Health Plan
The next item of business is a statement by Susan Deacon on the health plan. The minister will take questions at the end of her statement and there should therefore be no interventions. I invite members who wish to speak to press their request-to-speak buttons now.
This statement marks the publication of "Our National Health: A plan for action, a plan for change". It sets out a radical plan to improve the health of the people of Scotland and to rebuild and renew our national health service. It is not just another Government policy document: it represents a continuum of policy, but a step change in delivery. Its focus is on the practical, and our aim is to ensure that record investment delivers record results for the people of Scotland.
This Parliament was created not just to talk about problems, but to deliver solutions. Devolution was never intended as an end in itself, but as a means to deliver improvements in people's lives. That is what the health plan is about. "Our National Health" is the culmination of almost a year's work: a year of dialogue, discussions and debate; a year of listening and learning; a year of capturing strengths and identifying weaknesses.
We did not simply sit behind closed doors in St Andrew's House when developing this plan. We reached out; we consulted the public—patients, individuals and communities; we spoke to health care providers, including NHS staff, their representatives, voluntary organisations, local authorities and many others; and we listened to the views of members of this Parliament and of its Health and Community Care Committee. The actions and priorities that are set out in "Our National Health" reflect those views.
"Our National Health" seeks to provide a platform on which we can build a national effort to improve health and health care. Improving health comes first, and rightly so. It is time for Scotland to cease being a case study in ill health, and to become a showcase of good health. Tackling the root causes of ill health is at the heart of this Executive's agenda—not just in health itself but across all our work to achieve social justice in Scotland.
We will work together to close the health gap between rich and poor. Over this and the next three years, more than £100 million will be spent through our new national health improvement fund. Health boards and local authorities will work together to route that money to local communities, especially the poorest ones. There will be a major expansion of breakfast clubs, fruit in nursery schools, free toothpaste and toothbrushes to 100,000 Scottish children and better screening and immunisation. Those are just some of the ways in which that money is being put to work.
The Public Health Institute for Scotland has recently been established, and will start work in earnest early next year. Four major health demonstration projects, backed by £15 million, have been launched in the fields of children's health, sexual health and the prevention of cancer and of coronary heart disease.
Prevention is as important as cure. We want the NHS to be a truly national health service—not simply a national illness service—working together with local authorities, the voluntary sector, the public and private sectors and, crucially, individuals and communities to improve health.
Alongside our plans for improving health are those to improve the health service. The NHS is our nation's biggest and most important public service, and its creation in 1948 was a defining moment in our nation's history. Its architects—William Beveridge, a Liberal, and Nye Bevan, a Labour minister—left us a legacy of which we can be proud. It is a legacy upon which this Labour-Liberal Democrat coalition is determined to build. The founding principle of the NHS, that care be provided according to need, not ability to pay, holds good today, as it did more than 50 years ago.
There is much to be proud of in our NHS. Too often we forget that in the cut and thrust of political debate. It has skilled and committed staff, and offers leading-edge clinical practice and life-saving treatment and care, delivered every day throughout Scotland. In just one day in the NHS in Scotland more than 60,000 people will visit their general practitioner; community nurses will make more than 12,000 visits; 2,500 operations will be performed; and more than 24,000 out-patients will be seen. It is a formidable operation, one that we should be proud of.
In our research with patients across Scotland, time and again people told us how much they value the NHS. They do not see it just as a service, but as part of the fabric of our society. They told us that, in general, they were satisfied with the care and treatment that they received and they described many examples of good practice and high-quality care.
There were also concerns. People said that there were too many delays, too much fragmentation and too much waiting. Concerns that there was too little information and poor communication came up time and again. People felt that too often the NHS did things to them rather than with them. They wanted to be cared for as well as cured. They wanted to be rushed less and listened to more. They wanted more flexible access to services and to be able to make informed choices.
It was striking that our discussions with staff echoed many of those themes. They, too, wanted to put care back at the heart of the NHS, to be able to respond more effectively to the needs of their patients, and to be valued and listened to more. They, too, complained of fragmentation and the loss of identity of the service that they joined.
This plan acts on those concerns. Our aim is to champion what works, as well as to deal with what could work better. Investment is the key to delivering improvement. The NHS has suffered from decades of underfunding and short-termism. By any measure we have made a major start to turning that situation around.
We have committed record levels of spending for this year and each of the next three years. The health budget will rise from £4.9 billion in 1999-2000 to £6.7 billion in 2003-04. Next year, every health board will receive an increase of at least 5.5 per cent. Under the new fairer funding formula, which recognises the needs of deprived and rural areas, many parts of the country will receive much more. New hospitals and health centres are coming on stream. We are investing in technology and vital equipment. We are recruiting and training more staff.
However, more spending is only half the picture; we must spend better. Our aim is to ensure that resources reach front-line patient care, and that investment is matched by reform. Reducing bureaucracy and rooting out outmoded ways of working are equally important if our people are to get the treatment they need and deserve.
Reducing waiting is a priority. We will work to ensure that the patient's journey, from GP practice to out-patient clinic, and from hospital to home, is better, faster and more responsive. Our aim is for people to get the right care in the right place at the right time. Progress has already been made. In the past year, the number of one-stop clinics has doubled, giving patients better, faster diagnosis and treatment. More people are being treated—50,000 more operations were performed this year than last.
Much more still needs to be done. "Our National Health" sets out a radical programme to transform fundamentally the experience of patients. We will provide better, more comprehensive access to services through the introduction of round-the-clock telephone advice via the new NHS 24 helpline. We will accelerate the development of telemedicine and improve communications to speed up appointments, prescriptions and test results.
We want to work with staff to make the best use of the skills of all members of the health care team. We will roll out existing pilot schemes to develop new roles for our 1,100 community pharmacists, thereby improving access to advice and medication in our communities. We will extend the role of nurses in prescribing and will publish major new proposals on public health nursing, including the school nursing service. We will develop alternative contractual options to ensure that GP services are provided where they are needed, particularly in our poorer and more remote communities.
We will work to reduce the time that patients have to wait. Our target is to ensure that appointments are available within 48 hours with an appropriate member of the primary health care team. We will reduce waiting times for non-urgent in-patient care, and will ensure that, by 2003, no one will have to wait more than nine months, instead of the current maximum of 12 months.
The patients' voice must be strengthened, and £14 million will be made available over three years to improve communication, patient information and partnership working with individuals and communities. All clinical guidelines will be made available in a patient-friendly format, and the NHS complaints system will be reviewed and improved. Advocacy services will be expanded. Training for managers and staff to involve patients and communities more effectively will be introduced.
For most of us, most of the time, the NHS is simply a reassuring presence—it is there if we need it. However, we all need it most at the beginning of life and when we grow older. We will make children and older people a priority for the NHS in Scotland.
We will provide better support for parents—along with child health promotion initiatives and better health services for the very young—to give all our children a better start in life. Better and more joined-up community services for older people will be backed by increased investment. Those services will make a real difference, as they will help older people to stay at home longer and to get home from hospital more quickly and safely.
Coronary heart disease, cancer and mental health are the three agreed clinical priorities that have been identified for special action. There is sound knowledge of what needs to be done, in relation to both prevention and treatment and support for those already affected. The challenge is to ensure that such knowledge is applied systematically to reduce illness and improve patient care.
In 2001, we will publish a national strategy for reducing heart disease and, by 2002, access to diagnosis and treatment will meet strict new targets. Managed clinical networks will link local, regional and national services for heart disease. In 2001, a comprehensive Scottish cancer plan will be published and new investment will provide equipment for the diagnosis and treatment of cancer. To improve care in mental health, we will speed up the implementation of the framework for mental health and new investment will support the delivery of national standards of care across Scotland.
Key to our approach is the development of national standards that will be delivered locally. We will work to end the postcode lottery of care that grew up under the internal market. The market fragmented the system and demoralised staff. It has been abolished, but too many of its systems and practices remain. Patients and staff need stability and now is not the time to embark on more wholesale structural reform; however, it is the time to rewire the system to make the NHS work more effectively for patients and staff.
There is a range of views on the optimum number and configuration of NHS bodies in Scotland. However, any major structural change must be the product of full and considered discussion and debate. That will take years, not months, and will almost certainly require further statutory change. We will initiate a review next year to consider those matters and to allow people to participate fully in that debate. In the meantime, we will take immediate steps to streamline the bureaucracy of decision-making structures and to improve accountability. We have made changes already in the health department to achieve greater integration and improve performance. We will do the same locally.
In each health board area the separate board structure of NHS trusts and health boards will be replaced by a single unified NHS board that will be held to account for the performance of the whole local health system. The plethora of health improvement programmes and trust implementation plans will be replaced by a single local health plan. Stronger links will be forged with local authorities and the voice of staff and patients will be enhanced.
NHS trusts will remain and will retain their operational responsibility for the delivery of services, but they will do so with streamlined management arrangements and with a greatly reduced number of non-executive trustees.
A new performance management framework will be introduced, so that each unified NHS board is held to account for its actions against agreed national and local priorities. We will work to re-establish the identity of our national health service, rather than retain the proliferation of signs and logos that confuse patients and alienate staff.
This is not about centralisation; it is about rationalisation, integration and improvement. We want front-line staff to be empowered. We want decision making to be pushed to the local level as far as possible, while remaining within a framework of strong national clinical and service standards. It is unacceptable that good policies—the result of hard work and wide consultation, approved and supported at the national level—should fall down at the crucial stage of implementation in local communities.
We believe that we can and must rebuild the NHS as a truly national health service, delivering national policy to the same standards of excellence across the whole of Scotland, from our cities to our islands. NHS staff will be at the heart of our work. The public value NHS staff, and the NHS must do the same. Staff must be involved in decision making within the NHS, in accordance with the principles of partnership working that we have pioneered and driven forward in Scotland. In future, NHS boards will be assessed on their record as employers, and staff will be involved in that through their local partnership forums. We will continue to work with the other UK health departments to develop NHS pay modernisation, and we will continue to recruit and train more NHS staff and to plan effectively for the future.
Today I have set out the main themes in "Our National Health". In the time available, I could only touch on those themes. The plan does not seek to identify every issue and every action that is important, but it sets out a clear and unequivocal direction of travel: to build a national effort to improve health; to rebuild our national health service; and to put patients and staff at the heart of that effort. The publication of this document is a beginning, not an end. Over the months ahead, a programme of measures will drive forward its implementation. We will work to change culture and practice.
"Our National Health" is a plan for action. It is a people's plan. It is a Scottish plan. It is the right thing to do. Now we need to work together to make it happen.
We will now have questions on the minister's statement, for which I will allow approximately 25 minutes.
I thank Susan Deacon for her statement. It is reassuring to know that, after two years, Labour at last has a plan for the future of the NHS in Scotland, even if large parts of it appear to consist of plans to produce further plans. Nevertheless, I welcome much of what the minister has announced today, especially the parts of the statement that focused on improving health in Scotland. In a spirit of consensus, I commend Susan Deacon for focusing on health in Scotland rather than simply on the health service.
Does Susan Deacon agree that, after two years of Labour and one Labour reorganisation of the health service that clearly did not go far enough, we simply cannot wait another five years to put in place an NHS structure that can deliver for patients? Can we not move much more quickly—with consultation, of course—to put in place an effective structure that works, and that works for patients? Does the minister also agree that, as she has failed to deliver on the waiting lists pledge on which she was elected to office, any pledges that she makes today will be treated with some scepticism?
It is the detail of the minister's plan that counts. Much of what she has announced today seems to be predicated on an expanded work force. Will she tell us precisely how the Scottish Executive will address the nursing shortage in Scotland and how it will recruit and retain staff in the NHS to make up for the 900 nurses lost to the NHS since 1996? Can she tell us when this Parliament will have an opportunity to debate the detail of the plan? She said that there was insufficient time to go into detail. When will we get the opportunity to do so? If the minister can answer those questions in the spirit in which they are asked, I am sure that all of us in this Parliament, working together, can make progress towards implementing certain parts of her plan.
I hope that, in the months to come, we will have not just one opportunity to debate the detail of this plan but many opportunities. I stress that the plan should be seen as the start of a process and not the end. Part of the key to achieving the changes we seek is fostering widespread, open, measured, mature and informed debate on health and the NHS in Scotland.
Since devolution the Parliament has given more consideration to health-related issues than to any other subject area. It is good that the Parliament is choosing to scrutinise the issues, but we owe it to the people of Scotland to raise the standard of some of the contributions that we have heard from some parts of the chamber recently. I am pleased that Nicola Sturgeon and others have joined us in debating health improvement, for example. I hope that they will join us in taking forward change.
Nicola Sturgeon suggested that this was the first plan to have been produced in three years. I suggest, respectfully, that she look at the vast policy framework that has been developed since Labour was elected in 1997 and since the partnership Executive came to power in 1999. It includes "Designed to Care", the health white paper, the acute services review, the mental health services framework, the community care action plan, the learning disabilities review, the human resources strategy, the education, training and lifelong learning strategy and much more. We do not need to add to those policy documents; we need to ensure that they are translated into practice. Patchy implementation has been identified in all our discussions with staff and patients and there is now a desire to move forward and ensure that the implementation is improved.
A question was asked about structural reform. Let us not make the mistake of seeing that as a panacea. Let us recognise that we now need to change culture and practice as much as, if not more than, structure. Proper and full consideration should be given to the optimal arrangements for a post-internal-market, post-devolution NHS in Scotland. We will initiate that process next year.
We need also to work quickly within the existing statute and structure to strip out bureaucracy, to ensure that decision making is more effective and that patients' needs are responded to more effectively. I think that we have struck that balance. We are radically changing what goes on in the boardrooms, with a view to improving what goes on in the wards and communities. We will take that change forward quickly, in consultation and dialogue with the health service. I fully expect it to deliver results.
There are many points in the plan that I would welcome, but given that it has been delivered to us only in the past hour, it is quite difficult to respond to it. I acknowledge the commitment to mental health, greater patient information, greater support for parents, child health promotion and, in particular, the commitment to GP services in poorer and remote areas. I agree with the Minister for Health and Community Care that it is implementation that counts. I am glad that she can remember all the plans, strategies, reviews, consultations and focus groups. They are beginning to fill a library.
It is difficult to believe that the minister will endorse and implement the plan announced today when it is a full admission of failure. Labour has had four years—not two years as Nicola Sturgeon says—to get waiting lists down and to show how Labour works for the NHS.
I would like to know the answers to the following important questions: how will the new boards be responsive to local needs, how can the minister be sure that they will implement the strategies that she announces and how will she hold them accountable? What is being done to fully integrate general practices into the health service and to encourage them to provide more services and greater innovation?
We are very concerned to ensure that the NHS at a local level is responsive to local communities. There was a concern that once the Scottish Parliament was established things might shift to the centre. Sometimes truly local issues have been overly elevated as national issues in this chamber. It is important that local public service providers are accountable to local communities.
We believe that achieving the integration, clarity and transparency of local boards will aid that process, as will strengthening the links with local authorities. The new accountability and review process to be announced early next year and the new performance management framework for NHS bodies in Scotland will assist us to strike the appropriate balance between national standards and local priorities—being responsive to the needs of local communities. It is a demanding agenda and a big culture change for the NHS, but we must work to bring that change about.
Mary Scanlon is right to say that GP and other providers of community-based health services are key to delivering the changes that we need. All too often, debate and discussion in the NHS focuses on what goes on in our hospitals. Nevertheless, 90 per cent of all contacts with the NHS in Scotland begin and end in a primary care and community health setting. All too often, the problems that arise in our hospitals find their causes—or indeed solutions—in a primary care or community-based setting.
We do not agree with the previous GP fundholding system, which we think was inequitable and led to a two-tier system—that is why it was ended. We believe that the local health care co-operatives that have been established since the abolition of the internal market are beginning to show the way to ensure effective innovation in primary care. In developing the new unified boards, we will work to ensure that LHCCs, GPs and all members of the primary health care team take a full part in planning and decision making for the local NHS.
I welcome the minister's statement and in particular her determination that the record resources being spent on the NHS reach front-line patient care.
Although I do not dissent from the proposed streamlining of the NHS structure, I want to know whether the minister will take on board the strongly held view of the Liberal group that the last thing that the NHS in Scotland needs is a prolonged—I stress the word "prolonged"—period of restructuring, upheaval and uncertainty, which will not improve patient care, will demoralise doctors and nurses and will deter high-quality candidates from applying for senior management positions. Will she set a tight deadline for the proposed restructuring?
How does the minister expect the plan to impact on an acute services review, particularly in regard to cross-boundary co-ordination and co-operation between health boards to ensure national standards of care? I say that with some feeling as a regional member whose constituency contains three health boards.
Keith Raffan raises two important points. I agree with what he said about structural reform. I am concerned that Nicola Sturgeon is urging us to implement wider structural reform more quickly. The last thing that the NHS needs at this time is widespread and ill-considered structural reform. The NHS needs the removal of bureaucracy and the introduction of more effective decision-making arrangements. That is what we are aiming to achieve to ensure the improvement of front-line patient care and the empowerment of front-line staff. All too often, the complex machinery of the current system stands in the way of that task.
The immediate changes that we aim to make will be rolled out from the beginning of next year and through 2001. We recognise that it will take more time to manage that change in some parts of the country than in others. We are talking months, rather than years, to bring those changes about. The longer-term consideration of management and structures in the NHS in Scotland ought to be considered through open and sensible debate. When we announce that exercise early in the new year, we will include a timetable for the process.
The issue of local acute services reviews is important. The national acute services review that was published in 1998 set out a sound and robust national framework for the way in which acute services could be provided across Scotland. It set out ways in which centres of excellence could be developed effectively while we ensured that, where appropriate, services could be provided closer to peoples' homes. It set out how managed clinical networks could be used to make the best possible use of skills in the NHS across Scotland.
As with other areas, however, implementation of the acute services review has been patchy; the management of change at local level has been varied, in terms of the effectiveness of local discussions and local decisions. It is important to take decisions locally, but it is also important to look across borders and between health board areas to ensure that change is managed effectively across Scotland. One of the many commitments in the plan is that we will set up a national advisory body to assist local NHS boards and the Scottish Executive in taking forward the much-needed change process.
Understandably, many members wish to ask questions on this statement, so I ask members to keep their questions as succinct as possible.
I welcome many of the principles that the minister has expounded and I look forward to the Health and Community Care Committee studying the detail of the plan. The Parliament should congratulate all those who have been involved in the work.
What arrangements does the minister propose to put in place to ensure the detailed implementation of the proposed local health plans, which will replace health improvement programmes and trust implementation plans? How will those plans link with local authorities' community plans and the plans for developing community schools, health-promoting schools—under the health promotion unit—and the long-term commitment to healthy living centres? How will the plan cement local authority links?
Links with local authorities and other providers of care, including voluntary organisations, are essential if we are to build services around the needs of individuals and communities. In the plan, we are clear that there must be effective links between local health plans and the emerging and growing role of local authority-led community plans and, as Richard Simpson says, other community-based initiatives, such as health-promoting schools, new community schools and healthy living centres.
We have set out clearly in the plan the key principles and priorities that we want to achieve and we have pointed to other work that will address those priorities. We will be publishing three major programmes early in the new year to drive forward the implementation of the changes that I have outlined today and the changes that are outlined in the plan. The detailed implementation of the points that Richard Simpson and many others raised will be taken forward in that process, in full discussion with the national health service and other care providers.
I take this opportunity to thank the Convention of Scottish Local Authorities and various local authority representatives, as well as people within the NHS, for their contributions to the plan.
During the health debate this morning, Frank McAveety said that the waiting lists pledge in Labour's 1999 manifesto was a mistake. That was later contradicted by the Deputy Minister for Health and Community Care, who said that the Executive would deliver on the waiting lists pledge by 2002. Who is right? If it is Malcolm Chisholm, why did the Minister for Health and Community Care make no reference in her statement to delivering on the waiting lists pledge?
I may not have been in the chamber at the time, as the Opposition commented, but, through the wonders of technology, I was able to listen to and watch much of the debate, including Frank McAveety's speech, and I know that that is not what he said. However, let me answer on my own behalf. Waiting lists are and remain one measure of performance on waiting in Scotland. They tell us how many people are waiting for treatment—in a snapshot—on a given day at a given time. Those data are relevant and it is relevant to work to reduce the number. We are doing so, and remain committed to doing so, but we also need to look at how long people are waiting on lists and at how many people are receiving treatment.
I am pleased that, in relation to those other measures, the NHS in Scotland is performing better than the NHS in other parts of the UK. It is treating more people and is treating them more quickly, with more than eight out of 10 Scots receiving in-patient treatment and care in less than three months—that is the best performance in the UK. We want the performance to get better still. We want a full and transparent report of performance on waiting across the NHS in Scotland. I hope that we will consider in a full and considered way all the data that are available, rather than just picking and choosing numbers. I answered Shona Robison's direct question about waiting lists. It would be interesting to know whether the SNP continues to hold the view that what matters is reducing waiting times.
In asking questions on the document, I find it tempting to treat it as a summary of every press release on the website since 1997, as that is what the vast majority of the plan seems to be. I have one simple and straightforward question for the minister. Why did she not print in full the results of the MORI survey on attitudes towards the health service? Was it because the half of the survey that is not printed showed complete dissatisfaction with the Labour party and its health policies? Is she frightened to publish any of the public's criticisms?
We did not print the MORI survey in full in the plan, but we printed a pretty candid summary of the key findings. We did not print in full the plethora of comments that we received or the range of submissions from many stakeholder groups. We did not print the wide range of feedback that we received through the qualitative research that we undertook and the quantitative research that was conducted.
As Ben Wallace knows full well, members of the Health and Community Care Committee were given a full presentation on the MORI survey, because the time was available to do that. It is unfortunate that someone chose to put selective figures from that survey into the public domain. We have been as open, candid and frank as we can be about the strengths and weaknesses that we have identified in the NHS in Scotland. Rather than simply talking about weaknesses, we want to address them, fix problems and build on strengths. That is the purpose of the plan.
Will the minister say how the health plan will tackle health inequalities in deprived areas such as Greenock and Inverclyde?
There is no quick answer that does justice to that question. I will simply say that tackling health inequalities is one of the key priorities not only in health policy, but across the Scottish Executive's work. Narrowing the health gap between rich and poor must be a priority in Scotland. In "Our National Health", we set out how we want to take health to people, not just people to the health service. We want to work in communities to empower individuals and communities to achieve better health. We want to tackle the root causes of ill health, such as poverty, poor housing and lack of educational and economic opportunity. I assure members that ministers across the Executive will continue to work together to achieve that goal.
I welcome the document and hope that it makes a difference to Scotland's health. In his foreword to the health plan, Henry McLeish says that he wants to build a 21st century health service in Scotland. Many medical staff tell me that they must deliver the service using antiquated medical equipment. In Grampian, 25 per cent of general medical equipment is beyond its standard life. Will the minister outline what action the health plan will take to address that worrying situation? Will she instigate an investigation into the age profile and condition of medical equipment in Scotland's hospitals?
The condition of medical equipment in Scotland's hospitals worries me, too. That is one of many matters that has suffered through the many years of underfunding in the NHS and the short-termism that was characteristic of the internal market, which militated against decisions to make long-term investments.
To address that, we have made available more money for capital spending this year and next. From memory, I think that £179 million will be provided this year, which will rise to £194 million next year. In addition, we have targeted investment where there is the greatest need in equipment, including £30 million to deal with some of the most pressing equipment needs, which Richard Lochhead rightly identified.
When members have an opportunity to read the detail of "Our National Health", they will see that the Executive reiterates that that matter is one for attention nationally and locally. For some major equipment, work must be done nationally. We have already taken action on that in relation to investing in major cancer equipment. However, the NHS must be able to take decisions locally on X-ray equipment, scanners, endoscopy equipment and other items. It is also important to ensure that the equipment is in place.
I, too, welcome the minister's statement, but I would like clarification on an important issue. How will the new structure respond to local needs? Given the need for proper local accountability and the fact that trusts will, in time, be abolished, how will the structure address the fundamental need for proper local accountability? How does the minister envisage that decision making will be pushed to a local level if the trusts disappear and local representatives are no longer able to reflect local needs?
What will happen over time in the structure of the NHS will be a matter for proper and fair consideration through the review process to which I have alluded. It is crucial that there is effective local accountability, but that and local operational autonomy are not necessarily the same thing. NHS trusts may have created and strengthened local operational autonomy, but the way in which they were created under the internal market did not increase local accountability. The essence of the internal market was to run local NHS bodies as though they were small private businesses, rather than as a public service that was accountable to local communities.
The short-term changes that we propose will—as well as being achievable within the existing structure and statutes—facilitate local operational autonomy and the continuation of effective local management. The system will be clearer and more transparent and it will be clearer to local communities who runs the NHS. Through the wide range of measures that I have outlined in my statement and in "Our National Health", we will work actively with the NHS in the months ahead to equip it to get better at communicating with local communities and individuals, to ensure that people can influence effectively the development of the NHS.
It is difficult to disagree with the minister's general objectives, but—as ever—delivery will be the problem.
Every reorganisation so far has brought extra costs. What are the minister's estimates of the possible job losses, redundancies and costs of the proposed reorganisation of the health boards? What does the minister mean when she says that local authorities will be given a strong voice on the new unified health boards? I welcome guaranteed staff membership of the boards, but why should not democratically elected local authorities also be granted membership so that they can speak for their communities? Given the experience in Tayside, will the minister spell out how she will counteract the inherent centralisation in the new unified boards?
I stress that in that area of the plan, as in other areas, we have worked closely with a range of people in the health service to examine what changes will be most effective in improving health and health care. That is why we have reached the conclusion that we did. We have not—as a number of members have suggested—concluded that we should restructure the service. We have concluded that we should shake up decision making in the boardrooms and make improvements at that level.
Andrew Welsh asks about costs. We see our plan as a more cost-effective way of taking decisions in the NHS, although I stress that cost is not the main driving and motivating force. The NHS should be more cost-effective as a result of the plan, because there will be fewer all-singing, all-dancing boards in the NHS in Scotland. There will be a greatly streamlined local planning process and fewer appointed members on NHS boards throughout Scotland. I hope that the system is not only cheaper, but better.
I reiterate that the detailed arrangements of how the boards will be made up in each area will be part of the programme of change that will be launched early in the new year and taken forward during the early months of next year. Different parts of the country have different needs and a different geography, and different numbers of local authorities will be covered by health board areas.
I congratulate the minister on her statement and on getting Nicola Sturgeon to utter the word "consensus"—that must be some kind of first for the Parliament.
Does the minister accept that a single unified board that must be held to account for the performance of the local health service will be difficult to achieve if trust chief executives continue to be separately accountable to the management executive in Edinburgh for the spending by their trusts? Will that separate financial line of accountability be abolished and will those who are responsible for performance within the local health services also be directly accountable for the spending in those services?
Yes.
My first question is about developing national standards. The minister said that she wanted to end the so-called postcode lottery of care. Will she give a bit more detail about how that will pan out? At the moment, the Health Technology Board for Scotland is able to offer suggestions to local health boards and trusts, but it is not compelled to do so. Unless that is changed, the minister can say only that she will attempt to end the postcode lottery of care; she will be unable to say unequivocally that the lottery itself will be ended.
My second question is on patchy implementation. On waiting times, I welcome the minister's statement that, by 2003, people will have to wait for no longer than nine months. At the moment, although the average figures for waiting times across the board are relatively good, there are parts of the system in which waiting times for particular specialist treatment exceed 12 months. How will the minister bring down those times to nine months?
My other point—rather than question—is that we must get work-force planning correct. If we do not, we will be unable to extend the role of nurse practitioners and so on, because the nurses will not be available to do those jobs.
Work-force planning is key and there are a number of specific references to it in "Our National Health", including a commitment to conduct a full-scale review of our work-force planning arrangements for the medical profession. We think that the time is right to do that. We know that there is an appetite for it among representatives of the medical profession—indeed, many have raised that matter with us in their submissions.
On the achievement of national standards, let me make it clear that national standards can derive from a number of sources. They are not just about Government policy documents. They can derive from the Clinical Standards Board for Scotland, which was established last year. They can come from the Scottish intercollegiate guidelines network, which has led the way—arguably not only in Britain, but in many areas worldwide—in establishing effective clinical standards.
However, whether those standards are taken forward is to some extent voluntary. Although I gave a brief answer to John McAllion's question—I have always been desperate to give a one-word answer in the chamber—his point about separate accountability illustrates one of the factors that have militated against our being able to work towards national standards. Clear national standards and requirements have not been set for local NHS bodies and there have been too many different planning systems and separate accountability review processes.
At the heart of the various changes that we will make during the coming months is a desire to bring all that together. We must make it clear that a core requirement of local NHS bodies should be to work towards good, sound national standards in clinical quality or service standards, such as cleanliness in our hospitals.
With the proviso that he will ask a one-line question, I call Mr Sheridan.
I, too, hope that it will be a one-line question, because the minister has already referred to the matter about which I will question her.
The minister rightly puts great store by national standards. Page 26 of the document states:
"High standards of cleanliness are particularly important. There is a perception that standards of cleanliness in hospitals have deteriorated over the years."
Will she give a commitment that cleaning and catering in our hospitals will return to the public sector? That would get rid of the lottery of contracting out those services to the private sector, which has resulted in the problems that we now face.
That was more than one line.
I am sure that Tommy Sheridan has seen that the section of the plan from which he quoted goes on to say more on those issues. In those—as in many other matters—the approach under the Conservatives suggested that private was good and public was bad. We are concerned with ensuring that patients get what is best. We want to see the NHS go for best value, not merely lowest cost. At times, it is appropriate to contract out services, but we say clearly in "Our National Health" that the contract culture should no longer be seen as the norm, as it was for too long in the NHS in Scotland.
I apologise to the six members whom I could not call, but we must now move on.