Protecting Scotland’s NHS
Good morning. The first item of business is a debate on motion S4M-01275, in the name of Jackie Baillie, on protecting Scotland’s national health service.
09:15
I am very pleased to lead the debate on protecting the NHS. It is true to say that the NHS is probably one of our most-valued public institutions. We are all very grateful to the staff who care for us and our relatives daily, contributing to the NHS that we know and love: the doctors, nurses, laboratory technicians, porters, cleaners, occupational therapists and so many more besides. All of them play a critical role in the patient journey and are central to the quality of healthcare and the experience of patients. I think that that view will be shared across the chamber.
I say at the outset that I regret the tone of the Scottish National Party amendment. It is inaccurate, but what is perhaps more worrying is that it reflects a degree of complacency about how wonderful things are that is absolutely not mirrored by the experience of health service workers on the ground. It is incumbent on politicians of all parties to be honest. People understand that times are tough. They understand that budgets are tight—for goodness’ sake, it is happening to families across Scotland, too—yet they are treated to spin, fudge and dissembling. I recognise the tactic in the SNP amendment: in a tight corner, blame somebody else. In fact, SNP members are masters at playing the blame game; they excel in the it-wisnae-me school of politics. However, the NHS is just too important to play those kinds of games with.
I want to shatter two myths that the Scottish Government is fond of peddling. The first is that it protects health service spending and the second is that there are more staff in the NHS now under the SNP than there were under Labour when we were last in office. Let me start by talking about resources. The SNP makes great play of protecting the NHS. It promised increased spending and promised to pass on the Barnett consequentials. It added up all the money and stuck a figure up on a billboard, which the First Minister unveiled during the election. There was a veritable plethora of promises, one surpassing the other—promises, promises, promises.
Perhaps someone can explain to me why, when health funding was rising under the previous United Kingdom Labour Government, the SNP failed to pass those increases on. Let me see, the rises in England were an average of almost 6.7 per cent year on year, yet the SNP passed on an average of only 4.1 per cent. Historically, the SNP has not passed on the extra money for health, leaving the NHS in a weaker position to deal with the cuts.
Perhaps someone can also explain to me why there is a real-terms cut in funding. There is a cut of some £319 million over the spending review period. Those are not my figures but independent analysis by the Scottish Parliament information centre.
I am grateful to my critical friend for giving way, but does she not understand that the failure to pass on all the Barnett health consequentials, as Labour proposed in May, would have meant that there would be less money, not more money? When will she acknowledge that fact?
We did, indeed, agree that all the Barnett consequentials should have been passed on. I made that commitment in the chamber—the member can check the Official Report.
However, what the SNP provided was not an increase, as promised, but a cut. When we consider that health service inflation runs at more than 4 per cent, we begin to understand the scale of the challenge ahead. It will be tough for health boards. They are faced with ever-increasing demand on services and a declining budget. It does not take a rocket scientist to work out that it will be difficult for them to spread their resources even more thinly without that having an impact on patient care. Rather than acknowledging that openly, the SNP simply changes its mantra from, “We are protecting health,” to, “We are protecting health boards.” Yet, is the SNP doing that?
The briefing from the Royal College of Nursing prior to this debate is instructive. Again, we see that some of the so-called new money passed on to health boards is not that at all: it is in effect money that has already been committed. The briefing points to the £76 million of waiting times funding that has simply been transferred from one health directorate budget heading to another—from non-recurring funding in 2011-12 to health boards core recurring funding allocations for 2012-13. Removing the impact of that money, which the RCN points out is not new funding, on health boards means that their combined cash uplift drops to 1.6 per cent. If we look again, we see that, for the first time, the cost of delivering healthcare in the prison service is being transferred from justice to health without the corresponding transfer of resource. That will cost the health service an additional £20 million a year. Strip that out and we are left with an uplift of 1.4 per cent set against inflation pressures of more than 4 per cent. Even a primary school child can understand that arithmetic.
Simply transferring already committed money from one heading to another and pointing like a conjurer at what you want people to see does not hide the reductions elsewhere. The alcohol treatment and tobacco control budget lines have reduced by £3 million in real terms, the mental health budget line is down in real terms, the budget for specialist children’s services is down in real terms, and the clean hospitals and MRSA line is down in real terms, too. Let us have an honest debate about what our priorities in health should be, because the money is not there. Demand is increasing, resources are decreasing and we cannot just stick our heads in the sand.
The second substantive issue that I want to raise is staffing. It is truly astonishing and breathtaking that the SNP expects us to believe that, while there are unprecedented cuts to staffing levels, it is still somehow protecting the NHS. Since 2009, 4,000 staff have been cut from the NHS. Some 1,700 of those are nurses and a further 1,000 nurses will be out by the end of the year. However, it is not just nurses. There are fewer occupational therapists, fewer speech and language therapists and fewer physiotherapists. Numbers have declined across many staff groups, and the situation is worse than the figures suggest because they include posts that are frozen and unfilled. The staff left behind are having to shoulder the burden, pick up the pieces and cope with the increasing workload. It is interesting that staff reporting of safety concerns has risen in the same period. The Government cannot remove that level of staffing without having an impact on front-line patient care.
I know that, in the modern world and in the Parliament, too, we like to talk about outcomes, but let me talk about some old measurements that should give us an early warning of the problems that lie ahead. The number of operations cancelled by health boards is up. Bed numbers are being reduced, which is not in itself a bad thing except that the data show that readmissions are going up in cases where people have to go back into hospital because they were discharged too early.
If members are not convinced by any of that, let me tell them about the RCN survey of employment and morale. Less than a third of nurses felt that nursing will continue to offer them a secure job. Two years ago, the figure was 82 per cent. Some 74 per cent reported increased stress at work and 66 per cent were more worried about job cuts than they were a year ago.
Members will remember that the Cabinet Secretary for Health, Wellbeing and Cities Strategy is fond of telling us that there are more nurses in the NHS than there were when Labour left office. She has repeated that mantra time and again, and her boss, the one and only Alex Salmond, who was keen to get in on the act, said in the chamber on the day before the summer recess began:
“The protection of the health budget has meant that, even in these difficult times, health”
unemployment—sorry, I mean employment; that was a Freudian slip—
“in every single category—through medical consultants, general practitioners, dentists and nurses to allied health professionals—is substantially up today on the level that we inherited in 2007.”—[Official Report, 30 June 2011; c 1270.]
That is simply not the case. The First Minister and his Government are coming to believe their own propaganda. His statement is a complete fantasy and has no basis in fact. The Government’s own statistics on workforce numbers demonstrate that one has to go back to before 2006 to find fewer nurses and midwives in our hospital wards and communities. The SNP has taken us back almost six years and there are even more cuts in nurse numbers to come.
The SNP promised to protect the health budget and promised that there would be no compulsory redundancies, but we are seeing a real-terms cut in the health budget and thousands of staff are being shown the door. Those are real cuts that are happening to our health service right now. The SNP’s promises on the NHS are sounding hollow to me.
Back in 2010, the SNP had an election slogan, “More nats, fewer cuts”, to which Scottish Labour replied, “More nats, fewer nurses”, a claim that the SNP vigorously denied. I take no comfort in being right but, today, there are more nationalists in the chamber and, regrettably, fewer nurses in Scotland’s hospitals.
I believe that we are on the brink of a crisis in the NHS, but do not take my word for it. This is what the RCN had to say about the workload and morale of staff: It is “at breaking point”.
It is time that we had an honest debate about the challenges that the health service faces. The SNP must stop spinning and wake up to the reality of staff struggling to cope in hospital wards, health centres and communities across the country.
I move,
That the Parliament notes with concern that, since 2009, almost 4,000 whole-time-equivalent NHS staff have left their jobs, including more than 1,700 nurses and midwives, leaving the number of nursing and midwifery posts in Scotland’s NHS at its lowest point since 2006; further notes that the latest NHS workforce statistics also show a decline in other workforce categories, including consultants and allied health professionals; notes that the declining trend in Scotland’s NHS workforce began prior to 2011-12, at a time when the overall Scottish budget was rising; believes that the proposed £319 million real-terms cut to the overall health budget over the spending review period threatens further frontline job losses, including the reduction of nearly 1,000 whole-time-equivalent nurses and midwifery posts that have already been projected by NHS boards in the current financial year; further believes that such a rapid and disproportionate reduction cannot be explained by changes to service delivery and that it will impact adversely on the care of patients as well as the workloads and morale of remaining staff described as being at "breaking point" by the Royal College of Nursing in Scotland, and calls on the Scottish Government to take responsibility for its own cuts and to accept that such a deep and disproportionate loss of frontline healthcare professionals is not compatible with protecting Scotland’s NHS.
09:26
I begin by congratulating the Edinburgh-based Veterans First Point medical team for its outstanding success in winning two awards at this year’s military and civilian health partnership awards ceremony, which is a tremendous achievement for a team that does tremendous work.
I also take this opportunity to welcome the news that Jackson Carlaw is returning to the Tory front bench as health spokesperson. I wish him a quick recovery from his recent illness and thank Murdo Fraser and Mary Scanlon for the contribution that they have made to the health portfolio in this Parliament. I hope that we will see them in future health debates.
Protecting the NHS is my job. It is my responsibility as health secretary, which I take extremely seriously. It is what I spend every waking hour striving to do. It is, of course, for others to judge the success of that but, for my part, I am incredibly proud of our NHS. I am proud of the quality of care that it provides and—particularly this morning, as we hear of the first NHS hospital in England to be handed over to the private sector—I am proud that, in Scotland, under the SNP Government, we have an NHS that is true to its founding principles and which Nye Bevan would recognise.
It is because I care so deeply and so passionately about our NHS that I agree with Jackie Baillie that honesty in this debate is paramount. I therefore make no apology for starting by pointing out the hard reality that Labour’s motion tries to gloss over, which is that, if Labour were in power today, the NHS would have less money in its budget than it currently does. I will give two quotes that demonstrate that.
Before the 2007 election, Jack McConnell said that, if Labour were re-elected, every extra penny would go to education and that that would mean
“other budgets having to cut their cloth”.
In simple terms, that means that, if Jackie Baillie or one of her colleagues had been health secretary, the extra £1 billion that the NHS got in the previous session, under the SNP Government, would instead have gone to education. The NHS budget would have been £1 billion less. That is a fact.
Secondly, in September 2010, Iain Gray said:
“Labour would not ring fence the health budget.”
That presumably means that at least some of the extra £1 billion that we will give to the NHS during this session would have gone elsewhere, too. Based on either of those quotes, the inescapable conclusion—the hard reality that Jackie Baillie and Richard Simpson do not like to recognise—is that, if they were standing where I am now, the NHS would have significantly less money in its budget than it currently does.
Nonsense. Not true.
That is a fact. That is true.
The Scottish Labour Party manifesto might not be bedtime reading for the cabinet secretary, but would she accept that it contains an absolute commitment to pass on all the Barnett consequentials to protect health spending?
It is not bedtime reading for anyone.
If Jackie Baillie is correct, those Barnett consequentials, given what Jack McConnell said, would have been applied to an NHS budget that was already £1 billion smaller than it was under this Government. Also, if she is correct, the best that we can say about Labour’s position is that it promises to provide not a single penny more for the NHS than the Government has. Let us have some honesty. The issues in the motion are serious, but Labour’s position on them does not have a shred of credibility. That is no doubt part of the reason why, despite all Labour’s rhetoric before the election and the snazzy campaign slogans that Jackie Baillie has reprised today, in overwhelming numbers the people of Scotland trusted the SNP with the future of their national health service.
I will talk about the Government’s record on health, of which I am proud. More important, I will talk about the achievements of the NHS, of which I am also proud. It is shameful that they do not rate a mention in Labour’s motion. Every penny of the Barnett consequentials has been passed on—£1 billion of extra cash that has been deployed to protect front-line services. In each of the next three years, NHS board budgets will rise in real terms. When Jackie Baillie talks about a real-terms cut, she is being economical with the truth, as that reflects the cut in traditional capital spending, which in turn reflects the 36 per cent cut in the Scottish Government’s capital budget—a cut that was implemented by the Tory-Liberal Government but planned to the very last penny by the previous Labour Government. In short, I will take no lessons from Labour on NHS funding.
In true, age-old Opposition style, Jackie Baillie wants to talk down the NHS to get at the Government. In doing so, she does a great disservice to the women and men who are delivering a first-class NHS in tough times. The reality of the health service today is that it is treating more patients than ever before and more quickly than ever before. Waiting times are at a record low. In seven out of the 11 most common hospital procedures, our NHS has the lowest waiting times in the entire UK. Scotland is the only part of the UK where waiting times continue to fall. Infection rates are also at a record low, and there are more day cases than ever before. That is the reality of our NHS.
The issue of staff numbers is hugely important. There are 4,850 more staff working in the NHS today than there were when Labour left office. There are also no compulsory redundancies in the NHS—something that I am not sure could be said about the NHS in England when Labour was last in office. Yes, the shape and size of the NHS workforce is changing; I recognise the challenges of that and the anxieties that it can cause. However, it is my job to work with staff and NHS boards to make sure that those changes happen at an appropriate pace, reflect service redesign and do not compromise the quality of care. That is my job and I take it very seriously.
Will the cabinet secretary take an intervention?
I am concluding, Presiding Officer.
In my view, there is no more sacred duty of any Government than the duty to provide free universal high-quality healthcare for the people and to protect our national health service. That is what I will always strive to do, and it is what the SNP Government will always do. From the bottom of my heart, I thank all those who work so hard in our NHS to deliver those high-quality services.
I move amendment S4M-01275.1, to leave out from “with concern” to end and insert:
“that despite real-terms cuts in the Scottish block grant by the UK Government and the previous UK Labour administration, NHS resource spending in Scotland has been protected; further notes that, over the next three years, NHS boards’ resource budgets will increase by £740 million and in real terms, ensuring that resources are directed to frontline services; recognises that, under the SNP administration, cancer waiting times targets have been met for the first time, waiting times are at record lows, MRSA and Clostridium difficile rates have been cut substantially, day case rates are at an all-time high and length of stay in hospitals at a record low, and welcomes the fact that the SNP administration has rejected the NHS privatisation agenda pursued by both the UK Government and the previous UK Labour administration.”
09:33
It is with great pleasure that I rise to speak in the debate on what will be my last outing—at least, for the time being—as the Conservative health spokesman. I say to the cabinet secretary, to Jackie Baillie and to others how much I have enjoyed debating with them over the past couple of years. They will shortly have a new face, or perhaps a returning face, to contend with when someone else fills my current role as I move on to pastures new. It is fair to say that those are not the pastures that I had originally intended to move on to, but I am sure that the grass will be just as green.
Jackie Baillie’s motion makes some fair points about the decline in NHS staff numbers over recent years. Indeed, the statistics that have been cited this morning have been raised frequently in the chamber over recent months. However, the motion, which I read in great detail when it was published yesterday, refers to a real-terms reduction in the overall health budget, and, on scrutinising the figures, it becomes apparent that the situation is not quite so clear cut.
Revenue spend on the NHS remains more or less constant in real terms, in line with the commitment by the UK coalition Government to ring-fence NHS spending and the subsequent commitment by the Scottish Government to pass the Barnett consequentials of that on to the NHS in Scotland. The reduction in funding referred to in Jackie Baillie’s motion is, as the cabinet secretary said, in the capital budget. It is not entirely correct to say, as the motion states, that the reduction threatens further front-line job losses. Indeed, I would have to say to Jackie Baillie that there is more than a little whiff of Labour opportunism about the motion as I cannot see anywhere what the Labour Party is proposing as an alternative.
We all know that the public finances are in a horrendous situation, and that that is a legacy of Jackie Baillie’s colleagues in the previous UK Labour Government. We also know that, with a fixed Scottish budget, if the Labour Party proposes to increase spending on the NHS, it has to tell us what other area of the budget it would cut. We have heard nothing from the Labour Party this morning about how much it would increase health spending or how it would afford to do that in the current budget round. Perhaps later contributions from Labour will set out in detail whether it thinks that the NHS in Scotland is underfunded and by how much, how much extra it would spend, and where that money would come from.
That said, there are serious issues affecting the NHS because of the standstill budget and continually rising costs, more expensive treatments and—[Interruption.]
Ms Baillie and Ms Sturgeon, please stop having a conversation across the chamber. Mr Fraser, please continue.
I am not used to such disruptive womenfolk, Presiding Officer. I am glad that you are keeping them in order.
We know that costs are rising in the NHS and that the population is ageing. I am sure that we have all met people working in the NHS who have extreme concerns about workforce cuts. The RCN briefing for the debate highlights the fact that the number of nursing staff who are in post is at its lowest since 2006. The Royal College of Speech and Language Therapists, which held an event in Parliament just a couple of weeks ago, also raised concerns about vacancies not being filled and about that having a knock-on effect on patient care. That is particularly concerning, given that we are all supposed to be investing more in preventative spending. If the problems that such therapists deal with are not dealt with early, they will cause greater problems and incur more costs further down the line.
Service redesign and change are always going to be a part of the NHS, with treatments that used to take weeks in hospital now being reduced to a day or two, and workforce reductions in themselves are not always a bad thing, nor do they always mean poorer services. However, we need to be careful that we are not impacting adversely on patient care.
We remain of the view that it was an error to take more than £50 million out of the health budget to give free prescriptions to all, including members of the Scottish Parliament who can well afford to pay for their prescriptions. If given the choice, I am sure that the public would rather make a small contribution towards the cost of their medicine than see cuts in NHS services. I am delighted that our new leader, Ruth Davidson, is maintaining our opposition to the policy of free prescriptions for all, and I hope that, in time, other parties will realise that the policy is a good example of a wrong choice with serious and negative consequences for our public services.
We have some sympathy with the terms of the Labour motion, which raises some serious issues. However, it would have been better if Labour had offered an alternative rather than simply being on the attack. These are serious issues and they deserve more than a superficial treatment.
09:38
I begin by telling the Labour Party a few home truths about this morning’s debate, if the cabinet secretary has left me any to give following her opening speech.
I hope that by the end of my speech I will, unlike the Labour Party, have made a few constructive suggestions on the NHS. The Labour motion alleges:
“the declining trend in Scotland’s NHS workforce began prior to 2011-12, at a time when the overall Scottish budget was rising”.
Labour does not tell us that the budget settlement from the UK Labour Government at the time the motion refers to was the worst ever settlement to Scotland since devolution. Labour fails to tell us that fact. I also acknowledge that Labour’s fellow London-based colleagues have since given increasingly damaging cuts to Scotland.
I am disappointed that the Lib Dems are not here this morning to share the blame.
That point is vital for a number of reasons. First, at the last election, the Labour Party in Scotland refused to commit one additional penny to Scotland’s NHS, despite being asked repeatedly and directly to do so in interviews with Iain Gray, the party leader. I thought that he, and not Jackie Baillie, spoke for that party. Perhaps she is making a belated leadership bid—who knows? The SNP Government, however, promised to give NHS boards a real-terms increase and to pass on future Barnett cash consequentials in full. That is why the NHS has seen a 2.5 per cent increase in cash terms and a 0.5 per cent increase in real terms. I shall return to NHS inflation later in my speech, if I have time.
I appreciate the challenges faced by the NHS, including nurses. My wife is a nurse and she leaves me in no doubt about the challenges that she faces daily. Let the message go out loud and clear, however, that despite the continuing pressures and challenges facing the NHS in the years ahead, the position would have been significantly worse had Labour been re-elected. That is simply a fact. More nats, less cuts. Woe betide us if Jackie Baillie’s party was in power and she was in charge of the health department, as who knows how many fewer nurses there would be. Do not take my word for it, take Iain Gray’s, as he refused to pledge any extra cash.
The same element of Labour’s motion highlights a second deficiency in Labour’s thought processes as it focuses on the NHS head count before 2011-12 without giving any thought to the reconfiguration of NHS services. The staff reduction will have been due at least in part to forms of service reconfiguration. That shows that there is an underlying and complete misunderstanding of the workforce management complexities that are at play when we move NHS provision away from acute service delivery into community delivery.
Will the member take an intervention?
I wish I had longer than four minutes, but I do not, so I will continue.
In effect, we are talking about NHS staffing levels that are roughly comparable with those when Labour left office in 2007. Does the Labour Party believe that, when it left office with staffing levels unsustainably low, the NHS was in crisis? Labour presided over eight years of failure of the NHS—thank you, Jackie Baillie, for putting that on the record—[Interruption.] I know that Ms Baillie does not like the truth, but she should put her listening ears on.
Let me try to highlight a couple of positive elements. NHS inflation is notoriously difficult to calculate, and the problem that the Scottish Government has is that the Barnett consequentials from London do not take it into account. I wish that they did. I wish that Labour was saying that they should, so that we could build a consensus to challenge the UK cuts, but whenever the Scottish Government challenges the UK’s spending commitments, Labour runs feart and terrified that that will open up more powers for this Parliament. Labour would rather put—
You need to wind up now, Mr Doris.
That is why I cannot support the motion this morning.
09:43
Let me start by picking up on a point that the cabinet secretary made. It is both outrageous and offensive to say that if anybody in this chamber tries to point out some of the inadequacies of the present Administration they are, as Nicola Sturgeon asserted about Jackie Baillie, trying to talk down the NHS. We are not trying to talk down the NHS or those who work for it if we express genuinely felt concerns. If we try to express the concerns articulated to us by our constituents who work in the NHS, how can we possibly be trying to talk it down? We are simply repeating what they are telling us. Surely those SNP members who represent constituencies must have some constituents expressing concerns to them—it cannot be the case that they are not receiving any complaints about what is going on in the NHS. Nurses are probably the biggest source of complaints to me about the NHS. I cannot be talking down the NHS if I say what nurses are telling me.
The member mentioned constituencies and nurses. My case load from nurses is to do with the car parking charges at Glasgow royal infirmary, which the Labour Government implemented under a private finance initiative. That is my biggest case load.
There may be a specific issue in Glasgow, but across Scotland, nurses, who are overworked, stretched and concerned, are the biggest source of complaints about the NHS. They are caring professionals who are concerned about impacts on their patients. They are worried and scared about what will happen not only to their jobs, but to the future of the NHS.
We have heard a lot of talk about the SNP wanting honesty. Bob Doris and the cabinet secretary mentioned that. The SNP’s manifesto said:
“We have increased the number of ... nurses”.
Fair enough. It went on to say:
“In the next Parliament”—
that is, in this session—
“an SNP Government will ensure that we continue the progress that has been made.”
Fair enough. From September 2009 to January 2011, nearly 2,000 nurses lost their jobs. That is 2,000 fewer nurses. How is the SNP ensuring progress and maintaining the increase in the number of nurses? Something does not stack up.
If we are going to have some honesty, let us forget the rhetoric from all the parties in the run-up to the election, and the SNP should tell us whether there are fewer nurses now than there were in September 2009 and how that squares with the promise that it made. The SNP owes it not to members who support the motion or to other MSPs, but to the nurses and doctors who deliver the services and, more than that, to patients to say that they will be safe and secure in a health service in which there is an adequate number of nurses.
It is surely not beyond the wit and capacity of members to have a debate at some point about what is happening. Surely we can reach an agreement, leave aside election rhetoric and all the posturing, do the right thing, and ensure that we have nurses who can deliver.
09:47
After Jackie Baillie’s track record last year, when she combined the housing budget with the NHS budget to claim wrongly that health spending was going down, I thought that she might be a bit more circumspect in her selective use of figures, but it seems not. She might wish to choose 2009 as her starting point for employment figures, but it is far more illustrative to compare the current situation with the situation when Labour was in power. Even with the recent changes to staffing levels, there are still significantly more whole-time equivalent staff than there were when the SNP first entered government.
Unlike what happened in the dark days of Labour control, the NHS is meeting its targets and improving the incredible service that it provides to the people of Scotland. Before the 2007 election, there were 32,000 out-patients waiting for more than 12 weeks. Last year, there were just 150. Before the SNP Government, Labour utterly failed to meet its 62-day waiting time target for cancer patients. Under the SNP Government, we have not only met that target; we have halved it to 31 days and met that, too.
The NHS budget is going up in absolute terms, from the £10.2 billion that it stood at under Labour to a record £11.9 billion in 2014-15. That is an increase of £1.7 billion under the SNP Government. The NHS’s share of the devolved budget is going up, from 42.4 per cent of the resource budget this year to 44.2 per cent by the 2014-15 financial year. As promised, the Scottish Government has passed on the full consequentials from Department of Health spending south of the border and, as promised, it has protected the NHS budget at a time when UK Government decisions have led to savage cuts to the Scottish budget.
Labour motions usually contain demands for infinitely more resources, but there are never any indications of where those resources should come from. Is Labour suggesting that the proportion of the budget that goes to the NHS should be even higher than it already is? If so, what cuts to the rest of the budget is it asking for?
The Scots have seen through the Labour Party, as was clearly demonstrated in May. It thought that, if it kept throwing money at the organisation and taxing Scots more highly in the process, things would only get better. That is not true. This is about how we make best use of the money and the tremendous talents of all in our health service to achieve the best outcomes for patients.
It is the nature of the NHS that, as Bob Doris said, it needs ever-increasing resources to maintain its position as new treatments and drugs are developed. The biggest threat to the NHS is clearly not the actions of the Scottish Government, which is straining every sinew to protect Scotland’s health budget; the real danger is the rampant rate of inflation in the health service, which drives up costs while budgets are falling.
How does Maureen Watt square the fact that the Government repeatedly says that there is a real-terms increase with what she has just said?
I have just given the Parliament all the figures. Dr Simpson obviously was not listening earlier.
Why else does the Royal College of Nursing say:
“the NHS settlement is as good as we could have expected in the current climate”?
As long as we are tied to the dead hand of Westminster’s failed economic policy, we will continue to face those challenges. That makes the need for preventative spending more important than ever before. It must be at the heart of future plans for the NHS, and the money identified for that purpose in the spending review is perhaps the most significant part of the Scottish Government’s budget plans.
I support the amendment in the name of Nicola Sturgeon.
09:51
As I have only four minutes, I do not plan to take any interventions.
The motion is about one of our most respected institutions, and it must be—I put this in the best way possible—the most breathtaking piece of hypocrisy ever. Even Dick Turpin could not have hijacked 60 minutes of parliamentary time like the motion does.
A week ago, the motion might have won a Hallowe’en prize. We are bewitched. It is a trick, not a treat. It is full of doom and gloom, gripe and groan and hypocrisy. It is a melange or a cauldron of distortive numbers and an attempt at sorcery over our memories.
The Labour Party is waving its wand, hoping that we will forget that, when it was in power, it tried to close the accident and emergency departments at Ayr and Monklands and then had a Damascene conversion just before an election. For the record, Ayr accident and emergency department treated nearly 20,000 people over the summer.
A party whose London leadership called for cuts a little deeper and tougher than Thatcher’s is asking the Scottish Government to take responsibility for its own cuts. They are not our own cuts. In what school of wizardry is £11.03 billion—the Government’s proposed resource spending in 2012-13—less than the £10.8 billion planned for 2011-12? What magic compels a rich country that is desirous of creating a caring, compassionate and concerned society for its sick, elderly and ill to be Hogwarted because it is reliant on handouts from another Government?
Ms Baillie and the Labour Party in Scotland again focus on the wrong target. She and her party may find it acceptable, even desirable, to go down the road to Damascus, following her English colleagues, who changed their views just before the previous election. What did they call for? “Our health, our care, our say”. However, unless she can clearly tell us where she would find cuts to fund her unexplained, mythical aspirations, we might end up with an NHS like the one in England, where people do not know whether it is new year or New York.
The NHS in Scotland has 25.3 members of staff per thousand head of population, compared to 20 in England. Ms Baillie uses her mythical numerical powers to move her baseline conveniently to 2009. However, she knows that, since 2007, NHS staffing has gone up by 1.4 per cent, support services staffing has gone up by 0.4 per cent and the number of allied health professionals has gone up by 5.2 per cent.
We do not deny that times are tough, but even the RCN briefing that Jackie Baillie quotes acknowledges that health is in a relatively strong position in the proposed 2012-13 budget. The RCN and the British Medical Association say that the demographics and financial constraints are challenging, but they accept that challenge.
I have been going round to meet boards and staff in the NHS in the south of Scotland, who are focused on achieving better clinical outcomes and results and on long-term restructuring, buttressed by quality care, and who are targeting increased participation and consultation locally, to marry clinical service with efficiency.
The challenge for Ms Baillie is to leave aside the gripe and groan and the doom and gloom. Let us—the Government, the Opposition and participants in the national health service—work together to provide a health service and health workers with international distinction. I support the amendment.
09:55
Good morning. I will be a little different today. I am new to the game of politics in the Scottish Parliament, so I will try not to criticise anybody.
It is important to find a solution. We have a tremendous service, of which I am a customer—I have been so since birth. I continue to enjoy the services in our hotels—I call hospitals that because the only time that I get a rest is when I am in hospital. As a patient in hospital, I have noticed the tremendous work that all the people there do. Every one of our staff does tremendous work for us in what we accept are extremely difficult circumstances. I know for a fact that no member would disagree with that.
The important issue is how we retain and develop that service. I have reams of figures for all the cuts that departments face. Cuts are a reality. I have been in politics for 17 years and I have not experienced a year in which a cut has not been made. I have seen cuts and cuts. A lot of times, I have wondered when the cuts would stop. I do not see the light at the end of the tunnel—the tunnel is circular and there is no light at the end of it.
We need to start thinking outside the box and to ask how we deal with the situation. One way of dealing with it is to develop the service. We are proud that the national health service is one of the best health services in the world. We are also proud that we work with people overseas, but we have done so through token gestures and not seriously. We do not invite patients from overseas to come here, as is done in other countries. Australia, India, China and now Malaysia all sell facilities. We should look at encouraging such trade, if we are looking for new input to inject cash into our hospitals and our service. If we do not have money at home, we must look for it elsewhere. The market is global and we must compete.
At home, we have a lot of issues. We have people from 140 communities who travel all over the world and return with all sorts of challenges for us with diseases. Recently, I was in Lahore in Pakistan. It is a twin city of Glasgow, which has signed a memorandum of understanding with the Punjab Government. The Chief Minister there sent a message to the Scottish Parliament in which he asked the Parliament for assistance in dealing with dengue fever, as people out there have been challenged by a new outbreak. At a meeting there, I realised how fortunate we are to be protected by so much. However, we are also vulnerable. Developing our international links and encouraging such trade would be helpful.
I plead with the cabinet secretary—although I know that I do not have to, as I am pushing at an open door—to save the service. I am keen for the Government to develop opportunities for fresh input into the service that is not just from Government funding. We need a new injection of resource into the service, for which we need to look outside the box for once.
09:59
The debate has been somewhat disappointing so far—apart from Hanzala Malik’s speech. We have heard the usual scaremongering from Labour about the state of the NHS in Scotland. I for one do not recognise the image that it presents of an organisation on its knees; I recognise an organisation that is delivering for the people of Scotland.
I do not think that the NHS is perfect—I do not have a blinkered view on that. The NHS needs to change, and reducing its senior management by 25 per cent over this session of Parliament will be a welcome change. It will certainly make the organisation more efficient and I am sure that the public will be happy with that, too.
Jackie Baillie spoke about the SNP playing the blame game—I think she used the phrase “it wisnae me”. I know that there are financial difficulties across the UK. This Parliament received a £500 million cut to the budget from the previous Labour Government and a £1.3 billion cut to the budget from the current Tory-Lib Dem UK Government. So, with less money coming to Scotland, the funding allocated to the NHS in Scotland by this SNP Government is actually a good deal.
I know that Labour does not appreciate the issue of balancing the books. The situation that the UK Government—and the whole of the UK—is in is not all the fault of the banks, but Labour does not understand that. At least Alistair Darling had the decency towards the end of his term in ministerial office to be honest by telling us that the cuts that he would initiate would be tougher and deeper than those of Thatcher. Labour members might not want to hear that unfortunate truth about Alistair Darling. I hope that they are not proud, but ashamed, about what we have heard this morning about the NHS in England.
The cabinet secretary spoke about the first moves to privatise NHS facilities down south. Unfortunately, there is no Lib Dem in the chamber this morning, which just shows what they think about the NHS. Labour needs to accept that the Tories and the Lib Dems are moving on, at pace, the project of privatising the NHS, which was started by the previous Labour Government.
I firmly believe that the NHS should remain free at the point of need. Of the range of public services over which this Parliament has control, our NHS is, for me, the jewel in the crown. Every member should be proud of what the men and women in the NHS deliver for us on a daily basis.
Some of their achievements need to be highlighted again. Waiting times are at record lows; cancer waiting times are being met for the first time; day case rates are at an all-time record high; and the length of stay in hospitals is at a record low.
I said at the beginning of my speech that the NHS is not perfect—no organisation is. The NHS can still improve, because there is always room for improvement. Unfortunately, in their speeches today Labour members provided no suggestions for how to improve the NHS, apart from the usual mantra of “more money”. I mentioned Hanzala Malik’s speech in my opening comments; his was the exception.
Every person in Scotland and the UK is now suffering on a daily basis as a result of the profligacy of Labour colleagues in the previous Government in London. Throwing money at an organisation is not always the answer. I know that the NHS in Scotland is safe in the hands of Nicola Sturgeon. I also know that the population in Scotland trust Nicola Sturgeon to safeguard the NHS. Yes there are challenges, but nobody outside this Parliament wants to go back to the dark days of Labour in control not delivering for the benefit of Scotland and not delivering the NHS that Scotland needs.
10:03
I thank the health secretary for her kind words. I know that Jackson Carlaw will be a great asset to the health debate in Scotland and I am sure that he is looking forward to coming back to health. Although I am leaving health, I certainly do not intend to leave some issues, such as mental health and care of the elderly. I am not quite sure whether I will feel as passionate about carbon capture in my new role, but I certainly do not intend to leave the issue of mental health.
I thank the Labour Party for using its time to discuss the NHS workforce. Plenty of figures have been mentioned this morning, but the one that I cannot forget—and which should be at the back of our mind in everything we do—is the £120 million of interest that this country pays each day on its national debt. Given that, we should all be committed to better-quality and more efficient and effective healthcare that provides the best value for taxpayers’ money.
Although, like others, I acknowledge the value, commitment and dedication of our NHS staff, I must recognise a very good point that Hugh Henry made. I, too, find that the complaints that I am getting are coming not just from patients but from the workforce—and from nurses in particular. The Government needs to explain why, of the 3,910 staff that have been lost in the past 21 months as a result of efficiency savings, 1,747 have been nurses and 1,100 administrators.
Jackie Baillie also made a good point about the NHS providing services in prisons. That work has only just started, but we need to know what impact it will have on existing NHS service provision. After all, as the prison population amounts to more than 7,000, the move represents a huge increase in responsibility for the health service.
We should also consider areas such as mental health, where more staff might be needed. A first-class example of preventative spending, early diagnosis and treatment can, as we know, prevent mild depression from becoming severe, chronic and enduring. That is why I was so shocked and disappointed by the response to a recent freedom of information request that I submitted recently, which revealed that children seeking mental health treatment can wait up to 182 weeks—or more than three years—in Tayside and 56 weeks in Glasgow and that, in adult mental health, an individual might have to wait more than two years in Grampian, Tayside and Highland for psychological services. Moreover, many health boards simply did not have the data. Given the increased demand on the mental health workforce to meet waiting times in future, which I welcome, I ask the cabinet secretary to look at whether retraining and redeployment opportunities are being offered to existing staff where appropriate.
No one has yet pointed out that, compared with levels when the Parliament was established, the percentage of procedures carried out as day cases has risen by 10 per cent and the number of nurses by 5,000. As a result, we should be concentrating not just on the workforce itself but on what it is doing.
In conclusion, I want to quote from the RCN. I do not wish to be flippant but I have to say that I do not remember a time in the past 13 years when the RCN has said that morale is good. Nevertheless, I accept that, as Jackie Baillie pointed out, it is making a comparison with the situation two years ago; indeed, I was going to make the same point in my speech. In its briefing for this debate, the RCN says:
“a decision to close a hospital ward may be sound in the context of shifting more care to community settings. However, if the nursing posts from that ward are simply cut, rather than transferred to the community, the capacity to deliver increased preventative interventions is lost.”
We need more honesty and accuracy with regard to current and future workforce planning in the NHS.
10:08
In summing up, I will make three points, the first of which concerns—to use Murdo Fraser’s rather polite terminology—Labour’s opportunism. I recognise the importance of the issues that have been raised in the debate; indeed, I spend every day dealing with them. I say very directly to Hugh Henry that I know that staff have anxieties and concerns. In a time of change such as the one we are living through, that is only understandable and it is for me as health secretary and indeed for the Parliament to respond to such concerns. However, it is simply not good enough for Labour to come to the chamber simply to criticise and not offer any alternative.
The key moment in the debate was when Murdo Fraser asked Jackie Baillie the crucial question: how much more money would Labour spend on the NHS and where would it take that money from? Jackie Baillie blushed a wee bit at that moment, but she stayed firmly in her seat—“No answer” was the very loud reply. Jackie Baillie tried to clarify Labour’s position on NHS funding by saying that Labour would have passed on all the Barnett consequentials. If that is true, the most charitable thing that we can say about Labour’s position is that it would have spent exactly the same on the NHS as the SNP is spending and not a single penny more.
However, the reality is different. The positions of Jack McConnell in the 2007 to 2011 session of Parliament and Iain Gray in the current session show that, had Labour been in power during those years, the NHS budget would be smaller today. Labour members do not like the reality to be pointed out, but either Jack McConnell and Iain Gray were not being honest then, or Labour is not being honest now. They cannot have it both ways.
My second point is about the changing shape and size of the NHS workforce. Those changes are the reality, and I recognise the challenges that they pose and the anxieties that they cause. I laid out clearly in my opening remarks my responsibility in that respect, which I take incredibly seriously. Let us look at some facts. The fact is that more NHS staff are in post today than when Labour left office. I will give Jackie Baillie the precise numbers: between September 2006 and June 2011, the NHS workforce grew by 4,850 whole-time equivalent posts. That is more staff in every single professional group, with, I accept, the exception of nurses and midwives. The number of nurses and midwives has reduced by 0.2 per cent from the level that we inherited. Of course, that figure does not take account of the increased number of nurses working in primary care. If we add that in, the number of nurses has increased from the level that we inherited from Labour, as with every other professional group. In Scotland, we have more nurses per head of population than in any other part of the UK.
None of that means that it is easy out there. I know that it is not easy and that nurses and other members of the NHS workforce are finding this time of change tough. They are finding it incredibly tough to be faced with the prospect of increases in their pension contributions at a time of a wage freeze. I put on record the Government’s opposition to that cash grab on the pension schemes of NHS workers. I know that things are tough, but I have set out the reality of the NHS workforce, and it would do Labour good to recognise that reality.
My third and final point has already been made by other members, particularly Maureen Watt, Chic Brodie, Bob Doris and Stuart McMillan. What matters most about the NHS is what it delivers for patients, but that is the bit that Labour members do not want to talk about. The hard reality is that the NHS today is performing better than at any time in its entire history. Hanzala Malik made a good speech in which he recognised the quality of service in our NHS. Waiting times and infection rates are lower than they have ever been. Thanks to our world-leading quality strategy and patient safety programme, which is admired throughout the world, we have higher quality and safer care than ever before in the NHS. Jackie Baillie calls all that a crisis, but I call it a fantastic achievement on the part of the people who work in our national health service and, again, I thank them for that.
I have been where Jackie Baillie is, so I know what it is like—her job is to criticise from the sidelines. I understand that that is in the nature of opposition. However, my job is to preserve the progress that we have made on our national health service, to build on that progress and to do everything in my power to protect it. That is what I will do, because I am proud of our national health service and of every single member of staff who works in it.
10:15
I hope that we all agree that the debate is extremely important, even if it has been fractious. It centres on the fact that there is a denial of the reality of what is happening on the part of the SNP. It is not that Labour is saying that budgets are not tight—we know that budgets are tight—but let me add to the facts that have been read out so far. In 2007-08, the gap between expenditure on the health service in England and expenditure on the health service in Scotland was £216. In the coming year, it will be £26 and, in 2013, it will be a negative balance. That is the reality.
I simply want to ask Richard Simpson the question that Jackie Baillie did not answer when Murdo Fraser posed it: how much more money does Labour propose to spend on the NHS and where in the Scottish budget would that extra money come from?
That is the reality of the per capita spend.
Regardless of what we said or what the SNP purported to say, the reality is that, year on year, the cash increase in the SNP’s budgets in the times that were good was 2.4 per cent less than the increase in England. [Interruption.] You can shout from a sedentary position as often as you like, but the reality is that we had an advantage in health service spend, which you have taken away during the good years.
Richard Simpson did not answer my question. It is not good enough to come here and criticise. How much more would Labour spend and where would it take it from?
I am sorry; I am trying to make it clear—
Dr Simpson, could you speak through the chair, please?
Labour spent considerably more when it was in government in England and Labour would have spent more if it had been in government in Scotland, so we would not have been at the same starting point.
I say to the cabinet secretary that the issue is not the amounts of money that are spent. We know that budgets are tight; we also know—every speaker has said this—that in Scotland, unlike in England, productivity has been going up. The fact that our staff are doing a fantastic job is reflected in parts of the SNP amendment. I accept that things have improved—I am not saying that they have not—but that is down to the fact that staff are working extremely hard.
We are asking the SNP to join us in starting from a position of reality. The SNP’s complacency in saying that all the cuts are due to change is breathtaking. The reality is that, as of June 2011, the number of nurses, who are critical to front-line delivery, was lower than it was in 2006. [Interruption.] The figures from ISD Scotland show that the number of nurses is down. If ISD is wrong, the cabinet secretary should correct it, but she should not come to the chamber and tell us that the figures that she has published are not correct.
I read out the figures for the period between September 2006 and June 2011. Did Richard Simpson not hear me when I said that the nursing and midwifery workforce had reduced by 0.2 per cent, not taking account of the increase in the number of nurses working in primary care?
So the numbers are down. You said that the numbers would be up, but they are down.
As Hugh Henry and others said, the reality is that NHS staff are coming to our surgeries to tell us their concerns—perhaps it is because we are the Opposition that they have more to tell us than just complaints about car parking charges, which is what the SNP’s back benchers are getting. My postbag is increasingly full of worries and expressions of distress from staff. In the short time that remains, I will deal with some of those.
I will start with the position that we are trying to get to: everyone wants us to increase prevention. If we are to improve prevention, we need the number of specialist nurses to increase rather than decrease. The number of specialist nurses who deal with heart failure, whose work prevents readmissions, reduces costs and improves patient quality, has gone down since 2008. The number was 50.5 and it is down to 46. The cabinet secretary might say that that is a reduction of only four, but it is a reduction of 9 per cent. The cabinet secretary can play with figures all day, but the fact remains that, instead of increasing, the number of specialist nurses is decreasing.
There have been cuts of 20 per cent in speech and language therapy for adults with learning disabilities. Jim Eadie referred to that yesterday and that is a concern that we share. Argyll and Bute is planning cuts of 50 per cent in its speech and language budget, and there are other cuts. According to a report from the Royal College of Speech and Language Therapists, there is a reduction in service, a reduction in budgets and a reducing workforce. Is that not a reality? Are we being fed misinformation? Are we being told the wrong thing? I do not know.
The statistics are difficult. We know that the ISD statistics on speech and language do not count frozen posts, maternity leave or family-related leave. They do not reflect the changes in skill mix and they do not expose the long-standing gaps in provision, which go against national guidelines. We have a dearth of good statistics, but those that we have tell a clear story.
The Government’s response to Harry Burns’s concern about early years is interesting. The Government’s response is against the background of an increase from 54,000 to 58,000 in the number of births and of prenatal, antenatal and immediately postnatal stages being recognised as crucial to the development of children. It is against the background of increasing recognition of the problems of drug and alcohol misuse and of the recognition by midwives that they do far more child protection work than ever before. It is against the background that twin births are rising and that more older women are having children. Against that background, and with a static neonatal death rate, what has the Government done? It has cut the midwifery intake by 40 per cent.
I am sure that the cabinet secretary would say, if she got in, that the Royal College of Nursing agreed to that. To be frank, the RCN did not look at the wider picture. Since I raised the issue in a parliamentary question, midwives have been coming to me. I am getting a lot of mail saying, “We are in real difficulty.” All that we ask is that the Government recognises that.
There is a problem. Take the example of radiography, which is one area where there has been a substantial increase, where we have improved things and have improved the skill mix considerably. However, in my own area, NHS Forth Valley, only one radiographer is qualified to read plain films. What happens if she is off sick or goes on holiday? The responsibility goes back to the doctors, but are they not doing other things? Of course they are. They are doing other things, because the skill mix has changed.
We are not saying that things are not tight, that things are not difficult and that there are not problems, but we are saying two things. First, in the good years this Government spent less on health, as a proportion, than it received. The reality is that England, which was always behind us in per capita spend, will have a per capita spend greater than Scotland’s in 2013-14.
That must be down to the decisions of the SNP Government. No matter what the cabinet secretary says that Labour said or did not say, or would have done or could have done, the SNP is the Government, not us. The reality is that the cabinet secretary has eliminated the per capita spend difference, that there are 1,700 fewer nurses today than there were two years ago and that there are 230 fewer allied health professionals than there were two years ago. That is the reality that she must face up to. She is simply in denial and that should stop, now.