Health and Community Care
Good morning. The first item of business is a debate on motion S1M-3106, in the name of Malcolm Chisholm, on investment and reform in health and community care, and two amendments to that motion.
Nothing is more important to the people of Scotland than health and the health service. It is therefore right that we should turn our attention once again to investment and reform in health. I make no apology for the fact that we will return to the subject in Aberdeen, with a debate on investment and reform in cancer services.
At the end of April, we debated investment in primary care and I stressed the central role of primary care in transforming the national health service into a right time, right place, right quality care service. Last week, I emphasised the importance of investment in staff and the crucial role of front-line staff in leading change. Today I shall pick up on those themes and describe some other key aspects of the reform agenda and the change process in the NHS, in community care and in the wider arenas of improving health and tackling health inequalities.
First, I shall say what reform is not. Reform is not a top-down imposition, although Government has an important role. Reform is not about structural upheaval, although structures might evolve and change. Reform is not driven by ideology, unless a belief in the founding principles of the NHS and in patient-focused care can be given that name. For us, reform is a collaborative venture with patients and front-line staff to develop and deliver the services that people need in the way that they need them, and to find new ways of improving health and tackling health inequalities. Reform is about making services more accessible and responsive. It is about establishing a culture of continuous improvement that is grounded in evidence and explicit quality standards.
I shall talk about the role of national standards in the reform agenda and the best way in which we can ensure that those standards are implemented throughout Scotland. The Clinical Standards Board for Scotland has been a good example of positive change. I shall refer in a future debate to the board's extremely important cancer reports and in this debate to its crucial work on hospital acquired infections. Nonetheless, we recognised some time ago that we needed to look again at the range and complexity of clinical effectiveness organisations, because their multiplicity had led to confusion and lack of clarity. We are now in the final stages of an extensive consultation on our proposal to establish a new quality and standards board for health in Scotland. That board will build on and develop the role of the existing organisations and it will have new and challenging responsibilities and powers. The development of the quality and standards board for health in Scotland will be an important driver for change and for ensuring change.
The reform of clinical effectiveness bodies will give a new focus on ensuring the delivery of quality services and will provide an independent mechanism for regulating the quality of care. The new body will not be part of the Executive; it will operate independently and its actions, findings and reports will be independent. As such, the quality and standards board will be a key factor in strengthening public accountability. As a body that will have independent mechanisms for regulating the quality of health care, it will provide much more than an inspectorate, because inspection alone does not ensure quality. The board will provide clarity about expectations through standards and guides for best practice; it will be responsible for assuring the patients' safety agenda; and it will provide a focus for national clinical audit. It will have powers to ensure that action is taken when organisations are found wanting, with agreed escalation procedures. It is important that it will have the power to investigate serious failures in clinical service delivery. Those are new and important areas of responsibility, although the new body will also continue the excellent work of the Clinical Standards Board.
If the new board is to be truly independent, who will appoint its membership?
Its members will be appointed in the same way as those of any other public body in Scotland. However, the new board will function completely independently of the Scottish Executive.
The Clinical Standards Board is doing a great deal of important work and is going round all the NHS trusts in Scotland to check their performance against the standards on hospital acquired infection. I asked the board earlier this year to bring forward and accelerate those visits, and I thank it for doing so. Reducing the incidence of infections that are picked up by patients in hospitals is a big health care issue worldwide. We need better ways of tackling the problem and we are supporting the NHS in finding those through the external standards and inspections that I have mentioned. We are doing that by introducing new surveillance systems throughout Scotland, by investing in more training for infection control nurses and by promoting the concept of a cleanliness champion in hospital wards, who will take responsibility for, and offer leadership on, good infection control practice.
The planned infection control convention, which I announced in April, will take place on 28 June and will enable us to gather more ideas, spread best practice and drive forward action in an area that is extremely important to us and—I know—to patients.
The reduction of waiting times for patients is also extremely important. Yesterday, I was able to announce that since January, the national waiting times unit had purchased an additional 2,100 cases from spare NHS capacity that had been identified in eight NHS trusts, and that it had facilitated an estimated 2,000 operations from spare private sector health care capacity on behalf of the NHS. That has resulted in a significant reduction in the number of patients who are waiting more than six months for acute in-patient and day-case treatment. I cannot understand why the Scottish National Party, in its amendment, should regard that as undermining the principle of a universal service that is free at the point of use, to which I and the Executive are passionately committed.
The national waiting times unit is also working on out-patient waiting times—an issue that is of concern to me—and on reducing waiting times for diagnostic tests and for therapies that are provided in out-patient settings. The unit is visiting every NHS board in Scotland to ensure that action plans to reduce the longest of those waits are completed by June. We will also work to ensure that patients and the public have readily accessible, high-quality information about waiting times in every Scottish NHS hospital. That is the aim of the new waiting times database that is being developed. The objective of the database is to provide general practitioners, patients and members of the public with readily accessible, accurate and up-to-date information about waiting times throughout Scotland, so that patients can, if they wish, choose to be treated at a hospital where they will have a shorter wait.
The minister has passed the point that I wanted to make, but I shall take him back to it. In talking about the new inspection regime, he referred obliquely to its having the powers to enforce standards when hospitals fall below those standards. Can he go into more detail about what those powers will be and about what actions the new body will be able to take if, for example, hospitals fail to meet basic standards of hygiene?
Other bodies are involved as well. Nicola Sturgeon has talked before about prosecution. The Health and Safety Executive already has that role, so there is no need for a power of prosecution. The new body will have a power of escalating intervention to ensure that the new standards are implemented. If matters arise in the territory in which I know Nicola Sturgeon is interested, those will be dealt with by the Health and Safety Executive.
Patient choice—the last topic that I mentioned in relation to the new waiting times database—is part of a much wider agenda that has been gathering pace since we published "Patient Focus and Public Involvement" in December. The challenge and the aim of our extensive underpinning programme is to have an NHS in which people are treated as individuals and with respect; in which they are listened to and involved in their care; in which they can improve the quality of care through the feedback that they give and in which they can become involved in monitoring and development of services.
Will the minister give way?
I have a lot to get through. I will give way later, if I have time.
An extensive body of work is being done on that agenda. For example, NHS boards have established some 90 partners-in-change projects, which work with patients and the public. We are developing a public information strategy and we have funded the establishment of an advocacy safeguards agency and an independent alliance of advocacy projects. We have developed much more detailed guidance on public involvement, which has been published in the form of a toolkit. Last week, we issued specific new guidance on consultation in relation to service change, and we will consult soon on new public involvement structures, including a Scottish health council that will be independent of the NHS.
We must also address the concerns of those who feel that they have not received the service that they expected from their national health service. That is why we will consult soon on a new NHS complaints procedure that will be credible, easy to use, demonstrably independent and effective.
If the aim of reform is patient-focused care and designing services around the needs of patients, and if the involvement of patients and the wider public is central to the reform process, it is self-evident that the other key agents of change are front-line staff, because only they can deliver more patient-focused care. Those staff are in the best position to design and lead the necessary service changes. We recognise, however, that work must be done to enable staff to deliver reform. This is about making the NHS a good employer in ways that impact directly on staff. It is about creating the environment that supports innovation and personal development. It is about developing career pathways that are attractive to staff at all stages of their working lives. It is about staff joining the NHS because it delivers the flexibility that they need, rather than their leaving because the NHS cannot deliver. Finally, it is about partnership working in practice.
I remind members that we must apply all that to all members of the health care team. On Friday, I shall be pleased to launch NHS Education for Scotland, which is a new body that will look, for the first time, at the continuous professional development needs of every member of every health care team in Scotland. We must target investment at the right staff.
Will the minister take an intervention?
If I have time, I will give way in a moment. However, I have a lot to get through.
We must equip staff with the right skills not only for today, but for five, 10 and 15 years' time. That means looking ahead at what kind of work force Scottish health services will need in 2020 and beyond. We must therefore ensure that everyone inside and outside the NHS who will have a role in the delivery of that work force works together, with determination and focus, to make that happen. We will publish an action plan in June about what needs to be done, which will be the first national action plan on work force planning and development.
A main theme that I covered in the primary care debate three weeks ago was the need for more integrated care across the primary and acute sectors, so that the patient's journey of care is smooth and seamless. That is critical to the reform process. In that debate, I mentioned examples of new services in primary and acute care, such as the managed clinical network for cardiac services in Dumfries and Galloway. I know that, in the asthma debate earlier this week, Margaret Jamieson mentioned a managed clinical network for asthma in her part of Scotland. Yesterday, I met the respiratory alliance and we discussed the development of such networks for other respiratory diseases, such as chronic obstructive pulmonary disease.
In the primary care debate, I also said that work will go ahead throughout Scotland to change diabetes services by collaboratives of primary and acute care to redesign those services. We need to give local heath care co-operatives and primary care teams the authority and resources to develop and manage enhanced local services, as well as give them real influence over the shape of the whole system. Those issues will be at the heart of our current review of management and decision making in the NHS. However, I am sure that we need to make the necessary developments without reintroducing the bureaucratic systems of the past, although last week the SNP proposed, in its small health document, to reintroduce such systems.
The reduction of bureaucracy is a key part of the reform agenda because it will free up front-line staff. It is also an important reason why investment in information technology is such an important part of the reform agenda. IT is the key to providing better services in line with what patients need and want; it is also the key to improving the quality of health services by allowing better audit of activity and improving access to treatment through telemedicine, electronic booking and faster transmission of information.
In the current year, we will spend £50 million on national IT programmes of work in support of the national information strategy that I launched in February. That covers important national programmes including NHS 24, which uses sophisticated IT and telecom systems, and several other initiatives that I do not have time to detail. They can be mentioned later, if required.
I have emphasised reform because nobody is unaware of the unprecedented, sustained investment in health that was given such a boost by the recent budget. I am also, of course, going to talk about investment and reform in community care. I am sure that we all know about the money that is already going into developments in community care. There is the learning disability review, £20 million for the delayed discharge action plan, £24 million—rising to £48 million next year—to expand home care, over £50 million of extra investment for the care home sector and, of course, £250 million during this Parliament for free personal care.
I do not have time to cover the whole reform agenda in community care, but I think that members will agree that the joint working agenda, backed up the Community Care and Health Act 2002, is key to the development and redesign of services in the area. Our early analysis of initial local partnership agreements that were submitted by local partners in April shows that much has been achieved in establishing joint resourcing and joint management arrangements, but there is still a lot to do. Trust and transparency must replace tribalism and tradition.
The framework of joint budgeting and joint management that we seek to achieve can drive the reform of services from the individual's perspective rather than from the organisation's perspective. We do not want more of the same for our investment. We have no intention of pouring new money into old silos. We want to see more and better joint services and new routes to community care. We also want to see progress on the acid test of delayed discharge.
Of course, members will know of the new way in which we are distributing the £20 million to address the critical issue of delayed discharge. We are examining the action plans that were drawn up by local partnerships and will distribute money only when we are convinced that those plans will deliver. In a sense, dealing with the delayed discharge is the key to the beds issue that the SNP amendment raises.
Investment and reform are also key parts of the health improvement agenda, with particular focus on tackling health inequalities. We are determined to step up our efforts across the Executive this year on that important agenda.
I want to mention a particular demonstration project in a little more detail, because it has attracted media comment this week. However, I will take an intervention from Tommy Sheridan before I do that.
I want the minister to elaborate on the establishment of the new board that will, with other members of the health care team, tackle problems. Will the new board be able to make recommendations about wage levels? The biggest problem in the NHS is the growing gap in remuneration for porters, auxiliaries and other essential members of staff. Will the new board have the power to tackle that problem?
The quality and standards board will not look particularly at that issue, but other bodies are obviously doing so. As I said last week, we are deep into the agenda for change in negotiations that will cover the work force members to whom Tommy Sheridan referred. There has been progress on that issue, but we want more. We also, as I said last week, want progress on the nursing agenda.
The starting well project is an example of the new ways of working in health improvement to which I want to refer. David Olds, an international expert in intensive support for vulnerable families, is addressing a conference about that issue in Glasgow today. The conference is led by the Glasgow health city partnership, with partner organisations that represent a range of statutory, voluntary and academic interests. Starting well is focusing on the promotion of health and protection from harm in the period leading up to birth and throughout the first three years of childhood. The project is based in two of the most deprived areas of the city and aims to demonstrate that child health in Glasgow can be improved by a programme of activities that supports families and provides them with access to enhanced community-based resources.
The project's health visitors and a team of health support workers are providing intensive home-based support in the target areas to all families with new babies. The focus is on parenting and on giving parents practical support, with contact beginning before children are born.
Can I take the minister back to the issue of patients' choice? Will he, as well as publishing waiting times, produce information on the productivity or success of individual hospitals? Will he inform us, like his colleague in England and Wales, of surgeons' performances?
I knew that I could not get through the debate without Ben Wallace mentioning Alan Milburn. I suppose that I should be pleased that Ben Wallace has such a high regard for Alan Milburn. We have made it clear that we shall publish meaningful information about the performance of individual surgeons. Also, we have said that we do not believe in crude league tables that could well be counterproductive.
I want to conclude what I was saying about starting well, which I hope illustrates our determination to be bold and radical when it comes to health improvement. An innovative partnership management model has been developed with One Plus, the lone parents organisation, which enables lay health support workers to fulfil a vital role in the intensive support model. It complements, rather than replaces, the role of experienced health visitors and it is building community ownership for the project, which is well on course to help 1,800 families in some of the most deprived parts of Glasgow. Some 98 per cent of eligible families have agreed to take part.
We must work together on new ways to improve health and to reduce inequalities. Starting well shows how we can do so through new ways of improving health, new ways of tackling health inequalities, new ways of delivering services and new ways of driving forward change. Government must step up its efforts with regard to funding, standards, and—where necessary—intervention and best practice must become common practice. Most of all, Government must create an environment that allows solutions to be developed by those who know best—front-line staff—with the involvement of patients.
I move,
That the Parliament welcomes the Scottish Executive's commitment to sustained investment in health; agrees that investment must be accompanied by reform that is focused on the needs and expectations of patients and service users; acknowledges the progress that has already been made by the National Waiting Times Unit and looks forward to further improvements; supports a collaborative approach to reform which involves patients, staff and the wider public; welcomes the priority attached to dealing with delayed discharge and hospital-acquired infection, and believes that improving health and tackling health inequalities in both urban and rural Scotland should be central features of the reform agenda.
All that we have heard from the minister this morning is a new way of filling 20 minutes without saying anything new. Nevertheless, I welcome the debate.
For the past three years, the SNP has argued that the NHS is chronically underfunded. For three years Labour and its Liberal Democrat partners have said that the NHS is not underfunded, that investment in the NHS is at record levels and that shortage of resources is not a problem. The Wanless report and the budget have proved once and for all that we were right and that the Executive was wrong.
The extra £3 billion that will be invested in the NHS in Scotland over the next few years is welcome, but the NHS might not be in the state that it is in today if the Government had invested more earlier, rather than sticking to Tory spending plans and pursuing an income tax agenda that was designed to win votes only in middle England.
It is absurd that the Executive, in its motion, congratulates itself on providing sustainable investment in health. In a motion that is absolutely littered with incredible claims of success where none has been achieved, that claim really takes the biscuit. Malcolm Chisholm might have delusions of grandeur, but the reality is that the sustainability of health spending in Scotland has nothing to do with the Scottish Executive. It should have, but it does not. It depends entirely on the decisions that Gordon Brown takes south of the border. That is why we have had to wait three years for something approaching the scale of investment that the national health service in Scotland needs.
If the Scottish Parliament had the same powers as virtually every other Parliament in the world, it would be up to us to decide how much to spend on our health service. Some members might not like hearing that, but they will hear it a lot more often in future. We would be able to stimulate faster growth in our economy, which is essential to securing long-term sustainable investment in our health service. However, we have no such powers—we are dependent on decisions that are taken elsewhere. Few things illustrate better the fact that the Parliament is a job half done.
Will the member give way?
Not just now; perhaps later.
The amount of investment is only a part of the equation. As I am sure the Deputy Minister for Health and Community Care has been told many times, it is what you do with it that counts. The extra money that Labour has invested in the past three years and which, according to the Wanless report, is clearly inadequate, has delivered little tangible improvement for patients.
The Executive's motion today is a classic triumph of spin over substance. It praises first the work of the national waiting times unit. The minister told us yesterday and today that there has been a reduction in the number of patients waiting more than six months for acute in-patient and day-case treatment. If that is true, it is good news. But is it true? The Executive's approach to cutting waiting lists and waiting times in the past has been simply to fiddle the figures, to close lists, to dump patients in deferred lists and to reclassify patients to suit Government statistics rather than individuals' needs. Who can say that yesterday's announcement is the result of anything more than the same old fiddling that led to the Audit Scotland inquiry?
I thank Nicola Sturgeon for giving way. If she had read the motion or had listened to my speech she would know that my main emphasis was on the fact that improvement is required. The motion acknowledges progress. It is an undisputed fact that there has been extra activity in the past three months; if Nicola Sturgeon had spoken to hospital workers, she would know that. We are keen to have transparency, which is why we commissioned the Audit Scotland report that will be published next month.
I wonder why, in its press release yesterday, the Executive did not publish figures for every health board in Scotland, rather than for just a select few. The Executive might want to pat itself on the back this morning. It would be better advised to wait for two things. First, it should wait for publication of the official figures in two weeks' time. They will tell us whether the number of people waiting more than six months has reduced significantly in all areas in Scotland, rather than tell us only about the select few areas that the press release chose to highlight. The figures will also tell us whether median waiting times are coming down—in other words, whether the quality of service is improving for every patient throughout Scotland. According to the most recent figures, as the minister will recall, median out-patient waiting times are two weeks longer now than they were when Labour took office. Let us wait to see in two weeks' time what improvement has been made.
Secondly, we should wait for the outcome of the Audit Scotland inquiry. Until it is available no one can trust a word that the Executive has to say about waiting times. The Executive cannot prove what it needs to prove—that every single patient who has been removed from the official figures has been treated.
The motion goes on to say that tackling delayed discharge is a priority and I agree with that. However, Susan Deacon said in December 2001 that tackling delayed discharge was a priority. The problem is that in the year between January 2001 and January 2002 the number of patients awaiting discharge increased by 10 per cent—even after Susan Deacon identified the matter as a priority. Instead of our being told repeatedly that it is a priority, let us see solid and sustained evidence that progress is being made. We need less spin and more substance from the Executive.
The same goes for hospital acquired infection. Again we are told that that is being tackled as a priority. A press release that Susan Deacon issued on 9 February 2001 said:
"Health chiefs told to act now on hospital acquired infection."
Did the health chiefs listen? Not according to the Clinical Standards Board for Scotland's report that was published last month. It said, among other things, that most trusts could provide no evidence of a structured infection control programme. One year and three months after Susan Deacon first said that hospital acquired infection was a priority, most trusts have not even put in place plans for dealing with such infection. However, there is no need to worry, because Malcolm Chisholm issued another get-tough press release, which said:
"NHS told to raise their game on infection control."
The tragedy is that in the period between Susan Deacon telling the NHS managers to "act now" and Malcolm Chisholm telling them to "raise their game", hundreds of people will have died from hospital acquired infection. Only this week the Victoria infirmary in Glasgow was closed for the second time this year because of infection, but all that we get from the minister today is another assurance that tackling infection is a priority.
Will the member give way?
I will take the minister's intervention in a minute when I have told him what we need to do to tackle infection. We need to tackle the root causes of infection, which are overcrowded wards, overworked staff, too few cleaners in hospitals, and private profit taking precedence over patient safety. Those are the root causes of infection—the minister can tell us now how he will tackle them.
Once again I thank Nicola Sturgeon for giving way, but I say again that she has neither read the motion nor listened to the speech. The motion does not display any sense of complacency about either delayed discharge or hospital acquired infection. It says that we have given priority to dealing with those, which is evident from the way in which we are dealing with delayed discharge, including the unprecedented amounts of money that we are making available.
The range of actions that I described with regard to hospital acquired infections show that I acknowledge that there is a problem. This year we will have the first national standards and inspections, which I have introduced because I wanted them to be carried out as quickly as possible. The other actions that I described will culminate in the convention on 28 June, to which I hope Nicola Sturgeon will come.
If the minister had listened, he would have heard me say that the problem is that hospital acquired infection has only got worse since Susan Deacon identified it as a problem. That is not good enough and the motion, which I have read, is not good enough. That is not because nothing good is happening in the health service; that is not the case. Those who work in the service are doing a sterling job and we should never tire of praising them. Despite what the minister is saying defensively, the problem is that the motion is self-satisfied and self-congratulatory and it bears little resemblance to the experience of patients throughout Scotland. The Executive is not making enough progress and it is not making progress quickly enough.
Let me turn from investment to reform. The minister and I agree that the status quo in the health service is not an option. Let us be clear that when we are talking about reform, we are talking about reform of our public health service. Too often, for new Labour and the Tories alike, reform is nothing more than a code word for privatisation—for inviting the private sector into our national health service to make profits at the expense of taxpayers and patients. The SNP wants none of that. We want a health service that is accountable, responsive to public needs and that is supported, but which is also challenged at all times to deliver the very highest standards. We want a health service in which "patient focused" is more than a Government slogan.
Let me suggest some reforms, over and above those that the minister has mentioned, which would begin to make a real difference in the health service. First, let us be bold and get rid of some of the NHS bureaucracy that prevents investment getting to the front line. Trusts are an unnecessary and expensive layer of bureaucracy. The number of NHS boards should be reduced. Secondly, let us shift the balance of power in the health service away from politicians and bureaucrats and in favour of patients and staff. That means democratising the health service. Health boards make decisions that have significant impacts on people's lives, yet they are not directly accountable to the populations that they serve. Health boards do not have to answer to the public for the decisions that they make about the shape of local services or the way in which they spend taxpayers' money. People from all over Scotland feel alienated from the decision-making process in the health service.
Will the member give way?
In a moment. Health boards might go through the motions of consultation, but they rarely act on the outcome. As Bill Butler will know only too well, the health board in Glasgow embarked on a glossy, expensive consultation exercise on its acute services review, but the proposals at the end of the consultation exercise were virtually identical to the proposals at the outset. What is the result of that? The public feels alienated and disfranchised. People feel that they have been consulted but not listened to. It is time to give the public a seat at the table through direct elections to health boards.
Democracy, accountability and transparency are very important and I am sure that members want us to drive towards greater levels of all three. What advantage or progress, in terms of transparency or accountability, would death-rate league tables for individual surgeons give us? On that point, the Scottish secretary of the British Medical Association, Bill O'Neill, said that the different services that are provided by different hospitals would also cause difficulty for that proposal. That is common sense—we would be comparing apples with oranges. How will that help transparency? Is not that the converse of Nicola Sturgeon's argument about league tables in education?
I am glad that Bill Butler managed to read the intervention notes that were provided by his party bosses. I am coming on to surgeons' performance indicators, because they are crucial to giving power to patients. If Bill Butler exercises a little patience, it will be rewarded.
I want to finish my point about democracy. I am glad that Bill Butler is in favour of increasing democracy, because as a Glasgow MSP, I am sure that he has been struck, as I have in recent months, by how excluded from decision making ordinary members of the public are. Democracy will not make the decisions that health boards have to make any easier, but it will make health boards accountable for those decisions in a way they are not at the moment. I hope that the Minister for Health and Community Care is prepared to listen on that point.
We must create a genuinely independent inspection regime in our hospitals that does more than set and monitor standards. It must have real and meaningful powers—not just the opportunity for "escalating intervention", whatever that means—to enforce standards where hospital management is found to be wanting. That is in the interests of patients and those who work in hospitals. A hospital that is failing to ensure high standards of hygiene and infection control, for example, is putting at risk its nurses, doctors and ancillary staff, just as much as its patients.
We must ensure that patients have the power that comes with robust and easily accessible information about the performance of hospitals and those who work in them. Mr Butler might want to listen to this point. That is why greater transparency will be a powerful lever for change in the national health service. I make no apology for saying that patients should have access to information about the clinical performance of surgeons. Patient who are about to go under the knife should have the right to that information if they want it. As long as the information is presented responsibly and takes account of work load, case mix, comorbidity, deprivation indices and so on, there is nothing to fear. If the minister does not agree with that, why did he say, in a press release commenting on the Bristol report, that he would make available robust information about surgeons' performances? Perhaps he can explain the difference between what I propose and what he has already suggested—other than that he is backing off because his chief medical officer told him to.
Once again, Nicola Sturgeon has not listened to what I have said. I explained our position on that very clearly to Ben Wallace. I know what our position is. What is Nicola Sturgeon's?
Perhaps the minister could educate his back benchers about the Government's policy. The excellence of the medical profession in Scotland means that it has nothing to fear from such openness and patients have everything to gain. For Mr Butler's information, I presume that that is why the BMA consultants committee supports our proposal.
Let us make sure that our health service has the capacity to cope with the demands that are placed on it. Reforming the NHS is about many things, not least the shift from acute to primary care—ensuring that patients are treated in the most convenient and appropriate setting is fundamental. Everyone I speak to in hospitals tells me the same thing: there are too few beds and not enough staff. We must do more to tackle staff shortages. We must pay our health care professionals salaries that reward them properly for the jobs that they do and that make it attractive for them to work in Scotland.
The nursing students to whom I spoke last week told me that it was simply impossible for many newly qualified nurses, who are already carrying huge burdens of debt, to resist the lure of enhanced salaries that already are being paid by health authorities south of the border. We are losing nurses and we must stem that flow. [Interruption.]
It appears that Brian Fitzpatrick has a problem with his hands—I am sure that it is not the first time that he has had a problem controlling his hands or other parts of his anatomy.
We must halt the reduction in acute beds. We now have 700 fewer acute beds than we had in 1999 and it is no wonder that the service is under such enormous pressure.
I have made suggestions for reform that would make a difference. I hope that the Executive is listening. We can build a consensus around some ideas for reform in the health service, but we must first have a Scottish Executive that is prepared to listen.
I move amendment S1M-3106.1, to leave out from first "welcomes" to end and insert:
"regrets that the sustainability of investment in health is dependent solely on decisions taken by Her Majesty's Government rather than determined by the Scottish Parliament; agrees that reform in the delivery of health care is essential if we are to create a modern NHS which improves health and tackles health inequalities throughout Scotland, is transparent in its operation and publicly accountable, and prioritises the needs and expectations of patients and service users; is concerned that the Scottish Executive's use of the Private Finance Initiative and private healthcare capacity to redress decades of under-funding by the Tories damages the NHS and undermines the principle of a universal service that is free at the point of need; is further concerned that waiting lists and times are manipulated to the point of being meaningless, and believes that continuing reduction in the NHS acute sector capacity and staff shortages across the range of healthcare professions must be reversed if the NHS is to tackle effectively the crucial issues of bed blocking, waiting lists and times and hospital-acquired infection which remain fundamental obstructions to improving the health of the people of Scotland."
I have participated in most of the health debates in the past three years and I am interested to note a slight change of tone in today's debate. Rather than the 100 per cent self-congratulatory tone that we have become used to over the past three years, a wee bit of honesty is creeping in. The Executive motion acknowledges the progress that is being made, looks forward to further improvements, supports a collaborative approach and welcomes priorities. I welcome that honesty, although, unlike David Blunkett yesterday, the Executive does not go as far as apologising.
The only progress that has been acknowledged is that of the national waiting times unit. It is interesting to note that the progress of the national waiting times unit is due mainly to more than 2,000 NHS patients being treated in the private sector. Where there is spare capacity, that is progress indeed.
I welcome much of what the minister said. The Conservatives welcome the diabetes framework, the cancer plan, the Clinical Standards Board for Scotland assessments of cancer and managed clinical networks. No one could refuse to welcome those. More than anything, I welcome the improvement in patient outcomes. The plans are good and the ideas are good, but we have to see improvement in patient outcomes before we can acknowledge the action plans.
Although the motion mentions community care, the minister said very little about it. Given that there are only six weeks before free personal care is implemented, I hope that we will continue to monitor developments and debate the issue in the Parliament. I note that the motion also refers to "investment" in the health service. We should remember that the Chancellor of the Exchequer received an £18 billion boost to his war chest from the mobile phone licence auction.
Although there is no doubt that "further improvements" are required, the minister's motion points out that reform must be
"focused on the … expectations of patients and service users".
Much of the problem in that respect may arise from the expectations that Labour itself created as it showered the electorate with grandiose promises that Blair's new Labour wizards and its members in the Scottish Parliament would provide a panacea for all the ills in the NHS. The 1997 Labour general election manifesto stated that waiting lists would be reduced. By 1999, the future Labour leaders of Scotland felt able to be more specific and promised that waiting lists would be reduced by 10,000 by 2002. It is now 2002 and, according to the latest published figures, waiting lists have increased by 10,000, with a further 6,000 on the deferred waiting list. Although no one denies that more money is being spent, one would not expect to find that the more we spend, the less we get.
Other great bluffs include the promise in 1997 to end waiting for cancer surgery. That initiative failed. In its 1999 manifesto for the Scottish Parliament elections, Labour promised to "end postcode prescribing"—it has failed to do so. It promised to spend money on patients, not bureaucracy—it has failed to do so. It promised an airline-type booking system where patients would know when their hospital appointments would be before they left the surgery—it has failed to introduce that. Furthermore, where are the walk-in, walk-out hospitals that Labour promised for Scotland?
In the same manifesto, Labour promised to reduce waiting times to see a hospital consultant. The median waiting time was 46 days; it is now 57 days. Labour has failed again. The percentage of out-patients seen in nine weeks has fallen from 63 per cent to 53 per cent—Labour has failed in that as well. In fact, in Highland and the Borders, 67 to 68 per cent of patients are seen within nine weeks, but in the Fife, Forth Valley, Grampian and Lanarkshire health board areas, fewer than 50 per cent of patients are seen within the same time.
In its manifesto, Labour told us that we would have
"a centre of excellence … in Inverness to ensure that rural communities … get access to the highest standards of care".
I welcome the minister's regular visits to Dundee, but I ask him to visit Lybster, Dunbeath or Wick. Many Highland health officials were fairly traumatised when they left those areas, and they would welcome the minister's support.
Just because I go to Dundee, it does not mean that I do not visit the Highland area. Indeed, last Friday, I visited Nairn and spoke to Highland NHS Primary Care Trust about the problems to which Mary Scanlon has referred. I assure her that I am concerned about those problems and that I am giving them great attention.
I am pleased that the minister visited the sedate town of Nairn, but I ask him to extend his visits further north.
Last night, one of the local GPs in Wick explained to me why the accident and emergency hospital in Thurso has had to close. Quite often, members of the Parliament talk about primary and acute care as if they are two quite separate aspects of health care. Indeed, I have been guilty of that in the past. We do not realise that GPs provide accident and emergency services in remote and rural areas. I was quite shocked to find that, until last November, doctors were paid £1.60 an hour for out-of-hours accident and emergency calls. Even Tommy Sheridan would be shocked at that rate of pay. After recent negotiations, GPs' wages for attending an accident and emergency call at Dunbeath have risen to £4 an hour, but they are still the lowest-paid in the room. Furthermore, the money to fund the wage increase has been taken from other services in the hospital. The minister needs to discuss the matter with Highland NHS Primary Care Trust.
Although I am pleased that Labour is now embracing the private sector, it is still not doing enough. If 2,000 NHS operations have been carried out since the waiting times unit was set up, how much more could have been done with forward planning? At a recent The Herald debate on the BMA's premises, the minister was told that planned use of the private sector in England and Northern Ireland has meant that there is no need for panic measures when a patient reaches the dreaded 12-month waiting time. It is also much cheaper for the public purse and will enable spare capacity to be properly managed in future.
If we are to improve the health system, we must tackle health inequalities. Although the minister recently stated that he was focusing on the issue, I was quite shocked by his comment at a recent meeting of the Health and Community Care Committee that he had no proper way of measuring benefits to health inequalities. That does not concern areas that have lost out because of Arbuthnott, but areas such as Highland, which have benefited enormously from the formula. I would like to think that the money is used to address problems such as poverty, deprivation and inequality, but there is a fear that it will not be used for that purpose because there is no way of measuring it.
Mary Scanlon will remember that I also said that examining health inequalities is a very important part of the performance assessment framework. We are urgently developing health inequality indicators. Although I accept that that has been a problem, I can assure Mary Scanlon that we will have those indicators soon.
I hope that that is the case, because the minister should be holding health boards and trusts to account for the money that they have been allocated.
The mention of delayed discharge in the motion at least gives me the opportunity to refer to community care. It is clear that delayed discharge remains a problem; indeed, according to the latest statistics, the figures for delayed discharge have doubled over the lifetime of the Parliament and it accounts for more than 3,000 beds a day. I am also concerned that the care development group, which the minister chaired, highlighted that £63 million that was earmarked for care of the elderly had been diverted to other budgets. I hope that the minister's joint planning and joint action will ensure that moneys earmarked for care of the elderly will be used for that purpose.
The community care system is crumbling. It is a matter of concern that the independent sector closed 100 homes last year. The Church of Scotland recently announced the closure of nine services, simply because it could not afford to subsidise them from its own funds.
Will the member give way?
I really do not have the time—I have taken a couple of interventions already.
We do have some time in hand this morning.
Does Mary Scanlon accept that the closures announced by the independent sector have been made solely for commercial reasons?
I certainly agree that the Church of Scotland had commercial reasons for announcing the closure of services. It was not able to provide £1.34 million a year from its social fund to subsidise its homes. Can Margaret Jamieson justify the fact that councils pay £83 a week more to their own homes than they do to those in the independent sector? She has a wee bit more to learn about the concept of commercialisation.
It takes a good Tory initiative to address many of the problems. The benefits of direct payments, which were introduced in 1996, have been acknowledged by Malcolm Chisholm, Hugh Henry and—I hope—Frank McAveety and the measure was included in the Community Care and Health (Scotland) Act 2002. Such payments present an opportunity to address many of the problems in community care. With direct payments, elderly people receive their own money to buy their own services. We must harness such opportunities and allow people the freedom and the choice to control their own budgets. It is disappointing—to say the least—that, until the new act was passed, only 200 people in Scotland received direct payments, mainly for learning disabilities. I ask the minister to offer direct payments to everyone who is left in hospital because of delayed discharge. Such a step would certainly end bedblocking as carers could access payments for home care following the assessment in hospital. Such a regime would free up an enormous number of beds in the NHS.
Lyndsay McIntosh will talk about hospital acquired infections. It is shocking that more than 450 Scots die from hospital acquired infections—that is more than die in road accidents.
I welcome the work done by the Clinical Standards Board for Scotland and its interim report into hospital acquired infections. Nonetheless, it is shocking that, after five years of Labour Government, infection control in Scottish hospitals is inadequate and disappointing. The interim report is scathing about Scottish performance and highlights the lack of a national strategy. I quote from the report:
"The information provided indicates that infection control is an area of concern … Most Trusts do not have plans in place to address the full implications of healthcare associated infections."
Patients are now more worried about infection than they are about surgery. The figure for added stays for elderly patients is 24 days, which is quite incredible. The surgical patient added-stay figure is 12 days and the orthopaedic patient added-stay figure is 11 days. That is not just a cost to the NHS: it is also a cost to the patient.
There is no denying that the funding of the Scottish health service will rise to unprecedented levels in the coming years. Unfortunately, the more that the Labour Government spends, the worse the system gets. Since 1997, waiting times for operations have risen, the number of out-patients being seen has fallen by 63,725 and the number of in-patients being treated has fallen by 5,000. Medical activity has decreased while waiting times have increased.
At this rate, and because there seems to be some sort of inverse proportionality between spending and performance, one wonders how much money Labour will have to spend before the NHS treats no patients at all.
I move amendment S1M-3106.3, to leave out from first "welcomes" to end and insert:
"agrees that investment in health must be accompanied by reform that is focused on the needs and expectations of patients and service users; supports a collaborative approach to reform which involves patients, staff and the wider public; believes that improving health and tackling health inequalities in both urban and rural Scotland should be central features of the reform agenda; regrets the failure of the Scottish Executive to deal with delayed discharge and hospital-acquired infection; notes that medical activity has decreased, and further notes that the Scottish Executive's National Waiting Times Unit has only achieved success after utilising the independent sector."
I welcome the opportunity to put on record our welcome for the Scottish Executive's commitment to sustained investment in health and to the reform of the services on which we all rely. Both those things together are essential. The amount of money that we put into the health service and health in Scotland has grown and will, thanks to the budget, grow more in the coming years. It is important that the money is used to the best effect, based on patients' needs.
Quality patient care must be central to everything that we do. Everyone in the chamber is aware of and welcomes the move towards a quality and standards board for Scotland. There has been confusion in the past about who was responsible for what. The various arms of the quality and standards groups, whether the Scottish intercollegiate guidelines network or the Clinical Standards Board for Scotland, have been doing good work in their way. However, it will be beneficial to bring those arms together into one organisation in order to proceed with an important agenda for the Parliament and, more crucially, for Scotland's patients.
We heard from the minister that we are starting to see movement on the issue of patient involvement—an area in which the health service has been lacking. We should not pay lip service to patient involvement. We should ensure that patients have access to information and that they are able to make choices. I note what the minister said about a waiting times database.
It is important that patients are given relevant and understandable information. A lot of the material that the Health and Community Care Committee reads is pretty unintelligible and inaccessible to the members, let alone to the average member of the public. If a member of the public were to read some health boards' annual reports, they would be bamboozled. They could not begin to try to make sense of the Scottish Executive's budget document and how it relates to health. We must ensure that patients are given information and are involved in decisions.
That might mean giving people full information about the need for prioritisation and the fact that resources are sometimes limited. When we consult people, they have to know that their involvement will be meaningful.
Will the member take an intervention?
I will come to Brian Adam in a minute.
Most people believe, rightly or wrongly, that when they are asked for their opinion on health service changes—for example in an acute services review—the exercise simply pays lip service to the process and their opinions are not taken properly into account. They believe that the decisions have been made before the consultation exercise.
On patients understanding about priorities, does the member accept that the fact that some health trusts are considering expanding the number of private beds in the NHS sends out the wrong message about their priorities? Does the member agree with the NHS trusts that are considering expanding the number of private patients and does she believe that that is the right priority for the future?
I have no problem with the use of the private sector for NHS patients. I have more of a problem with the use of NHS beds in NHS facilities for private patients. Those are two different matters. Yesterday, I welcomed the waiting times unit's news that we have made use of 2,000 spare capacity beds in the NHS and of spare capacity in the private sector. Scottish patients want an NHS that is responsive to their needs and that will make use of spare capacity to ensure that patients and their families wait as little time as possible for operations.
I return to consultation and patient involvement. The Health and Community Care Committee took evidence from Lothian NHS Board, which is going to undertake a life and health study. It will seek information about lifestyles from the population of Lothian and will use that information for forward planning of services. That type of approach is to be welcomed.
A couple of weeks ago, we held a debate about the importance of primary care services in Scotland. Primary care services account for 80 to 90 per cent of the services that people get from their health service. Most of us for most of our lives rely on the health service.
The health service relies on partnership within the NHS team and on the flexibility of a work force that should be valued, respected and rewarded. Last week, we held a debate that focused on nurses, but nurses are only part of an important team at local level. If we are serious about reform of the health service, partnership is crucial. There are initiatives around the country and a move from acute services to services that are more locally accessible to people.
At some point, if not today, I would like the minister to address the issue of community hospitals, particularly in rural areas. We can learn from community hospitals and the way in which they have functioned for many years. Some of those hospitals have been under threat, but they are good models for ways in which primary care services could develop in future.
Flexibility of service is often based on the work force's flexibility. In the past few years, we have expected a great deal. We have expected nurses to specialise more in areas such as diabetes, epilepsy and multiple sclerosis. That has been acknowledged by all members as being of particular note.
Yesterday, in the Health and Community Care Committee's report to the Finance Committee, we said that we want greater resources for neurological nurses, because there is a gap in the number of nurses in Scotland who are available and able to assist neurologists.
A welcome recent initiative is the introduction of the new NHS boards and the new audit system of performance assessment. The performance assessment framework is in its first year and the Health and Community Care Committee has questioned the minister closely on it during the budget process. Generally, we are positive—the Liberal Democrats are very positive—about the fact that the framework will be based on 60 or more indicators that relate not only to a board's financial performance, which is important, but to its delivery of quality services. The framework will examine not only the amount of money that is invested in a service, but the outcomes.
Mary Scanlon said that promises had been made but have not been delivered. We must ensure that promises that the Executive and the local health board make are delivered. The performance assessment framework seems to be receiving a positive response at board and political level, which shows that it is a move in the right direction.
Mary Scanlon talked about the Arbuthnott formula and health inequalities. Many health boards are embracing the health inequalities agenda. Lothian NHS Board is taking the matter seriously, but others may be taking the money from the upgrade of the Arbuthnott formula and not focusing on the health inequalities that the Executive wanted Arbuthnott to address not only in urban areas, but in rural areas. Much more work must be done. I acknowledge that the minister said that work to develop health inequality indicators continues.
Other continuing work that is critical to achieve the shift from the acute sector to the primary sector is on community care. The Parliament and the Executive have made good progress on that, but nobody should underestimate the difficulties and challenges that lie ahead in the joint future agenda of encouraging the health service and the social care sector—whether it is statutory or independent—to work together. The minister has made £50 million available for care home payments and the Community Care and Health (Scotland) Act 2002 has been passed. I would like the minister to give us a progress report on whether we are on track to deliver free personal care by 1 July.
It is welcome that the funding that supported the 2002 act was not only for care homes, but for care in the community, which is where we need rapid response teams and facilities to keep people in their own homes, instead of in hospital beds. The tragedy of our delayed discharge problem is that it is unacceptable for all the people who are involved. Patients are kept in an inappropriate place, as they may not receive the care that they need. It is often more appropriate for them to be in their homes. I hope that the funding is used to try to ensure that that happens.
The minister is actively pursuing the joint future agenda and local councils and local health boards have talked through their delayed discharge plans with him. The £20 million will be allocated and released on the basis of the evidence of how people can achieve the outcomes that we need. That level of joint working between councils and boards is facilitated by the fact that councillors are board members and by the Executive's plans and drive in the joint future agenda to ensure that people work together in a framework of joint budgets and joint management. That is made possible not only by the 2002 act, but by the Parliament's express will that community care should be developed in that way. The health service does not need major upheavals. Many changes, such as the unified NHS boards that involve staff more and involve nursing directors and local councillors, can be made through joint working.
In several speeches in the past few weeks, the minister has said that local health care co-operatives have a useful part to play and that their role should be expanded. We have said that because local health care co-operatives were not started in a prescriptive way, they have organised themselves in different ways in different areas so, for accountability, we may have to consider some prescription of local involvement in their boards or in their structures. However, in general, LHCCs have the ability, on the ground floor, to examine local needs and decide which services should be available and are required locally. It is up to health boards and the Executive to ensure that LHCCs have the tools to do that job.
Mary Scanlon referred to the minister's honesty, which contrasts with the attribute that Nicola Sturgeon accused him of having. When we have figures such as those that the waiting times unit issued in a press release yesterday, it is important that they are backed by figures from an independent source that confirm that progress has been made. The progress that was announced yesterday is to be welcomed.
The Executive is progressing with work on the issues of which we are all aware—waiting times, delayed discharge, hospital acquired infection and the great need for work force planning for the next two decades. To an extent, we have lost some time on hospital acquired infection, because recent figures suggest that hospital acquired infection takes up twice as many hospital beds as delayed discharge does. We have a duty to tackle that and produce a national strategy.
Movement has been made on national inspections, which the minister set in train, but they have shown that the service is patchy. Some people have had infection control nurses but some hospitals have not taken the matter seriously enough. Infection control nurses who work with microbiologists at ward level can and should decide on the movement of patients around hospitals and should decide on cleaning contracts. They talk to patients and their families and are at the sharp end in hearing people's views on cleanliness.
Hospital cleanliness is only part of the problem with hospital acquired infection. Much more can be done on educating staff all the way up. The anecdotal evidence is that doctors' knowledge of basic infection control is often more of a problem than that of porters and nurses.
We have made progress on delayed discharged with the £20 million, on hospital acquired infection and on waiting times. We will return to work force planning, because time and again, people say, "You can give me extra money for cancer care and for anything you like, but I don't have the trained staff available to deliver those services." If we do not get work force planning right, we will have a major problem in delivering the service that we all want.
I support the motion. I see nothing wrong in welcoming the Executive's obvious commitment to sustained investment in health. To acknowledge that and the fact that the recent budget gave the Executive the opportunity to guarantee expenditure increases that will total £3.2 billion in the next five years, which is an increase that borders on 50 per cent of NHS spending, is merely to record the investment position.
It is disappointing that the SNP has said only a little on the reforms that it proposes. Some may have merit, but others are ill-thought-out. However, the SNP's spokesperson said not a word on how the SNP would achieve more investment in an independent Scotland. Instead, we have had the usual doleful diatribe. The SNP has an almost dystopian vision. It is almost like "Nineteen Eighty-Four"—two plus two equals five. The minister said that 2,000 more operations had been performed and that acute in-patient lists were reducing, but good news that is unpalatable to the SNP becomes double plus ungood. The SNP's vision is a nightmare vision with little connection to reality. There is a rather Orwellian touch about the publication of death-rate league tables for individual surgeons. I am sure that Mr Orwell or Mr Blair—that Mr Blair—would have appreciated that fact.
Unlike the routine carping that we get from the SNP, we are not taking part in an exercise of self-congratulation and complacency. We would be doing that if we thought that all that was required to make our health service fit for the 21st century was to throw money at it. The challenges that we face in providing a modern, efficient, accessible health care service for 21st century Scotland are more complex.
Will Mr Butler tell members how he feels about the fact that Grampian University Hospitals NHS Trust is so worried about its finances that it feels that the only solution available to it is to increase the number of private beds in the health service in Aberdeen? Will he condemn that or will he explain why the trust considers that action to be necessary?
That was another good try by Brian Adam, but I refer him to the reply that my colleague Margaret Smith gave, which addressed adequately that question.
We know that money is not the only thing. However, we also know that the huge investment that is being made out of general taxation is a positive thing. Alongside that fact, which is only part of the equation, we must make a move towards reform. We need fresh approaches that will provide the best chance to use the additional moneys in the most effective fashion. I believe that that move is being undertaken. I want to concentrate on two interrelated factors: the needs and expectations of patients; and the need for a co-operative approach to change, involving patients, staff and the public.
I welcome the fact that, when the minister announced the new level of investment, he highlighted as one of the three key issues at the core of the Executive's programme the step change in accountability that is needed. Ms Sturgeon mentioned that in her speech. Along with probably everyone in the chamber, I believe that greater accountability is necessary to ensure that resources are directed at the areas of greatest need. I also believe that they should be seen to be so directed.
I am confident that the new performance assessment system, which I admit was introduced only on 1 April, will provide the means by which tangible benefits are visibly delivered. I welcome the fact that, in the interests of transparency, the results will be published locally. I also welcome the progress that is being made towards the establishment of a new independent quality and standards board for Scotland.
Such measures will build a more accountable NHS in which patients and the public are given the means to play a more active role and so become more confident in the ability of the NHS to deliver for them. Real public involvement is nurtured only in an NHS where involvement is encouraged and not frowned on, where patient's criticisms and aspirations are responded to and where information is readily available in order to judge performance. Such an NHS also requires a confident work force that is valued and given the opportunity to become involved.
One way in which the Executive has given such a signal is by taking action to expand capacity. I will mention only two developments. First, the Executive has more than trebled investment in the recruitment and retention of nurses—up to £5 million this year. Secondly, by 2005, 10,000 more nurses and midwives will qualify in Scotland, which is 1,500 more than planned.
I am not saying that everything in the garden will be rosy or that we will be living in some kind of utopia. We are talking not about utopias or anti-utopias, but about the practical material circumstances and challenges that we face in the NHS today. Anyone who tries to simplify the situation is not dealing with the real world.
I would like to take your intervention, Tommy, but the Presiding Officer has indicated that I have to wind up.
Hear, hear.
I thank Gil Paterson. I am always willing to take support from any quarter.
More money alone will not improve the NHS. We will only succeed by adopting a commonsense and comprehensive approach that involves more investment and is focused on the needs and expectations of patients and staff. Such an approach is contained in the motion, which I commend to the chamber.
I call Richard Lochhead to be followed by Keith Harding. I am looking for speeches that go no further than six minutes.
I notice that, despite being the fourth member to speak in the debate, Margaret Smith droned on for a quarter of an hour and then left the chamber. It would have been much more helpful if she had left the chamber before she made her 15-minute speech.
We have to remember that the NHS is owned by the people of Scotland and that it exists to serve the people of Scotland. That is why we want to deliver the best standards of care and why we have to ensure that safety in our hospitals is our number 1 priority.
We have discussed at some length hospital acquired infections, their implications and their relationship to hygiene. Another challenge that faces the NHS in Scotland is to reduce what are called, in the official language, adverse events. In essence, those are the clinical errors that human error causes in our hospitals. Although human error is perfectly understandable, such events can also be caused by the use of cheaper alternative equipment because funds are not available to allow hospital staff to use the best quality equipment.
At the same time as we are challenging that issue, we have to maintain a blame-free culture in our hospitals. Studies have shown that two thirds of adverse events in our hospitals were clearly preventable, as it was likely that they arose from deficiencies in ward care. Those occurrences can arise as a result of the use of older equipment. The minister might care to note a survey that was undertaken in Grampian a couple of years ago, which showed that a quarter of all general medical equipment was beyond its standard life span.
South of the border, the chief medical officer for England commissioned the report "An Organisation with a Memory", which was about learning from past mistakes in our hospitals. In Scotland, there has been no equivalent report. The chief medical officer found a high standard of care in hospitals south of the border, but he also found evidence of serious failure. We have to find out about the situation in Scotland.
Soon after I was elected, I asked a parliamentary question that elicited the information that litigation costs for hospitals in Scotland amounted to more than £3 million a year and that legal costs incurred by the NHS in defending cases was £500,000 a year. Litigation results in clear costs to the NHS and the figure is not going down—it is going up.
In August 2000, I asked the minister's predecessor
"what percentage of the clinical or non-clinical mishaps or accidents in respect of which claims were made against NHS Trusts in the last five years the NHS Management Executive considers to have been avoidable; what type of interventions would have prevented these incidents, and what plans are in place to implement any such preventative measures."
Susan Deacon answered:
"This information is not held centrally."—[Official Report, Written Answers, 21 August 200; Vol 7, p 574.]
The ministers do not know what the situation is with regard to clinical errors in our hospitals, what the implications for patient care are and what the costs are. If we cannot quantify the problem, we cannot do anything about it. However, if we do something about the problem we can save more people from becoming ill, save lives and, in the long term, save the NHS a fortune.
At the moment, in Scotland, we are playing catch-up. That is because last year, south of the border, the National Patient Safety Agency was created. When I asked Malcolm Chisholm what we are doing about that in Scotland, the reply that I was received was that we were doing nothing, but that we would see what could be learned from what was happening south of the border. Surely we should not be playing catch-up in Scotland. Surely we should be proactive. We should be setting up bodies like the National Patient Safety Agency in Scotland. Only a few months are left in the current parliamentary session and yet we are only now beginning to hear about bodies that will improve the situation.
Grampian is one part of the country where a lack of investment is causing many problems. I make no apology for raising the issue again with the minister, as he refuses to accept that there is a problem with health funding in Grampian, even though we have 10 per cent of NHS activity in Scotland and yet only 9 per cent of the funding.
Some of the longest waiting lists in the country are to be found in Grampian and yet the minister, on his recent visit to Aberdeen, said that he could not foresee any problem with funding in Grampian. That is despite palpable and blatant problems to do with the chronic shortage of funding in the region. Grampian has the third-worst drugs problem in Scotland and yet our drugs funding is 20 per cent below the national average. That is because even drugs funding is linked to the Arbuthnott formula. That formula is not delivering for Grampian. I ask the minister today to investigate the impact of the Arbuthnott formula on health care in Grampian.
At present, Grampian NHS Board is implementing cuts of £4 million and yet it is the most efficient health board in the whole of Scotland. Perhaps the minister would intervene on that issue, which is also leading to difficulties for the voluntary sector. The sector is losing money from the local health board even though that money saves a fortune for the board in the long term.
The minister wrote to me last month and acknowledged the valuable role that is played by the citizens advice bureau in Aberdeen, which has a health outreach service at the local hospitals. He went to great lengths to praise that service and recognised the part that it has played in improving health care in Grampian. However, Grampian NHS Board announced last week that it is pulling the plug on that project, because it disagrees with the minister and because it has financial difficulties. I ask the minister to intervene in that case. He has acknowledged that local voluntary organisations—the CAB is not the only one suffering such cuts—are playing an important role in addressing health inequalities in Grampian, but they are having the rug pulled from beneath their feet.
We cannot raise standards in our health service without investment, but it is not just cash that we have to invest. We must also invest fresh ideas, innovation and common sense but, unfortunately, the Executive's track record illustrates that it is lacking in those attributes.
As vice-convener of the cross-party group on palliative care, I welcome the opportunity to contribute to the debate. I have a personal interest in the treatment of cancer, and particularly of breast cancer. We are all too aware that that is the commonest cancer in Scottish women, with some 3,000 patients diagnosed annually. At least one in 12 women will be so diagnosed in their lifetime and more than 80 per cent of those are women aged over 50. The latest figures available show that, between 1989 and 1998, the incidence of breast cancer increased by more than 14 per cent, with 3,523 new registrations in 1998. That represents 25 per cent of all malignant tumours in women. The incidence of breast cancer across all ages is increasing and the death rates in the UK are at least 15 to 20 per cent higher than in the USA and other European countries. We have a serious problem that must be addressed.
Fortunately for some people in Scotland, treatment is better and more successful in some areas, such as the Forth Valley NHS Board area, where I live, than it is in others. I vividly recall the Sunday evening some seven years ago when my wife discovered a small lump in her breast. That was the first of many sleepless nights. The next morning, she telephoned our GP, who agreed to see her that evening. After examination, he referred her to the breast clinic in Stirling royal infirmary, which is run in conjunction with the Beatson, on the following Wednesday. There, a biopsy was taken and we sat and drank coffee awaiting the results. Our worst fears were confirmed and cancer was diagnosed. We then met the breast surgeon, who explained to both of us what would follow and what he expected the likely outcome to be. I will never forget the expression on my wife's face—and no doubt mine was the same—when the surgeon said that, if all went well, we would probably see him for the next 12 years. With some dread, I asked what he meant and he said that that was when he would retire, which caused some laughter and much relief.
On the Friday, my wife had a lumpectomy, but the results were not good, as we were told that she had a particularly invasive type of cancer, which had spread to her lymph system. On the Monday, she had a mastectomy and had lymph nodes removed, and she came out of hospital on the Saturday. It was only two weeks from finding the lump to full treatment and I commend the medical staff not only for the promptness and excellence of the treatment, which obviated much stress, but for their professionalism, caring and understanding and for the sympathetic counselling that we both received. Thereafter, chemotherapy took place, and we should not forget the role of the voluntary sector in that. The treatment was undertaken by John, a Macmillan nurse, who, by his positive and cheerful disposition, helped my wife through a very harrowing and, at times, painful experience.
It is the waiting and uncertainty that causes so much stress. Early diagnosis is very important. My wife is now fit and well, but after seven years she is still waiting for cosmetic surgery. I know from other people in our area that such speedy treatment is not an exception, but sadly that is not the case in other areas. We have the evidence that we can match any other country and we are now led to believe that there are the resources to bring about the necessary improvements throughout Scotland. However, I ask the minister to tell us, in summing up, how he will address the recruitment of the specialists who are needed. I understand that many hospitals do not have a specialist breast surgeon or access to plastic surgeons, specialist oncologists, palliative care specialists, lead pathologists and lead radiologists. We have the monetary resources, but without the medical staff we will make no headway.
I support the amendment in the name of Mary Scanlon.
I welcome the opportunity to contribute to the debate. Despite persistent nationalist attempts to talk down the national health service, it is without a doubt one of our nation's greatest and most valued institutions. The founding principles on which the NHS was built are as relevant now as they were when the service was created more than 50 years ago. The Labour party remains committed to a national health service that is free at the point of delivery and is not dependent on ability to pay. The steps that have been taken since Labour came to power in 1997 have begun to turn around a service that had been devastated by 18 years of Tory neglect. The unprecedented additional funding that was made available as a result of the recent budget will enable us to take the next steps towards restoring our NHS to its rightful place as one of the world's leading health services.
At local level, the additional investment and reform is beginning to make a real difference. Monklands hospital in my constituency will soon open a new accident and emergency unit—the result of its share of £11 million of funding for the development of accident and emergency services throughout Scotland. My constituents and the constituents of every other Lanarkshire MSP are benefiting from the improved transport service to the renal dialysis unit at Monklands hospital, again as a result of increased funding. That is an excellent example of increased investment linked to service redesign around the needs of patients. That is the reality of investment in the NHS. It is the real story about the NHS in Scotland that Nicola Sturgeon failed to pick up on.
Carers have also benefited from the Executive's commitment to improving community care, with the national carers strategy for Scotland and an allocation of £10 a year to local authorities for carers services—again linking investment to reform. The motion highlights the importance of collaboration in developing and reforming services. I am pleased that North Lanarkshire Council recognises the value of carers as key partners in the provision of care and ensures that carers and carer organisations are closely involved in the design and delivery of community care services.
How do those achievements compare to the health plans of our Opposition parties? The Scottish Tories still have to come clean about whether they will be pursuing the plans of their colleagues south of the border to privatise health services. At Westminster, the Tories have opposed the National Insurance Contributions Bill.
Perhaps I could give Karen Whitefield a wee lesson in devolution. The Scottish Tories—members of the Scottish Parliament and members of the party—decide on health policy in Scotland. Unlike the Labour party, we have autonomy and we understand devolution.
I am glad that Mary Scanlon has come round to the idea of devolution. Her party was very slow to get there. She must also understand that, as part of the devolution settlement, we get our money from Westminster. Would her party match the investment in the NHS in Scotland? That is the question that she must answer. As the Tories have given us no figures today, we can assume that they are not willing to match the funding that the Scottish Labour and Liberal coalition will put into the NHS over the next three years.
On the other hand, the nationalists offer us independence as the solution to everything, but their election manifesto said very little about the NHS. It offered us a series of uncosted and piecemeal policies, but no real strategy or vision for the NHS in Scotland. The nationalists' obsession with splitting Scotland from the rest of the United Kingdom has led to the proposal to give nurses in Scotland higher rates of pay than their counterparts south of the border. That proposal has been condemned by both Unison and the Royal College of Nursing as divisive.
I shall conclude with a quote:
"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."—[Official Report, 14 December 2000; Vol 9, c 1042.]
I am glad that Mary Scanlon reacted at that point, because those are not the words of an over-enthusiastic voluntary organisation trying to curry favour with the Scottish Executive, nor are they the words of a Liberal or Labour MSP; they are the words of Mary Scanlon in a debate in the chamber in December 2000.
Mary Scanlon spoke about honesty. What we need today is a real debate about what is happening in the NHS in Scotland. The reality is that the Parliament is delivering for the NHS in Scotland and, deep in her heart, Mary Scanlon knows that the Executive is beginning to deliver the quality of service that the health service was denied for 18 years while the Tories were in Government. Deep in her heart, Mary Scanlon would prefer to belong to a party that is willing to put its money where its mouth is. That is the reality. We still have a long way to go to deliver the quality health service that the people of Scotland deserve, but we have turned the corner. I urge all members to support the motion.
I welcome the opportunity to speak in the debate. I do so from the perspective of having a particular interest in mental health.
There is a need for a significant hike in investment in mental health services, which the recent Clinical Standards Board for Scotland report on schizophrenia accurately described as still the cinderella of the national health service in Scotland. In September, when the Minister for Health and Community Care announces the detailed allocation of the extra resources that were made available by the recent budget, I want to see planned expenditure for mental health services on a scale that reflects the status of a national clinical priority. That means pushing the rate of increase in mental health spending to higher than the average for total health spending. We must also ensure that we invest those extra resources in quality. We must invest in front-line services, not feed a massively inefficient and unaccountable bureaucracy.
We must recognise the need to focus on a range of outcomes, not all of which can be as easily measured as waiting times, to evaluate spending decisions. Mental health services do not lend themselves to simple outcome measurement. In many cases, treatment is about better management of a recurring condition and securing improvements in a patient's quality of life in the community.
On key priorities for investment in reform, we now need more acute beds, not fewer. The minister will be aware that more and more forensic patients are being treated by general psychiatric services, rather than being dumped into prisons as they have been in the past, much to our shame. Most such patients do not need to go to medium-secure units for their safety or for that of others. Rising demand is putting staff resources under too much pressure. Equally problematical has been a tendency to reduce staffing and resourcing for acute in-patient services in line with a reduction in the number of beds and a move to the provision of care within the community. That ignores the fact that the in-patients who now need acute beds are the more complex cases, who require more intensive care and treatment. Therefore, staffing per bed needs to rise to ensure that standards of care and treatment are maintained, let alone improved.
As has been emphasised many times in the chamber in recent weeks, we must do much more on pay, conditions and career development opportunities to retain experienced staff and attract new blood into the caring professions. Further investment is also badly needed to improve the physical environment in hospitals, for patients and staff alike. We need smaller units in the acute setting. For example, in Ayrshire and Arran there is no separate provision for adolescents. Teenagers are being put into adult wards with some very disturbed people. That is extremely distressing for the young people concerned and their parents. Most hospitals also lack step-down facilities to prepare people for discharge. I am reliably informed that the most dangerous time for patients emerging into the world after an acute episode is the seven days after discharge. I will use a military analogy. Their wounds may have been patched up in hospital, but they are not fit to go back into the front line and they quickly become casualties again.
We need more rehabilitation units in the community to manage the transition from continuing care to living in the community. The reform agenda must recognise that hospital management teams and those involved in putting together care packages are best placed to identify needs, or gaps in provision. They need flexibility to do a good job. Devolving managerial responsibility and budgets must be the way of the future.
I welcome the debate and I welcome the Minister for Health and Community Care's agenda of reform and investment.
I bring the minister some good news from the Borders. NHS Borders has a programme called options for change, which is introducing proposals to achieve more integrated care. The rationale behind the programme is to work better for patients and to change the local organisational structure to streamline bureaucracy, with the aim of making better provision throughout the NHS in the Borders and working better with other partners, such as Lothian NHS Board and Scottish Borders Council's social work department.
Joint working is proceeding well. The LHCCs are well set up and seem to be on board in relation to the proposed changes. An important feature of the process is that there has been consultation with stakeholders. I have read some of the reports of the stakeholders meetings, at which people have been able to put their views to Borders NHS Board before the changes have been proposed. It has been a good process. The proposals are driven by a wish to make the patient's experience of health care more responsive to the patient's needs, to shorten the lines of communication to bring the patient better treatment that is closer to home and to do so more quickly. Of course, change can be uncomfortable and not everything is perfect, but the changes are on the right lines.
Nicola Sturgeon spoke about a reduction in the number of trusts. I think that we will find that there will be a reduction in the influence and work of trusts inside the Borders, but I would object to her suggestion that the number of boards should be reduced if that meant that the autonomy of the Borders NHS Board was threatened.
In terms of investment, in the Borders we can see improvements in local health centre buildings, community hospitals and provision. For example, in Borders general hospital, a dialysis suite has recently been opened and a new cancer care unit is being constructed in association with Macmillan Cancer Relief. Reform and investment is taking place. That is good news.
I want to raise one or two points that modify that good news to an extent, and offer the minister some advice. First, I welcome the emphasis in the Minister for Health and Community Care's speech on attacking hospital acquired infection by dealing with standards of cleanliness and hygiene in the hospitals. I agree with Tommy Sheridan that part of that is about treating our ancillary workers in hospitals properly. People say that the big money that is being allocated to health through the budget ought not to be swallowed up in salaries. Of course, all the money ought not to be swallowed up in salaries and wages, but some of it must go to improve the treatment of staff at that level. A pay rise that is worth 3 per cent or 4 per cent of very little is very little. We must address that matter.
Secondly, I welcome the fact that Malcolm Chisholm, in his more recent speeches, has expressed a wish to reduce hospital waiting times and cut access time in primary care. However, I was at a practice in Penicuik recently and the people there are really worried about the message on 48-hour access. They are worried that, to provide what the public think is 48-hour access, they might have to damage some of the other clinics that they operate, such as diabetes clinics and arthritis clinics, because of an unreasonable demand from patients to see individual doctors within 48 hours. I want the ministers to clarify—if not today, then in the future—what they mean by 48-hour access. I believe that the practice that I mentioned already offers such access and that the doctors should not be worried. However, we must be clear about what 48-hour access means.
There has been talk of delayed discharge, free personal care and care in the community. I would like the ministers to consider carefully the role in those services of day centres and the way in which they are funded. The Broomhill day centre in Penicuik—of which I am a board member—provides facilities that save money for the health service and the local social work department. For example, the centre provides respite care during the day and care for people at home who would otherwise be in hospital. It also allows people to be brought out of hospital and into the community when otherwise the hospital beds would be blocked.
Funding for the Broomhill day centre is insecure, which means that the voluntary organisers spend much of their time scrabbling around for extra funds. That creates a disincentive to the work of the centre. The centre costs around £120,000 a year to run, but it gets only around £80,000 a year from Midlothian Council—a sum that would pay for two places in a residential home for a year. It would make a big difference if the funding were the equivalent of the cost of three places in a residential home. An extra £40,000 would change the face of the centre and give it a tremendous advantage. With such a sum, the centre would add value both to council services and to the health service.
I have one wee whinge on an issue that was drawn to my attention earlier. If people are to use new facilities, the facilities must be accessible. The new royal infirmary of Edinburgh has parking problems. I realise that the philosophy is to encourage people to use public transport by not providing too many parking spaces, but if no public transport is available—which is the case for people coming from Penicuik or Peebles—what should people do?
On that subject, does the member agree that the shift patterns in the health service exacerbate the problems with public transport?
I ask Mr Jenkins to come quickly to a conclusion.
The issue of car parking spaces must be considered carefully.
I do not want to end with a whinge. We have a great opportunity and I support the motion fully.
Last week, the Minister for Health and Community Care gave evidence to the Health and Community Care Committee as part of the budget process. During his evidence, I asked him how the new moneys—of which he is so proud—would be distributed. He said that there will be no distribution by challenge funding, although he qualified that slightly by giving examples in which challenge funding has been used.
This morning, I wanted to hear from the minister exactly how he intends to distribute the resources equitably around Scotland. Karen Whitefield suggested that everything is wonderful; it might be as far as she is concerned, but there are inadequacies in the health service throughout Scotland. I want to know how the minister intends to apply the resources in a way that will produce the goods. It is all very well to throw money at the system, but, at the end of the day, it must deliver something.
Will there be a straight share-out of resources so that all areas get an uplift of a certain per cent? Will there be an extra uplift for areas such as Grampian that are disadvantaged by the Arbuthnott formula? The Arbuthnott formula might help parts of Glasgow and the Highlands, but it does no favours for patients in the north-east of Scotland. Will the minister consider new services where there are none? I have had dealings with the G docs out-of-hours service in Grampian, which is concerned about out-of-hours access to patient records. Such access is often essential for providing first aid. Members of the service told me that when it is amalgamated with NHS 24 in the Aberdeen area, the facility to access records will not exist. G docs has applied to make a challenge funding bid—again, we have the word "challenge"—to run a trial that might be rolled out throughout Scotland. Health care should not be available only when doctors' surgeries are open—it should be available 24 hours a day.
Because demand has exceeded resource, cuts have been forced on health boards, which has led to a reduction in services. I am sure that I am not the only MSP from the north-east who had discussions last week with the Aberdeen Council of Voluntary Organisations about the local health board's decision to reduce its support for the voluntary sector by about £16,000. The health board funds organisations such as Mental Health Aberdeen and the Aberdeen disability consortium. Most of the organisations that are funded supplement the health service by providing services for people in the community. The minister has not said how he intends to help or supplement the work of that sector.
We want patients to get out of hospital and to be restored to their families and communities, but support is needed for that. Adam Ingram talked about the step-down facilities for certain aspects of mental health. From my experiences, which include experience of my daughter's eating disorder, I can say that it is fine to be released from treatment, but one must stay on top of and manage one's condition. It is a scandal that, day after day, parents who are tearing their hair out contact me because they cannot have their children assessed for eating disorders, which means that the disorder is not caught before the child's body-mass index drops away, which produces side effects.
There are no regional facilities in the health service that are dedicated to eating disorders. Hospitals in Aberdeen and Grampian are in liaison with Highland NHS Board to try to set up a dedicated residential unit, which would be a first in the NHS. In the midst of all the promises that Malcolm Chisholm gave when I raised the subject in a health debate last year, he said that eating disorders would be a priority. However, nothing has happened. In fact, an eating disorder unit at the Murray royal hospital in Perth has been closed. Excellent as the Priory hospital is, it cannot cope. Too many patients who have been given preliminary funding to go to the Priory find that the funding is withdrawn.
There is no support for people with eating disorders, which are a mental health disorder. One in four of the Scottish population suffers at some time from a mental health disorder, but they are treated as the poor relation in health care. Although such disorders affect many people, they are swept aside and are not focused on. I am amazed at the amount of correspondence that I receive on eating disorders. I receive story after story, all of which are identical. People cannot have their child assessed and do not know where to go. They cannot get funding even if they can secure a bed in the Priory hospital. They cannot get help other than having their children put into a general ward for people with psychiatric problems. I have nothing against such wards, but it is essential that sufferers of eating disorders are put into a climate that gives them the opportunity to recover. Even if sufferers are put in that climate, there are no dedicated trained staff.
Mental health problems affect 25 per cent of the Scottish population, but the minister has not said anything about using the extra money to create properly resourced facilities for a huge area of health care. People are considering moving, because a different postcode and health board might trigger some funding. That is nonsense. People should not have to do that.
The minister heaped praise and glory on himself and his team, but it is essential that he provides an action plan to deliver care in the right premises and in the right form with the right staff to support patients, regardless of their condition. I look forward to hearing something positive from the minister. I notice that all the Labour members' heads are down. I am sorry if they are embarrassed. I do not want to slag them off; I want a response from the minister to back up the comments that he made in the chamber last year.
The Executive motion refers to
"the priority attached to dealing with delayed discharge",
but I am far from satisfied that that problem receives the priority that it deserves. In January this year, an additional £20 million was announced to enable local authorities and NHS Scotland to reduce the number of delayed discharges. The Scottish Executive also set up an expert group—yes, yet another expert group—headed by Trevor Jones, the NHS Scotland chief executive, to report on the problem to enable the Executive to prepare an action plan to help to drive down the number of delayed discharges.
However, the problem is still with us. According to the latest Executive figures that I have, there are over 2,000 cases of delayed discharge throughout Scotland. That is over 2,000 people, mainly elderly, who have occupied beds in NHS hospitals for six weeks or more because they are waiting for more appropriate care settings.
The latest figures from the Forth Valley NHS Board area indicate a total of 116 ratified cases of delayed discharge, plus 61 unratified cases, which makes a total of 177 delayed discharges. I am concerned that over 73 per cent of the ratified cases are people from the Falkirk Council area. That is well above the 52 per cent of the Forth Valley population who live in the Falkirk area. I have been given no satisfactory explanation of why the figures for the Falkirk area are disproportionately high.
When I raised the matter at a recent meeting with health board officials, it was suggested that the reasons may be that there is a higher proportion of people with low incomes in the Falkirk area, that the dependence on public funding for care is therefore disproportionately high and that, if that public funding is not immediately available, delayed discharges occur. I do not know whether that is the fault of the health board, the hospital trusts, the local authority or the Scottish Executive, but all four have a responsibility to find a solution, and the Scottish Executive has a responsibility to show a lead.
I would like the Executive to investigate that matter urgently. Is it a bureaucratic delay or is it a lack of funding? Are the ring-fenced financial arrangements working? We are told that £1 million can purchase 50 places in more appropriate care settings for people who, at present, occupy beds in NHS hospitals. If that is the case, the £20 million that the Executive announced in January would purchase 1,000 places. However, if there are still more than 2,000 cases of delayed discharge, that suggests that the £20 million may be less than half of what is required to solve the problem.
Delayed discharge, or bedblocking, is not simply a problem of statistics and terminology. It is a problem of human beings: real, deserving people who cannot get the hospital treatment that they require because too many hospital beds are occupied by other real, deserving people—most of them elderly—who require a more appropriate care setting in a care home or, in some cases, even in their own homes. Many of those elderly people belong to the generation that built our NHS and our welfare state based on the principle that appropriate treatment and care should be freely available at the time of need. To deny them the appropriate care at their time of need would be an abandonment of that principle. The Scottish Executive must therefore take urgent action.
I welcome the fact that the Sutherland report's recommendations on free care for the elderly are due to be implemented on 1 July. Surely that is also a realistic target date for the complete eradication of delayed discharge, so that elderly people get the care that they need and other patients can get earlier access to the hospital treatment that they need.
I apologise to Mr Canavan for the disturbance that was heard during his speech. I understand that it was not an unguarded pager, but drilling work connected with the repairs to the external masonry. It therefore follows that, although the workers are trying to muffle the sound, there cannot be any guarantee that there will be no similar disturbance later in the day.
I will focus on the reform side of the invest and reform equation. I was going to say "the minister's invest and reform equation", but, to be fair to the minister, he was not the author of that new Labour soundbite. He is far too good a socialist for that.
Despite the party bickering that often disfigures debates in the chamber, all members, regardless of what party they belong to, agree that we want a better-run and more accountable NHS. Of course, being politicians, we cannot agree on how to achieve that. I do not say that as a criticism of other politicians: I am perhaps one of the worst to try to get to agree about anything.
I will focus on the Executive's strategy. As I understand it, the Executive's approach to making a more accountable and better-run NHS is multifaceted. It includes the new unified health boards, which will each include a nurse director and, I think, an elected counsellor. It includes the new quality and standards board, to which the minister referred this morning. It includes the popular performance assessment framework and the new review of management decision making in the NHS. Of course, it also includes the new focus on patients, about which we heard so much from the minister this morning.
I was impressed by what the minister said. We are all in favour of better information, better communication, more advocacy, more responsiveness, better consultation processes from health boards and, above all, the new health council to which the minister referred. I look forward to hearing more details about that in the future. That is all fine, and I hear what the minister says about rejecting a top-down approach. However, the Executive strategy could be represented as a top-down, managerial approach to change in the NHS. Nowhere in the strategy can I detect a surrender of power over decision making from the centre, where the minister and civil servants happen to sit.
For example, the unified health boards, which will spend the bulk of the NHS budget and make most of the key local decisions about the NHS, will continue to be appointed by and accountable to the minister and to no one else. The quality and standards board and the review of management decision making are hardly exercises in popular involvement and mass democracy. By definition, they will consist of professionals, bureaucrats and the great and the good among us. The performance assessment framework will, by definition, be assessed from the centre and not from the localities. The new patient focus—admirable as it is—continues to shut patients out from the key decision-making areas in the local health board regions throughout Scotland.
Perhaps leaving ultimate control at the centre is inevitable. I do not know. Perhaps the 21st century NHS is a highly complex business, which is hugely expensive to run and faces enormous problems in trying to ensure equality of access to clinically safe services for a diverse and scattered population. Perhaps such a service can be run only from the centre. Key strategic decisions in the interests of efficient and safe running of the whole service must sometimes override local sentiment about particular hospitals or services that people want to preserve.
John McAllion is giving an extremely interesting speech. The issue is balance. When I go to the Health and Community Care Committee, the main message that comes across to me is, "Why don't you exert more control over the local health systems?" I say that we should strike the right balance and know what the Government's role is in matters such as national standards, but ensure that change comes up from below. Does John McAllion agree that, if accountability is only local and not to the Parliament and the Executive, it will not deal with the issues about which he is concerned, such as postcode care and variations in priorities in different parts of Scotland?
Absolutely. I agree that there is a problem. I am always suspicious of politicians talking about balance, because that is usually in their favour and against everybody else. We need a debate before we decide that the structure that ministers have set up is the appropriate one for the NHS in the 21st century.
There is a different tradition. "The Red Paper on Scotland" was published more than a quarter of a century ago, under the editorship of Gordon Brown, who at the time was trying to overthrow capitalism rather than run it better than anybody else. That book contained an essay on the national health service, which argued forcibly, and from a socialist perspective, that control over the health service in Scotland should be taken away from the clinicians and bureaucrats and given back to the people through elected health boards.
Less than 10 years ago, back in the days when, as shadow spokesman on health in Westminster, I was treated a bit differently in the Labour party, I inherited a Labour party policy that had at its core a policy of having one third of the membership of health boards directly elected, one third elected councillors and the other third representing NHS staff. When I spoke to that policy at conference, it was endorsed by almost every current Labour MSP. I mention that because, on the left of Scottish politics, there is a long tradition of trying to make the NHS more democratic through accountability in health boards.
To bring things up to date, in my role as convener of the Public Petitions Committee, I have read all 500 petitions that have been submitted to the Parliament. Two of the major themes among them have been dissatisfaction over the way in which the health boards run the national health service in Scotland and even greater dissatisfaction that the boards are accountable to no one. The minister will intervene only in very limited circumstances, when the local population thinks that the health board has made a wrong decision. There is a growing perception that the NHS in Scotland is not responsive to the needs of the patients and is ignoring the real concerns of the patients and people of Scotland. We have to address that seriously.
I do not envy the Minister for Health and Community Care. It is a lot easier being the shadow Secretary of State for Health in Westminster than Minister for Health and Community Care here. The very existence of this Parliament has brought bubbling to the surface complaints from all kinds of groups of sufferers from throughout Scotland that had not previously been heard of in the political world of Westminster. Whether those people suffer from ME, autism, chronic pain or epilepsy—or a whole range of other problems—they are coming forward and saying that the NHS is not responding to their needs.
Many such illnesses reflect modern, changing conditions which the NHS is not yet geared up to deal with. The assault on our immune systems from pollution, high toxicity and environmental damage is creating havoc across the Scottish population, and a traditionally run NHS has not yet responded to the new conditions. Patients want to figure out how they can get their cause heard at the centre, where the key decisions are being made.
When we discuss reform in the NHS, let us not dismiss out of hand the question of having some local accountability. I am not convinced that because someone is elected locally and has to answer to a local electorate, they cannot be convinced of what is in the best interests of the national health service as a whole; but I am not convinced that the Scottish people can be expected to think both strategically and locally, or that democracy is the only answer. When we argued for a democratic Scottish Parliament, people said that it would lead to mob rule or that it would not work. Here we are, 100 years on. Why not try democracy in the NHS? It might work.
John McAllion's speech is a difficult one to follow. The frequency with which we debate the health service indicates how central it is to the population of Scotland. Much legitimate concern about the service has already been addressed.
The motion mentions "improving health". Although the minister touched on that, I would like to return to something that I have spoken about before: preventive measures. My ambition in life is to stay out of the hands of the medical profession for as long as I can, although chronology is obviously running against me.
Accidents and disease can strike at any time and can hit any one of us, but we have to make inroads in tackling obesity, heart conditions and respiratory complaints through changes in lifestyle. I am tired of reading that the area that I represent, the West of Scotland, has the worst record for heart attacks and bronchitis not only in the UK, but probably in western Europe.
We talk about joined-up government from time to time and we all believe in it. As far as health is concerned, good, dry housing that is designed to establish good and healthy living conditions would be a start—and homes should preferably be aesthetically pleasing, so that they and their surroundings raise, rather than lower, individuals' morale. Attempts are being made in that direction. Morale is important: giving people a feeling of self-esteem through appropriate education and life opportunities is vital, and cannot be separated from the solution of our health problems, both physical and psychological. Without self-esteem, individuals stick to diets, habits and indulgences that will ultimately shorten their lives—and I stand accused as a major pie eater in the Parliament restaurant across the road.
Encouraging exercise throughout life, rather than imposing it on reluctant conscripts in schools, is key. I am pleased to read that steps are being taken in North Lanarkshire to get pupils into organised games again, with more physical education teachers being employed. The system worked well before the strikes of the 1980s, and it died as a result of the long confrontation between the Tories and Scottish teachers. With one or two small exceptions, the system has never really recovered. I look forward to councils seeking out the findings of the Linwood experiment, which proved some years ago that daily PE improved formal classroom performance as well as helping with pupils' fitness. If classroom performance is improved, that helps pupils' self-esteem, something that the minister might like to take into account.
One of our aims must be to turn a nation of spectators or computer operatives into a nation of participators in physical exercise. That will promote health and help people to avoid the health service for as long as possible.
I was deeply concerned at an allegation made on television this morning that up to a sixth of operations in England and Wales are postponed because of administrative difficulties. The major administrative difficulty that was highlighted was that surgeons go on holiday at short notice, wrecking well-planned schedules. The Royal College of Surgeons, in its defence, stated that that was not the only reason for the difficulties, pointing out that there was a lack of high-dependency beds and intensive care beds, the number of which in Scotland has been cut, as has been mentioned. That reduction has to be reversed.
We have moved on a lot from the days when surgeons and consultants were gods whom nobody could criticise, but if that allegation is true, we have some way to go. A short-notice holiday is not a valid reason for postponing surgery, especially if the operation has been anticipated by a patient who has been in pain for any length of time. I have never been in pain for a great length of time, but I know that, if and when that happens, I do not want to hang about for weeks, months or, as can sometimes be the case, years.
I am sure that we all have anecdotes to tell. One of the most poignant letters that I have received in the time that I have been in this Parliament was passed on to me by a counsellor. He told me that his client could not take a seat in his surgery for pain. His consultation was not due, however, for several months. That state of affairs is totally unsustainable, and I know that every member wants to ensure that such circumstances do not arise again. Somebody else close to me recently went for consultation to have their condition compared with what it was six months previously, but the X-ray from six months previously was not available when the consultant tried to make some sense of the situation. That kind of administrative flaw will not do either.
I would like the minister to investigate, in the Scottish context, such matters as surgeons going on holiday at short notice. I am sure that such instances are not as prevalent in Scotland as they may be in the south, where private medicine is perhaps more dominant in the ethos of the health service. I would like the minister to consider that and to ensure that sensible use is made of facilities and surgical personnel.
I am pleased to have the opportunity to contributed to this morning's debate. I have a trio of items that I would like to mention.
First and foremost, it is appropriate that we are holding the debate during ME awareness week. ME has historically been a much misunderstood and misdiagnosed condition. It is timely that we are being reminded of the long-term nature of that condition, and we should consider its effects on its sufferers' family and wider circle of friends and relatives. That is also appropriate as we move into a new century, because the treatment of ME is a perfect illustration of the different directions in which the health service will have to move if it wants to address the health problems of the nation—not just those that the health service wants to address, but those that patients wants it to address. I am not alone in expecting that the Scottish Executive will take considerable strides over the next year to improve the recognition and handling of what is a dreadful condition.
Secondly, I cannot miss another opportunity to highlight my concern about the Church of Scotland's recent announcement of the closure of a number of its care homes for the elderly. One such home is Dunselma in the village of Fenwick. The closure of Dunselma is appalling news for the residents, their families and the local community as a whole. Many local people use the services that the home provides. There is a lunch club, meals on wheels and even a fitness club, for those who like that kind of thing. The nearest home to Dunselma is in Patna, which is a 45-minute drive away. Members can imagine the anxiety that residents feel and the concern that their relatives have.
I am concerned by the member's description of Ayrshire's geography. She said that the nearest home to Dunselma, which is in my constituency, is in Patna. I understand that there is another care home a few yards down the road from Dunselma. Lyndsay McIntosh should explain clearly to the chamber exactly what she means.
The care home to which Margaret Jamieson refers is not a Church of Scotland care home. I appreciate what the member is saying, but I am concerned particularly with the closure of Dunselma.
Charities such as the Church of Scotland do not run homes in order to make money, but out of a desire to care for others. The Executive claims to encourage that, but seems to be making it increasingly difficult. We will not tire of highlighting the Executive's hypocritical approach.
Finally, I would like to touch briefly on hospital acquired infections. I will not repeat what has been said about the number of blocked-bed equivalents, the increased likelihood of death for infected patients and the cost of HAI to our nation's health service. Instead, I will give members an example from my experience.
On 18 November, a phone call to my home advised us that my father-in-law had been admitted to hospital after suffering a heart attack. He was normally fit and active for a man of 75, but the heart attack came as a blow because his doctors were treating him for asthma. However, they seemed confident that his condition could be improved by a course of medication.
After a couple of ward moves because of bed shortages, my father-in-law's condition improved remarkably. At one visiting time, he said that he felt like a fraud for taking up a bed in hospital. A couple of erratic temperature and fluid checks later, he was discharged from hospital, 16 days after admission and armed with a pharmacy's worth of medication.
However, within a few days his condition started to deteriorate. He was nauseous, was suffering severe back pain and had not received a visit from the GP practice nurse, even though a request had been faxed to the surgery on his discharge from hospital. Communication was poor. The purpose of the nurse visits was to take blood samples for analysis. Two weeks later, on 18 December and still without a visit from the practice nurse, my father-in-law was readmitted to hospital, some 25kg lighter than when he was first discharged. By any standard, that is a dramatic weight loss. Tests showed that he had methicillin-resistant staphylococcus aureus, which had not been present at his previous admission. We know that because of the numerous blood tests that had been done.
My father-in-law was isolated and barrier nursing controls were put into operation. His condition was such that he had to be tube fed; bed pans and bottles were used for waste discharge. By that stage, only adult members of the family were visiting. At one afternoon visiting session, the family arrived while my father-in-law was away for a X-ray, to be assailed by a stench in the room. Two full bottles were left on the bedside cabinet, together with an assortment of soiled bed linen—and we wonder how people get hospital acquired infections.
It was distressing to see such a vibrant man in a poor state of health, but for him to have his human dignity destroyed in the way that I have described was unbearable. As members may imagine, phone calls were made, meetings took place, there were frank exchanges of views and changes were instituted. What a difference those changes made. The room was deep cleaned, the bed was replaced by one with an air mattress and a catheter was put in place. That is the standard of care that everyone should expect and receive—one should not have to phone a friend in the health trust.
After intensive physiotherapy, my father-in-law was discharged again, walking with the aid of a Zimmer frame and armed with a prescription that required him to take 18 tablets a day to fight the infection. Within a week, the frame was gone and he was walking with the aid of a stick. He began to eat normally—admittedly, only small amounts—and made a little progress.
On 21 February my father-in-law awoke in great pain. A visit from the family doctor was requested, but in the meantime the pain worsened. An ambulance was summoned and, as the paramedics were examining him, the doctor arrived and sent the ambulance away, saying that my father-in-law was suffering only from wind. Doctor knew best. By early evening, an emergency doctor had been summoned and my father-in-law had been admitted to the high-dependency ward. He had suffered a perforation. That would normally be corrected by surgery, but because his condition was so poor that surgery was not an option, we were told that he would have to try medication and hope for a natural repair. My father-in-law was seriously ill. Over the next few days, he rallied and relapsed.
Mrs McIntosh, you have had seven minutes and two other members are due to speak. I would be grateful if you would conclude your speech.
I crave your indulgence, Presiding Officer. I am nearly at the end of my speech.
My father-in-law finally died on 2 March. If I sound bitter and angry, that just about hits the spot. This was an unnecessary death, caused not by a heart attack, but by a problem that we should have addressed long ago. The Executive may have made progress on the issue, but it has not done so quickly enough for my family. It can add my father-in-law's death to its HAI statistics.
I thoroughly enjoyed John McAllion's contribution from the back benches—perhaps we should call them the pariah benches. I agree with much of his analysis and with the views that he expressed about the direction in which the NHS should go. He referred to a debate a long time ago in the Labour party. A similar debate took place in the SNP, which reached a not-dissimilar conclusion. I contributed to that debate and am delighted that its results are reflected in current party policy.
I have considerable concern that the investment that is required by the NHS in Grampian is likely to be enhanced by a reduction in the number of NHS beds and an increase in the number of private beds at Aberdeen royal infirmary. At the moment, considerable energy is being expended in a consultation exercise aimed at doing precisely that.
The driver for the measure is the lack of money in the NHS. That seems rather odd against the background of the alleged generosity of the Chancellor of the Exchequer towards the NHS. It is extremely sad that private medicine within the NHS is being promoted because of a lack of money in the north-east of Scotland. The complaints that members from most parties have made about the impact of the Arbuthnott formula in Grampian need addressed.
The Arbuthnott formula was a genuine attempt to address health needs throughout the country and to ensure that funding reflected a variety of circumstances. However, Grampian has suffered significantly as a consequence of the changes that have been made and is likely to suffer further in future. I have not heard even the Tories advocate an expansion of private medicine within the NHS, and I hope that they do not favour that. However, if the introduction of the Arbuthnott formula results in the expansion of private medicine within the NHS, that is a very sad state of affairs.
In his summing-up, I would like the minister to indicate whether the Executive plans to extend the Arbuthnott formula to general medical services funding. Changes are planned in the primary health care sector that could have a serious negative impact on the NHS in Grampian. We are trying to get more medical activity to take place in the primary care sector. However, if the Arbuthnott formula is applied to that sector, in Grampian the situation will deteriorate further. I share Richard Lochhead's concerns about general distribution formulae that seem to work against Grampian on a whole range of issues. Such formulae appear not to take into account particular circumstances such as the high prevalence of drug use in the area.
I also want to talk about the fact that a significant amount of the work in the health service is done by people who are not directly employed by the NHS. In particular, I want to highlight the increasing use of agency nurses. I do not for one minute suggest that agency nurses are not dedicated but, because they do not work on the same ward every day, agency nurses cannot be as familiar with how things are done as an NHS nurse would be. They will not be as familiar with the approach taken in a particular ward or know where everything is in that ward. Nor, indeed, will they be as familiar with the patients in the ward. One interesting innovation of recent times is the idea of the named nurse, who looks after particular patients. It is difficult to have named nurses when so many services are provided by agency nurses. We need to move towards a reduction in the number of agency nurses who provide direct care.
The use of private cleaning services has already been mentioned by others. The fact is that private cleaning services are accountable only through a contract specification and are not accountable directly. It is difficult to deliver a service against that kind of background. On bedblocking, I suggest that that is caused not only by the elderly but by hospital acquired infection patients.
If we are to look at health in the round, as was suggested by my colleague Colin Campbell, we need to look at winter pressures. The fact is that we have an excess of winter deaths and an excess of activity in winter in our hospitals. Such excesses relate to the fact that, outwith the NHS, there are many things in our society that are wrong, such as housing. Some of the additional money could and should be usefully spent to address that issue.
The Minister for Health and Community Care urged everyone to listen to what he had to say. He used some buzz words and buzz terms: reform should not be based on "ideology"; we should not have a "top-down" reform process; we should engage in a "collaborative" process that involves patients and staff within the health service.
The problem is that the new Labour-Liberal Executive reform process is, of course, based on ideology. That ideology is the ideology of the private finance initiative, which puts shareholders and profits before hospitals and patients. That ideology is one that relies on the exploitation of health workers. That is what PFI means. PFI works by extracting profit through cutting clinical staff budgets and lowering the wages and conditions of staff who are employed in our health service.
What the minister had to say was inadequate because it represents the continuation of the process that got us into the current problems. The first 30 PFI projects across the UK resulted in a 33 per cent reduction in bed capacity and in a 25 per cent reduction in staff. Everyone identifies our health service's two biggest problems as the lack of beds and the lack of staff, yet we are encouraged today to continue with the very PFI process that is delivering fewer beds and fewer staff. The minister's reform process is ridiculous precisely because it is a top-down instruction.
Who was consulted on the private finance initiative? The staff were not consulted; they reject PFI whole-heartedly. Professional organisations such as the BMA were not consulted; they reject it whole-heartedly. Not even the public were consulted. In opinion poll after opinion poll, the public have rejected whole-heartedly the use of private finance within our hospitals. The public have rejected PFI not simply on the grounds of ideology—although it is important that most of the public realise that patients and people should come before profits and shareholders—but on the practical basis that deploying the PFI financial process takes control of the health service not only out of the hands of politicians but out of the hands of the citizens of this country. PFI ties us in to contracts of 30 and sometimes 60 years. That removes the local devolution of decision making about what the future health priorities should be.
An examination of the full business case of Edinburgh royal infirmary illustrates my point and I hope the minister will address it. The new PFI hospital's annual capital charges will rise to £26.6 million, compared with the former figure of £14.5 million. The capital charges will rise from 9.3 per cent to 18.4 per cent of total annual revenue expenditure. Where does the rise in the capital charges come from other than a lower bed capacity and a lower staff budget? The staff budget has decreased by 17 per cent to pay for the PFI project. Within that staff budget decrease, there is a 21 per cent decrease in the nursing budget.
The fact remains that, under normal public procurement rules, the construction of the Edinburgh royal infirmary would have cost the public taxpayer £279 million. Under PFI, it cost £798 million. I hope that the minister will address that point. That is a bad deal for staff, for patients and for the citizens of Scotland as a whole. I have listened to the minister but, having read his motion, I can do no more than reject it because he encourages a continuation of the PFI, which is undermining our health service.
We come now to wind-up speeches. As we are a little over time, I appeal for brevity.
This has been a good debate on a good motion. The tone was set by the minister's opening speech, but within the debate we have had two ideological speeches. One was from Nicola Sturgeon, across whose contribution a veil of kindness would best be drawn. The other was from Tommy Sheridan, who seemed to ignore the fact that the figures over the past year show an increase of 1,200 in the professional staff employed by the NHS in Scotland. There has also been an increase of 376 in the intake of student nurses and midwives. We need to look at the picture as a whole and not simply at particular bits of it.
Inevitably, the state of the health service will always be of the greatest public interest. In many ways, it is a journalist's dream. There are human interest stories at all levels: medical misadventures occurring through individual fault or system failure; amazing success stories for new drugs or new procedures. However, the rate of medical cost inflation, which is fuelled by scientific advance and rising expectations, has made the NHS and health services generally the most intractable problem for Governments of all political hues.
We have a number of advantages in Scotland as we have our own Parliament and the focus that that gives, with a minister with responsibility for health showing the approaches that can be taken. We have higher investment levels than does the UK as a whole, although it must never be forgotten that we have problems of rurality and serious health problems in our cities. Those problems result in the need for greater investment in the health service in Scotland.
I genuinely welcome the news about the improved waiting time figures and the success of the national waiting times unit. I am glad that the Liberal Democrat contribution to the Executive partnership has resulted in a focusing on delivery on the issue of waiting times rather than on the sterile waiting list arguments of the past.
I am proud of the contribution that the Liberal Democrats have made to the introduction of free personal care for our frail elderly. As we move towards the introduction of the policy in July, it is proving to be a driver for higher standards for all, particularly against the background of the joint futures initiatives, as I discovered at a meeting that I had yesterday with the Greater Glasgow NHS Board. However, as the minister recognised, those improvements are simply staging posts.
In his moving speech, Keith Harding talked about the uncertainty that is involved while waiting for delayed treatment and assessment. A wait of six months for vital treatment means six months of enormous worry and suffering for the people concerned and their families against a background in which the same procedure could be done in two or three weeks if one could pay for it—or for free, in a number of other countries. That is a fair measure of the challenges that we face.
Despite what I said before, there are enormous staff problems relating to GPs and certain specialists. Adam Ingram talked about neurologists, but there are also shortages of mental health specialists and, recently, a number of cancer treatment appointments were cancelled at the Victoria infirmary in Glasgow because of a shortage of oncologists.
The trouble is that it takes five to 10 years for NHS staff recruitment to make a difference. As a matter of urgency, we need to expand the number of medical and nursing graduates in this country and we need to keep them in Scotland, as I said recently. The Herald has recently confirmed that the other background problem in relation to that matter is to do with GPs leaving practices in our urban centres because of pressure and burn-out.
The issue is to do not only with money but with conditions and good use of the money. The issue has a wide focus. Colin Campbell said that he wanted to stay out of the hands of the NHS professionals and that is a good target. We should encourage people to be sufficiently healthy and ambulant that they do not require health services, although it is inevitable that some people will. That raises the issue of creating healthy, active citizens with lifestyles, diet changes and health-promoting backgrounds to their activities that will produce health benefits in the middle and longer term.
A note that I have from the Chartered Institute of Housing echoed a point that Brian Adam made earlier. It says that good housing is hugely important to good health. The Executive has recognised that in its fuel poverty strategies and so on. Housing should form a core part of the response to Scotland's poor public health record. I hope that, when decisions come to be made in detail about the consequences of Gordon Brown's recent budget, a wide view will be taken of health that deals not only with the health service but with health promotion and housing.
Margaret Smith talked about performance assessment, which is an important issue. Adam Ingram talked about the need for a rise in spending on mental health and the fact that it is a cinderella service. The number of people, particularly young men, who suffer from mental health problems is a matter of great concern.
Ian Jenkins spoke of the advantages to the NHS of day care. Across Scotland, there are voluntary organisations that could be used to assist the discharge from hospital and provide the back-up that does not always exist at the moment. The problems of funding that Ian Jenkins mentioned have to be dealt with and the organisations have to be put on a proper basis.
I support the motion.
When I saw the motion, I thought that I had been transported to the setting of the old television programme "Fantasy Island"—I would not have been surprised if the minister had made a speech wearing a little white suit. The cheek that the Scottish Executive shows in lodging a motion that welcomes the priority that is attached to dealing with important issues such as delayed discharge and hospital acquired infection takes one's breath away and does no service to the patients who are waiting for improvements in the NHS.
The first recommendations and guidelines on hospital acquired infections came out under the Conservative Government in 1995. They were followed up by a National Audit Office document in February 2000 and a House of Commons report in November 2000. Finally, after months of inaction and delay, the Scottish Executive report was produced last month. If one reads all the reports, one will see that most of the recommendations are pretty similar. However, the minister has consistently failed to implement the recommendations. Nicola Sturgeon was right to point out that Susan Deacon announced more than a year ago that the issue was one of her priorities. A glossy brochure cannot cover up the Executive's negligence. After such a long time, with many reports available, it is too late for the Scottish Executive to say that it will move forward now that it has produced its report.
I have admitted in my speech and in every statement that I make on the subject that hospital acquired infection is a serious problem, as is delayed discharge. We should be judged not by the problem but by how we are responding to it. Ben Wallace should address that rather then delivering a history lesson.
The minister misses the point. My history lesson shows that the Executive is not dealing with the matter properly, as the recommendations have been public for years. The minister obviously disagrees with the dictionary definition of the word "priority".
It is true that the Executive has made progress on delayed discharges: it has doubled the number in four years. The cheek of the wording of the motion takes my breath away.
I will not speak further about delayed discharges and hospital acquired infections, because I want to talk about the larger issues of investment in and reform of health care. The important factor is the outcomes. The Scottish Executive's statistics show that the massive changes in waiting times that we heard about yesterday are not what they seem and have not borne fruit. In many areas, waiting times have doubled or more than doubled. For example, since 1997, the medium wait for out-patient appointments has risen by 17 days and the number of people waiting more than 18 weeks for an operation has doubled. That is the outcome.
By the next Scottish Parliament election, it will have been six years since the Labour party started running the health service in the UK and four years since it started running it in Scotland in collaboration with the Liberal Democrats. How many relaunches and reprioritisations does Labour think that it will take to solve the problem?
Mary Scanlon pointed out that the legacy of the 1997, 1999 and 2001 elections is a long list of manifesto commitments that Labour has failed to meet. For example, the abolition of mixed-sex wards has been included in every Labour manifesto since 1997. We have to bear in mind the reality of the Scottish Executive's record when we consider what it says.
We were relieved that yesterday's press release stated that the Scottish Executive has used the independent sector to try to alleviate the problems in relation to some operations. However, if the minister had signed a similar concordat to the one that Alan Milburn signed, perhaps 6,000 more operations would have taken place in the independent sector. I make no apologies for comparing new Labour south of the border with Scottish new Labour because—let us face the facts—the Government south of the border spends less money and gets better outcomes than the Executive does.
I understand Ben Wallace's enthusiasm for the private sector, but does he share my concerns about the fact that Grampian University Hospitals NHS Trust wants to increase the use of the private sector within the NHS? Will he join me in condemning the trust for trying to raise money by that route?
We are talking about using spare capacity in the independent sector, not about the independent sector being able to use more NHS beds, which I agree is not the right way in which to progress. However, the minister cannot, even in his press release, say that he used or purchased capacity from the private sector. He says that the national waiting times unit has "facilitated" a further 2,000 operations from the independent sector. The ministers have been kicking and screaming all the way along and the people who are suffering are the patients.
I know that the ministers and the muppets on the back benches will always say that Liam Fox and the Conservatives want to shut down the NHS. Brian Fitzpatrick looks up, as he is usually one of the first to jump up. He is not wearing a red tie today, but a yellow one. He is obviously moving on. That is usually all that we notice him for.
Will Ben Wallace give way?
No, I will not give way just now.
We are not fooled by what Labour members say. We do not want to dismantle the NHS. We want to ensure that reform means just that—real reform, not idealistic vandalism with no real purpose. We remember that the NHS is about patients and that, therefore, any changes should put the patient at the centre. We mean that and will not put unions or ideology before it.
We all know that the Scottish Executive wears its reforms like badges on its coat, perhaps to justify the phrase "new Labour". It is abandoning its socialist tradition and calling what it does "reform", which allows it to call itself new Labour. However, the definition of reform that Mr Milburn uses is completely different from the one that the Scottish Executive uses. Mr Milburn proposes a new model, with providers in the state, private and voluntary sectors; the Scottish Executive consistently believes in a state monopoly. Mr Milburn wants patients to have choice; Malcolm Chisholm will tell patients what information it is appropriate for them to have. He will not give them all the information, so that they can make up their own minds; he will tell them what the "meaningful" information is. That is the key. He will tell them what they should and should not know. Does he think that patients are idiots? Most patients can make decisions for themselves. Let us give them all the information and not patronise them.
Ben Wallace knows full well that I used the word "meaningful" in connection with the performance of surgeons. In other regards, we are absolutely clear—and I made it clear in my speech—that we want more information to be made available. On the subject of meaningful information on surgeons, is Ben Wallace saying that he wants information that is not meaningful to be made available?
I would like all the information to be made available, so that the customer—the patient—can decide what is meaningful. Who is Malcolm Chisholm to tell people what is meaningful information? He should let them decide. Will he make available infection rates for hospital acquired infections, so that patients can decide not to go to a particular hospital because it has a higher infection rate? We will see. On page 11 of Mr Milburn's document, "Delivering the NHS Plan", what are listed as the current problems in the NHS are almost identical to the measures in the Scottish health plan. That is the difference—reform means one thing and not the other.
Scotland is about to go to the top of the European league on health spending, but will the minister match that with top targets? For example, if there are still waiting lists and staff shortages in six or seven years, with people leaving the service and waiting lists getting longer, will he agree that his direction and policy on the NHS have been wrong? To Karen Whitefield and others who claim that we would vandalise the principles of the NHS, I say that we already have a two-tier system in which people are increasingly paying for private medicine or having to rely on where they live to get the drugs that they need. I invite the minister to come with me to Denmark, Germany or Spain. In those countries, people on low incomes, the unemployed and those in vulnerable sectors of society have a better health care system even though their Governments are spending less on health than we are.
I ask the minister to tell me whether he believes that the system is producing the right outcomes. It is clear to me that it is not. The Scottish Conservatives will not shy away from taking up the real challenges in health. We recognise—as Margaret Thatcher did and Alan Milburn does—that, if the money is allowed to follow the patient and the patient is allowed to make choices based on all the information, that is the best route towards achieving genuinely patient-driven reform and a health service that is based on patients' needs.
This has been an interesting debate, if for no other reason than the fact that we have witnessed the spectrum of views from Labour members. We had an off-the-shelf monologue from Karen Whitefield about how well the Executive has done.
Will the member take an intervention?
No, thank you.
After that, we heard a rather more interesting speech from John McAllion. I could not disagree with a word that he said, but I suspect that many on the Labour benches will disagree with him.
The difference, of course, is that the SNP will include in its manifesto the proposal to empower the public through direct elections to health boards. That is unlike the Labour party, which wants continually to tell the public how things will be.
The fact that Westminster decides how much money the Scottish Parliament receives affects all members of Parliament, across all parties. The fact that the future of our health service is not in our hands also affects all members. The sustainability of investment is outwith our control. That leaves us as mere administrators of someone else's decisions.
The limitations of the Scottish Parliament hinder our ability in the long term to tackle Scotland's appalling health record. I note in passing that even the proposed English regional assemblies will have more financial powers than the Scottish Parliament has. The Parliament's limitations were acknowledged by Bill Butler, who said that investment depends on Westminster's intervention. The problem is that that leaves us dependent on decisions that are made elsewhere.
Will the member take an intervention?
In a moment.
That dependency has affected Parliament's ability to tackle our problems. For years, health has been underfunded, as the SNP has pointed out. However, we have seen tax cuts at Westminster at a time when there should have been more investment in our health service. The Executive continually denied that there was a problem until Gordon Brown's sudden volte-face, when he decided that he had been wrong all along. Bill Butler can tell us why Gordon Brown changed his mind.
One of the things that struck me as incredible about the SNP's amendment is that it describes devolution, which is what the Parliament is all about. Devolution is about partnership, not about dependency. If Shona Robison had her wish of an independent Scotland, how would she improve on the supposedly deplorable record of £3.2 billion extra that we have just had delivered in partnership with Westminster?
We would not wait for a crisis in the health service before we started to do something. We would have invested Scotland's huge potential resources in Scotland's health service years ago, rather than waiting until the health service was in the state in which it is.
The fact that the destiny of Scotland's health service is in someone else's hands is a problem. As Karen Whitefield so simply put it: we get our money from Westminster. However, it is time to end the dependency culture to which Bill Butler referred.
We have all agreed this morning on the need for reform in the health service, but we disagree on how that should be achieved. The SNP believes that the starting point for reform should be what is best for the patient. We believe that the public have a right to transparency and accountability. I do not think that there is anything to fear in giving patients the power to make decisions. The minister's proposals for public involvement sounded fair, but they are simply not enough. As was pointed out, the accountability of the bodies to which the minister referred remains with the minister.
The only way of giving people real power is to have directly elected positions on our health boards. People have had enough of the sham consultations throughout the country. If they feel that they have no say in their local health service and are involved in a consultation process that asks them questions to which the answers have already been decided, they are unlikely to take part in a similar process again. That leads to further disengagement from the political process.
The SNP believes that the right way forward is to give people a place at the top table where the decisions are made—our health boards. We also believe that the public should have access to robust and accessible information about hospital performance and the performance of people who treat patients. I do not think that medical staff—doctors or consultants—have anything to fear from that, because, as we know, the quality of our doctors' performance is high, except in unusual cases. There is nothing to fear from giving the public access to the information about the people who have patients' lives in their hands. I cannot see why the Executive is so reluctant to do that.
I will make the same point that I made to Nicola Sturgeon and Ben Wallace. I made it absolutely clear that we believe that information about surgeons' performance should be available, but the fact remains that that information has to be meaningful rather than meaningless. Anybody who knows anything about the issue agrees with us.
When will the public get access to that information? I am sorry, but the comments of the minister and those of his predecessor led me to believe that that information will not be provided.
We do not believe that the use of private finance does anything to build up capacity in the NHS. The use of private finance is further proof of the Executive's policy of saddling future generations with massive debt in order to finance its short-term political goals. The national waiting times unit's use of the private sector is only a short-term sticking plaster. Of course we all hope that the official figures, which we still await, will show that waiting times have gone down, but that cannot be a solution to the long-term problems of the health service. If waiting times are not to go up next year or the year after next, we need to ensure that the capacity of the NHS is built up sufficiently to treat patients quickly.
I see that time has moved on. I conclude by saying to the minister that we have heard nothing new this morning. I listened to 20 minutes of the minister's speech of restated policies. We will debate health as often as the Executive wants to, but we expect the minister to tell us something new and to update us with information about what is happening and how he intends to tackle the many problems that patients in Scotland face. He has told us nothing about that this morning. Perhaps we will hear something on it from the Deputy Minister for Health and Community Care in his first main debate on health. However, I suspect that we might be treated to more of a stand-up comedy act, which will do nothing to further the debate on the way forward for our health service. I remain to be surprised.
With that remarkable introduction I call the deputy minister to respond to the debate.
Thank you for letting me enter centre stage, Presiding Officer.
I am surprised by the SNP's amendment, which contains a policy commitment that was not costed in the party's statement on Friday. Rather than considering the resource base from which we have to make sensible and difficult choices, the SNP has gone back to its old claim that independence would resolve all the difficult decisions that Scotland has to make.
I would hate for the SNP's health team to join Ben Wallace on "Fantasy Island"—members on this side of the chamber would not want to visit it—but some of the key points that SNP members have raised suggest that they might do that.
I want to identify some of the key points made by more than 20 speakers, although I will not cover all of them. First, I re-emphasise what the minister said in his opening remarks. The debate is about how we use the new level of resources over the next five years to make the dramatic changes that are required in our health service and our experience of health. We have kept an open mind on how to relate that to the broader strategy of the Executive's other social policies, which Robert Brown mentioned. That is critical to our development.
How do we demonstrate that that investment will produce the reform that will affect the services that matter to citizens? Change is always difficult. One of the key challenges that anyone faces in the decision-making process—perhaps the reason for the SNP's relatively inexperienced contribution is that it has never needed to make such difficult decisions—is that as you try to modernise—
Will the minister give way?
If Nicola Sturgeon will allow me, I will finish my point. Sometimes modernisation comes at a price that local people might at first find difficult to accept. How do we build into the modernisation process consultation mechanisms and democratic accountability at all levels to ensure that we are making a decision that has the consent of the community?
Unified health boards are already demonstrating a partnership approach, which is a genuine way to try to address some of the central issues that have bedevilled the Scottish health service for far too long. Yesterday, I visited Lothian where partnership councils, the health board and other major players are coming together to consider ways to address delayed discharge. The fact that social care providers from councils, support carers from the voluntary sector and the health service were all in one room demonstrates how we can integrate such work more effectively.
I agree with the minister on one important point: those responsible for the running of the local health service will always have to take difficult decisions. How will the minister ensure that local patients and the wider public are not just consulted on such big decisions—they were in Glasgow, where the consultation exercise was extensive, expensive and glossy—but are listened to by the decision makers in the health service, and feel that they have been listened to?
As the MSP for one of the constituencies affected by the Glasgow acute services review, I have regularly attended consultation meetings. I have found the health board willing to open up to wider participation. That has resulted in more effective dialogue between decision makers and the communities and individuals affected. Our agenda must be to continue that process and make a genuine difference. That is true not just for Glasgow, which is currently undergoing acute services reviews, but for other parts of Scotland.
How do we move forward in tackling the issues that have been identified to date in parliamentary debates? How do we tackle waiting times and joining up patient-centred services at a local level? How do we ensure that people have better access and how can we improve standards? The comments made to Malcolm Chisholm this morning were rather curmudgeonly, given that he has just identified a clear programme to address those issues.
I will touch on some of the issues that have been raised by members and identify how we are making progress on them. Several members raised the immediate issue of infection control. Since 1999, there has been a 25 per cent increase in the number of nurses involved in infection control. That is a tremendous development and one that must continue. Another, more important, issue is that raised by the Clinical Standards Board in relation to standards in hospitals across Scotland. We are undertaking an independent review of infection control over the summer and we hope to produce a final report at the end of the year. I hope that that will address some of the issues raised by members this morning.
Will the member give way?
I would like to touch on the key comments of another Opposition member. At least Mary Scanlon identified some issues for serious debate—that is much more than the main Opposition party in Scotland did—and I thank her for that. Mary Scanlon indicated that there was no significant way to address the issue of dealing with one definition of health-care-associated infection. A major drugs company has identified some issues relating to that. We want to find out what information we have on that and feed it into the inspection control measures that were identified earlier.
Mary Scanlon identified several key issues, which were touched on earlier. Interestingly, neither Ben Wallace nor Mary Scanlon addressed the connection between the resource base available through the devolved settlement and decisions made by the Westminster Government. We have yet to have a commitment from the Conservatives to match the spend identified by the Chancellor of the Exchequer, Mr Gordon Brown, in the budget. That will have consequences for the Scottish budget.
We recognise that. We have said that we do not support increased investment because it is being thrown into the current, unreformed system. Until there is reform to match investment—just as Frank McAveety said earlier—we will not support it.
Interestingly, the Conservatives have not ruled out using social insurance to pay for health care. The majority of people in this country would find such a step deeply troubling.
The Conservatives have also failed to address how we reform the system in a way that is appropriate to a Scottish health service. Although I welcome the Conservative commitment to Alan Milburn's strategy for the health service in England, I should point out that there are substantial differences between the Scottish and English health services. We are doing what we are supposed to be doing under devolution and adopting strategies that appropriately recognise the differences—and will make a difference—in Scotland.
Mary Scanlon touched on the problem of reducing waiting times. We recognise that that is a challenge; however, as Malcolm Chisholm indicated, we have already set up the national waiting times unit, which should make a substantial difference in future. We must also address the issue through local plans that are co-ordinated both by the health board and by social services departments and organisations in local authorities and the voluntary sector to work up more effective, local ways of dealing with waiting times, delayed discharge and other matters.
A few weeks ago, 81-year-old Mary Innes had to spend £4,000 of her life savings on simple eye surgery. Does the minister not agree that, rather than expect the elderly to spend their life savings on eye surgery, we should give Grampian NHS Board its fair share of the cake?
It is interesting that Richard Lochhead raises that issue. I look forward to the SNP health spokesperson arguing in her next column in the Glasgow Evening Times that the Arbuthnott report should be changed to favour Grampian instead of Glasgow. Perhaps that is an internal debate—[Interruption.] Richard Lochhead should listen carefully. I am simply pointing out that he might wish to take up the argument with the decision makers in his own party.
The Arbuthnott report was rigorous and effective in its attempt to identify how we allocate health spending across Scotland. Both Richard Lochhead and the SNP amendment omit to mention that more resources than ever before are being focused on the health service in Scotland. The growth agenda, which has been welcomed by many folk in Scotland and the UK, will genuinely make a difference. However, it is incumbent on all health boards and others to use those resources effectively and to address some of the impact of the redistribution of funds in the same socially equitable fashion as the Arbuthnott report.
If resources are increasing, why does Grampian University Hospitals NHS Trust feel that it does not have enough money and wish to consider increasing the number of private beds within the NHS?
I thank Brian Adam for allowing me to deal with that. I should point out that there will be 6.5 per cent growth in NHS funding in Grampian in 2002-03, which is the same as in Tayside and Lothian. He also implied that consultants in the Grampian area, without any encouragement or approval from the Scottish Executive, want to explore the possibility of more private provision. Brian Adam should raise his concerns with those individuals. That is subsidiarity in action.
I want to turn to participation and democratisation. We have an open view on local participation. Although we welcome the development of the unified boards, we will need time to assess their effectiveness before we decide on any major structural upheaval. As Malcolm Chisholm said, the Scottish Executive has identified other key areas in the health service in Scotland that are much more important and we wish to move forward on those.
Members raised many other points. As I have only a couple of minutes, I guarantee that I will respond in writing to their comments.
Will the minister give way?
I thank Tommy Sheridan very much, but I am in my final minute and want to address my final point on ideology. I presume that that is what he is concerned about.
I am concerned about the Edinburgh royal infirmary.
As I know that Tommy is as much in favour of monopolies of the high moral ground as of other areas, I hope that we will engage in debate on that.
Let me be clear: the essential point is that clinicians assess the requirement for beds. That assessment is not made through the PFI process. Tommy Sheridan has made the same mistake as John Swinney in wrapping together all the expenditure on PPP/PFI models and expenditure that would have been invested anyway in health service delivery into a headline that suggests that money is being lost in the health service. However, his point does not bear critical examination.
Will the minister give way?
The minister is in his last minute.
Tommy Sheridan has a singular, fixed position on PPP and PFI that does not recognise that any model can be modified. We acknowledge that we have inherited certain elements of PFI from the former Government. We have modified much of that and we have delivered outcomes.
As Karen Whitefield rightly said—and I will end on this point—it is the outcomes that matter. I would be hard pushed—[Interruption.]
Order.
I will be hard pushed to finish a sentence if members keep trying to intervene.
Public-private partnerships occur not just in health, but in other sectors such as education. I have already seen substantial investment in secondary schools in my constituency. I would be hard pushed to identify any constituent who has come to me to say that they regret that investment, that they are concerned about it or that it is not making a difference.
I would also be hard pushed to find many MSPs disagreeing with that. People want outcomes and it is our responsibility to ensure that we have effective business plan assessment, that we deliver the important health care outcomes, that we modernise our health service at the acute level and that we deliver our primary care services more effectively so that folk do not need to find themselves in hospitals. That will make the difference. That is why I commend Malcolm Chisholm's motion and reject the Opposition amendments.