Health Strategy
The next item of business is a statement by Nicola Sturgeon on the Scottish Government's health strategy. The Deputy First Minister and Cabinet Secretary for Health and Wellbeing will take questions at the end of her statement, and there should be no interventions.
I am delighted to publish today our new action plan for health and well-being. "Better Health, Better Care" sets out a clear vision for the national health service in Scotland. It outlines the actions that we will take during this session to improve health, to tackle health inequalities and to enhance the quality of our health care services. "Better Health, Better Care" builds on the strong foundations of the NHS in Scotland. We will retain what is working well, but we are determined to add fresh impetus and new momentum to our efforts to improve health and to deliver health care that is truly patient centred.
Our action plan has at its heart a strong commitment to participation and involvement—to the participation of patients as partners in their own care and to the involvement of patients, the public and staff in the design and delivery of health care services in the future. The action plan has developed out of one of the most thorough and wide-reaching consultation processes ever seen in Scotland. More than 2,000 people took part in face-to-face discussions, and we received around 600 written responses. I am grateful that so many people and organisations took the time and trouble to give us their views, and I place on record today my thanks to all of them.
The consultation process demonstrated the passion of people in Scotland for the NHS. I brought to this job a firm belief that that passion should be viewed as a strength to be harnessed, as a powerful driver of change in the NHS, and not as an obstacle that NHS boards need to get round. My experience over the past few months has served only to reinforce that view—I have been impressed time and again by the commitment of patients, the public and staff to using their experiences to drive change and improvement in how services are delivered. I have also been left in no doubt that their voices must be heard and listened to even more.
Our action plan represents a new era for patient and public participation in our NHS, and it represents a step change in the power, influence and voice that the Scottish public will have in it. It recognises the public not just as consumers who have rights, but as owners of the NHS who have both rights and responsibilities. It represents a radical shift towards an NHS that is truly publicly owned.
The action plan sets out a clear vision of a mutual NHS, in which ownership and accountability are shared with the public and the staff who work in the NHS. That concept of mutuality does not mean a change in the financial or structural arrangements of NHS Scotland, but it does mean gathering the people of Scotland, the voluntary and community sectors, all our partner organisations and the staff of the national health service around the common purpose of building a healthier Scotland. That common purpose, which will be delivered through integrated care and co-operation, involves a genuinely collaborative approach to health care that builds on the founding values of the NHS but completely rejects the market-based model that is favoured elsewhere in the United Kingdom.
Over the next three years, we will take a number of steps towards a more mutual NHS in which patients, the public and staff are treated as partners in health and as co-owners of the national health service. We will launch a public consultation on the possible content of a patients' rights bill by May 2008. That will cover waiting time guarantees and the right of patients to be treated as partners in their own care.
We will produce proposals for independent scrutiny of major service change by April 2008, building on our experiences of the independent scrutiny panels that are already established and working well in Ayrshire and Arran NHS Board, Lanarkshire NHS Board and Greater Glasgow and Clyde NHS Board.
Following public consultation, we will by next summer introduce a local health care bill that will include proposals for direct elections to NHS boards. We will also develop a participation standard for all NHS boards to reflect the needs of our diverse population and we will by 2009 incorporate assessment against that standard into NHS Scotland's performance management system.
We will produce and distribute an annual ownership report to every household in Scotland. It will set out the rights and responsibilities of patients and their carers alongside information on how to access local services and raise issues or complaints.
The strategy is a step change. It will take time to fully embed that new mutual approach, but I believe that the steps that I am announcing today set us firmly on the right path.
I turn to the twin challenges of improving health and tackling health inequalities. Last month, the chief medical officer for Scotland published his annual report on the state of our nation's health. He accepted that our health is improving—it is—but that it is improving faster in the wealthiest sections of our society than it is in the poorest sections of our society. As a result, health inequalities are widening. This Government is clear that, in a country that is as rich as Scotland, those health inequalities are simply not acceptable, which is why we have made tackling health inequalities our top health priority.
The ministerial task force on health inequalities—led by Scotland's first-ever Minister for Public Health—will report to Cabinet by May 2008 on a range of cross-Government recommendations to tackle our most significant and widening health inequalities. The discussion around "Better Health, Better Care" has informed the work and the priorities of the task force and the action plan sets out some of the early measures that we will take to add real momentum to our shared national drive to improve the health of people who live in our most disadvantaged communities.
As I announced in Parliament last week, we will abolish prescription charges by April 2011 and, in so doing, remove a tax on ill health and a significant barrier to self-management of long-term conditions. We will develop new approaches to anticipatory care, building on the early success of the keep well programme, and we will introduce life begins health checks. We will roll out simple but effective interventions to promote good health in our acute hospitals and we will implement a systematic approach to assessing the impact of policies and strategies on health and health inequalities.
Crucially, we will ensure that the NHS uses its considerable influence as Scotland's largest employer to promote good health and to take the lead in getting people into work through innovative employment schemes that offer pre-employment training and first-destination work opportunities for people who are on benefits.
Of course, it is not the job of the NHS alone to improve health and tackle inequalities, but there is no doubt that it has a leading role to play. That is why the plan puts greater-than-ever emphasis on the unique contribution that the NHS can make, in working with its partners, to enable people to improve and sustain their health.
We recognise, of course, that health improvement requires a long-term effort. The full value of the work that we do now to support children might not become apparent until those children have become parents or grandparents. However, there is action that the NHS can take now to create the conditions in which people have the confidence, motivation and ability to make healthy choices. That is why we will invest an additional £3 million a year in new measures to prevent smoking and set a target for NHS boards to increase the number of people they support through smoking cessation services.
We will invest an additional £85 million over the next three years to tackle alcohol-related harm, with greater focus on changing behaviour through brief interventions delivered by general practitioners and other professionals in primary care. We will also invest a total of £94 million to allow NHS boards to increase drug treatment and rehabilitation services. We will invest an additional £11.5 million to tackle the rising tide of obesity in our country and set a new target for completion of programmes that support healthy weight management. In other words, we will focus the NHS on activity that has real and practical effects while leaving plenty of scope for boards and their highly professional staff to use their initiative and judgment to achieve the best outcomes.
We recognise that good health requires more than the absence of disease—it also requires good mental health. Scotland is rightly recognised internationally for some of its work around mental health legislation and services. However, we will do more to address stigma, prejudice and discrimination, particularly for people who have been diagnosed as suffering from psychosis. We will roll out the mental health first aid programme so that more key workers are mental health and well-being literate.
We will also do more to deliver better outcomes for people who suffer from depression by matching appropriate therapies to their specific needs. Although antidepressants will offer the most appropriate help for some people, for many more a range of other interventions will be more effective. That is why we will target NHS boards to reduce the annual increase in antidepressant prescribing to zero by 2009-10 and to reduce it by 10 per cent in the years thereafter.
We can make the biggest difference in the long term—and must do so—by giving our children the best possible start in life. Work that is emerging from around the world shows that the circumstances in which a child is brought into the world can have a major impact on physical and mental health. It is therefore critical that we give our children the best possible start by supporting good health choices and behaviours that will enable them to sustain good health throughout their lives. The key to that approach will be the development by autumn 2008 of a cross-Government early years strategy, which will provide the framework within which we will work with our partners to deliver effective early years support for children and young people.
The action plan also outlines a range of steps that we will take now to improve the life chances of our young people and to break the link between early-life adversity and adult disease. For example, we will focus intensive support on children who are identified as being particularly vulnerable; we will expect each NHS board to identify a lead maternity care professional to help mothers quit smoking and drinking during pregnancy; we will challenge boards to improve breastfeeding rates; we will extend entitlement to free school meals; we will increase nursing and other health care support in schools; and we will roll out a new schools-based preventive dental service and ensure that 80 per cent of all 3 to 5-year-olds are registered with a dentist by 2010-11.
We must make our health service better, more local and faster. First, let me acknowledge progress that has already been made. Waiting times are shorter and outcomes for patients are improving, so I pay tribute to the previous Administration for the part that it played in delivering that success. However, above all else, I want to pay tribute to everyone who works in our NHS because their hard work has delivered that success. We all owe them an enormous debt of gratitude.
The challenge now is to accelerate the pace of improvement on behalf of the patients and the public whom we serve. Better quality care has a number of dimensions: it must be patient centred, safe, effective, efficient, equitable, and timely. It must also be designed for the future as well as for the present. The challenges that we face—an ageing population, a rise in long-term conditions and growing inequalities—require us to further shift the balance of care towards community and anticipatory services that are effective. That means that we must develop primary care services that are more accessible and flexible.
During the consultation, we were told repeatedly by members of the public that improved access to primary care is important. The current contract for general practitioners defines their opening hours as being from 8 am to 6.30 pm, Monday to Friday. However, routine appointments are usually scheduled between 9 am and 5.30 pm, with very few GP practices offering early morning, evening or even lunch time appointments.
No-one expects GP services to be available 24 hours a day, seven days a week, but many patients—including those in some hard-to-reach groups—want to see, and would benefit from being able to see, a GP before or after work or at the weekend. That is why the Government will work with professional bodies, NHS boards and individual GP practices to provide a more accessible service that fits in with the lives of patients. That will involve more flexible access during existing contract hours as well as some extended-hours opening. We will use the framework of patient experience surveys to develop a robust evidence base that will support the drive towards improving access and patients' experience of care.
Another issue that is of concern to patients, certainly in some areas, is their inability to book appointments in advance, or with a GP or member of the primary care team of their choice. We will, therefore, work with the profession to secure guaranteed access within 48 hours to an appropriate member of the practice team, and to secure more flexible advance booking arrangements.
Of course, improving access to primary care should not be just about providing more of the same; we will develop innovative methods of accessing services, such as more effective use of telephone consultations and e-mail communication. We also intend to enhance the role of community pharmacies. Community pharmacies offer convenient access to primary care in high streets and other community settings. That is why, by March next year, we will establish pilot projects in five of our largest health board areas—Grampian, Greater Glasgow and Clyde, Lanarkshire, Lothian and Tayside—which will provide walk-in access to a range of primary care services via community pharmacies. Those pilots will be located at main commuter points, major shopping centres and inner-city areas. They will provide extended-hours walk-in access to a wide range of services, including nurse-led minor injury treatments, sexual health screening, simple diagnostic tests and some adult immunisations.
That ambitious package of improvements to our system of primary care—more flexible GP access, development of the keep well model of anticipatory care and easy walk-in access to a range of primary care services—will start to deliver the local and more preventive health service that we must develop for the future.
I now turn to the very important issue of patient safety. First, I assure the public that NHS Scotland is safe by any international standards. However, there is no room for complacency—as the report that NHS Quality Improvement Scotland published today reminds us. I want NHS Scotland to be a world leader in patient safety. The Scottish patient safety alliance has been established to achieve significant measurable improvements in patient outcomes through the implementation of specific evidence-based interventions. That work will ensure that robust quality improvement methodologies are implemented, and that we embed a culture of patient safety in all our NHS hospitals.
Of course, one of the key aspects of patient safety is our work to tackle hospital-acquired infections. The prevalence of infections in our hospitals and, indeed, in other health care settings is understandably a matter of considerable public concern and anxiety. That is why the Government will introduce a range of new measures to tackle health care associated infection and why we will invest more than £50 million to support their implementation through the HAI taskforce. Those measures will include the introduction of a national MRSA screening programme, tougher hospital cleaning standards and a more rigorous approach to hand hygiene.
I turn now to timeliness. The benefits of national waiting times for patients are very clear: earlier diagnosis leads to better outcomes, there is less unnecessary worry and upheaval and, of course, there is less postcode variation. Shorter waits benefit the NHS as well, because they reduce the need to manage complex queues and backlogs for treatment. That is why, by 2011, the Government will deliver a maximum wait of 18 weeks from GP referral to treatment. That target differs from previous waiting time targets because it does not focus on a single stage of care, but will instead apply to the whole patient journey. Achieving that ambitious target will demand new ways of working in the NHS. That is why, by spring 2008, we will publish a national framework for delivery of the 18-week target and why we will support its implementation with £270 million of new resources in the next three years. That commitment represents the biggest step change in waiting times in the history of NHS Scotland. It is no exaggeration to say that it will transform patients' experience.
I have been able to touch on just a few of the areas that are covered in "Better Health, Better Care". Its publication today will be followed by detailed guidance on implementation for the service and those who work in it.
Finally, I will touch on a central and important issue, which is how the Government will hold NHS boards to account, and how Parliament will hold me and the Government to account for delivery of our ambitious programme. "Better Health, Better Care" sets out new annual performance targets and measures for NHS boards in Scotland. It describes a framework that identifies and drives NHS Scotland's contribution to the Scottish Government's overall strategic objectives. It also links closely with the new accountability and performance arrangements that will apply to local government, and demonstrates a clear alignment between short-term operational targets and our longer-term direction of travel.
The new performance framework represents a better balance than we have had before in relation to the impact that the NHS can have on the health of the people of Scotland. It places much more emphasis on health improvement, mental health, efficiency and anticipatory care, and it reduces correspondingly the number of targets around waiting times. For the first time, it also includes targets on the unique contribution that NHS boards will make to our overall approach to health improvement; targets on our manifesto commitment to make dementia a national priority and achieve agreed improvements in early diagnosis and management of patients with dementia; targets on reduction of hospital admissions for patients with a primary diagnosis of chronic obstructive pulmonary disease, asthma, diabetes or coronary heart disease; and targets on delivery of clear milestones towards the 18-week whole journey waiting time.
In the next few months, all NHS boards will be expected to produce local delivery plans that show how they will meet, or make progress towards, those targets in the next year. Boards will track their progress against the plans and take action where necessary to bring performance back into line. The health directorates will manage boards' performance to ensure that planned levels of achievement are delivered. The performance management approach provides a sound basis for outcome agreements that are established jointly with other service delivery partners. It will also provide the basis on which I will report NHS Scotland's progress to the public and be held to account by Parliament.
The action plan is published at a significant time. As I have said before in the chamber, the NHS will celebrate its 60th birthday next year. That will be an occasion on which to reflect on what the NHS has achieved—it has achieved so much—and to ask questions about its future direction. With the action plan, we show how the NHS in Scotland will answer those questions. We have set out a plan for a national health service that is based on the values of collaboration and co-operation—not on the whims of the market. We affirm a unified structure in which decisions are made in the interests of the people whom we serve and not to meet the demands of internal competition. We describe a public service that is used by the public, paid for by the public and owned by the public.
"Better Health, Better Care" sets out a vision for a national health service that is true to its founding principles but which also has the confidence to extend those principles through a commitment to involving the public, patients and staff in shaping its future direction. It delivers a national health service for the Scottish nation—a truly Scottish health service. I hope that our action plan will have the whole-hearted support of all members.
I thank the minister for an advance copy of her statement.
I have one note of significant disappointment—although there are perhaps a few others—that ministers have yet again made a statement rather than introduce a debate. It is curious that in the past few weeks we have had three debates on European Union reform and not one on health. I hope that that does not indicate the significance of health to this Government's agenda.
The minister will be aware of widespread concerns that the Scottish National Party is not maintaining the high levels of spending on health that Labour had when we were in power and that it is not maintaining the drive to tackle health inequalities in Scotland. She must be aware that many question whether the SNP has struck the right balance between universal and targeted services. That was reinforced recently by the First Minister telling us that a report on poverty will be issued, I think, next month. That report has clearly not been used to inform the action plan or the budget. Put together with the fact that there are no inequality targets in the national reporting framework that was published with the budget, that raises serious questions about the Government's determination to tackle health inequality.
Given the scale of the concerns, will the minister bring forward in Parliament an early debate on the action plan that affords MSPs an opportunity for wider debate and more detailed examination? She must know the importance of health to the people of Scotland. Given their views, it is vital that the Parliament has that debate. When are the life begins health checks due to be implemented, and are they to be funded out of existing allocations? When will the SNP manifesto commitment to double the number of school nurses be implemented, and how will it be funded? Finally, will she produce targets to tackle health inequality in Scotland, as we had before?
I thank—or at least I think that I should thank—Margaret Curran for those questions. It is slightly depressing that although I have just published a wide-ranging programme to improve health, tackle health inequalities and enhance the quality of health care across Scotland, she can only complain about the format of the announcement. That shows a dreadful lack of vision.
Let me draw Margaret Curran's attention to and encourage her to read the Official Report of a debate on free personal care that I led in June this year. My colleague Shona Robison and I were roundly criticised by Andy Kerr and Lewis Macdonald for making announcements in the form of a debate rather than a statement. They said that it was only courteous to the Opposition that, when documents were published and announcements made, that was done in the form of a statement. I respectfully say to the Opposition that it really should make up its mind.
I will move on to some of Margaret Curran's other points. She talked about the level of health service funding. I am sure that I do not have to do this, but I remind members that we have received the tightest funding settlement since devolution from Her Majesty's Treasury. However, in the context of an overall budget increase next year of 0.5 per cent, the increase in the health budget is 4.1 per cent. That is a sign of the Government's commitment to improving health and health care in our country.
On tackling inequalities, I gently suggest to Margaret Curran that the next time that we turn up in the chamber—whether it is for a statement or a debate—she listens to what is said. I have just made a 25-minute statement, the vast bulk of which concentrated and was focused on the need for the Government to do more than the previous Government did to tackle the widening health inequalities in our country. I set out a range of actions that the Government will take in the next few years to tackle poverty and reduce the gap between the richest and the poorest in our society—something that our predecessors signally failed to do in eight long years in government.
I tell Margaret Curran that one sign of our commitment is that we recognise that although the health portfolio plays a leading role, tackling poverty and inequality is the responsibility of everyone in government and all my Cabinet colleagues see that as a priority.
I will briefly deal with other points that Margaret Curran made. We are progressing our commitment to introduce life begins checks, which we want to do by building on the keep well programme's success. In the spirit of consensus and constructive debate, I pay tribute to the previous Administration for introducing the keep well programme. We are determined to increase nursing and other health care support in our schools, where we can contribute significantly to tackling the problems that our youngest children face, which have an impact on their health later in life.
We intend to deliver all our manifesto commitments over the Parliament's four-year session. When we do so, that will deliver significant benefits for all the people of Scotland.
I, too, thank the cabinet secretary for the advance copies of her statement and the action plan. I put it on the record that the Scottish Conservatives acknowledge and appreciate the continuing commitment of all NHS staff.
We welcome much in the statement but, as we have had only an hour to read it and the action plan, we will need more time to read it more thoroughly. We welcome the reintroduction of the patients charter, which the Conservatives introduced in 1991, when it was not roundly accepted by every other political party in Scotland. I trust that the cabinet secretary will build on the excellent practice that the Conservatives set out in the patients charter all those years ago.
I welcome the increased role for community pharmacists and the identification of lead maternity care professionals.
Any measures to tackle MRSA and reduce hospital stays are welcome, but we would like more information on the evidence base for the MRSA proposal.
We welcome the additional spending on alcohol and drug treatments, but we are concerned about the evidence base on what works and is most effective. How will the cabinet secretary allocate funding to ensure value for money, achieve the best outcomes and—an issue that I have raised many times before—tackle any underlying mental health condition at the same time?
The additional funds to tackle obesity are welcome but, given the patchy service throughout Scotland and the fact that the Scottish intercollegiate guidelines network guideline on obesity is largely ignored, how will the considerable need that exists be met, and how will a consistent service be rolled out throughout Scotland?
I am concerned that two forms of local authority funding for mental health services have been abolished and that we will not know the local authority outcome agreements for mental health spending and outcomes until January. Will the cabinet secretary give a commitment that a driver or incentive will ensure that the money follows the patient for mental health services?
The cabinet secretary did not mention the importance of early intervention. In many cases, treating people for mild depression means that the condition does not become severe, chronic and enduring. Will she make a commitment on early intervention?
I thank Mary Scanlon for her questions and for asking them positively. I accept that all members will want more time to read the action plan—on recent evidence, some members certainly need more time to read it.
I meant to say something in response to Margaret Curran's questions, which I am happy to say now. I would be more than happy to have a debate on the action plan, because it sets out a positive vision for the future of health and health care in Scotland.
Mary Scanlon is right to point to our proposal to devise a charter of mutual rights, but I am not sure that she is right to draw an analogy with the Tories' patients charter. I will say what the difference is. I think that the Tories introduced a patients charter at the same time as they were cutting health service funding and eroding the principles on which our health service is based. The charter of mutual rights is meant to enhance and build on those values. It will be set against the Government's on-going commitment to proper funding of the health service and ensuring that health service funds are properly targeted.
Mary Scanlon is also right to point out the importance of the proposals that I announced on community pharmacies and lead maternity care professionals and on the range of measures to tackle hospital infections. I think that she asked about the evidence base for MRSA screening. I point her in the direction of the NHS QIS report on that. I am sure that she will find that report interesting.
Mary Scanlon also raised a range of issues relating to drugs and alcohol, as she has consistently done, and she is right to point to the need for a strong evidence base in that respect. Indeed, there was a substantive discussion about that at a Health and Sport Committee meeting that John Swinney, Kenny MacAskill and I attended a couple of weeks ago. We are committed to ensuring that we grow the evidence base on what works and what does not work. However, I am sure that she agrees that there is already a strong evidence base in respect of brief interventions to tackle alcohol misuse that suggests that such interventions work. That is why we have put so much emphasis on them in the action plan.
We will publish our action plan to tackle obesity next year. We must ensure consistency. It is important that attention is paid to SIGN guidelines on obesity and on other matters. We need consistent weight management strategies throughout Scotland, and our action plan intends to deliver them.
I appreciate the concern about mental health services. There are few more important aspects of the Government's health strategy than mental health services. I do not want to be confrontational towards Mary Scanlon; I simply want to be factual when I say that no mental health funding has been abolished. It is important, and it is in the interests of service users throughout Scotland, not to perpetuate the myth that mental health funding has been abolished. Funding has been rolled into the local government funding, and the NHS and local government will be jointly accountable for delivering quality mental health services in the future.
Finally, I point Mary Scanlon and other members towards the health improvement, efficiency, access and treatment—HEAT—targets at the back of "Better Health, Better Care". Out of 30 HEAT targets that cover the whole range of issues that we are discussing, we have, for the first time, four specific HEAT targets that relate to improving mental health services. We will ensure that NHS boards and, through joint working, local government are held to account by using those targets. That is, of course, an extremely important matter.
I, too, thank the cabinet secretary for the advance copy of her statement and action plan. Like others who received them, I thought that the 3,328 words of the statement and the action plan's 78 pages made interesting reading over the extended luncheon interval.
Like other members, we need time to study the cabinet secretary's important statement and to reflect on the fact that although there is much in it that the Liberal Democrats could welcome, there are a number of areas about which we are not clear. I welcome what I take to be a commitment from the cabinet secretary to offer Government time for a debate on this important subject. That would be appropriate.
Early in her statement, the cabinet secretary referred to increasing patient participation, which the Liberal Democrats would certainly welcome. However, I think that she is aware that these are difficult issues, even without a great bureaucracy behind them. She referred to a number of stages and steps to increase patient participation. Will she clarify whether there will be a range of additional consultations on patient participation or whether she may be able to wrap things up into a more simplified form so that we can tackle the problem?
I want to press the cabinet secretary on the ministerial task force on health inequalities. What she said about that is to be welcomed, but I see that there is also a cross-Government early years strategy. There is clearly crossover between elements of that strategy and the task force on health inequalities. There are similarities between the two and similar problems to be addressed. How will she ensure that, by establishing two separate groups, she does not separate those problems?
I agree that on mental health nothing has been abolished, but although the cabinet secretary has made it clear that the issue is a priority, spending on it in the part of the budget that is not devolved to local government is fairly flat lined. It is difficult to see how the issue will be prioritised if it does not receive improved funding.
The statement that the Government is
"to further shift the balance of care"
is important, leaving aside the infelicity of the split infinitive. Improvements in the funding of primary health care are to be welcomed, but it is not clear from the statement what the shift in the balance will be. Equally, it is not clear from the budget what significant shift in resources would give weight to that rhetoric.
We welcome the improved contribution of community pharmacies, but can the cabinet secretary confirm that her statement today goes beyond what has been signed up to in the new community pharmacy contract?
Finally, in your closing remarks you made much of performance management accountability, and it is vital that the Parliament is able to hold you and health boards to account. The Liberal Democrats and I welcome the shift from input to outcome measurement. However, in your statement—unless I misheard you—and in other documents, you talk about annual targets. Until now, a large number of input measurements, imperfect though they may be, have been made much more regularly than on an annual basis. I would welcome confirmation that the Parliament will be able to hold you to account not only several months after a year has ended, but much more regularly.
Before I call the cabinet secretary to reply, I remind members that they may refer to her in many ways—as "cabinet secretary", as "minister" or as "Nicola Sturgeon"—but not as "you".
That is better than how members sometimes refer to me outside the chamber—at least, it is better than how Margaret Curran sometimes refers to me.
Ross Finnie raises a number of important issues. I am glad that he was able to read the statement at lunch time, but counting the number of words in it was perhaps a step too far—he might have been better having lunch instead.
Ross Finnie made some points about participation. I am glad that the Liberal Democrats agree that it is important further to involve not just the public and patients, but NHS staff, in the way in which the health service is delivered. Rightly, Ross Finnie expressed concern that we should not have too many separate consultations. The other side of that argument is that we must ensure that the arguments relating to issues such as patients' rights—some of which have been made by Ross Finnie—are properly explored.
We will undertake three main consultations over the next few months. One—the consultation on embedding independent scrutiny in all future proposals for major service change—is already under way. Next year we will launch a consultation on the possible contents of a patients' rights bill. I know that Ross Finnie, in particular, will take a close interest in that. The third consultation will be on a local health care bill, which will be published very early in the new year. That will look at how we can enhance the existing arrangements for public and patient participation and will cover our proposal for direct elections to health boards, which raises a number of complex issues to do with governance, accountability and relationships with existing non-executive board members. It is important that those issues are properly and adequately explored.
The relationship of the ministerial task force on health inequalities with the early years strategy is an important issue. The task force is already up and running, is well into its programme of work and will report to Cabinet next year. There is close alignment between its work and work on developing the early years strategy—the two are feeding into each other. Adam Ingram, the minister in charge of the early years strategy, is a member of the ministerial task force, so there is deliberate integration of the two, which is important.
I dealt substantially with the issue of mental health in my answer to Mary Scanlon's question, but I stress again that we are concentrating more on outcomes than on inputs. No funding has been abolished—we are simply changing the arrangements for funding local authorities. We are increasing accountability through the increased number of targets, which will ensure that we can be held to account on the delivery of those important objectives.
On Ross Finnie's point about the need to further shift the balance of care—the split infinitive is, I think, the responsibility of Professor David Kerr who wrote the report in which the phrase was first coined—he is right that the concept must be about more than rhetoric and must have some substance. When he has time to read the action plan in more detail, he will see that much of the substance is in measures to keep people out of hospital by, for example, ensuring support through good-quality community services and providing more local community-based diagnostic services, which will be critical for delivering our 18-week waiting time target. I agree that we need to ensure that budgets follow the aspiration of shifting the balance of care. He will note that the action plan's section on community health partnerships talks about the need to devolve more resources to those partnerships to allow them to give reality to that concept. I hope that he will find a lot to assure him when he reads the action plan.
Ross Finnie's final question was about targets. I certainly take his point, as I believe that it is right and proper that the Parliament can hold the Government to account, and that the Government can hold the health service to account, not just annually but more regularly. I will certainly reflect on that.
However, previous practice is not quite as Ross Finnie remembers it. Many of the previous Administration's targets for the health service fell to be met at the end of December this year, which is some seven months after the election at which that Administration was voted out of office. I can assure him that I will ensure that I am subject to parliamentary scrutiny that is much more regular and meaningful than that.
A large number of members have pressed their request-to-speak buttons, so questions should be brief and focused. I call Christine Grahame.
I do not know why that is always said just before I get up to ask a question, but there we are.
Quite rightly, the cabinet secretary stressed the commitment to break the link between early-life adversity and adult disease and she referred to the cross-Government early years strategy. The Health and Sport Committee heard evidence that between 70,000 and 100,000 children in Scotland live in households with substantial alcohol and drug problems. In Glasgow alone, 40,000 children have been identified as at risk, but only 20,000 have any form of support. How will the Cabinet address the difficulties in identifying the tens of thousands of children in need of intervention? Further, once those children are identified, how will resources be made available to meet their needs?
I thank Christine Grahame for asking perhaps the most important question that could be asked about the action plan. She will recall that when the Cabinet Secretary for Justice, the Cabinet Secretary for Finance and Sustainable Growth and I attended her committee a couple of weeks ago, we spent a great deal of time talking about that issue. There was a shared acknowledgement that it is perhaps one of the most difficult issues to crack. Far too many children in Scotland live with drug and alcohol-addicted parents—we do not even know about many of them. That is why a large part of any strategy to tackle the issue must consider how such situations are identified as well as how they are dealt with subsequently. I can assure her that a big focus of the early years strategy and of the health inequalities task force will be on that issue.
I said in my statement that we want to take action now to try to ensure that there is more intensive support for the children who are already identified as being the most vulnerable. Those will not exclusively be children who are living with drug and alcohol-addicted parents, but I suspect that a large proportion of them will fall into that category. We are determined to do what we can. I hope that the Parliament will unite on the need to give those children far more support than they have had to date. I point Christine Grahame to the early years strategy and assure her that the issue that she has raised is a big—if not the main—focus of that work.
The cabinet secretary has focused on making waiting times shorter for people to get into hospitals, but I have evidence of a sudden increase in patient waiting times for getting out of hospital. It is almost as if a ball and chain has been thrown round some people's legs. Delayed discharge was one of the Labour Party's success stories, because we reduced the number of patients in Scotland who were waiting to get out of hospital from more than 3,000 to just a few hundred.
What steps has the cabinet secretary taken to tackle the issue? As a result of the situation, some of the most exquisite homes that have ever been built for disabled people have lain empty for six months or more, even though professionals have declared that people could have those care packages. Moreover, a young baby who has already been kept in hospital for five months will have to wait there for two more years because suitable community care facilities are not available. Given that the number of blocked beds in Fife has risen from 90 to 146 and that the trend across Scotland is up, I hope that the cabinet secretary will address this major issue.
I assure the member that this Government gives absolute priority to tackling delayed discharges. Indeed, we have spent a long time discussing the topic in the annual reviews that I have chaired throughout the country over the past few months. The fact that we are on target to meet all the delayed discharge targets by April next year is a credit not only to NHS boards but to local authority partners.
The member asked me specifically about Fife. There are particular issues to deal with in that area—and I will tell her why. The previous Labour administration in Fife overspent its budget by £600,000.
Absolute nonsense.
Order.
That administration then set a budget to bring the overspend down to nil. That is the reality of what the new administration in Fife inherited—[Interruption.]
Order.
I know that the member might not like hearing the truth, but she might do well to listen. That is the reality of what the new administration inherited, and it is now dealing with the situation. NHS Fife and Fife Council are working closely and productively together to tackle the issues, and I have every confidence that they will do so in a way that the previous administration at Fife Council failed to.
It is clear from the cabinet secretary's speech that the Scottish Government is looking for an NHS that is responsive to people's needs and available at the point of need. I advise her not to listen to the moaning and girning from members on the Labour benches, who in their time in office allowed health inequalities to increase. [Interruption.]
Order.
What I would like to say—if I am allowed to—is that, as a former GP, I am interested in and agree entirely with the cabinet secretary's proposal to extend GPs' hours and make them more available for consultation. What discussions has she had with GP organisations and patients on that proposal, and what response has she received?
I thank Ian McKee for those questions. I would have to come into the chamber wearing earmuffs in order not to hear the moans and groans of the Labour Opposition members. However, I suppose that these days they have a lot to moan and groan about, none of which has anything to do with the Government.
On Ian McKee's serious point about GPs and primary care access, we want an NHS that is responsible, available at the point of need and flexible enough to reflect the lifestyles of people throughout Scotland. Through the British Medical Association, I have had very good discussions with GPs on the issues, and they understand the Government's reasons for progressing the agenda. I have also received a range of submissions from patients and members of the public, who are overwhelmingly enthusiastic about having more flexible access to GPs.
That said, the same people are also keen to tell us that the GP service in this country is extremely valued. GPs do fantastic work, particularly in our most deprived areas, and I put on record both my thanks to them and the enormous value that I place on their work. With the Government working with GPs and the wider health service, we can further improve the service not only by targeting it on deprivation and disadvantage but by making it more flexible and open to those who need such flexibility and openness. If—as we will—we implement the measures that I have announced today, we will have a primary care service that is genuinely able to meet the challenges that we will all face over the next few years.
The cabinet secretary's 25-minute statement to Parliament contained little more than we already knew, apart from new words for the principle—already accepted by health care professionals—of working in partnership with patients, health service providers and voluntary and local authorities to improve our health.
It is a disgrace that it is almost six months since we have had the opportunity to debate health issues. I have a lot to moan and groan about, as do my constituents in Kilsyth, who face a delay in the provision of health care facilities in their area. I have not had the opportunity to debate that in the Parliament, because the minister's Government has not initiated a debate.
There should be a question, Ms Craigie.
When will the Government initiate a debate on health?
The SNP supported Bill Butler's member's bill on direct elections to NHS boards in the previous parliamentary session. Will the cabinet secretary lift the principles from Bill's bill to avoid delays? How much of her budget will the cabinet secretary put towards primary health care facilities? Will she give the independent scrutiny panel in Lanarkshire, Ayrshire and Arran—which she held up as an example—more time to scrutinise and do the job that it is intended to do? It has been so much involved with—
The member has spoken for long enough. Minister, will you answer, please?
Cathie Craigie is absolutely right that my party supported Bill Butler's bill on direct elections. Unfortunately, her party did not, which is why the bill fell. However, she heard me say today that, next year, after public consultation, we will introduce a local health care bill that will include proposals for direct elections to health boards. I look forward to having her whole-hearted support for that bill when it is published.
Her colleague Jackie Baillie warmly welcomed the independent scrutiny panels in the Parliament only last week. The panel that is working in Lanarkshire, Ayrshire and Arran is scrutinising proposals as we speak, and most people think that it is doing an extremely good job.
On the length of my statement, perhaps we can get to the heart of the matter. The Opposition spokesperson said that she did not have enough time to digest it and Cathie Craigie said that it was too long. They should compare notes before they come to the Parliament and start asking me questions.
Cathie Craigie seemed to suggest that, after six months, this Government had not done enough on health.
No, you haven't.
Let me give her a few highlights of what we have done on health since the election in May.
You haven't done enough.
Order.
We have saved the accident and emergency units in Monklands and Ayr and invested an extra £23 million in primary care premises. We have outlined plans to abolish prescription charges, which Cathie Craigie's party failed to do. We have set out a timescale for meeting a radical new waiting times target. We have laid regulations to extend the Emergency Workers (Scotland) Act 2005 and give health care workers more protection. Those are a few highlights of the enormous progress that this Government has already made, and we have only just got started.
I have a short question. I welcome the cabinet secretary's support for the provision of services through community pharmacies. As she is focusing on areas of deprivation and poor access, will she consider using the pilot projects to increase the capacity of and services offered by pharmacies in smaller towns and rural areas, where access to GPs is often limited?
I thank Aileen Campbell for an extremely sensible and important question that gets to the heart of some of the issues that we are debating. This is a debate about how we boost primary care, shift the balance of care and design a health service that is fit for the future. At last, somebody is asking questions about that, rather than trying to score pathetic political points.
The pilot projects about which I spoke in my statement will target areas of deprivation. Community pharmacy has a fantastic role to play in boosting and developing primary care by providing a much wider range of primary care services much more easily and conveniently. We will evaluate the pilots—which will all be up and running by March—and we are keen and determined to spread the model across the country, to ensure that the broadest possible range of primary care services is available via community pharmacies, which will not replace but complement current primary care services.
There is a lot in the strategy with which it would be difficult to disagree. The disappointment that I express, as someone who has pursued the health inequalities agenda for some time, is that we will have to wait until May 2008 to hear what will be done to reduce the health inequalities gap, which is completely different from tackling health inequalities in general. I hope that, at that stage, we will bear in mind the words of the chief medical officer for Scotland, who said that access to health services can reduce that gap.
Does the cabinet secretary have any concerns that, in the absence of clarity about the future of the minor ailments scheme or the extension of GP services, the move to abolish prescription charges may have an undesirable outcome for the poor in our deprived areas, who, it is conceded, already receive less time with their GP, are less likely to be referred to a consultant and are less likely to survive their condition?
I remind Duncan McNeil that, over the next three years, this Government will invest an additional £350 million in tackling inequalities and improving health. For the avoidance of doubt, I make it clear to Labour members that tackling inequalities means narrowing the gap between the richest and the poorest in our society.
Duncan McNeil expresses concern that we will not publish an action plan to reduce health inequalities until May 2008. By May 2008, this Government will have been in office for one year. Given that the previous Government failed to publish clear action on the issue in eight long years in office, I think that our progress is to be commended.
I confirm to Duncan McNeil that I will take everything that the chief medical officer said in his report very seriously indeed. It was an excellent report that should focus all our minds on what we must do in the future.
For the benefit of all members, I confirm that the abolition of prescription charges will not alter eligibility for the minor ailments scheme, which will continue to be available to everyone who is currently eligible for it. Duncan McNeil will want to take that point outside the chamber, so that he spreads facts rather than anything else. [Interruption.]
Order.
On access to GPs and whether free prescriptions will increase demand for GP services, we had lengthy discussions about that last week, when I told the Parliament that I expected free prescriptions to increase demand for GP services to some extent. Given that we have evidence that, at the moment, people do not go to their GPs out of fear of the prescription charge, greater access to GPs is an intended outcome of the policy. Many of our other policies are about ensuring that people get more meaningful and longer access to GPs. For example, the keep well programme is about ensuring that people spend more time with GPs, as are the life begins checks.
On all those issues, this Government is acting much more quickly and effectively than the previous Government ever did, and I am sure that people around Scotland will warmly welcome that.
In the spirit of the season, I congratulate the cabinet secretary and her deputy not just on their statement today, but on the manner in which they have discharged their duties and on the substance of what they have done since May. In particular, Nicola Sturgeon should be congratulated on the introduction of the independent scrutiny panel process, given the valuable work that has already been done in respect of Ayr, Monklands and the Vale of Leven hospitals. I am intrigued by her announcement that she intends to build on the work of the independent scrutiny process. Will she give a hint about the possible scope and breadth of such panels?
Does the cabinet secretary agree that direct elections to health boards should be conducted on a non-party-political basis? It would be a tragedy if board proceedings degenerated into partisan squabbles, as some of this afternoon's exchanges have. How does she intend to ensure that, once they have been elected, lay members will have the courage and confidence not to feel intimidated by the opinions of professionals and to be suitably and independently informed when key decisions must be taken?
In respect of general health, does she agree that a more proactive approach needs to be taken on the detection by screening and the treatment of prostate cancer, which is a major and potentially preventable killer? Does she share my disappointment at the Westminster Government's recent decision not to consider a screening programme? Will she agree to undertake a proper review of such a scheme in Scotland, given that screening programmes have saved the lives of thousands of men worldwide, not just through the screening that they do, but by helping to make men much more self-aware of that aspect of their health?
Order.
I think that Jim Tolson was being a bit premature—but you never know.
I thank Jackson Carlaw for his constructive questions. After his first few remarks, I was expecting a "but", so I am glad that there was not one. He raised a number of issues. He might be aware that we have published the consultation paper on options for embedding independent scrutiny in all future major service change proposals. We can learn much from the experience of the current independent scrutiny panels. When the panels have concluded their work, their chairs and members will want to give us their views on how we can improve the process.
The consultation paper proposes three options: scrutiny through a decision conference; scrutiny through an independent body such as a local authority; and scrutiny through an expert panel. The latter is closest to the approach that currently operates, and is the Government's preferred option, but we want to ensure that we get the detail right, which is why the experience of the Lanarkshire, Ayr and Arran and Greater Glasgow and Clyde scrutiny panels will be so important.
Jackson Carlaw raised important issues about elections, which must be properly debated and explored during the consultation. The principle of elections to health boards is sound, but it is clear that fundamental issues come into play, which are about the people who would stand and be elected, whether there should be a political element—I share some of the member's concerns about the prospect—the impact of elections on health boards' governance and accountability to ministers, and the need to ensure that elected members are properly equipped and informed to discharge their functions when they are working with board members who have expert knowledge. I will not give definitive answers to all those points today—that would be wrong, because we want to explore such issues through the consultation. I look forward to hearing the views of all members, including Jackson Carlaw.
On Jackson Carlaw's serious point about prostate cancer, early diagnosis and access to treatment is fundamental, as with all cancers. We will always follow expert advice on screening, as members witnessed in the context of cervical cancer screening. Such decisions are not political decisions and are best guided by experts. I am more than happy to discuss the member's concerns with him, to try to reassure him further.
I apologise to the cabinet secretary for my interruption. I was struggling to get over the new love match between her and Jackson Carlaw.
The cabinet secretary said that she would produce and distribute to every household in Scotland an annual ownership report. Can she tell the Parliament how much that will cost? If the cost is anything like the £2 million or so that I estimate it to be, it will be the equivalent of approximately 100 nurses per year. Does the cabinet secretary agree that the people whom we serve would much rather have 100 more nurses per year than a booklet that gives information that is accessible in other ways?
Under this Government, people stand a chance of getting both—a well-staffed NHS and information that tells them how to access it.
The obvious answer to Jim Tolson is that the cost will depend on the format that we choose for the ownership report. However, I am sure that Jim Tolson, who is a constituency member, is aware that many health boards publish and distribute to every household in their area newspapers or bulletins. The development perhaps gives us an opportunity to standardise information and ensure that we disperse quality information that is useful to patients.
The development is potentially important, particularly as we move towards having a more mutual NHS, with more sophisticated patients' rights and responsibilities. It is right not just that patients understand their responsibilities, but that they have much more readily accessible information on how to access different parts of the health service. One of the most frequent comments that I hear as I travel around the country is that people do not know about the services that are available to them and how to access them. The strategy gives an important opportunity to address that. I am happy to undertake to keep Jim Tolson informed on the matter, as we further develop our proposals.
I congratulate the Cabinet Secretary for Health and Wellbeing on her statement. Those who founded the NHS 60 years ago would be proud of its content. In particular, they would be proud that, after eight years, we have, at last, a serious strategy for dealing with health inequality in Scotland.
My question is on tackling health inequality and the transition from the Arbuthnott formula to the new NHS Scotland resource allocation committee funding regime, which we expect will come into being in 2009. I seek an assurance that boards such as NHS Lanarkshire will not lose moneys in the transition from Arbuthnott to NRAC.
I will deal first with the generality of Alex Neil's question before turning to the specifics of the point on NHS Lanarkshire.
On a day like today, I am certain that great politicians such as Nye Bevan would look on this SNP Administration with considerable approval.
He was never a nationalist.
Order.
I am not sure why, but Labour members seem not to like the reference to Nye Bevan. I am certain that Nye Bevan would thoroughly approve of this SNP Government.
He was not a nationalist.
Another Labour member has shouted from a sedentary position that Nye Bevan was "not a nationalist". I concede that that is probably the case, but I am certain that, right now, he would be thinking that Labour Opposition members are no socialists.
As Alex Neil is aware, the NRAC report was submitted to me only a couple of months ago. It proposes certain refinements and adjustments to the Arbuthnott formula to better take account of issues such as rurality and deprivation. I asked the Health and Sport Committee for its view on the recommendations, which it has given. I am grateful for its work on such a technical report. I also asked all NHS boards to give me their views, which most of them have done. I am considering those views and my response to the recommendations. I will make further announcements in due course.
I repeat the important assurance that, whatever we decide to do with the NRAC recommendations, no health board will receive less funding than is the case at present. Any introduction of the new NRAC allocations will be phased to ensure that no health board loses out in the process. I appreciate that that is not much comfort for boards such as NHS Lanarkshire, whose gripe—if I can call it that—is not that it might lose money but that it should get more. I acknowledge the issue. I will take careful account of such factors in deciding whether to implement NRAC. If we agree to do so, I will also decide how to ensure that the aim of Arbuthnott and NRAC is brought about—we want to distribute resources between NHS boards fairly.
During the May election campaign, the SNP gave a commitment to my constituents and people elsewhere in West Lothian that, if elected to government, it would return trauma orthopaedics and acute surgery services to St John's hospital in Livingstone from Edinburgh royal infirmary. Will the cabinet secretary confirm how often she has met the chairperson or medical director of Lothian NHS Board to progress the return of those services to St John's and whether she can give a date for the return of those services? If no date has been set, will she confirm that the return of those services to St John's is an objective in Lothian NHS Board's medium and long-term plans?
Perhaps I should ask for clarity. When Mary Mulligan asks about the return of trauma orthopaedic services to St John's hospital, I should check that she is talking about the same trauma orthopaedic services that her Government removed from St John's.
I have met the chair and the medical director of NHS Lothian on several occasions to discuss a number of issues, including that of what NHS Lothian will do to secure the future of St John's as an acute emergency hospital. I have also met a range of campaigners for services at St John's, and I know that they want that assurance, too. I assure the Parliament that, as long as the Government is in office and I am Cabinet Secretary for Health and Wellbeing, St John's hospital has a secure and rosy future, which is more than could be said when the previous Government was in office.
I am afraid that we must move on to the next item of business—my apologies to members whom I have not been able to call.