduce all the issues to the single question of diagnostic and treatment centres. The phrase "raise your game" has been used in the chamber many times during the past couple of years and, really, members should raise their game. An Opposition should be prepared to scrutinise properly, and we have had no proper scrutiny.
It is a bit rich for the SNP, through Stewart Maxwell's speech, to talk about privatisation. I will come back to that.
The Kerr report itself raises practical concerns about the implementation of some of its recommendations. It poses unanswered questions and raises challenges about issues such as recruitment and retention and where staff are going to come from. However, according to Nicola Sturgeon last week, the SNP wants the Kerr report to be implemented now, without exploring such questions.
There are a lot of things to be concerned about. According to the report, more care should be co-located with pharmacies and delivered on the high street. We know that the Executive is already trying, with the help of the so-called Opposition, in the guise of the Smoking, Health and Social Care (Scotland) Bill, to introduce local improvement finance trusts—LIFTs—which are primary care private finance initiatives. Soon, the general practitioner will be competing with the pharmacy for space in the LIFT primary care centre. More and more health checks, diagnosis and prescribing will be done by private pharmacies that are itching to branch out.
The report also says that more options should be explored to reduce waiting times, including partnerships with overseas private sector providers, who might bring in complete surgical teams. If the SNP is so concerned about privatisation, why is it not picking up some of those references in the Kerr report? Have SNP members actually read it?
Does the member believe that the private health sector in Scotland should be completely banned? Is our position not more sensible? The NHS should be the primary focus, but if there is a private health service, people should have the right to go to it, although we would not fund it at the expense of the NHS.
Mr Maxwell obviously does not understand that the private health care sector undermines the very ethos of the NHS.
Would the member ban it?
Yes. I am quite proud to say that. We would incorporate everything into public provision. That would be absolutely clear to Mr Maxwell if he had read my amendment.
The Kerr report also talks about the separation of emergency and elective care by establishing diagnostic and treatment centres. As we have seen from the Executive's actions, that translates into implementing the suggestion of independent treatment centres based on the English model, just 24 hours after the Kerr report is published and a statement is made in the chamber. That is the way we are going. I asked Andy Kerr about what the Kerr report meant in terms of an increased market share for private health provision in Scotland. He did not answer that question, and I do not know whether that was because he could not answer it or because he refused to.
The Westminster Government is quite happy to tell us that it predicts that, over the next five years, the market share for the private sector in England will go from 5 per cent to 15 per cent. What is the projection for Scotland? Has the Executive done a projection? If it has, why is it not sharing the result?
I am grateful that paragraph 60 of the document lays down a challenge to orthopaedic surgeons on the amount of time that they spend operating in the NHS. It is interesting that orthopaedic surgeons have been singled out, given that, as we know, of all medical professionals in Scotland, orthopaedic surgeons are the most prolific providers of private surgery. There is a relationship between those two issues, because the more activity that surgeons carry out in the private sector, the less they carry out in the NHS. That is why we must make it clear that health care should be provided within a public framework.
We already have rationing in the NHS, but despite that context the report's proposals—they are supposed to be cost-neutral, but Kerr himself acknowledges that his report provides no evidence to substantiate that claim—will require a further reorganisation of NHS staff. A witness at last week's meeting of the Equal Opportunities Committee said that a section of the community had been "consulted to death", and I believe that NHS staff have been reorganised to death. How will the Executive reconcile the need to tackle the recruitment and retention problems that are endemic in the NHS with this further call for reorganisation on a cost-neutral basis? Staff will be required to retrain and to take on even more roles and responsibilities. Where will the money come from for that retraining? Who will back-fill those posts and who will pay the money that doing that will cost? If all of that is to be done through overtime, who will pay for the overtime?
In conclusion, I return to the issue of joint ventures. When it comes to the crunch, are SNP members opposed in principle to privatisation, given that their position on joint ventures means that they are railing against Unison, the Scottish Trades Union Congress and the Royal College of Nursing? Does their policy depend on whether they are fighting in the north-east of Scotland or in Glasgow? Are they for privatisation or agin it? I ask them please to make their position absolutely clear.
I must say that I agree with David McLetchie that the Tories are the most successful lobby group that exists. They do not even need to get elected to get the policies that they want. The Tories do not win elections because their class already has the Government that it wants. Everyone is competing on the same terrain.
Will the member take an intervention?
I am sorry, but I do not have enough time.
Since the report was published, the only thing that the SNP has opposed is the Executive's failure to implement its policies sooner. Where is the Opposition? The SNP really should raise its game.
I move amendment S2M-2931.2 to leave out from "welcomes" to end and insert:
"notes the contents of the Kerr report and recognises its contribution to the debate on the future of the NHS in Scotland; believes that, if protected within a public model, many of its proposals are useful; is concerned, however, that the report suggests, in line with the current trend of Scottish Executive policy, several avenues for the further marketisation and privatisation of health care, relies heavily on NHS staff co-operating again with reorganisation and retraining and accepting new and additional roles and responsibilities but claims that the proposals within the report are ‘cost neutral', and therefore believes that the NHS's capacity, workforce planning and recruitment and retention problems will not be resolved by the report's recommendations or current Executive policy, and that only securing and expanding the NHS as a public service, delivered by public service workers from publicly-owned facilities, will offer the foundation for the improvement and development of an NHS in Scotland fit for the 21st century."
That was an interesting contribution from Carolyn Leckie.
Despite what David McLetchie said, the Conservatives ensured that today's debate would not be focused simply on the Kerr report when they inserted into their motion ideologically inspired and partisan proposals that would have the effect of undermining the national health service in Scotland. However, I want to begin by focusing on the report, which makes a major contribution to developing an NHS in Scotland that, as the title of the report suggests, needs to be "Fit for the Future". Indeed, the report's main objective of ensuring that most health services continue to be provided at a local level fits in well with the vision for the national health service that the Scottish Liberal Democrats have long advocated. We have no doubt that the Kerr review should mark a turning point for the way in which the NHS operates throughout Scotland.
Some of Kerr's proposals will have a real impact on the national health service. His proposal to take action with anticipatory care chimes well with the Liberal Democrat emphasis on focusing on preventive health measures such as free dental and eye examinations for all. We have also delivered a new emphasis on health promotion by tackling issues such as sexual health, smoking, alcohol, lack of exercise and poor diet. The proposed creation of community casualty units for the provision of the vast majority of hospital-based unscheduled care is a major and welcome step. In addition, his proposal to support our remote communities by developing networks of rural hospitals and establishing a school of rural health care is an excellent idea that the Scottish Liberal Democrats whole-heartedly support.
However, before I venture too far in giving a 100 per cent welcome to Kerr, I must flag up an issue that causes concern. Although I absolutely accept the proposition that specialised or complex care needs to be concentrated on fewer sites to secure clinical benefit, I am somewhat disturbed to see that, for neurosurgery, he recommends
"a networked approach from a single hub."
Although I agree entirely that we need to provide highly specialised services such as heart operations and neurosurgery on a limited number of sites, I cannot envisage much support for neurosurgery being limited to a single Scottish location, wherever that may be. I welcome the opportunity to flag up such issues in today's Opposition debate, but I look forward to engaging in the Executive's extensive debate on the issue when we return from the summer recess. We should have far more time to debate the issues in depth.
I share the member's concern about the proposal to concentrate some specialist procedures on one site. Distance is a problem not only between Wick and Inverness but across Scotland, so providing and directing care from one centre is not the route to take. Does he agree that it would be much better to have a managed clinical network approach, provided that we can get cross-boundary arrangements among health authorities?
I completely agree with Brian Adam on that point.
Will the member take an intervention?
I have just taken one. I will come back to the member later.
The Conservative motion before us today raises other issues. I cannot understand the Conservatives' reluctance to welcome good news when they see it. All the Scottish Executive's commitments to reducing the very long waits that patients suffer have been achieved. Everyone with a guarantee has been seen in the timescale envisaged. I can tell Mr McLetchie that, as a constituency MSP, I used to be inundated with complaints from constituents about the length of time that they had to wait to be seen. By the end of this year, no one with a guarantee will need to wait more than six months. That is a real achievement compared to the situation that existed when the Conservatives were last in power.
Will the member give way?
I will do so in a moment, but let me make my point.
Perhaps that is the real reason why the Conservatives now say, as Mr McLetchie did today, that they will no longer bandy about statistics. What a cheek. Mr McLetchie knows that the statistics are all pointing in the right direction.
If the statistics are all pointing in the right direction, can Mr Rumbles tell us why waiting lists in Scotland are higher today than they were in 1997 and why the median waiting times for out-patients and in-patients in Scotland are higher today than they were in 1997? They seem to be pointing in precisely the opposite direction.
That is precisely the kind of bandying about of statistics to which I referred. David McLetchie has just talked about the numbers of those on the waiting list; I am concerned about waiting times, or how long individuals need to wait—an issue that the Scottish Liberal Democrats got into the partnership agreement. David McLetchie is not listening to the points that everyone is making. He seems to be cloth-eared.
Let me keep with the Conservatives' motion for a moment. One part of it states:
"a truly patient-centred NHS will be possible only if purchasing power is put in the hands of patients".
I could not disagree more, because what David McLetchie means by that is patient passports, which would take patients straight out of the national health service. To allow patients to be able to afford private health care, the Tories would give them a direct subsidy of money that had been earmarked for the national health service. No wonder the Conservatives no longer dare to mention patient passports, as everyone knows what they mean by that. David McLetchie's plans would undermine the national health service, and he knows it. There is nothing wrong with engaging the private sector to provide much-needed health care, but the fundamental principle of the NHS must remain that patients are not required to pay for their treatment. Health care needs to be free at the point of use.
The Conservative motion goes on to call for the establishment of foundation hospitals, as in England. The Scottish Liberal Democrats oppose that initiative, on the ground that it would give a false impression of competition. The initiative would not work in Scotland, where many patients, especially in rural areas, do not have a choice of hospital.
There is no way that the Scottish Liberal Democrats can support the motion, which strikes at the heart of the national health service in Scotland and would be a disaster for the people of Scotland. I urge members to throw out the Conservative motion and to agree to the Executive amendment.
I thank Rhona Brankin for taking the time to meet representatives of the Society of Chiropodists and Podiatrists last week. That was much appreciated. I also thank Carolyn Leckie for reminding us what the SSP is all about. If the party is looking for a new slogan, I suggest, "Remember Trotsky and forget the patients." That would be most appropriate.
In his report, Professor Kerr outlines the dominant issues that are of concern to the national framework advisory group. He is right to raise those issues again, as for the past six years we have been promised that they are being addressed. The report refers to
"Maintaining high quality services locally",
but we face current threats to downgrade hospitals in the Highlands and elsewhere. It also mentions "Improving waiting times", but waiting times have got worse. I say to Mr Rumbles that the waiting list has increased by 22,000 since the Parliament opened in spring 1999.
Another issue that Professor Kerr highlights is
"Supporting Scotland's remote and rural communities"—
tell that to people in Argyll and the islands. He mentions
"Using new technology to improve the standard of care",
but we still do not have joined-up information technology services. Also of concern is
"Reducing the health gap between rich and poor".
If someone can pay for a dentist, podiatrist, hip operation or care home, they get the service instantly. If they cannot, they wait and wait and wait.
This is an excellent report. However, as David McLetchie said, it cannot be implemented using the existing approach—the past six years have proved that. Over the six years of the Parliament's existence, we have been told by three health ministers that, if something can be done in primary care, it should be done there. The problem is that, under the Tories, things were being done in primary care. The advent of GP fundholding was the driver for more care, more treatment and more services to be offered as near the patient's home as possible. Dr Richard Simpson, a Labour MSP during the previous session, often acknowledged that. When the Labour Government ended fundholding, nothing was put in its place to drive forward care and treatment in the primary care setting.
The Kerr report also focuses on patient choice and seamless care across health, social work and all sectors. We all voted for free personal care and more care in the community. However, that is a major thrust of the Kerr report, because it is simply not happening. Either the Labour-Liberal Executive is not giving councils sufficient resources or councils are using money that is earmarked for care of the elderly to fund other services.
This week a lady in the Highlands came to my surgery regarding her mother's move to a care home. Like many others, her mother has fallen into the category of bed blocking, or delayed discharge, through no fault of her own. The figures for delayed discharge are higher now than they were at the inception of the Parliament. In a letter to the lady, Highland Council social work department states:
"Unfortunately the situation at present is that all funding available for the purpose of addressing delayed hospital discharge is fully committed, and therefore we have to operate a waiting list for care home placements."
There used to be a waiting list for people to get into hospital, but now there is one for them to get out.
The letter continues:
"I have … reviewed both the current waiting list and the amount of resource released",
and
"I am sorry to have to reply to you that I see no immediate prospect of being able to provide funding".
The concerns of the patient in this case are certainly not being put first. I would understand the council's inability to provide funding if we were at the end of the financial year, but the letter is dated May. We are two months into the financial year, but the social work department has no money.
Will Mary Scanlon accept that in recent times there has been a sustained reduction in delayed discharge? Will she welcome that?
No, because there has been no such reduction. The Highland Council has an enormous waiting list. The information and statistics division figures do not prove the minister's claim. Funding for a bed in the NHS is about three times greater than funding for an independent care home place, but people cannot be moved on. Of course, if someone can self-fund they will be placed immediately. Those who can pay get the place and care that they need, and those who depend on council funding must wait and wait and wait.
We are all led to believe that there is a national shortage of dentists, but this week NHS Highland informed me:
"There are also 10 dentists who have expressed an interest in joining the service as soon as further opportunities arise."
However, those dentists have no premises. We have 10 dentists with nowhere to go, at a time when thousands of people across the Highlands are desperately waiting for treatment.
Will the member give way?
No—I am in my final minute.
Let us consider the issue of investment. The previous Conservative Government's real-terms spending on capital equipment was £65 million per annum, on average. In Labour's first seven years, average spending on capital equipment was £48 million—a fall of 35 per cent. Professor Kerr is right to highlight that issue.
Labour cuts.
Absolutely.
Is it not sad that the eminent professor must tell the Liberal-Labour Executive to
"establish a clear policy about what patients in Scotland want in the way of choice."
That is sad, but it is necessary. I hope that this time the Executive will listen to Professor Kerr and the patients. I support the motion.
If Elton John, the man who famously spent £293,000 on flowers in a mere 20 months, can lecture us on world poverty, I suppose the Tories can lecture us on the national health service.
When the Kerr report was published, it received a favourable response all round and, having read the report over the past week or so, I concur with that response. There is much in the report that will give us plenty of food for thought over the coming months. Professor Kerr's proposals offer a more strategic view of how we should deliver health services in Scotland as a whole. They contain an implicit criticism of the failed board-by-board approach to service reorganisation, which led to such disasters as the discredited Argyll and Clyde clinical strategy.
I do not understand how the Tories can welcome the report and, in the same breath, call for any sort of strategic planning to be abandoned. I know that there is some disquiet in the Tory ranks—there is talk of splits and defections—but I did not think that things had become so bad that they were arguing with themselves even in the motions that they lodged. The Tories want design decisions relating to the health service to be handed over not to patients, as they allege, but to vested interests—hospitals and the professionals who dominate the service. They say that their market-led chaos theory would deliver a better service, but it was hardly a roaring success when they ran the NHS in the past. This morning reference has been made to trusts, which were bad enough.
Will the member take an intervention?
No.
We saw what happened when individual health boards hunkered down behind the Berlin walls of artificial boundaries, and dreamed up grand reorganisation plans with no regard for the outside world, for neighbouring authorities or for the people to whom they delivered services. In Argyll and Clyde, maternity services for up to a quarter of the Scottish female population were to be concentrated in two hospitals that were 7 miles apart, as were consultant-led in-patient services for 800,000 women and children in the West of Scotland. What on earth would the system be like if it were even more insular and disjointed?
The Tories say that they want local, non-centralised health services. Good—don't we all? However, they cannot condemn centralisation and at the same time advocate renouncing all our powers to do anything about it.
Will the member take an intervention?
No thank you.
Having continually done battle with the vested interests in the national health service over the years, I have learned that we—the only elected element in the decision-making process—have the least power. Why should the power of our voices and, by extension, of our communities' voices be even further diminished? That would be the effect of the Tory policy. Our communities elect us to improve services, not to abdicate responsibility.
On one point the Tory members are correct: if we are to have the level of services that we want and deserve, the NHS must reform. Where we are now, or where we were a few years ago, is not good enough. Before the explosion of public fury over the latest round of unpopular clinical strategies—almost a year ago to the day, in the case of Argyll and Clyde NHS Board—I was not exactly overwhelmed with letters telling me that the NHS was perfect.
The Kerr report proposes a number of far-reaching reforms, which I look forward to debating in the Health Committee in the coming weeks. I applaud Kerr's intention to move away from the idea of the patient merely as a passive recipient of health care. Patients' interests, and not the interests of doctors, managers or politicians, should be the starting point for service design, with more services being delivered locally.
Will the member take an intervention?
No—I have run out of time.
The raft of far-reaching reforms that Professor Kerr proposes will be examined and debated in the coming months. During those considerations, we will have to focus on the basic ethos of the national health service, which still commands universal public support. That ethos is that free and comprehensive care should be available to all. The challenge to politicians of all parties here will be to provide genuine leadership and to create a compelling vision of where we are taking our health service. That will be our test in the coming months.
Presiding Officer, I begin by offering my apologies for my having to leave the debate before its conclusion because of other commitments.
On Monday this week, I had the pleasure of attending a new Maggie's Centre at Raigmore hospital in Inverness. It was an extremely happy occasion. I know that the minister has taken a very close interest in such matters; some years ago, she spoke very courageously about her own experience. That improvement at Raigmore has followed other improvements. For example, there is a new accident and emergency unit and a new breast clinic. Staff have told me of many other services that are now on their wish list, which include a day-care centre for ambulatory care. We are seeing improvements in the NHS and it behoves us to acknowledge that because debate on it has, from time to time, been characterised by a jarring and malignant tone.
It is relevant to point out that there would not have been a Maggie's Centre in Inverness had it not been for the generosity of numbers of individuals and families in Scotland, such as the MacTaggarts and the Cayzers. Those people made their money in a private sector that some people think should be banned. We should all give our whole-hearted support to the philanthropic efforts of people who want to give something back to Scotland.
In the short time since publication of the Kerr report, I have sought to consult people in my constituency and I have to say that the report has been broadly welcomed. A number of GPs have said that they like it and welcome the fact that the significance of rurality and transport problems have been recognised. There is a suspicion that NHS politics will stifle some developments and prevent their being realised, but the initial reaction has been to offer broad support.
I want to talk about the recommendation on page 31 of volume 2 of the Kerr report, in which Kerr recognises the impact of the working time directive. The hours of junior doctors will be reduced by 40 per cent by 2009. Kerr concludes that a rural general hospital model should be central to providing services in rural areas. I fully support that recommendation and I want to stress how important it will be to the Highlands—not solely to the Belford hospital in Fort William in my constituency, but in other Highland towns such as Oban and in island towns such as Kirkwall, Lerwick and Stornoway. In the light of Professor Kerr's strong recommendation, does the Executive now accept the model of a rural general hospital? I hope that the minister will comment on that.
Kerr has not defined precisely what the rural general hospital model should be. He talks about "core services", but what are the core services? I have spoken to consultants at the Belford hospital over the past few days and I suggest that, at core, a rural general hospital should be a hospital in which services are consultant led. Obviously, the services would not always be provided by consultants, but they should be consultant led and should be provided 24 hours a day. Those services would include general medical services and surgery. To me, those are the core services.
I am no expert and I am not a health professional, but I do know about the importance of places such as the Belford hospital. Over three months from January to March last year, a study was carried out by consultants and others at the Belford, which sought to calculate and quantify the impact of downgrading the hospital and of loss of consultant services. That study proved that the number of emergency admissions that would have to leave the area would increase by three or four times. Those people would also have to travel huge distances over long periods. The study also showed that the number of elective surgery treatments that would have to be dealt with elsewhere would increase by about 200.
Does the minister accept the importance of generalist training for the workforce in the new rural general hospitals? I certainly welcome the recommendation to establish a centre for that purpose. Logically, it should be in a rural part of Scotland—preferably in my constituency. I hope that the minister will acknowledge the importance of training generalists. If such training is not provided, where will we find the consultants, nurses and allied health professionals to staff the rural general hospital model in the future?
I believe that the kernel of the Kerr report offers a blueprint that will serve Scotland well, and will serve rural constituencies such as mine very well indeed.
I welcome Professor Kerr's report and I note that many of its findings mirror those of the Scottish Parliament Health Committee's report into workforce planning. However, I reiterate a point that I made at the Health Committee when the then Minister for Health and Community Care announced the commissioning of the Kerr report. I said that the report would have been better commissioned six years earlier, before many controversial decisions on NHS facilities had been taken. We have had reviews of acute services and maternity services, and changes to the GP and consultant contracts, which will make it harder to plan service delivery around the recommendations of the Kerr report. However, that is where we have now to start from.
In opening the debate, David McLetchie said that he regretted the Conservatives' having to use their time to debate the issue because the Executive refused to debate it before the recess. I suspect that David McLetchie is actually delighted that the Tories have again had the opportunity to have a go at the NHS and the Executive.
I agree with the Executive that we need to have an informed debate about the report, but I do not think that we have had time to consider it fully. The Health Committee certainly hopes to take evidence on the report, and I would welcome that opportunity's being given before we debate the report in full. I would also like the opportunity to speak to local service providers and service users in my area before we come back for a full debate on the Kerr report in Parliament.
David McLetchie also said that patients are not receiving the level of services that they demand and deserve. Having listened to a few speeches and read some of the comments in the press since the report was published, I note that people are saying, "Kerr says this," or "Kerr says that." They are interpreting what Professor Kerr said based on their own political ideologies or geographical situation, but I do not think that Professor Kerr is saying that we should consider centralisation versus local delivery, or that local delivery is better. What he appears to be saying is that the appropriate care should be given at the appropriate time in the appropriate place. I would have thought that everybody, wherever they come from geographically or politically, should be able to sign up to that.
I have seen evidence of that recently. A close relative of mine had a heart attack just over a week ago. The first care that he received was at Victoria hospital in Kirkcaldy, and he was then moved to the Western general in Edinburgh for angioplasty. The care that he received was excellent and he certainly thinks that the move from the Victoria hospital to the Western general was seamless. I understand that the stent that was used in the operation cost more than £3,000. That does not include the cost of all the care that he received or the other costs that were associated with the operation. He got what he needed when he needed it and where he needed it. It was appropriate that the care that should be provided locally was provided locally, and that the care that should be provided at a specialist centre was delivered in a specialist centre in Edinburgh. All the staff who attended to him did an excellent job: auxiliaries, paramedics and all other staff with whom he came into contact.
That leads me to the problem with having a debate such as this, when the debate is relatively uninformed. When we held a public debate in the chamber on reshaping the NHS, Jim Devine of Unison said that for every person who has a bad experience with the health service, thousands of people have excellent experiences and have no complaints. I do not want to suggest for a minute that we should not have a debate about health—it is an important issue and it is where a lot of money goes—but I do not think that it should be used as a political prop in the chamber, as it often is. We can understand that it must be demoralising for staff to come to work every day when all they read in the press is reports from politicians about what a rubbish service they are delivering. Politicians obviously say that they are not blaming the staff; everybody would say that health service staff do a great job and that it is the Executive's fault or somebody else's fault—
It is the Executive's fault.
That is what the Opposition says, but if members of staff are working really hard to try to deliver a service, it is demoralising to read that or hear it on the news before they go into work every day to try to deliver the best service that they can, which is an excellent service 99.9 per cent of the time.
Will Kate Maclean take an intervention?
I am just about to finish. It is certainly not because I am worried about any questions that he may ask that I am refusing Mr Monteith's intervention; it is just because I am about to finish.
I hope that we can take time over the recess to digest the contents of Professor Kerr's report fully and to consult local service deliverers and users. I look forward to coming back after the recess and to having an informed debate about the report.
Today's debate is a welcome opportunity to raise many issues of concern about our health services, and to highlight the recommendations in Professor Kerr's report, which was presented to Parliament recently. Like many other members, I particularly welcome Professor Kerr's report, which clearly identifies some of the major problems in current provision of health services. More particularly, it makes sensible and practical suggestions on how improvements could be achieved and implemented quickly.
I have been an elected member in the Highlands for many years—more years than I care to remember—and during that time I have been involved in many campaigns that attempted to retain and protect our rural health service provision, particularly the excellent services that have been provided by our small community hospitals and their dedicated staff. However, our entreaties invariably fell on deaf ears—or on stony ground—with successive health boards, which inevitably resulted in drastic reductions in locally available health services.
Fergus Ewing mentioned the hospitals at Lerwick, Kirkwall, Stornoway and Oban, but he missed out the most important island of all—the island of Skye. The MacKinnon memorial hospital on the island of Skye previously had a full-time surgeon and a consultant anaesthetist, which allowed the dedicated team there to undertake most surgical provision for that community. That provision, of course, is no longer available because successive Highland health boards have not been prepared to continue funding a full-time anaesthetist at a cost of £250,000 per annum. That has resulted in all emergency surgical patients being transferred to mainland hospitals for treatment, some of which are 100 miles distant.
However, in the Kerr report there is a bright light on the horizon, which strongly suggests that far more use must be made of community hospitals, where patients can expect to have their health needs attended to locally and in their own hospital. Why not? If the facilities are available, let us make sensible use of them. If cost is to be the main impediment, let us consider and calculate the cost that is associated with the loss of a life through lack of surgical services in rural Scotland.
Like many other members, I congratulate the Minister for Health and Community Care on commissioning the Kerr report. I hope that in the months ahead the Executive can be encouraged to support many of the suggestions that are made in the report. By strengthening provision in our community hospitals, which is strongly recommended in the report, we will see an immediate and welcome reduction in current waiting times that we hear so much about every day. Far more important is that we will also restore confidence in our national health service, which is the envy of the developing world.
I note once again how quick off the mark the SSP speaker has been in leaving the chamber. I would like it to be noted for Carolyn Leckie's benefit that the SSP does not have a monopoly on socialist principles. Many of us here have been espousing such principles since long before the SSP was established and will be espousing them long after that party's demise. I hope that she reads the Official Report. It is typical of the SSP to say something and then not to stay for the rest of the debate. I hope that Carolyn Leckie will answer me if she comes back.
I welcome the opportunity to debate certain aspects of the Kerr report. However, I cannot say that I thank the Conservative party for using its time to debate the report, because all that we have heard from the Tories is the usual diatribe about further privatisation of the health service. I am not the only one who is worried about that; even the BMA is concerned about the creeping privatisation of the health service. In its briefing, which we all received, the BMA said:
"The BMA remains concerned that the Scottish Executive"—
not just the Tories—
"is increasingly considering expanding private sector involvement in the provision of NHS services".
Perhaps the BMA knows what we know, which is that there is not a great deal of difference between the Tories, Labour and the Lib Dems. The minister and other members on the coalition benches should think about that.
Will the member give way?
I am sorry, but I am short of time as it is.
I whole-heartedly agree with the great emphasis that the Kerr report puts on consultation of the public, but I am concerned about decisions that were taken before the report was produced. I cannot agree with Kate Maclean's view that we should have more time to discuss matters, because the big problem—especially in the West of Scotland—is that decisions have already been made and are, as has been said, not reversible.
As we all know, the consultation process in the West of Scotland was less than perfect; indeed, it was deeply flawed. It led to countless protests, petitions and public meetings. I am concerned that, in his statement to the Parliament, the Minister for Health and Community Care said that the Kerr report
"will not be used to reopen decisions that have already been made."—[Official Report, 25 May 2005; c 17155.]
The minister has reiterated that. However, I think that those decisions should be re-examined, especially in the light of the situation involving Argyll and Clyde NHS Board that has materialised over the past few months.
For the sake of accuracy, does the member accept that NHS Argyll and Clyde has not taken a decision on the acute part of its clinical strategy and that that is set aside?
I take on board what Jackie Baillie says, but the position of Argyll and Clyde NHS Board has a significant knock-on effect on the situation in Glasgow, where a decision has been taken to have only two full accident and emergency-equipped hospitals. As Jackie Baillie will know from consultation of her constituents and from meetings that she and I have attended, people want to come to Glasgow for services, but the decisions of Argyll and Clyde NHS Board and the Executive will have a significant impact on Glasgow. The issue must be revisited because it is not enough to have only two A and E hospitals for Glasgow, West Dunbartonshire and other areas. I had hoped that this morning's debate would allow us to probe the issues in the Kerr report, but unfortunately the Conservatives have not given us the opportunity to do that.
The position of maternity hospitals is not mentioned in the Kerr report. That issue, too, was the subject of flawed consultation. The people of West Dunbartonshire and the West of Scotland as a whole went to public meetings and signed petitions and there was a great deal of unrest. We still do not know what will happen to the Yorkhill hospitals, where maternity services in Glasgow will be sited or when they will be moved elsewhere. Those questions must be answered. I had hoped that the Conservatives would seek to obtain such clarification during the debate, but it seems that written questions to the minister will be necessary.
We cannot afford to wait until after the recess. I am disappointed that we will not debate the issue for another few months because we do not know what decisions will be taken. I asked the minister what advice and guidance had been given to health boards in the past and what advice and guidance they would be given now, but I have received no answer. We must wait another three or four months, but we do not know what decisions the health boards will take in the meantime and what impact that will have on users—patients and the public—and the professionals who work in the health service. We should have had an answer, but by the time we get one, it may be too late.
Many members have spoken about staff retention and recruitment—an important issue about which there is a great deal of concern. A written answer from the minister shows that, in 2004, the number of medical graduates from Scottish universities fell by 61 to 727. At the same time, the proportion of those graduates who went to work outside Scotland rose from 9 per cent to 12 per cent. That is worrying. We must find out why we cannot solve that problem and keep staff here. If we intend to implement the Kerr report, we must get that right—we must ensure that we have sufficient staff to further the report's recommendations.
I turn to an issue that I would like the minister to take up. Medical students at the University of St Andrews do a three-year course in St Andrews, but then go to the University of Manchester to finish their degrees.
Will the member give way?
I am sorry, but I am in my final minute.
By the minister's own admission, medical students who study at St Andrews enter the health service down in England. They spend three years at university in Scotland, but cannot continue their course without going to England. I want to know why that is the case. Surely it must be possible to ensure that we retain those graduates.
As the motion in the name of my colleague David McLetchie makes clear, this morning's debate provides a welcome and necessary opportunity to debate the structure of the national health service in Scotland post the Kerr report. It would have been helpful and timely if the Executive had offered such an opportunity sooner.
As someone who lives in the middle of the beleaguered Argyll and Clyde NHS Board area, I am no stranger to the challenges and difficulties that confront the NHS in Scotland and I am certainly no stranger to the frustration, bewilderment and anger that constituents who live in that area have expressed about an administration that, over the past four to five years, has been characterised by crisis and dogged by lack of confidence.
Let me outline the damning chronicle of events. In 2001, the Minister for Health and Community Care had to send in a management task force to investigate the scale of mismanagement. That team found a culture of managerial and financial incompetence and a deficit that was projected to rise to £100 million in 2007-08. In 2002, four senior managers resigned. As Audit Scotland's report and the recent report by the Audit Committee disclosed, matters deteriorated further. The ensuing crisis induced the recent ministerial statement.
The human face of all that is represented by the patients who have grappled with threats to maternity services at Inverclyde royal hospital and Vale of Leven hospital, the closure of A and E services at Vale of Leven, the removal of consultancy-led maternity services from both hospitals and an ever-increasing reliance on the already overstretched resources at the Royal Alexandra hospital in Paisley. That outcome presented tensions and anxieties for patients, not to mention the sheer practical challenges of transportation.
A deep-seated and corrosive lack of confidence in governance at both Scottish Executive and local levels has developed among patients and professional workers in the NHS. I commend the professionalism and dedication of health service workers in Argyll and Clyde during what have been very trying times. The malaise to which I have referred is accompanied by a palpable cynicism that no one is listening and no one cares. Six years down the road of devolution, who would have thought that such an impasse could have been reached in the delivery of such an essential public service?
The recent declaration that the days of NHS Argyll and Clyde are numbered has simply exacerbated the low morale and cynicism. I repeat the call that I made on the day of Mr Kerr's statement for the Executive to assume interim responsibility for the administration of the board's affairs—that is the only acceptable way forward.
Quite simply, we are in a state of flux. There is no doubt that the Kerr report has implications for the Argyll and Clyde NHS Board area. The former regime drew up proposals for the closure of the Victoria infirmary in Helensburgh, the Dumbarton joint hospital, Ravenscraig hospital in Greenock and the mental health hospital at Lochgilphead. Are those proposals to be withdrawn or are they to be put on ice and, if so, for how long? How can the Kerr report be considered for the Argyll and Clyde area, who is to do that and what strategy is to be deployed?
For all those reasons, the only sensible way forward is for the Executive to run an interim administration. We are talking about the most crisis-fraught health board in Scotland. The people in the area and the professional workers who work in the service need leadership, guidance and reassurance. Heaven knows, the people of Port Glasgow, Greenock and Gourock are due that minimum reassurance after all they have been through, as are the people of the Vale of Leven, Helensburgh, Dunbartonshire and the surrounding area.
I turn to the broader platform of the debate. There must be a genuine debate on whether the present system of governance of the NHS and the mechanisms for the delivery of health care in Scotland are working. The patients of Argyll and Clyde would say resoundingly that they are not. They want more control over and a greater say in how and from where their health care services are procured. At the moment, they feel uninvolved in, disengaged from and powerless to influence such matters. That situation is unacceptable and, in a devolved Scotland, unsustainable.
Under the Conservative policy that would have each NHS hospital operate as a company limited by guarantee, what public involvement would there be?
As Mr Purvis will be aware, the proposal for foundation hospitals is not analogous with that structure. From speaking to staff in one of those hospitals, I can tell him of their clamant desire to have more control over and say in how their hospital is run.
We have to contemplate reforms that put the patient in the driving seat, offer them choice and increase capacity. If the Parliament really cares about patients, those proposals cannot be consigned to some no-go ideological cul-de-sac. It is a matter of regret that there has been little response to those proposals except from the Conservatives, who have tried to introduce new thinking and to instil, instigate and encourage debate.
Will the member give way?
I cannot; I am in my last few seconds.
The independent sector can support the efficient provision of a public national health service without impugning or threatening in any way the valued ethos of the NHS. Sadly, the abolition of NHS trusts, which was supported by the Executive parties and the Scottish National Party, has led to the loss of meaningful local control and has directly contributed to the centralisation of services that we are now seeing throughout Scotland. That process has made the patient remote from what is happening and from the decision making that causes it to happen. That is not acceptable and it is not sustainable. I support the motion in David McLetchie's name.
The clear point that emerges from the Tories' criticisms of the Scottish Executive for not holding a debate prior to the summer recess is that Tory members appear not to believe in hearing the opinions of their constituents or of the various stakeholders across Scotland. As the Tories do not have a track record of listening to what people say, it comes as no surprise to me or to anyone else in the chamber that they want to make pronouncements and to have debates before they have had the opportunity to hear what those opinions are. After all, when did the Tories' representatives ever turn up at health board meetings or at the liaison meetings that we hold with health board representatives in order to hear at the local level what the professionals have to say? I am therefore not surprised that the Tories do not want to listen to what people in Scotland have to say.
Will the member take an intervention?
No, not at this point—I will later on.
I disagree with the point that Sandra White made about the Executive not having time to listen to what the people of Scotland are saying. As Kate Maclean said, we have to take time to hear what they are saying. She argued that we should engage with our constituents, hold meetings with the professionals, hear people's opinions and come back after the Parliament resumes in the autumn to debate the issue on an informed basis.
Sandra White also referred to students at the University of St Andrews. Obviously, she is not up to date on the issue—I quite understand that, as she is not a Fife person and so would not be aware that an agreement has been reached between all the agencies involved. Christine May, who is sitting behind me in the chamber, can give Sandra White chapter and verse on the developments that are to take place and the resources that are to be made available. Instead of all trainees being sent to Manchester as a matter of course, the first group of trainees will go to the Randolph Wemyss memorial hospital in Fife. Everyone in the chamber ought to know about that welcome development, which many members have campaigned for and of which the Health Committee was made aware.
David McLetchie said that the increase in resources did not lead to a corresponding increase in productivity. That is simply not true. I notice that David McLetchie never stays to listen to what back benchers have to say—yet again, he has walked out on a debate. I point him to a report that Dr Andrew Walker, the Health Committee adviser, prepared for the committee, in which he considered a range of conditions from hip and knee replacements to angioplasty and cataracts. The figures show the real productivity increases from 1997 to 2003, including, in some instances, a fivefold growth in the number of procedures that are carried out each year. It is disingenuous of Mr McLetchie once again to distort the facts. However, as the journalists always say, why let the facts stand in the way of a good story? Mr McLetchie needs to be taken to task on the issue.
The British Medical Association Scotland and the Royal College of Nursing Scotland kindly sent members some useful information, which supports my argument that the changes that are taking place are making a difference. The BMA and the RCN highlight initiatives that are improving patients' access to hospital services. Some of those initiatives are preventing hospital admissions—after all, that is the name of the game. The BMA is clear in saying:
"The telemedicine unit based in the A&E Department of Aberdeen Royal Infirmary provides a direct link for GPs in community hospitals to A&E specialists who can offer advice on treatment. The sleep clinic at the Edinburgh Royal Infirmary is providing patients with equipment to enable them to manage their conditions at home and, in Dumfries and Galloway, dermatologists are encouraging patients to manage their own conditions and provide regular telephone consultations preventing the need for patients to travel, often great distances, for outpatient appointments."
I will now take Brian Monteith's intervention.
The member drew the attention of the chamber to the fact that David McLetchie has temporarily excused himself from the debate. Clearly, the evidence is there on his desk that he is coming back, but will she tell me why the Minister for Health and Community Care is not in the chamber for such an important debate? We have only the junior minister—perhaps health is a junior item on Labour's agenda. [Interruption.]
I am getting all sorts of advice, but I have absolute confidence in the approach that our ministers take to partnership and equal responsibility. The Deputy Minister for Health and Community Care has more than shown that she is up to the challenge. She is one of the best deputy ministers that the Parliament has had—of that I have no doubt.
As ever, the Tories have focused disproportionately on acute services when, as we know, the report rightly emphasises the fact that 90 per cent of the care that is provided to patients in their local communities takes place primarily in general practice. I make that accusation not only of the Tories but of the SNP. Yet again, Bruce Crawford distorted the facts this morning; like others, he does not let the facts stand in the way of a good story. He knows, as Scott Barrie and I do, that there will continue to be a casualty service at the Queen Margaret hospital. We will continue to campaign for the resources that Fife needs in order to get the right for Fife solutions. There are big challenges and we have to tackle them.
The debate this morning has not been about the issues; it has been about political capital gathering. Members of the Health Committee have been well informed through our discussions with our constituents and our visits across Scotland. The issue is much too important to be used as a political football. It is time that members of the Scottish Parliament reached consensus on the need to press forward together to ensure that the health service in Scotland is one of the best in the world. That is what we have to deliver for our people in Scotland.
The Kerr report is excellent and will provide the blueprint for the next 20 years. I admit that I was scared to read it when it first came out. My experience of reports is that they either gather dust on the shelf or destroy things for the future. I hope that we can learn from the past.
The first report that I remember as a young doctor was the Salmon report. Although I never read it, I suffered from the implications of its implementation when I was an anaesthetist in the Southern general hospital. Experienced nurses were taken out of their own wards and put in charge of about eight wards. Patients who were undergoing emergency anaesthetic and surgery had to stay in the recovery room an awful lot longer than would previously have been the case, because we had to ensure that they were safe to return to their ward. Two young nurses were looking after what was like a Nightingale ward and, although they were keen, they were terrified out of their wits—the only person looking after them was a senior nurse on a rotating shift. As a result of the Salmon report, we lost matrons, whom everyone now wishes we could bring back. I would like to think that we will gain knowledge from the Kerr report and think about it with due care and attention.
When I think back to my time in anaesthetics and theatre in the Southern general, I remember the Monday orthopaedic list. It started at 9 am, when the first patient was put on the table; the last patient probably came off it at 9 pm. That was because we had to add in the emergency work from the night before and from that morning, as well as feeding through our elective cases. That happened practically every Monday. The Kerr report tries hard to separate elective work and emergency work, which is an important point.
I wonder why it has taken so long for everybody to realise that doctors and nurses cannot work efficiently on long hours. It has been 40 years since I qualified, but only now are decent hours being applied to doctors, as a result of the working time directive, which will make a lot of difference to how we implement the report.
Much has been said about recruitment, retention and the fact that young doctors who want to start their careers leave medical school with adequate qualifications but cannot get places. The situation is similar for nurses. In addition, all allied health professions say that there are people who want to do the job but do not have a job.
I say that the Kerr report is a good report because it sets out the way in which I worked for 25 years in general practice and therefore I understand it. Its proposals describe the way in which Stobhill hospital, which provided secondary care, and the doctors round about it, who provided primary care, worked together. We had integrated working care, in which the patient came first. We had no waiting lists of any significance. We looked after our patients, who were seen as urgently as they needed to be seen; we could pick up the phone and speak to a consultant and, if we required results, we got them back very quickly so that we could keep the patient in the community.
There was no difficulty with our trying to keep our patients in the community and in their own homes, which is where they wanted to be. Nurses are necessary for that to happen. I am sad to say that, in the 1990s, there was a move to take away our district nurses. We had wonderful district nurses and health visitors, who are needed to help to keep people in the community. When they are scarce, it becomes unsafe for patients to come out of hospital quickly. General practitioners need hospital beds for patients who need to go into hospital for assessment. Stobhill had a general hospital side to it, but we always said to the hospital, "For goodness' sake, send them out as quickly as possible; we're very willing to look after them."
The other thing that I love about the report is that it takes account of chronic conditions. We cannot ignore all the chronic conditions, as we seem to be doing at the moment by not getting our chronic pain clinics up and running. According to the McEwen report, we could save about £1,000 a patient on drugs if we could get such clinics up and running. We would also free up some time for general practitioners and consultants in the hospital service.
We need more doctors in primary care and we need more nurses, pharmacists, physiotherapists and speech therapists—you name it, we need it. I also note that, as the RCN highlighted, we need to improve the health of children. Therefore, I would like school nurses and school medical examinations to be reinstated.
GP fundholding was a two-tier system and I do not want it back. Foundation hospitals might easily end up doing the easy work and leaving the NHS with the rest. We need quality and continuity of care and patient safety. There are too many stories of patients from the private sector ending up in the NHS needing to be fixed after things have gone wrong. I am suspicious of joint ventures—everybody knows that—and a lot of people and bodies, including the BMA and the RCN, have written to me saying that they are anxious about them.
No doctor whom I ever knew would have invented NHS 24, but we now have it. That shows what happens when we rush into implementing throughout Scotland an idea from south of the border when we are not organised to do so. NHS 24 is well organised and has wonderful information technology, but it has stolen staff from the working sector. I honestly think that anybody who is going to work in NHS 24 should have another job in the acute sector.
I would certainly not get rid of private care, but it does not train doctors and nurses.
I welcome every opportunity to debate health matters and I came to the debate genuinely interested in whether the Tories had any insights to offer on the Kerr report. Their first offering was to complain that we were not going to debate it soon enough. Given that they said little on the substance of the report, today's debate was a wonderful opportunity for them to lay out their policies.
So what did we hear? Mr McLetchie—who is still absent—talked about reform and choice. I have no problem with either of those concepts, but all we heard from him was a tired, recycled agenda, which was rejected at the ballot box a mere month ago. Yes, there would be choice, but it would be choice for the few who have access to substantial sums of money and who statistically enjoy better health anyway because of the level of their incomes. People could get the patient passport, which sounds good but would not cover the full cost of treatment. What would happen to somebody who does not have thousands of pounds salted away? To be precise, nothing. The Tories made no mention of people on lower incomes or of the link between poverty and health inequality. Moreover, there was not one word on those matters in their manifesto, because they do not understand them and do not really believe in the ethos of the NHS.
The rejection of the Tories at the ballot box is now the subject of intense media speculation. The Tories are riven by internal dissent and questions of who is up and who is down. I will offer them some free impartial advice, which I am sure that they will not take. Some members might recall the Clash, a popular beat combo from the late 1970s and the early 1980s. One of their songs could have been written for the Tories; it has the lyric:
"Should I stay or should I go now?"
First, we had James Gray as shadow Secretary of State for Scotland. He is gone. He lasted all of a week and was savaged, we are told, by Brian Taylor—surely not that nice man Brian Taylor. Secondly, there was Margaret Goodman, who was deputy chair of the Scottish Tories. She, too, has gone and her parting advice was
"keep topping up the formaldehyde".
Who will be next? Will it be Michael Howard, David McLetchie or Brian Monteith? Brian Monteith in particular might want to consider the song's next line—
On a point of order, Presiding Officer. Is Jackie Baillie speaking to the motion on the Kerr report on the future of the health service or has she chosen to debate the Conservative party's internal structure?
She certainly began with reference to the debate. She may have strayed, but I suspect that she might be about to tie the next line of the song back into the debate. If she is not, perhaps she should jump a page or two.
As ever, you are extremely perceptive, Presiding Officer. I will give members the next line of the song, because it is worth hearing. It runs: "If I stay there will be trouble". Brian Monteith should take that as a warning and get out now.
Unlike the Tories, I welcome the values that underpin Professor Kerr's report. Those values are at the heart of our NHS, which is about being fair to all and personal to each. Duncan McNeil is absolutely right that the patients' interests must be firmly at the centre of our national health service.
That ethos was not evident in NHS Argyll and Clyde, where boundaries mattered much more than geography and patient flow. That is not a criticism of front-line staff who, throughout the piece, continued to deliver excellent care for our local community. I welcome the deputy minister's initial comments on the provision of emergency services, which build on that commitment to us all. I also welcome the support from her and the minister for the integrated model of care that clinicians are developing at the Vale of Leven hospital. That model will provide access to safe and sustainable services on a 24/7 basis that fits with the framework that Professor Kerr has laid out. It also fits well with the principle of delivering services as locally as possible and as specialist as necessary. However, there must be complete transparency in determining what services should be concentrated, which should happen only where a clear clinical benefit has been demonstrated and patients have been involved in the dialogue. I commend the framework that Professor Kerr sets out, which will deliver that transparency.
Annabel Goldie's comments about NHS Argyll and Clyde were disappointing. Her support for keeping the trusts is completely misjudged. The Tories created the conditions for the problems that we are now experiencing in Argyll and Clyde. If Annabel Goldie had seen the internal bickering and systems failure, which were all too evident, even she would not stick to the Tory ideological nonsense that has never served patients well.
I look forward to having a real debate in the autumn, not this shadow-boxing in which the Tories trot out their tired policies. Those polices were rejected by all at the ballot box. How many times do the Tories need to be told?
I did not get the chance earlier to explore fully the topics in the Tory motion, particularly foundation hospitals. Rather than creating opportunities for the development and progression of the NHS, foundation hospitals take us back to before 1948. David McLetchie—who is still not in the chamber—said that people who support a publicly owned and delivered, comprehensive and universal NHS are stuck in a 1948 time warp. The Tories are stuck in a pre-1948 time warp. The idea is that foundation hospitals will control their own resources, but that was exactly the policy that created and perpetuated inequalities before 1948, which was what Bevan and all those who supported the creation of the NHS were trying to eradicate.
Foundation hospitals suck in resources and staff and perpetuate inequalities in the NHS. People who least need the care get most care. Allyson Pollock has done a lot of research to expose the fact that, with foundation hospitals, divisions in the delivery of health care become worse and the inequalities get wider. Foundation hospitals might be the answer for the Tories' big business pals, but they are not the answer for patients.
There are some contradictions in the Kerr report. I think that it was Kate Maclean who said that some people have pounced on sections of the report to justify their analysis. That selectivity does a disservice to the necessary debate on the report.
It has been claimed that the report will secure local services and some people hope that Kerr offers solutions for the problems facing hospitals such as Stobhill. However, paragraph 57 of chapter 8 of the report offers this advice for the NHS:
"Regional planning should enable demand across a wider population to be met by streaming hospitals for particular specialties or groups of specialties."
Earlier in that paragraph, Professor Kerr says that hospitals in the central belt are within 30 minutes of one another. That can be interpreted as a centralisation agenda, which has serious implications for the ability of Stobhill and similar hospitals to maintain their status as general hospitals. We need to explore that matter in a lot more detail.
At present, Stobhill is very much required, because Glasgow royal infirmary is not coping. Centralisation of orthopaedics to the Glasgow royal infirmary resulted in increases to the orthopaedics waiting list in Glasgow, which was already 10,000. I think that Stobhill might stay.
I absolutely agree with Dr Turner's analysis, but I advise her not to make the mistake of thinking of Kerr as a saviour. There is plenty in the Kerr report that could justify the centralisation of the NHS for those who want to promote that agenda.
I turn to the subject of diagnostic treatment centres. The experience in England should make us very concerned about the impact of independent treatment centres on patients. The centres, which are separate from the NHS, carry out low-risk, low-cost procedures, to the detriment of the NHS in their area. In many cases, contracts with the private sector come first.
Will Carolyn Leckie give way?
No—I am sorry.
The NHS has the capacity to carry out the required procedures but, because there is a contract, that takes precedence. Patients who would rather have their care provided by the NHS are prevented from doing so because of the contract. NHS providers have to carry out the high-risk, high-cost procedures and they end up, in the words of Allyson Pollock in a recent article in The Guardian, getting "squeezed out" of the NHS market. I suggest that members explore that matter.
You have one minute left.
Private practices leach training, experience and public education from the NHS for their own profit at the expense of NHS patients.
I do not have much time to cover maternity issues. It is interesting that they have been excluded from the Kerr report, yet the models for maternity care that were proposed in the report from the expert group on acute maternity services very much resemble the models that have been proposed for acute care in the Kerr report. I therefore assume that Kerr has accepted the EGAMS model for maternity care. I would like to explore that whole issue in more detail, but, as I said, I do not have time.
Things can go wrong, despite the most robust risk analysis. I am concerned about the geographical separation of elective care from emergency care.
Please wind up now.
I will conclude, Presiding Officer.
We need to read between the soundbites of the Kerr report. Nobody will disagree with the sentiment behind the phrase
"fair to all, personal to each",
but the devil is in the detail. We need an NHS that is universal, comprehensive, free and fit for the 21st century.
You must close now.
The NHS must meet the aspirations of the visionaries in—
You really must close now. We do not have the time for this. I am sorry, but I have to take your sound off you.
Mr McLetchie—who I see is now back in the chamber—began his comments by correctly stating that there was more to debates on health than statistics. Taken out of context, statistics can skew the debate, and they can be meaningless to many of our constituents. There are some statistics that are very relevant to our constituents, however, and which they fully understand: those concerning people who are on in-patient and day case waiting lists for a very long time. Mr McLetchie referred to such people as "languishing on long waiting lists", and I agree with that description.
Mr McLetchie also made much reference to the situation south of the border. Let us do that, too. Mr McLetchie did not explain why, in England in 1994, 19,800 people waited 15 months or more on in-patient waiting lists. According to the most recent indicators from the Department of Health, 12,538 patients south of the border waited between eight and nine months for admission. According to the most recent indicators for Scotland, no one waited more than nine months on an in-patient or day case list.
Why can Mr McLetchie not explain that? It has happened because we are making a difference for individual people in Scotland, who used to have to wait for a very long time. That has been the right approach. The minister was right to strive to reduce the targets even further. Mr McLetchie repeated the Conservatives' policy—which is in their motion—of privatisation, fragmentation and competition. In their purest form, those would not reform the NHS, but remove the NHS.
Any brave individual who wishes to look in more detail at the Conservative party policy will find that its proposals fudge many of the issues and are inconsistent. The Conservatives want foundation hospitals, free from government interference and open to competition. They also want a national tariff to determine unit costs for treatment. Why? Why not let the market determine costs? Why have a national tariff? Why have bureaucrats determine unit costs?
The main inconsistency in Mr McLetchie's approach and in the Conservatives' policy is that they want hospitals to be independent, yet they have the cheek to say that the core principles of the NHS would be safe under the Tories, and that the service would be free at the point of use and available to all, while hospitals would also be accountable.
Mr McLetchie stressed accountability; Miss Goldie stressed accountability; other Conservative members stressed accountability. However, page 47 of the Conservative policy paper "The Right to Choose", under the heading, "32. How will each hospital be governed?" says:
"Each NHS hospital will operate as a company limited by guarantee".
How can that be accountable to the communities that they seek to serve? How can they operate under a national pricing structure and be accountable at the same time? Miss Goldie denied that that Tory policy paper existed. The policy is a dangerous model and a fudge, and has at its core a deeply unfair and regressive factor—[Interruption.] Perhaps Miss Goldie did not deny that the paper existed, but I suggest that she should read it.
Even more damagingly, the NHS under the Tories would subsidise private care and treatment for those who can afford it, not the people whom Ms Scanlon talked about. The Tory policy paper, which obviously does exist, but which the Tories have not read, asks the simple question:
"Isn't the entitlement to take half of the NHS tariff to hospitals that charge patients a subsidy to the rich who can already afford private healthcare?"
Its answer is:
"It is true that people who currently pay for private healthcare will benefit from lower costs. They have paid their taxes and are entitled to a contribution to their healthcare"—
but not, I suggest, through a private health care system subsidised by taxes paid by poorer people, who contribute a far greater proportion of their income through taxation than do the richest 20 per cent of the population. Why should that group's private health care be subsidised by people who cannot afford it?
The member accuses us Conservatives of wanting to subsidise the independent or private sector. However, does not the Liberal Democrat-Labour coalition have a policy whereby it is necessary to fund 100 per cent of the cost of operations for NHS patients in the independent or private sector? Is that not privatisation?
Mr Monteith denies the fact that that treatment is within the NHS and free to the patient, not half price to the patient and subsidised by poorer people, which is unacceptable to the majority of people in Scotland.
Mike Rumbles, Duncan McNeil, Fergus Ewing and others raised real issues arising from the Kerr report. Fergus Ewing, in a constructive contribution, expressed many views that I share on rural general hospitals. There is a need for further clarification in that area and definition of the characteristics and concept of the rural general hospital. The suggestion in the report that an RGH would provide emergency medical care, locally based routine elective care and care for chronic illness was interesting, but it would require us to build structures with both community hospitals and centres of excellence. As has been said, interdependency in a hospital is also important—for example, maternity services linked with paediatrics linked with anaesthesia—and the cumulative effect could be worst in cases such as John Farquhar Munro described in Skye.
The Kerr report mentions, but does not major on, health links with other agencies, which is a crucial area that we need to debate, especially with local authorities, over the summer. I would welcome a fuller debate on that subject after the summer recess.
There have been a few entertaining speeches this morning, and I particularly enjoyed Jackie Baillie's three-minute riff on the Tories' troubles.
I welcome the fact that the Conservatives allowed their time to be used for a debate that the Executive has so far refused us. I am somewhat surprised at Labour members, including Helen Eadie and Kate Maclean, who seemed to think that we need further consultation on what has already been a long consultation. Do we then consult on the consultation on the consultation? Sooner or later we have to get on with it and do something.
I welcome the fact that the Tories have given their time; sadly, I cannot welcome the terms of their motion or their contributions. I listened to David McLetchie praising his party's record, but it did not accord with anything that the rest of us remember happening in practice. With respect to Annabel Goldie, I have to point out that David McLetchie said nothing that was in any way new to anybody.
As for the Scottish Socialist Party, I have to advise members that Carolyn Leckie is in a bit of a huff because she did not get any support for her amendments at the Health Committee on Tuesday. There is little that I can say about a policy that would close down all private providers—including, presumably, the local chiropodist and Chinese herbal medical centre. That seems an extraordinary position for the SSP to take.
When the Kerr report was published, my initial reaction was that it was an anticlimax; it was a real case of "What's new?" and "What now?". There is not much in the report that has not been said before. I agree that there has been a lot of consultation to get to this point, but a lot of what the report says was being said anyway. Much of what Kerr has to say is basically an endorsement of the recommendations and conclusions of the Health Committee's report on workforce planning in the NHS, which focused on many of the same issues, including the important issue of staffing. As convener of the Health Committee I point out that our report came out months earlier and at a substantially lower cost to the taxpayer. I wish that our committee system, which is often referred to as the jewel in the Parliament's crown, got a bit more recognition.
I am happy to give the Health Committee credit—and take some of it myself—for driving the agenda on when the previous convener of the committee dragged her feet on it. However, surely Roseanna Cunningham is being disingenuous in describing Professor Kerr's report as similar to the committee's report. There are common themes, but Professor Kerr takes us further and offers us options and solutions, which we on the Health Committee have not yet done. We look forward to taking evidence from him.
I suggest that Duncan McNeil read the whole of the committee's report, because as I recall, it did suggest options and solutions.
Leaving aside the comments that I have made, I accept that the Kerr report raises important questions, and that a great deal of detailed work was done in the various sub-committees, which none of us has gone through in its entirety. The minister needs to start answering some of those questions. It is time the Executive told us when and how it intends to deliver the health service fit for the future that we all want to see.
In her opening speech, the deputy minister talked about being pro-patient choice and pro-diversity. I welcome those sentiments, but as many members have said, the problem is that that is not being translated into any reality that ordinary people experience.
Professor Kerr supports diagnostic and treatment centres in the NHS. I listened to Labour members laughing when my colleague Stewart Maxwell talked about that being SNP policy—but it is, and if Labour members agree with it, why do they not just say so instead of laughing? They call for consensus, but when they see that there is consensus it does not make them happy.
One of the key messages that comes through clearly from the Kerr report is the importance of providing health services as locally as possible. Like Fergus Ewing—who had clearly taken his happy pills this morning—I would have preferred a clearer definition of what core services are, which the report acknowledges that the public want to see delivered as close to home as possible. I assure members and the minister that throughout Scotland—and certainly in my constituency—they will find a determination that such services should and must include both maternity services and accident and emergency services, which are precisely the services most under threat. Everybody recognises that there are specialist services that can best be delivered in a few centralised centres, but when it comes to giving birth or receiving urgent treatment people want to be as close to home as possible.
I now turn to waiting times. The reality in Scotland is that too many people are waiting for too long to get the treatment that they need. The figures for Tayside NHS Board show that the average out-patient can now expect to wait 72 days for an appointment—17 days longer than last quarter, 22 days longer than last year, and 26 days longer than in 1999. For in-patients the picture is no better, with average waiting times of 61 days—18 days longer than last quarter, 16 days longer than last year, and 26 days longer than in 1999.
Labour and the Liberal Democrats can try to spin their way out of that reality, but the fact is that they have now had eight years to make a difference. Despite a few successes, there are too many areas in which they continue to fail. The Tories offer no alternatives except privatisation, the SSP is, frankly, on another planet, and the debate supports my view that only the SNP has a clear and realistic view of the NHS's future. Support the SNP amendment.
The commissioning of the Kerr report in April 2004 was a proactive move by the previous Minister for Health and Community Care and the Scottish Executive to take an overview of the changing demands on Scotland's health service.
By better understanding those demands and the system's response to them, Professor David Kerr has produced a modern and rational model of the health service that has the potential to put NHS Scotland at the forefront of European health care.
Contrary to Mr McLetchie's assertion about tariffs, the Minister for Health and Community Care made it clear in his statement to Parliament on 15 December 2004 that the Executive was considering costing systems to promote equity and efficiency. If Mr McLetchie did not understand those words I am sorry, but it was hardly a secret.
Further, also contrary to what Mr McLetchie said, we are pro-reform, pro-diversity of provision and pro-patient choice. Most important, we are pro-NHS.
Will the member give way?
I will make some progress on my speech and give way later.
On foundation hospitals, we believe that the Scottish health service will be better served by developing integration and co-operation than by competition. The conditions in Scotland are not the same as they are in the rest of the UK, and we cannot simply lift models from elsewhere. I was heartened to see that that was recognised by Professor Kerr in his report.
We have made it clear that we expect boards to develop their service change proposals with reference to the Kerr report. With regard to the Argyll and Clyde situation, when the consultation on boundaries is complete, any proposed changes would be expected to reflect the Kerr proposals. The overriding ethos of the report is that safe high-quality care should be delivered as close as possible to home. However, services can be maintained only with redesign. Where there is evidence that greater volume secures better patient outcomes, we should ensure that that happens, even if it means concentrating services such as cardiac surgery and some cancer surgery. In that regard, I can tell Mr Rumbles, who talked about neurosurgery, that we are currently considering the proposals made by Professor Kerr, who has done some good work on that difficult topic.
The Kerr report also makes a number of suggestions for maintaining the vast bulk of unscheduled care locally, but suggests that every hospital will not provide the whole range of emergency medical services. Local services will develop, but that will mean change.
I welcome the work in the report on the delivery of remote and rural health care, which was mentioned by several members, including Fergus Ewing and John Farquhar Munro. That takes us in the opposite direction from centralisation. In response to Fergus Ewing, I say that the rural general hospital model has much to commend it, as has the recognition that we need to do more to provide appropriately trained rural health care specialists.
Will the minister outline what discussions her department is having with professional bodies to ensure that those general physicians and surgeons are supported by their professional peers, as that does not seem to be the direction in which things have been moving?
Ministers have regular discussions with bodies representing professionals in the NHS. Mr Kerr has already started discussions with NHS boards and we will continue to discuss the recommendations in the Kerr report, including those on remote and rural health care.
Carolyn Leckie alleged that the Kerr report opened up NHS Scotland to privatisation. We remain absolutely committed to an NHS free at the point of need. However, that will not stop us from considering models that allow us to deliver better and faster treatment for those who need it. We put patients before ideology.
On Stewart Maxwell's points about treatment centres and health inequalities, which are the subject of the SNP's amendment, I have made it clear that we welcome the emphasis in the Kerr report on separating planned care from emergency care. We expect proposals to be brought forward for regional planned care centres. I have also already discussed the inequalities work in the report, which we committed to taking forward on 25 May.
Stewart Maxwell made allegations about the poaching of NHS staff. I have no evidence of that happening in Scotland. If Mr Maxwell does, I would be obliged if he would share it with us.
The allegation was made by the minister's colleague, Robin Cook MP, in an article in The Guardian in April. He said that up to 70 per cent of the staff of the private diagnostic and treatment centres could be seconded from the NHS. Perhaps Ms Brankin could respond to that allegation, which is Mr Cook's, not mine.
I have not seen specific allegations about the poaching of NHS staff in Scotland. Of course, if I receive any such allegations, I will consider them carefully. However, it is absolutely not the intention that that should occur.
Sandra White mentioned maternity services in Glasgow, and I am sure that she will welcome the £100 million that is being provided to create a new children's hospital in Glasgow, which will be co-located with acute and maternity services in order to provide a gold standard of care.
I would like to say that I welcome the changes in medical training for students at St Andrews University.
On waiting times, I am pleased to say that the position continues to improve. I note that members of the Opposition parties have not welcomed that fact, but I cannot say that I am surprised. During the six months from September 2004 to March 2005, the number of out-patients with a guarantee waiting for a first out-patient appointment with a consultant following referral by a general practitioner or a dentist fell by 31,113—a reduction of 42 per cent. That leaves us well placed to deliver a maximum six-month waiting time for in-patients and out-patients by December 2005, and to reduce those times further, to a maximum of 18 weeks, by December 2007. That is good news for patients.
Because of the time, I cannot answer all the points that were raised in the debate. The Kerr report is about the future of Scotland's health service, and it will not be used to reopen decisions that have already been taken. I believe that it gives us the opportunity to provide the people of Scotland with a world-class health service, if we can accept that improvement requires change.
Although the Executive was hoping to postpone a debate on this subject until after the summer recess, I hope that the minister will agree that we have had an interesting discussion this morning about the many issues facing the NHS in Scotland today and about Professor Kerr's proposals for its future structure. Of course, we have also heard the usual dogma from the usual suspects and the deliberate misinterpretation of our commitment to the principles of the NHS, which has never been in doubt.
I must take issue with Helen Eadie, who accused Conservatives of not attending health board meetings. Since I became an MSP two years ago, I have attended virtually every meeting of Grampian NHS Board that has been open to MSPs.
The Kerr report has been eagerly awaited by patient groups and health professionals across Scotland. We felt that it was only right for the Parliament to give its response to the report at the earliest opportunity.
The Kerr plan might well address the next 20 years, but there are issues that need to be dealt with urgently and people expect to know without delay what the future holds for them, particularly with regard to their local health care facilities. The anticipated Kerr report has been the excuse for indecision for long enough. Now that we have it, people expect some action. The report addresses some of the most fundamental issues facing the NHS in Scotland and, by considering the service as a whole, it gives a unique perspective on its possible future direction. The needs of an aging population, a growing incidence of chronic disease, workforce issues brought about by demographic changes and the European working time directive have all challenged the status quo to the extent that it is, quite simply, no longer an option and change is unavoidable. We welcome the focus of Professor Kerr's report on primary care services, its recognition that 90 per cent of health care is delivered at community level and its recommendation that patients' health should be looked after as close to home as possible. An increasing emphasis on good local management and the self-management of chronic disease could free up acute hospital services.
On the provision of primary care, one of the report's recommendations is that community health partnerships should take the budgets for secondary care as part of the proposed tariff scheme. Does Nanette Milne recognise that as the resurrection of GP fundholding, and will she congratulate the Executive on resurrecting it?
The report is in the name of Professor Kerr, not the Executive. Nevertheless, I think that fundholding was a very good system that worked well.
The proposals for the provision of community care as close to home as possible would help to combat bedblocking, which currently chokes up the system. People are undoubtedly better off in a community setting, wherever possible, away from hospital-acquired infections and closer to their family and friends. The proposals for rural general hospitals modelled on existing good practice and for generalist as well as specialist training of health staff are what the public want to hear. Few would disagree that highly specialist services need to be centralised, although I reiterate the concerns that have been expressed about patient welfare should specialties such as neurosurgery become overcentralised.
Professor Kerr's recognition of the role that the independent sector can play in expanding capacity is welcome and vindicates our position, which was derided for a long time by the Executive parties and is still derided by the SNP, which has accused us of privatising the NHS. Professor Kerr's promotion of information technology as a major plank of good health care in the future is also welcome and long overdue.
Will the member take an intervention?
I am a bit pushed for time.
It is several years since health centres in my native city were wired up to hospital labs and X-ray departments so that results could be accessed as speedily as possible. Sadly, however, the equipment to complete that exercise has not been forthcoming.
We will be delighted to see patients truly at the heart of the NHS. After all, as Mary Scanlon pointed out, that is precisely where they were under the fundholding policy that was introduced by the Conservative Government.
Will the member give way?
No.
That policy was working, but the Labour-Lib Dem Executive could not swallow the fact that anything that the Tories did was working, so the Executive dropped it.
We welcome many of Professor Kerr's proposals, but they will not on their own solve the problems in the NHS. It is still, largely, a monopoly provider of health care, with decisions made by the Executive at the centre and services developing in response to directive and targets that are set by politicians rather than in response to the demands and needs of patients. Until that situation is reversed and patients, together with their GPs, are given the means to purchase their care where they choose to receive it, the Kerr proposals will be difficult to implement because the capacity in the system is not always where it is wanted and needed.
We have concerns about the report's implementation for several reasons. Current staffing problems are a major worry and will, at best, take many years to correct. Without local teams of health care professionals, local services simply will not be available. We are also concerned that the deficiencies in the NHS 24 service are putting patients at risk and causing them a significant amount of distress at times when they are vulnerable—not because of the staff who are operating the system, who are an extremely dedicated group of health professionals who are doing their best with inadequate resources, but because the system was not tried and tested adequately before it was rolled out. It has been unable to cope with the pressures that have been put on it as a result of the new GP contract and receives far more out-of-hours calls than it can deal with. That has resulted in long delays and call-backs for patients who seek medical help. The situation must be addressed at the earliest opportunity.
Patients in many areas—especially rural areas—are unhappy with the new out-of-hours arrangements and do not understand why the changes were made or why the new GP contract has come about. When the GP contract was debated, I warned the then minister that it would be essential to explain the out-of-hours system to patients via a major public awareness and information campaign. However, he did not listen and left it to the health boards to do that job. That clearly has not worked.
We are also concerned that the technology and equipment for carrying out diagnostic tests in community hospitals and health centres may not materialise—especially given how, for example, Greater Glasgow NHS Board has struggled to replace its out-of-date computed tomography scanners despite ministerial pledges that that would be done. We also have serious concerns that care for the elderly in our communities will not be adequate unless and until the Scottish Executive allocates sufficient funding to allow independent care homes to expand their capacity or even just to stay open. The situation is already at crisis point and it will not improve until the Executive accepts the case for providing funding that matches the cost of care.
Although we are happy with much of what Professor Kerr recommends for the NHS of the future and are pleased that the Executive is, at last, abandoning its ideology and looking to the independent sector to expand health care facilities for NHS patients, we remain convinced that money that is poured into an unreformed NHS in Scotland will never produce the results that people expect and deserve. As long as everything flows from the top down, the service will be incapable of autonomous development. Centralised planning and micromanagement through targets and directives, in an attempt to improve performance, results in rigidity of the system, inefficiency and waste. Managers spend their time trying to deliver the centrally imposed targets on which they are judged and are accountable to their political masters rather than to their patients and the professionals who look after them. That leads to low morale among staff and dissatisfaction with the service.
That is not what patients want, and they are saying that loud and clear throughout the land. They must be the driving force for the development of services within the NHS. They must be given the resources to achieve that, and health care providers must be given far greater freedom to respond to patients' needs. Professor Kerr's proposals give the Executive a great opportunity to raise standards in the NHS. That is a massive challenge but, if the Executive rises to it, it will have our full support. I support the motion in David McLetchie's name.