Cancer Services (West of Scotland)
Good morning. Our first item of business is the Scottish National Party debate on motion S1M-2541, in the name of Nicola Sturgeon, on west of Scotland cancer services, and one amendment to that motion.
It is clearly a Liberal Democrat group away day today.
The debate is extremely serious. Cancer is Scotland's biggest killer. One in three men and one in four women in Scotland can expect to be diagnosed with cancer by the time that they reach their 70s. Not only do more people in Scotland get cancer than in almost any other European country, but more people in Scotland die from cancer. Every year in Scotland, 15,000 lives are lost to cancer. Our survival rates are the lowest in the United Kingdom and among the lowest in Europe. In spite of all that, the quality of our cancer services lags considerably behind that of other countries.
Only last year, a survey conducted by the Royal College of Radiologists found that one in five lung cancer patients might die needlessly because of tumours becoming inoperable in the average time of 13 weeks that it takes for radiotherapy to begin. A significant proportion of our diagnostic and treatment equipment needs to be replaced. The Government recently announced funding for new magnetic resonance imaging scanners. However, as we heard yesterday, hospitals such as Ninewells in Dundee have difficulty in meeting the running costs of those scanners.
None of that is news to anybody, but it does no harm to remind ourselves of the scale of the problem. It also serves to remind us that, although cancer services in the west of Scotland have been in the headlines of late, we have a long way to go to improve services throughout Scotland. It is worth remembering that, even at full strength, the Beatson oncology centre will have fewer than 30 consultants for a population of nearly 3 million people. Many other European countries have around 100 consultants for a population of an equivalent size. That gives an idea of the gap that has to be made up in Scotland.
Cancer is one of the Scottish Executive's clinical priorities, and rightly so. It is probably a huge relief to patients in the west of Scotland that cancer is a priority. It does not bear thinking about what state the services in that part of Scotland might be in if cancer was not a priority.
The situation that has developed at the Beatson is deeply worrying, especially for cancer patients and their families. Anyone who has visited the Beatson in any capacity will know that its problems of the past few weeks and months have not arisen out of nowhere. The events of the past few weeks and months are symptoms of problems that have accumulated over many years. The problems include outdated equipment, and not even enough of that; dilapidated facilities; a shortage of resources, in particular staff resources, and not just medical staff; and a lack of support for those who work so hard to keep the service going.
Those problems are the result of long-term underfunding and neglect. Before Labour rushes to blame all that underfunding on the Tories, I remind Labour members that, in 1997, the Labour Government became the first Government in a generation to impose a real-terms cut in health spending. At the end of a dark period of Tory rule, when Labour had a chance to invest immediately in cancer services and to act to halt the decline, it chose instead to make a spending cut. We continue to live with the legacy of that decision, just as we live with the legacy of Labour's inability to deal with the symptoms of the Beatson's problems as soon as they became evident. That would have prevented the service from hitting crisis point. [Interruption.] Would Mr Fitzpatrick like to intervene at this point?
No.
He may want to share what he is saying with the rest of the chamber.
The member must not solicit questions.
The nationalists tell us something that every Labour member recognises to be a serious issue. However, the member also has a duty to explain to the Scottish public, as she makes those points, the spending plans of her party in relation to the national health service in Scotland. What does £35 million mean for the NHS in Scotland?
If Mr Fitzpatrick listens instead of muttering to his colleagues, he will hear about some of that in just a moment.
At the start of this year, Professor Karol Sikora, one of the world's leading cancer experts, called the Beatson a slum. In March this year, consultants at the Beatson warned of mounting problems. In April, a senior member of staff at the Beatson wrote to Susan Deacon to tell her that the volume of patients that each doctor had to treat was unsafe, that mistakes were being made with radiotherapy and chemotherapy treatment and that a large number of staff were on the point of resignation. That letter was answered by a junior civil servant and no action was taken.
Following the first three resignations in November, I wrote to Susan Deacon, advising her of information that I had about possible further resignations. That letter was also ignored. It was only after the fourth resignation that Malcolm Chisholm showed me the courtesy of a reply. If those warnings had been heeded, some or all of the consultants who have resigned over the past few weeks might still be in post.
I say to Mr Fitzpatrick, in particular, that the point of narrating this history is to stress that lessons must be learned. Never again should professionals working at the coalface of the health service be ignored, as has happened for years with those working in cancer services in the west of Scotland.
What happens now is what really matters. I welcome the decision that was taken last week by the minister to remove the Beatson from the management of North Glasgow University Hospitals NHS Trust and to appoint a medical director who is answerable to the health board. Of itself, a new management will not make the crucial difference. What matters is what it does differently from the old one.
The immediate priority is to attract enough high-quality applicants to the new and vacant consultant posts. That is pertinent on a morning when the newspapers have news of gastrointestinal consultants in Glasgow threatening to resign from the NHS. Will the minister tell us how many applications have been received to date for the Beatson posts? Will he respond to comments made by other senior consultants that, of the five applications that were received at the end of last week for those posts, none was appointable?
We heard yesterday that there is a national shortage of cancer specialists. It will take years to train a sufficient number. In the short term, we must attract people from south of the border and abroad. Does the minister agree that, if the new Beatson management is to be successful in doing that, a new approach will have to be adopted?
With the greatest respect to Dr Adam Bryson, I doubt that the sheer force of his personality will be enough to have cancer consultants flocking to Scotland. In the consultant labour market, Scotland needs a competitive edge. I ask the minister again to examine the powers that the Scottish Executive has to enhance the UK pay and conditions packages for consultants. That would allow us to encourage the consultants that we need so desperately to work in Scotland rather than elsewhere in the UK or the wider world.
The second priority is to protect cancer services in the west of Scotland. Even before the current staffing crisis at the Beatson, the volume of patients seen by each doctor was unsafe. There was already a three-month wait for a computed tomography scan and some patients with suspected bowel cancer waited for up to five months for an appointment with a consultant. That was before the current crisis.
What I have heard since about service rationalisation worries me deeply. It suggests that there will be a significant deterioration in the diagnosis, treatment and aftercare of many patients in the west of Scotland. Today marks the third time that I have raised in the chamber my concerns about the withdrawal of lung cancer, breast cancer and gynaecological cancer clinics from south Glasgow. I have not yet had those concerns addressed adequately.
Patients who should be attending those clinics will instead be referred to the on-call oncologist at the Beatson, who will not necessarily be a specialist in the patient's cancer type. Earlier this week, it came to light that hundreds of women who have had breast cancer have had their check-ups postponed for a year. Those are two examples of what I consider to be a dangerous reduction of service. I could give other examples.
In an interview this morning, the First Minister warns patients to expect
"delays that otherwise would not be there."
That is not acceptable. With cancer, delays cost lives. One of the early indicators of the success of the new management at the Beatson must be that it can put in place temporary staff cover to maintain those services. The minister has a duty to be candid about what exactly is meant in the action plan by rationalisation of services and about what action has been and is being taken to avoid the loss of services in the part of Scotland that has the worst cancer rates in Europe.
There are issues on which it appears that progress is being made, such as the speeding up of the new building at Gartnavel and—so far at least—the prevention of further resignations. However, those matters, together with the ones I mentioned earlier, must continue to be monitored carefully by the minister and the Parliament. The minister must continue to be accountable to the Parliament on a regular basis for developments in the west of Scotland. For too long, cancer services in the west of Scotland have been neglected and allowed to fall into crisis. It may have taken four staff resignations for the Government to pay any attention, but we have a duty to ensure that the minister is not allowed to forget his pledge to make the recovery of the Beatson his No 1 priority.
I move,
That the Parliament notes with concern recent developments at the Beatson Oncology Centre and the inevitable impact on cancer services in the West of Scotland; welcomes the removal of the Beatson Oncology Centre from the management of North Glasgow University Hospitals NHS Trust, and calls upon the Scottish Executive to now set out in detail what action will be taken to prevent further staff resignations, attract suitably qualified consultants to fill new and vacant posts, ensure temporary staff cover to avoid a rationalisation of cancer services such as the cancellation of clinics, and significantly shorten the timescale for the construction of the new Beatson Oncology Centre at Gartnavel Hospital.
I thank Nicola Sturgeon for introducing the subject for debate today. We all recognise that this is a most important and serious situation. In my first two weeks as Minister for Health and Community Care I have flagged the issue up as being at the top of my agenda.
Nicola Sturgeon began by acknowledging the bigger picture. We ought to reflect on that. There are serious short-term difficulties and our top priority has been and will be to address those. Equally, however, we need to look ahead and acknowledge the many positive developments in cancer services, which came together in the cancer strategy that was issued this year. It is important to do that for various reasons, including the need to raise the morale of staff who work in the Beatson and elsewhere in the west of Scotland and the need to attract staff. If people feel that there is a positive future for cancer services in the west of Scotland, we are more likely to attract the kind of staff that we want.
Members will know about the cancer strategy that was launched in July, which had £10 million attached to it in the first year. Quite a lot of that was spent on the kind of areas that we are concerned about. For example, £4 million was spent on building capacity to speed up diagnosis and treatment. Of the £10.7 million in the first tranche of investment, nearly £6 million went to the west of Scotland.
The minister talks about a recruitment crisis and people having faith and confidence in the service. How would he respond to an article today in The Herald that says:
"A team of specialist surgeons is considering a breakaway move from the NHS to set up … in a private hospital"?
If there is such trust in the way in which the minister is running those services, why are the top specialists leaving?
I was pleased to visit Gartnavel hospital about two months ago and to meet several of the upper gastrointestinal surgeons who are involved in that. I am extremely concerned to read that story and would deplore any such move. However, I hope that those people, some of whom I met at Gartnavel, will enter discussions with the North Glasgow University Hospitals NHS Trust and resolve the difficulties. The issues that they raise are important. They are concerned about the development of specific cancer services in the west of Scotland.
There are grounds for hope in that the west of Scotland regional cancer advisory group will meet for the first time on 20 December. It is up to the group, with the support of the external clinical support group that we sent in as part of the action plan, to develop the configuration of services in the west of Scotland. Part of that work is to develop managed clinical networks for upper GI cancer and other specific cancers. I hope that those specialists get involved in that process and that some of their difficulties will be resolved through that. They also have concerns about critical care beds but those are being addressed by the trust. Surgeons and specialists have been involved, and I hope that they will continue to resolve their differences in that way.
One of the novel features of the strategy was the nature of the new Scottish cancer group and, in particular, the patient involvement that was part of it. I pay particular tribute to Dr Anna Gregor, who heads that group. I know of her great commitment not only to cancer services but to the involvement of patients. That relates to one of the themes that I was talking about yesterday. She said:
"Patients are the key to this new way of working. In partnership with NHS professionals, patients will be able to influence the way we provide care in Scotland, both for a smoother journey of care and for better outcomes."
Patients were involved in deciding how the first tranche of money was spent. I agree entirely with Dr Gregor. I received a report yesterday of a questionnaire by the Scottish Breast Cancer Campaign. It is important that we listen to women with breast cancer as well. The piece of research I received yesterday will inform our thinking on that important area.
Looking to the future, there is the £44 million we have set aside for the new Beatson. I said last week that I wanted to see the outline business case by the end of this month. I am pleased to report that all the west of Scotland boards met yesterday and backed the outline, which I expect to receive soon. I have confirmed that those plans will be fast-tracked and that decisions will be made by the end of January. We are focusing on the short term—Nicola Sturgeon made several points about that. I agree with her that clinicians have not been sufficiently involved until now, but I am pleased to say that that is changing. As members know, I appointed Dr Adam Bryson as director last week. The new joint management board that we set up as part of the action plan has met twice. I have had two conversations with Dr Bryson this week. He has told me that he will chair the next meeting of that board. The clinicians are more involved now—that is an important development.
In the immediate future, the issue of recruitment is essential. I am told that five people have expressed an interest. They are all well qualified but it is up to experts to appoint people. One of the options is to appoint locums, if that is what the experts decide is best. Concern has been expressed about the clinic rationalisation. As part of the development and configuration of services in the west of Scotland it would have been desirable to reorganise the clinics. I am not saying that every change that is made in the coming period is the result of that. It is simply a fact that it would be necessary to reorganise the clinics anyway.
Is the minister saying that some of the clinics that are being withdrawn because of staff shortages may never be restored?
We have to treat the subject with the seriousness that it deserves and to listen to what the experts say. I have to be influenced by the experts in cancer. Changing the configuration of services is key in the development of services. However, too much alarm has been spread about this. I am assured, for example, that if there were to be fewer clinics in Lanarkshire, it would not mean that there would be no clinics in Lanarkshire; it would just mean that they might be configured differently. There will be changes, but we should not say that every change is necessarily a bad thing.
This is an issue of extreme importance to people in south Glasgow. It is of concern not only to the patients who use services; the clinicians to whom Malcolm Chisholm has referred have also raised the issue with me. Can the minister guarantee that lung cancer, breast cancer and gynaecological cancer clinics in south Glasgow that may have to be withdrawn because of staff shortages will be restored to the people of south Glasgow as soon as the shortages are resolved?
I am not an expert in cancer services. It is up to the regional cancer advisory group, supported by the expert clinical group, to decide how services should best be configured. It is not up to me to decide how clinics in the west of Scotland should be configured.
Is there not a contradiction in what the minister has said about listening to clinicians on the important configuration of cancer services and the failure of the Government for years to listen to the message from the clinicians at the Beatson about the lack of direction in that unit? The minister is trying to have his cake and eat it on the issue of listening to clinicians.
I am certainly listening to clinicians. I have had many conversations over the past 10 days with leading clinicians in the west of Scotland and I am pleased to continue doing that. I am determined to listen to clinicians and work in partnership with them. However, the general point I have made about the configuration of services stands.
The action plan is being implemented but other issues may have to be addressed as well. I have received a letter today from the patients support group that has been formed at the Beatson. One of the issues that the group is raising in the short term is whether we can get additional space before the opening of the new Beatson. That option is being considered. It relates to our discussions about Health Care International, since space there is one of the options that can be considered.
My time is up. I have to say in conclusion that the tone of the debate has been slightly regrettable. I had hoped that we would be able to address the subject on its merits. Nobody can question the priority that I have attached to the subject over the past two weeks and over the many years at Westminster and here that I have been committed to cancer services. It would be helpful if we could work together on this subject. I am happy to hear positive suggestions from the SNP and any other political party. I will seriously consider all positive suggestions. It would be regrettable if this most serious of issues were turned unnecessarily into a party-political football.
I move amendment S1M-2541.1, to leave out from "; welcomes" to end and insert:
"if further urgent action is not taken; supports the appointment of Dr Adam Bryson as Medical Director and welcomes the additional impetus and focus this gives to implementation of the agreed action plan, including as a top priority measures to secure appointments both in the short term and on a more permanent basis; supports the Executive's Cancer Strategy, Cancer in Scotland: Action for change, and the additional £40 million investment to support implementation; and calls on the Executive to drive forward the necessary changes, including the construction of the new West of Scotland Cancer Centre, as quickly as possible."
I commend the minister for what he has done in the past two weeks. Unfortunately, we have reached the depths of a crisis and it would take an awful lot more than two weeks to fix it. It is very unfortunate that the previous Minister for Health and Community Care, Susan Deacon, did not address the problems when they came to her.
Malcolm Chisholm tells us to listen to what the experts say, but breast cancer patients whose cancer is in remission are being told that their clinical appointments are being delayed by six months. I listened to Anna Gregor saying last night that she is reconfiguring the services and that all the clinics are not necessary. I think that the minister should start listening to women who have had breast cancer. He should ask them how much assurance, reduction in anxiety and peace of mind they get when they go along to see an oncologist who tells them that their cancer is still in remission. We would all have far more trust and confidence in the reconfiguring of cancer services if we felt that it was driven by clinical priorities. We are all mature and professional enough to accept that. However, when four oncologists have walked out, when morale is at rock bottom and when resources are desperate, we can hardly be blamed for being sceptical about a sudden reconfiguration of cancer services in the midst of an enormous crisis.
As cancer is one of the top three clinical priorities, we are entitled to expect the best in cancer care. If that is an example of a clinical priority, where does it leave people in Scotland who suffer from asthma, diabetes and epilepsy? God help those whose conditions are not clinical priorities. If the cancer care that is available is the best that ministers can do, there is not much hope for the rest.
To lose one consultant at the Beatson is unfortunate; to lose two is careless. To have four consultants resign is an outrage and an indictment of the Executive's appalling inability to run the NHS in Scotland. The most recent resignation—that of Dr Adrian Harnett, who has no job to go to—has robbed the Beatson of one of the UK's leading authorities on breast cancer. His resignation will also impact on the Scottish ophthalmic oncology service and on patients throughout Scotland. That resignation could and should have been avoided if support had been available from management and sufficient resources made available. As Dr Kemp, the consultant ophthalmic surgeon, wrote in The Herald, those developments could have been avoided if consultants' concerns had been listened to over the past two years. I commend what the minister has done in two weeks, but I cannot commend what has been ignored for two years.
It is unacceptable that services should be allowed to deteriorate at all. What is disgraceful is to be aware of such problems and to allow them to continue to fester. The Beatson, the biggest cancer centre in Scotland, is in a state of crisis. With Dr Harnett's departure, the staffing level will become half of that in Edinburgh. That is certainly no way to run cancer services in the west of Scotland.
Indicative of the performance of our much-vaunted Executive is the response earlier this year to a letter from a doctor at the Beatson warning of near disasters due to staff shortages. As has been said, Susan Deacon did not even deem that worthy of her attention. It is alleged that the reply was given by a junior civil servant without Ms Deacon apparently even being aware of it. The Beatson was clearly not a priority for the Executive. That fact is glaringly obvious and now comes back to haunt ministers.
The current crisis is undoubtedly a headache for the minister. For too long, doctors have been bypassed and ignored by managers and the Executive. Staff morale is at a low ebb. In terms of embarrassment for the Scottish NHS, surely nothing can compare with the words of Professor Karol Sikora, who led the World Health Organisation's cancer control programme, when he described the Beatson as like "going into Bombay". He said that we had a "black hole in Glasgow" and were running the operation like something from the 1950s. It cannot be acceptable for that to continue.
The decline of the Beatson cannot be blamed wholly on mismanagement at the North Glasgow University Hospitals NHS Trust. The buck stops with the Minister for Health and Community Care, particularly when concerns have been raised over a period of years. Although the Beatson is facing so many problems, we heard yesterday that the minister will now embrace the underutilisation and spare capacity in the private sector. Will he tell cancer patients in Scotland how their care will be affected in the new configuration of services? Will he utilise the 540 beds, the 24 operating theatres and the 67 intensive care beds, as well as the expertise in cancer care, for diagnosis, treatment, surgery and aftercare, all of which are readily available at HCI?
We are looking for a commitment from the minister that health care in Scotland is decided not by dogma but by patient needs. I was pleased to read in The Herald today that Jack McConnell would not "be bound by dogma". He just needs to get his troops to believe that. When the First Minister puts patients first, before political dogma, the Conservatives will wholly and fully support that approach.
I apologise to Nicola Sturgeon for missing the first part of her speech this morning.
On behalf of the Scottish Liberal Democrats, I say that I share everyone's concern at the situation. The Beatson centre provides more than half of Scotland's cancer services, covering not only Glasgow but the west of Scotland. Given Glasgow's poor health record and poor cancer record, cancer care is an area that needs investment and the best possible service. It certainly does not need the crisis that it now faces. That crisis has been brought to a head by the resignation of four consultants who were concerned that they were unable to perform their duties effectively because of conditions at the Beatson, which was described by Professor Sikora, the WHO cancer specialist, as a slum.
I agree with Malcolm Chisholm that this is not the time for blame. It would be quite easy to spray blame around and apportion it all over the place, but this is a time for solutions. The minister has said, quite rightly, that he is happy to listen to suggestions from any direction, from political parties or, as Mary Scanlon said, from outside the public sector. All such suggestions must be considered.
We still need answers to a number of questions, and I would like to raise a couple of points. We need to see the situation in a short, mid and long-term context. The short-term crisis must be dealt with and we welcome the minister's decisive action in that regard. To visit the Beatson within a day of the most recent resignation, to remove day-to-day control from North Glasgow University Hospitals NHS Trust and to appoint Dr Adam Bryson to oversee the running of the centre and report directly to Greater Glasgow Health Board, to pledge resources and support and to ask for the business case for phase two of the new Beatson at Gartnavel hospital to be on his desk by the end of the month is to take the sort of decisive, short-term action that we would expect from a minister. If that is a clear message that the buck-passing stops with him, we will be very pleased.
The first question is, what extra resources might be made available and what resources have been made available? The recent announcement of £10.7 million for cancer staff and equipment was overshadowed by the Beatson news. More than half of that money will be allocated to spending in the west of Scotland and the Executive recognises that there is a need for investment in the Beatson. How much of that money will go to the Beatson? What will it be spent on? Has any thought been given to whether some of the £86 million in the chancellor's budget statement that is yet to be assigned to health spending will go to cancer services and specifically to cancer services in the west of Scotland?
There is a crucial short-term recruitment problem in respect of 10 places—there are four unplanned posts and six additional planned posts. Where will those doctors be found? There are different reports on whether the five who have so far applied have the relevant experience. Is it true that Dr Bryson is looking abroad for recruits? How can we possibly attract the best calibre consultants to the Beatson, given its current reputation and the fact that other consultants appear to be contemplating leaving the centre and are apparently being headhunted within the NHS?
To some extent, the minister has given a clear steer today and in his previous actions. However, a clear steer from the minister is needed to show that failure at the Beatson will not be acceptable to any of us and that support will be forthcoming so that consultants who come forward—although they may experience difficulties in the short term—will, in the mid to long term, with specific support and within the broader long-term framework of the cancer plan, be given the full backing of the Executive and the Parliament.
I ask the minister for an update on the progress of the new Beatson project. When is it likely to be completed? What scope is there for speeding up the process, as the minister indicated that he wishes to do?
Nicola Sturgeon spoke of concern about the knock-on impact on services. Five hundred women, who have all suffered from breast cancer, have had their appointments put back by anything up to 18 months. Does the minister have any idea about the anxiety that that delay represents for those women? This morning, the minister said that we must listen to women with breast cancer. Women who have had breast cancer would say that we must address that issue. Incredible anxiety is involved in delays of six, 12 or 18 months before there is a follow-up in the system.
What is being done to ensure that alternative services are in place? What will happen in the 16 other clinic sites throughout the west of Scotland where specialists from the Beatson would ordinarily hold clinics? Nicola Sturgeon made a point about those clinics and the minister spoke about reconfiguration. If those services are to be reconfigured, proper consultation needs to take place. It would be unacceptable for those services to close at this time of crisis—which might be seen by patients as a short-term need—only not to open up in the mid or long term without further consultation, if that were thought to be the best clinical course of action. I will not second-guess a clinician any more than the minister will, but we must ensure that there is consultation.
It is obvious that there are short-term issues. We are keen to hear what is happening and to hear the minister's vision for the long term.
I want to touch on two other issues.
The member should be brief.
The first issue is staff morale and listening to staff. It is clear that the Beatson's clinical, managerial and resource-led problems did not happen overnight. Press reports suggest that Professor Barrett met health department officials two years ago and suggested that they ought to think about using spare capacity at HCI. There are also reports of letters that were intended for Susan Deacon but did not get beyond a junior official's desk. I said yesterday that it is essential that we listen to staff and act on what we hear.
The second and wider issue is work-force planning. That issue arose in the cardiac surgical unit and at Stracathro hospital. For whatever reason, a few people move on and suddenly an entire unit and service are under threat and in crisis. That is not good enough.
I am being very patient. You are two minutes over your time.
Work-force planning must be seen not only in the short term, but in the long term.
When I came in, I picked up a copy of the report on the west of Scotland cancer service. I do not need to read more reports. They give statistics, but the debate is about the suffering and worry that people go through when they have cancer. A member said yesterday that all of us probably know someone who has attended the Beatson. We should remind ourselves that the debate is about the people and the care that they should receive.
The staff have been mentioned. We must make clear the tremendous debt that we owe to the workers in the NHS. Daily, they demonstrate their loyal dedication to the health service, often working under extremely difficult conditions to service the health needs of the nation. However, the unfortunate reality is that our hard-working health service workers have not had the support that they deserve. The new Labour Government's custodianship has been a catalogue of failure and disasters. The failures are all too apparent to me, as a Glasgow MSP, and to other members.
The Government's record on the health service and on cancer services in particular is not one of which it can be proud. For too long, the Government has buried its head in the sand when confronted by the problems that are faced by cancer services. Those problems are real and have been identified by patients and staff in the health service. That is not scaremongering, as Labour members often say. If the Government had taken those problems seriously, perhaps action would have been taken to solve them at a much earlier stage and the crisis at the Beatson might not have arisen.
I welcome the fact that, at long last, the minister and the Government have taken action to resolve the Beatson's problems by installing new management and removing the centre from the control of the North Glasgow University Hospitals NHS Trust. However, questions must be asked. Why has it taken them so long to act when problems were identified—as has been stated—at a very early stage? The trust that mismanaged the Beatson was a creation of the new Labour Government.
As early as November 1999, Dr Nick Reed, the clinical director at the Beatson, identified the problems. The Beatson serves almost 3 million people in Scotland, but had only six radiotherapy machines when it required 12. As a result, patients waited up to nine weeks for treatment. Unfortunately, some patients had tumours that returned after six to eight weeks. That is a sad indictment of the mismanagement of the Beatson. At the time, the Scottish Executive said that it was aware of the problem, but it washed its hands of it by saying that the problem was purely a matter for the trust. I am glad that that has now been resolved.
The question remains: why has it taken until now to act when the Executive was aware that there was a problem over two years ago? I have spoken to staff at the Beatson and have been concerned about the problems that they face. The new site at Gartnavel has been welcomed, but only now has action been taken to speed up the transfer to the site. Problems remain, as Nicola Sturgeon highlighted in asking the minister about care in the south side. There are many doubts about whether the Executive's plans will result in the improvement that is required in Scotland's appalling cancer rates.
We all recognise that cancer requires the earliest possible diagnosis and treatment if a patient is to be cured. It is an absolute scandal that the situation at the Beatson has been allowed to continue and to deteriorate into the crisis that it is today.
Studies carried out at the Beatson have identified that cancers are becoming inoperable because of a lack of machines. A study identified that 29 cancer patients had to wait between 18 days and more than four months between diagnosis and their second CT scan. In this day and age, that is not acceptable. Five hundred women suffering from breast cancer have now had their check-ups postponed for at least a year as a result of the staffing crisis at the Beatson. Patients who have been identified as low risk have had their appointments put back. I say to the minister that people could die if the crisis is not resolved.
The minister's announcements, and those of the Labour party, about new cash represent a drop in the ocean in comparison with the investment that is desperately needed for the treatment that is required in the 21st century. Scotland is a wealthy country, but that is not apparent from the health treatment that is provided to our people. We can afford better standards of care. The Government must take steps to resolve the crisis at the Beatson and to give back confidence to the Beatson and cancer services throughout the country.
I welcome the opportunity to discuss the situation at the Beatson oncology centre, which is based at the Western infirmary and Gartnavel general hospital, which are part of North Glasgow University Hospitals NHS Trust. Although I accept that the Opposition has a legitimate role in questioning the Executive's plans, I hope that no one in the Parliament will play party politics with an issue as important as the cancer strategy.
There is no doubt that the resignation of a fourth consultant oncologist at the Beatson shows that a serious and grave situation is emerging, which has the potential to harm the service in the short term and undermines the public's confidence in our biggest cancer centre. Therefore, I call on ministers to leave no stone unturned in providing immediate solutions for patients who are receiving treatment or follow-up consultations. I welcome the action plan that Scottish ministers have put in place.
The setting for the Beatson oncology centre is the Western infirmary, which is a two-site hospital that provides a medical service in two locations. That is detrimental not only for cancer services, but for orthopaedics and other clinical specialities. The Opposition has failed to call for the speeding up of action on that matter and fails to understand the issue.
Will the member give way?
I will not take interventions because I have too much to say. Perhaps SNP members will learn something.
Bringing together the two hospitals on one site will deliver better services. That is why Malcolm Chisholm's decision to speed up the action plan and to get the hospital in one location is crucial to patients. That must be understood.
For two years, I have called consistently for the move to be speeded up. I have monitored the situation and called for the speeding up of a one-site option at Gartnavel for cancer patients and orthopaedic patients. Work on that started in 1997. Where do SNP members think that the plans that are being put into operation at Gartnavel came from? Work on the plans has been going on since 1997.
Like other members, I have visited the Beatson oncology centre many times. I accompanied Malcolm Chisholm on his visit to the centre last week. I am well aware of the conditions under which staff work. Doctors do not have proper facilities and the facilities are cramped. Because the centre deals with life-threatening conditions, it is busy and like no other place. The issue is not only about conditions for doctors; it is mostly about conditions for patients. The male chemotherapy ward is of an unacceptable standard. That is why so much effort has gone into bringing about the one-site option.
The Beatson service serves half the population of Scotland and deals with the more complex cancers. The centre of excellence is hosted by North Glasgow University Hospitals NHS Trust, but is delivered across five health board areas. I welcome the minister's decision to remove the service from local management, because it is not a local service but a regional and national one. I ask the minister to consider whether in the future it would make more sense to manage and fund the service directly on a regional basis. Glasgow cannot continue to endure the burden of running the service in the Glasgow funding envelope.
We should pay tribute to the staff who make up the specialist team at the Beatson centre: specialist nurses who are dedicated to cancer patients; clinical scientists—of whom there is a definite shortage that must be examined—who work extremely hard to ensure that cancer treatment is modernised; and radiographers who work all hours to provide the special type of radiography that the service requires. Doctors are crucial, but we must acknowledge the role of other staff in the service.
The NHS faces shortages of specialists and it is unfortunate that cancer services do not attract medics. The discipline is difficult. I ask the minister to consider the possibility of increasing numbers in medical schools. To have more specialists in all areas—not only cancer services—we must consider having more doctors in the system.
There has been underinvestment in imaging services, particularly during the Conservative Government's time in office. That is a fact. Ultrasound, MRI and computed axial tomography scanning are beginning to rectify that situation. We have a strategy to deal with the underinvestment and, unless we deal with it, we will not be able to resolve many issues in the speciality areas. An adequate supply of radiographers is needed. Again, to reduce waiting times we must do something about the number of people who come into the system.
I want to mention the importance of setting up ambulatory care and diagnostic units in the NHS. The point of ACAD units is to recognise that patients are often most worried about diagnosis because they are waiting to find out what is wrong with them and what treatment they will need. Therefore, investment in ACAD units is a crucial point in the diagnostic debate.
The Labour and Liberal partnership does not believe that it has all the answers. It is not arrogant enough to think that. However, we have many answers. I would like to hear more answers from the Opposition on what can be done about the situation.
Mary Scanlon referred to an article in this morning's edition of The Herald. I do not believe everything that I read in the press and I hope that that article is not true. It would be a disgrace if a profession were to take advantage of the crisis and I hope that members would condemn that.
Crises often give us an opportunity to consider what we could do better. I ask the minister when he examines the future of the Beatson oncology centre—which I hope will be at the one-location site at Gartnavel—to consider doing something bigger and better. We must deal with the issues now. The land at Gartnavel will not be available for ever. We must consider the possibilities for what we can do in the future and we must use the crisis as an opportunity. Everyone recognises that there is a crisis, but they should also recognise that a lot is being done. I ask the minister and the Opposition members in their summing up to mention some solutions and not only problems.
I will speak on behalf of cancer sufferers in Ayrshire and the west of Scotland. I want the Executive to note the headline in today's edition of the Ayrshire Post: "Cancer fears mount as fourth specialist quits". That succinctly catches the mood of people in Ayrshire. I also speak on behalf of the concerned constituents who contacted me about the Beatson centre and about the withdrawal of clinics from Ayrshire to Glasgow.
As members have said, the situation at the Beatson oncology centre has become untenable and the prospects for cancer care for the 60 per cent of Scotland's population that is covered by the centre decline daily. Yesterday in the chamber, I heard and welcomed Malcolm Chisholm's Pauline conversion to Conservative policy—his commitment to using private care facilities to treat NHS patients. I welcomed that, because with Dr Adrian Harnett's resignation last week from the Beatson centre, Ayrshire hospitals lost not only a consultant but a highly regarded man who is at the top of his profession.
I understand that, as a result of Dr Harnett's resignation, breast cancer care in Ayrshire will be reduced by up to 50 per cent and post-operative care clinics might be withdrawn from Ayrshire and go to Glasgow in the short term. Like Nicola Sturgeon, I seek the minister's assurance that those services will be reinstated as soon as is humanly possible. Of course, if another consultant were appointed, that cover would be resumed. However, instead of queueing up to join the once-famous Beatson oncology centre, by all accounts consultants are queueing up to leave.
The catalogue of mismanagement and lack of man management is simply breathtaking. The fact that Dr Harnett apparently resigned without a job to go to paints a picture of despair within the centre—despair among the staff at excessive work loads and at a situation for the improvement of which they think there are no prospects. As my colleague Mary Scanlon said, it is simply unacceptable to have Karol Sikora, an eminent professor of clinical oncology, describe conditions at the Beatson as similar to the third world. It is truly worrying for him to talk of "Stalinist solutions" as having been the management style at the Beatson.
That is why I welcome Malcolm Chisholm's new, pragmatic approach. He will allow patients who would otherwise have been penalised by old Labour policies to be treated at HCI. That is good news for Ayrshire. Waiting lists and waiting times that would have risen immediately as a result of understaffing at the Beatson might not rise so quickly.
If beds and treatment for Ayrshire patients cannot be found in Glasgow or elsewhere in Scotland, the minister must be prepared to find bed space and facilities in England and Wales. In a worst-case scenario, bed space and treatment facilities could and should be sought abroad, because it is a fact that if people have—or believe that they might have—cancer, they will travel huge distances to receive treatment, if need be.
Finally, I appeal to Dr Harnett to stay at the Beatson. If he has not yet taken a job elsewhere—I believe that he has not—I am sure that the Parliament, to a man, would ask him to reconsider his position and stay on at the Beatson. With a new minister and a new director in charge, surely things can only get better. For the sake of the people in the west of Scotland, let us hope so.
Anyone who has read "A Cornucopia of Pharmacopeia" by Father George Rutler of New York cannot fail to be impressed by the phenomenal contribution that Scots have made to the betterment of mankind. Although our nation's population accounts for less than one in 1,200 of the Earth's population, 11 per cent of all Nobel prizes have been awarded to Scots. Indeed, throughout modern history, Scots have contributed significantly to all areas of human development, not least in medicine. Scottish medical pioneers include William Leishman, who perfected the typhoid vaccine; William Smellie, the founder of modern obstetrics; John Hunter, the father of comparative anatomy; John Macleod, the discoverer of insulin; Joseph Lister, the founder of antiseptic medicine; James Young Simpson, who was the first to use chloroform in surgery; and Alexander Fleming, who discovered penicillin. There have been many others.
A nation that has contributed so much to—and still has a worldwide reputation in—medicine now has an Executive that, in the provision of cancer services, has failed to deliver the level of treatment that is so desperately needed by vulnerable patients.
In the recently published "Cancer in Scotland: Action for Change", Mr Chisholm's predecessor reiterates the Scottish Executive mantra that cancer
"is one of our three top priorities".
One can only wonder at the provision of services that are not among the top three priorities of this coalition.
The Beatson is in crisis. Years of mismanagement, malaise and underfunding have demoralised staff, delayed treatment and adversely affected the prognosis for patients. A critical shortage of specialist consultants, a catastrophic reduction from £8.5 million to £3.5 million in medical equipment expenditure in Glasgow during new Labour's first three years in office and an abysmally low expenditure on cytotoxic drugs cannot fail to impact adversely on patient outcomes.
An action plan has been produced, although it is of the closing-the-stable-door-after-the-horse-has-bolted type. We hope that it will be successful, but will it be enough? Will it be enough to overcome the loss of crucial staff, the erosion of confidence or the years of underinvestment? How long will it be before waiting lists fall, waiting times are reduced and the Beatson becomes a centre of excellence in which Europe's finest oncologists aspire to work? Is the minister even able to hint at a time scale and the implications for patients in the intervening period?
Ministers ignored warnings in April that the centre was lurching from crisis to crisis and sat complacently on their hands. Can they be trusted to turn around the situation now? If Glasgow is to lose its title of Europe's cancer capital, the Beatson must be turned around. However, that can be done only by listening to staff at all levels, examining the reasons why four consultants have resigned and acting swiftly to reverse the conditions that forced them to resign in such dramatic fashion.
At the Victoria infirmary, 500 women who have received breast cancer treatment might have to wait a year for scheduled checks. As one patient, Karen Jenkins, said in The Herald yesterday after being told that she would have to wait until January 2003:
"I am very worried. I fear that some of the people involved could die if they have to wait as long as me".
Dr Iain McColl, a general practitioner at Thornliebank health centre, said in the same newspaper the previous day:
"Patients with early treatable cancers are having surgery delayed beyond the curative stage. As a nation we cannot allow this to continue."
We must recruit specialists now, even if that means paying increased salaries and expediting equipment purchases, the construction of the new Beatson centre and the provision of more beds. Specialists must be headhunted, even if only on short-term contracts, to ensure that patients do not die because of the crisis in cancer services. Money cannot be the problem. We should remember that in the past financial year, at a time when the service was crying out for funding, we had the obscenity of a £143 million underspend in the NHS in Scotland. Lack of financial resources can no longer be considered an adequate excuse.
The Executive has paid only lip service to cancer prevention. By its own admission, smoking is
"by far the largest preventable cause of cancer".
However, smoking rates among the disadvantaged have barely fallen and the Scottish Executive has not only failed to deliver on its own promise in "Making it Work Together" to
"ban tobacco advertising by the end of 1999"
but appears to be less than supportive—to put it mildly—of my colleague Nicola Sturgeon's bill on the issue. Hugh Henry is very interested in the issue of tobacco advertising, and I hope that his addition to the ministerial team will mean that that
issue will be addressed. If the Executive is serious about reducing the incidence of cancer, backing the Tobacco Advertising and Promotion (Scotland) Bill would mean that it could deliver—albeit it two, or more, years late—on at least one pledge.
Although I support the Executive's amendment, I ask the minister to recognise that things will have to get a lot better at the Beatson clinic before constituency members whose constituents and families depend on the clinic's services will be satisfied or quietened.
We must not lose sight of the fact that some of Europe's finest consultants and other associated nursing and hospital staff continue to work at the clinic to provide better cancer services for people in the west of Scotland. From speaking regularly to key consultants at the clinic, I know that its medical staff and patients will genuinely welcome the minister's decision to move oversight of the centre from North Glasgow University Hospitals NHS Trust. The trust has proved too large, unwieldy and cumbersome for the tasks that it faces and it is clear beyond peradventure that the trust has been found wanting in its handling of the developing situation. Furthermore, we will have to revisit issues about democratic accountability.
The announcement of the external expert advisory group is but one example. The minister must be congratulated on securing the advice and assistance of pre-eminent advisers such as Professor Cummings from Toronto. I know that the professor will shortly be returning home for Christmas and I wish him a happy and restful short festive break. We look forward to his return.
However, the clinicians at the Beatson clinic have been asking for such external assistance and advice from the trust since early this year. I ask the minister to investigate through the NHS board what has been going on at the trust and why key staff members' repeated requests for and suggestions about improvements were downplayed and ignored. I know those people; they believe in and are proud of the NHS, and will not be leaving the service.
I agree with Nicola Sturgeon that the situation at the Beatson clinic is very worrying. That is partly why I welcome the amendment's support of Adam Bryson's appointment as clinical director. Although I also agree that individuals will not solve structural problems, they can help with the situation, and Adam Bryson's appointment certainly has the full support of members on the coalition benches. Adam Bryson is well known to specialists in the field, and should be well known to everyone who supports the cancer service. He deserves everyone's support.
Although I wish Adam Bryson and his new team every success and although I welcome the NHS boards' agreements concerning the new Beatson clinic—which represents a capital investment of more than £44 million—I urge them all to examine seriously the phase two business case that Margaret Smith mentioned. I am pleased to see Margaret in the chamber, and welcome what she said. The phase two business case should be changed to increase the number of beds and scanners and the scale of the out-patient facilities at the new Beatson centre.
I welcome the comments that have been made by coalition members about what should be done with the additional financial allocations. Members of the coalition parties will have no difficulty in supporting any better and further much-needed resources for cancer services in Scotland.
The history of medical care in my lifetime has been one of increasing specialisation and, by definition, increasing centralisation of such specialisations. The reasons are partly financial and partly down to the colleges' view that consultants' posts can be justified only if there is given and predetermined throughput of patients. As John Scott pointed out, the defects in provision in Glasgow impinge on a wide surrounding area—they apply in equal measure to the whole of the west of Scotland.
As someone who has been lucky enough not to have a life-threatening emergency, I am fairly confident that the system works, be that accident and emergency care or the diagnosis of an immediately life-threatening condition. However, the diagnosis process is fatally slow.
A letter from Dr Iain Campbell McColl in The Herald on Monday 10 December stated:
"a patient, who has worrying bowel symptoms strongly suggestive of cancer, has a seven-week wait before she will be seen for a first appointment by a colorectal surgeon."
That seven-week wait was achieved only after the consultant's secretary was begged to put the person on the waiting list—her original appointment was for April 2002. It was made clear that, at the end of that first waiting period, the patient would be at the end of the queue for a colonoscopy and barium enema and that it might take up to five months before that treatment could be received. The letter further stated:
"national cancer guidelines state that these patients should be seen within two weeks and have their investigations performed within another two weeks".
No one in the chamber is unaware of how dire the situation is. The situation is profoundly worrying, not only objectively, to me in this debate, but also more subjectively, to the patient, whose life may be at stake as a result of the delay, and to the general practitioner, whose endeavours are being frustrated by a system that simply cannot cope. There is a shortage of cancer consultants as there is a shortage of all other consultants. Some hospitals in the west of Scotland have only half of their consultant posts filled. A consultant e-mailed "Good Morning Scotland" yesterday to say that some of his colleagues contemplated going into the private sector only because they wanted to treat more people and because the physical facilities were not available in the NHS to meet the demands for treatment—in other words, insufficient operating theatres are available.
The problem is one of resources and of making supply meet demand. The problem is about hospital boards and managers who have pushed risk management to the margins to establish how few facilities can be paid for within the budgetary framework without the system collapsing. The system has been pushed too far.
Unhappily, there is an insatiable demand for cancer services in the west of Scotland. I have not even touched on the contribution that proper funding could make to diminishing the need for acute cancer care. Today, we are dealing with the immediate problem, but part of our responsibility is to try to diminish the problem and the demand for the services in the future.
Some 80 per cent of cancers are caused by an unhealthy lifestyle. It is worth noting that, in the 10 years after California's anti-smoking campaign, there was a 14 per cent decrease in lung cancer. Smoking, bad diet, obesity and lack of exercise are all concomitants of hopelessness and urban deprivation, which we have done little to diminish although they cannot be separated from the current crisis.
I welcome the opportunity to speak in the debate, given that the cancer rate in my constituency is 12 per cent above the national average. As a consequence of that high rate, my constituents and I know the Beatson unit well.
Members of my family still speak of the day on which my grandfather left his house in Mill Street in Greenock for an operation in Broadstone hospital in Port Glasgow. The whole street turned out, not to wish him well, but to say goodbye—such was the low expectation of survival 60 years ago. Of course, the people in the street were right: it was discovered that he had stomach cancer and he never left the hospital alive. Contrast the fear of yesteryear with the high expectations of today. Now, people rightly demand early screening, early diagnosis, early admission to the hospital of their choice and the best available treatment when they are there. For many in the west of Scotland, the focus for those high expectations has been the Beatson oncology centre, where much good work has been done, continues to be done and needs to be done.
I am proud that the Labour party shares those ambitions. In our manifesto for the 2001 Westminster elections, we recognised that cancer care was a priority and we have put in place an overall strategy to treat, detect and prevent cancers. Early detection will be boosted by improving screening technology, which will in turn improve survival rates. Treatment will be improved by investment in new hardware, one-stop clinics, more specialist cancer posts, MRI scanners and cancer-imaging equipment in all the health boards. At the Beatson centre, where there is no denying the difficulties, hard work is being done by the minister to turn the situation around. I welcome, as does the SNP, the action that the minister has taken.
The Labour party created the national health service, worked to raise excellence and confidence and is now working to tackle decline and meet the public's high expectations. Contrast that action with the rhetoric of the Scottish National Party. Its members have said a lot about cancer this morning, but its 2001 manifesto had sections on referendums, a written constitution and freshwater fishing, but not on cancer. The SNP's uncosted health policies have plenty of room for sections on a national health care commission, the regulation of the content of school meals and on cleaner hospitals, but no room for a section on cancer services. In this morning's motion, the SNP missed an opportunity to tell us—
Since Duncan McNeil mentioned intervention in the health service, can he tell us why it took more than two years of doctors, clinicians and patients telling the then Minister for Health and Community Care about the situation at the Beatson centre before the Government intervened?
I am challenging Ms White and her party to come up with ideas to solve the problems that she mentions. I find nothing in the SNP's policies to explain to anybody what the SNP would do.
Will the member give way?
Just a minute.
Previously, Richard Lochhead suggested that we should take money from places such as Glasgow and put it into the north-east, although that would diminish the share of the funds that Glasgow gets to fight cancer—that is what the SNP says on the issue.
The SNP should rise to the challenge of improving cancer services and try to meet our vision. This morning, in a 10-minute speech, all Nicola Sturgeon could come up with was a suggestion that we should solve the situation by bribing consultants. "SNP" still stands for "Still No Polices". The minister has issued a challenge to the SNP to join Labour in the attempt to give the people of Scotland the cancer services that they require.
Will the member give way?
Will the member accept an intervention?
No. SNP members need to wipe away their crocodile tears, roll up their sleeves and get involved in ensuring that the people of Scotland have the cancer services that they deserve. Moaning and groaning don't solve nothing.
I have a difficult task in following Duncan McNeil, who got the whole chamber excited, but I hope that my contribution will be useful.
I want to broaden the debate beyond the issues in the west of Scotland. We are addressing serious issues there and the minister has indicated that he is personally committed to resolving the problems through the appointment of Adam Bryson and the commitment to fast-track the decision about a new cancer centre for the west of Scotland.
Much of the tone of today's debate has been disappointingly negative. Like many of the debates in this Parliament, it has focused too much on failure and not enough on celebrating success.
Will the member give way?
No, as I am short of time.
I want to highlight some of the successes of our health service's cancer services, as those successes can inform the way in which we develop services in the west of Scotland.
Margaret Smith emphasised the importance of patient involvement in shaping services. We can be encouraged by the commitment that Dr Anna Gregor, the lead cancer clinician, has given to that.
In the Lothians, many developments can be seen working in practice. Waiting times for breast cancer treatment have been cut by 60 per cent in recent months. Routine appointments for urgent cases are being offered within two weeks. In partnership with patients, new services that are closer to patients are being developed—the new dedicated cancer unit at St John's hospital in Livingston serves people who are receiving chemotherapy in that area. Also, new cancer treatment and assessment posts are being created in the Lothians. We must learn the lessons of success in the health service and transplant those successes to the areas in which problems exist.
It is important for the Parliament not to concentrate on failure and talk down our national health service. We must also focus on areas in which the Executive's policies are working and have been translated into real service improvements. Through partnership between health service clinicians, patients and the Parliament, we can make a real difference throughout Scotland. I hope that some of the lessons of the health service in the Lothians can be transplanted to the Beatson centre and the west of Scotland.
Bristow Muldoon was right in his concluding remarks to concentrate on the positive. There is no doubt that the Beatson crisis is taken seriously by everyone in the Parliament. It is right to say that the minister has acted speedily and that his actions to impose what I might describe roughly as direct rule at the Beatson centre have been correct. The priority now must be to resolve the short-term problems.
There is no great merit in rehashing the history of the matter except to learn lessons for the future. There are a number of lessons to be learned. There are undoubtedly questions about the way in which NHS management is conducted. Brian Fitzpatrick made some useful points about the way in which we might have to approach that in the future. Too often, management have been unresponsive and unlistening, not only at the Beatson centre, but at the cardiac unit at Stobhill hospital and, for that matter, at the Victoria infirmary.
When the member talks about the attitude of the Liberal Democrats, will he reflect on their rather scandalous failure to turn out for the debate?
We are here to speak about the matter that is being debated. As a member for Glasgow, my interest is primarily to speak on that. With respect, Winnie Ewing's point is rather petty.
There are questions about the way in which the NHS management conducted themselves. There are also question marks over the respective roles of NHS management and medical staff. If consultants are telling management that certain things need to happen to provide a proper, safe service, there must be a presumption that those things will happen quickly.
As I said in yesterday's debate on the Scottish health plan, the problem is not money. The funds are in place for the replacement consultants and the six new posts at the Beatson centre. What immediate steps do we need to take? Most important are the steps that the minister has taken to beef up the management and accountability of the Beatson centre, to recruit new staff urgently, to speed up the replacement facility at Gartnavel and to seek the advice of the external group.
Kenny Gibson was right to call for urgent headhunting of staff. However, the staff crisis goes significantly wider than the Beatson centre: it is a problem in oncology throughout the United Kingdom. It stems from gross failures in ethos, from the misguided creation of cumbersome bureaucracies and, above all, from the failure of the previous Conservative Government and the Labour Government in its early days to provide adequate numbers of doctors and nurses qualifying from our universities. To get a medical student through university takes six years. It is quite obvious that we cannot just snap our fingers and produce new doctors and nurses overnight. It takes time.
Much has been made of the vacant beds at Health Care International at Clydebank. The fact that the beds are vacant is not exactly a tribute to the business efficiency of that rather troubled institution. The private sector does not have spare doctors any more than the NHS does. That is not just true of doctors; it is also true of other staff and of beds. However, it is certainly worth considering whether the space and facilities that are available at the HCI premises could provide a temporary home for the Beatson centre until the new facilities are available. That temporary home could be staffed and run by the NHS in much the same way that the Parliament has borrowed this chamber until the new chamber is ready.
It must be said that those would be short-term solutions only. We must concentrate on long-term solutions. After all the hassle and complaints—which were quite correct and justified in many respects—it is appropriate for members to back the minister. He has started well. He is on the right track. He has done the right things. Few people have suggested much that he should be doing beyond that. All power to his elbow. We should back the minister in trying to resolve the problems that have been such a blight on the Scottish health service at the Beatson centre.
When a facility such as the Beatson centre teeters weekly on the edge of crisis, that must surely come as a major embarrassment to the Labour Scottish Executive and former Scottish Office, which declared the provision of cancer services to be one of its leading initiatives. One of the major focuses of the Executive's health policy is failing—and badly. When that happens, we must call into question the Government's competence.
It never ceases to amaze me that a party that is so good at spin and launching initiatives is so thoroughly disorganised and unco-ordinated. One of the most worrying quotations to come out of the affair is from Professor Barrett, who said:
"The Scottish Executive is investing in the cancer plan, but what we want to see is transparency in where the investments are going and a strategy from the management to improve care."
Her sentiment is clear. She implies that, despite all the committees, sub-groups and documents, there is serious mistrust about how the investment benefits front-line services. It is obvious to anyone with any management skills that, when expectations are raised so high yet remain unfulfilled, morale will decline seriously. Part of the blame for that must be laid at the door of the Scottish Executive.
We must also question the incompetence of the previous minister's handling of the situation. It is unforgivable that the junior civil servant who dealt with the written concerns from the Beatson centre did not pass them to the minister. The fact of the matter is that the minister should have been listening and gathering information almost weekly on the state of one of her leading initiatives.
I ask the deputy minister to clarify in her closing speech why the human resources sub-group of the Scottish cancer group failed to do the job that it was given in the Government cancer strategy document. Will the minister tell us how many times the sub-group has met, how many reports have been received from it and whether any of those reports mentions the growing problems at the Beatson centre? Like most of the Government's strategies, the cancer strategy is dominated by committees, sub-groups and action plans that produce a lot of talk and centralised guidelines that seem to buffer the Executive from reality. For example, the Scottish cancer group has to my knowledge at least four sub-groups and three groups of regional advisers.
We heard today from Malcolm Chisholm, in response to Mary Scanlon, that he hopes that consultants will not break away from the NHS. We cannot run an NHS on hope. That is like trying to run it on a wing and a prayer. We need more than hope; we need action.
Will we hear clearly from the Conservatives where they stand on that question? Do they want such a breakaway to happen? They are always trying to talk up private health. Do they support the NHS or do they think that it is a Stalinist creation?
We want consultants to be paid properly for the job that they do. If a problem exists that means that consultants are attracted elsewhere, we must put in place pay—not bribery, as Duncan McNeil said—to keep them in the NHS. We must also ensure that they are empowered to do their job. If we take away the power of a consultant or a doctor, he or she will simply leave and go where they can carry out the job that they have been trained to do. Until the Government starts to return the power that fundholding gave, consultants and doctors will continue to leave. That is a reply and a solution, but the Executive will not listen, just as it does not listen to patients or other people on the ground.
The Scottish Conservatives make no apologies for much of the internal market, which gave doctors power and would have allowed a much smoother transfer of resources from the health boards to the network centres. We think that it has a role to play again. It would have increased the swiftness of purchasing of places for patients when they needed them most.
The Conservatives urge the minister to stop creating more and more sub-committees and more and more action plans and instead to do what he should be doing: getting out to meet the people on the ground and monitoring his initiatives constantly. The minister has to lead the health service by getting off his arse and finding out what is going on. We have had enough of committees. That is why people feel that the Executive does not listen to their concerns.
The Conservatives thank the SNP for lodging the motion. I ask members to reflect on whether a crisis at the cancer centre that provides 60 per cent of the cover for Scotland's cancer patients does not warrant a ministerial statement. That the Executive relies on the Opposition to spend its time debating such issues shows the contempt in which the Executive holds the Parliament.
The Conservatives will support the SNP motion. There is little to redeem the Executive's behaviour in the past two years or the past two weeks. The tragedy is that there will be more Beatsons under the Scottish Executive. There will be more gaps between initiatives and what actually happens. That is why we will back the SNP motion.
As Deputy Minister for Health and Community Care, I share this morning's clearly expressed concerns about the current pressures, particularly the recent loss of four consultant staff, at the Beatson oncology centre in Glasgow.
I am aware of the concerns and anxiety that the situation has raised not only among staff, but among patients—and their relatives—who receive cancer treatment in the west of Scotland. I take issue with Ben Wallace's comment that we treat the matter with contempt. I can assure him that we do not.
Is it not contemptible to ignore concerns for two years, only to come up with something when the situation reaches crisis level, as it did two weeks ago?
The way to resolve the difficulties is the approach that Malcolm Chisholm has taken over the past two weeks. Last week, the minister announced new management arrangements for the Beatson oncology centre, to give new leadership there. That shows that we will act and not just offer warm words.
The minister praised Malcolm Chisholm's speedy action of the past two weeks. Does the minister accept that Susan Deacon neglected to act for two years to stop the Beatson falling into decline?
Nicola Sturgeon will know that the Executive's action plan for cancer, "Cancer in Scotland: Action for Change", was drafted when Susan Deacon was Minister for Health and Community Care. Therefore, Susan Deacon cannot be criticised for the Beatson situation either.
Dr Adam Bryson's recent appointment as the Beatson director will drive forward the implementation of the agreed action plan, which was drawn up by the chief executive of NHS Greater Glasgow, Tom Divers. Dr Bryson will report directly to him. Tom Divers has also been asked to fast-track plans for the new replacement for the Beatson at Gartnavel—that matter was also asked about frequently this morning. An outline business case for phase two of the Gartnavel cancer centre is expected by the end of this month.
We are also aware that we need to tackle the immediate problems and the imminent staff shortages at the Beatson. That is our and Dr Bryson's top priority.
Will the minister take an intervention?
No; not just now.
Advertisements for the six Beatson posts have been placed in medical journals and a headhunter has been appointed to help to recruit for the forthcoming vacancies and the new posts that were created last month by the Scottish Executive's additional cancer services investment.
Will the minister give way?
Will Nicola Sturgeon give me one minute to finish my point?
Margaret Smith asked whether those advertisements would be dealt with appropriately. I assure members that only suitably qualified and experienced consultants will be employed. There is no question of our taking anything less than the best for Beatson. I hope that Margaret Smith accepts that reassurance.
Will the minister tell us today how many applications have been received for the new and vacant posts and how many of those applications are from people with the necessary training, qualifications and experience? Will she also tell us what action that is different from that taken by the old management Adam Bryson has taken since his appointment to the Beatson to attract consultants to Scotland? The minister undoubtedly recognises that we will have to attract consultants from south of the border and from abroad.
There have been five expressions of interest. I am not aware of those people's individual qualifications, but my reassurance must be accepted that only suitably qualified and experienced people will be considered for those posts. I am interested in considering new ways of attracting staff. I am sure that Dr Bryson is taking that matter on board by recognising that difficulties and shortages need to be addressed by looking not just here in Scotland, but in Britain and Europe.
In order to maintain services to patients during the period of consultant vacancies, locum posts have been advertised and the Beatson management team, through established contacts in Europe and at international centres, is proactively headhunting.
New internal management arrangements are being implemented at the Beatson. An external clinical support team has been established and a project manager has been identified to take forward the action plan.
The west of Scotland regional cancer advisory group will hold its first meeting on 20 December, when it will discuss matters such as how to deliver clinical services and how to improve the overall service.
Will the minister give way?
I will not take an intervention just now.
The head of the Scottish Executive's health department strategy change unit is working with Beatson staff to create an organisational development plan to support the cancer centre and the managed clinical networks. The unit will hold its first development day for senior Beatson staff on Friday 14 December.
All those actions show that work is on-going and that we are seeking to improve the present situation.
I must wind up.
Yes. The minister is on her last minute.
Better communications between staff will ensure that everyone works together for the benefit of patients. The minister said this morning that he will listen to the health service staff and will act on what they say. He has shown already that he is ready to act. Change will not happen overnight, but action has been taken. The minister has also said that he will listen to constructive suggestions that arise in the chamber—if any are forthcoming.
Our aim is to provide better and improving cancer services for people throughout Scotland. Given the present situation, we will be particularly looking to the interests of people in the west of Scotland.
I begin with a word of advice for members on the Labour benches. It does not matter how often they say that Labour is managing the health service well, nor does it matter how loudly Duncan McNeil says that Labour is doing a good job for the health service, because the people out there do not believe that. I say to Labour members that I understand perfectly their frustration at their Government's inability to tackle the problems. I suggest that Labour members should direct their frustration towards their front-bench spokespeople and their ministers, who should be getting to grips with the health service, rather than trying to blame the Scottish National Party for the ills of the health service. Those ills can be laid directly at the door of the Minister for Health and Community Care and the health department.
Will the member give way?
No. The member did not do so. He should sit down.
How did we arrive at a situation in Scotland in which cancer patients who are referred for potentially curative therapy have to wait up to six months after diagnosis before treatment starts? That is the situation for many cancer patients. Members from all parts of the chamber should be concerned that, in Scotland in 2001, that is the case. The situation is not good enough.
I do not doubt that all of us, across all the parties, want that situation to change. However, it is not acceptable for Jack McConnell to have said in The Herald today that people should accept delays in their treatment and that we should learn to accept that that is the way in which the health service operates. We should not accept that; we should aspire to something much better than that.
Nearly everyone in the chamber will have been touched by cancer in some way or another—through family or friends. We know the anxiety and fear that a cancer diagnosis brings. Cancer patients need to know that their chances of survival will not be hampered by a lack of cancer specialists, outdated equipment or poor facilities. It is unfortunate that that is the picture of many cancer services in parts of Scotland. Cancer patients need to know that they will have the best chance of survival.
The situation in the west of Scotland is, unfortunately, in a league of its own. We have heard from many members this morning the history of how the crisis at the Beatson centre arose. I do not intend to go into that again, apart from to say that there was clearly a catalogue of mismanagement and Government inaction. I reiterate the point that John Swinney made. The minister has talked about listening to clinicians. We should listen to clinicians, but for two years clinicians have drawn attention to the looming crisis at the Beatson centre and ministers have appeared not to listen to them. Their calls have fallen on deaf ears.
That is what we take issue with. It is not all about money or investment, although that is important; it is also about the lack of Government action and the arrogance of Government in not listening to clinicians when they told of the developing situation at the Beatson centre—[Interruption.] That arrogance is being ably demonstrated by back-bench members of the Labour party today. Such arrogance led directly to the current situation at the Beatson.
Although the Minister for Health and Community Care's swift action to deal with the management issues at the Beatson centre is welcome, his saying that he will accept a possible permanent reduction in cancer clinics in the west of Scotland is not welcome.
Shona Robison has said that she will not go through the history of the situation, but that is exactly what she has done. What would an SNP health minister in Malcolm Chisholm's place do differently, particularly with regard to staff recruitment?
We have already made a positive suggestion about an enhanced pay and conditions package to attract consultants to the Beatson, which has, as ever, been dismissed. Jack McConnell gave a line about listening to good ideas from other parts of the chamber, but unfortunately they have fallen on deaf ears once again.
In reply to Robert Brown, we would not ignore the pleas of clinicians. We would have listened and responded to their pleas; we would not have exhibited the arrogance that has, unfortunately, been exhibited by the coalition parties.
As many people have done, I commended the Minister for Health and Community Care for his swift action in response to the management issues at the Beatson, but it is not acceptable for us now to be told about a reconfiguration of services. We all know what that means—a reduction in the number of cancer clinics in the west of Scotland, which is not an acceptable state of affairs. I would have hoped to hear something a little more positive from the Minister for Health and Community Care this morning.
Will the member take an intervention?
No; we are running late.
I will accept an intervention from the minister.
I wish to clarify what I was saying. I did not say that I would justify every single change; I acknowledged that clinicians are saying that there needs to be some reconfiguration of services. I said that, as part of listening to them, I would go by their judgment on that matter.
Shona Robison must now bring her speech to a close.
Clinicians are saying that they want services in Glasgow back and that they do not want them to be withdrawn. I am suspicious about what is driving the decisions that are being taken.
Will the member take an intervention?
We can have no more interventions.
My concern is that the decisions are being driven by a cost-cutting agenda. That should be prevented. I hope that the minister will reconsider the situation. I also hope that the minister, unlike his back benchers, will take a more responsible attitude to the constructive suggestion that was offered by my colleague Nicola Sturgeon: to consider an enhanced pay and conditions package to attract consultants to the Beatson centre.
We need to take radical action. Otherwise, we will be discussing the situation again in a year's time and nothing will have changed. That would not be acceptable.