Health Service
We now move to the debate on motion S1M-383, in the name of Susan Deacon, and the amendments to it.
Before the debate starts, it is only fair to tell members that we already have more requests to speak than can possibly be accommodated. The four-minute time limit will be rigorously imposed, but even if everyone sticks to that limit, we will not get everybody in.
It is right and fitting that this, our last parliamentary debate before the turn of the century, should be about the future of our national health service in Scotland. That reflects the priorities of this partnership Executive, and I believe that it reflects the priorities of the Scottish people.
Today I want to look to the future—but first I would like to reflect briefly on the past. The NHS, which was founded 51 years ago, stands as one of the lasting monuments of the 20th century. Since its inception, the NHS has faced up to challenges. The first was that of its creation, when giants such as Beveridge and Bevan married vision with practical, determined action to create a new era— a new era in which care and treatment was based on need, not on ability to pay.
Over the years, the NHS has faced up to other challenges, for example, the challenge of diseases such as smallpox, diphtheria and tuberculosis, or present-day killers such as HIV. Another challenge is that of need. The NHS has met ever increasing demands on resources as medicine has advanced and technology and treatment have improved. It has also—rightly—met the challenge of the growing expectations of patients.
However, the biggest challenge might still be ahead of us: to meet the needs and expectations of the next generations and to deliver a truly patient-centred health service. The challenge is to deliver an NHS in Scotland that is fit for the purpose, fit for our people and fit for the 21st century. Today I lay down a challenge to every member of this Parliament to join the Executive in addressing meaningfully and constructively the real challenges and opportunities that lie ahead.
For the past six months, I have travelled the length and breadth of Scotland meeting NHS staff and patients in GP practices, in hospitals and in communities. I have spoken to those who provide care and have listened to those who receive it. I have sat around the table with nurses, doctors and other health care professionals who are working together to face the challenges of the future. Today I pay tribute to those professionals, who are at the heart of our NHS.
Let us make no mistake. The NHS in Scotland delivers superb care—often immense care—for patients. It responds practically and positively to new demands and new challenges, and this Parliament needs to do the same.
Will the minister give way?
I will take an intervention later; I want to move a little further into my speech.
We are often asked about how we will address such challenges. For example, we are asked whether we are putting more money into the NHS. The answer is yes. There have been record levels of investment—£1.8 billion over this and the next two years, which is real money, not false promises.
Is the minister aware that, in the past few days, there has been much publicity about the inability of health boards and trusts to fund their activities without getting into debt and not having the funds for next year? The minister talks about capital investment, but what about the revenue requirements?
Let me repeat my previous point. We are putting record levels of investment into the NHS in Scotland; we are not squandering resources on a divisive and bureaucratic internal market, which is what the Tories did before us.
I am asked whether there are pressures and demands on the system. Of course there are— there always have been and there always will be. However, those are situations to be managed, not crises to be manufactured. Although there are always issues and incidents in the NHS that have to be dealt with, it is important that we work constructively to deal with them positively and practically.
We are not talking about isolated incidents. Almost every acute hospital trust in Scotland has a significant cash crisis that is leading to bed closures and bed-blocking. How does the minister propose to deal with that crisis?
I will give members a choice: we can have another sterile exchange of numbers or a real discussion on the issues facing the health service. I have already answered Mr Adam's question; indeed I have answered it time and again. I challenge the Opposition to get involved in the real issues and the real debate, because we will not move forward—
Will the minister give way?
I am not taking another intervention, and I suggest that the Opposition listens to the point that I am about to make.
We will not move forward if the NHS is continually reduced to a cheap political football. The health service exists to improve people's lives, not to enhance politicians' careers. The NHS needs mature debate and sensible solutions, not the kind of soundbites and scaremongering that we hear all too often from the Opposition.
There is rarely a day goes by when I do not pick up a newspaper and see an Opposition member crying "crisis", "scandal" or "disgrace" about something in the NHS. That is political opportunism, not effective opposition, and it is not representative of the grown-up politics that the Scottish people were promised. They want politicians who give considered comment, not knee-jerk reactions.
If the minister concentrates on doing her job, we will concentrate on doing ours the way that we want. Her comment that Opposition criticism somehow leads to a crisis in staff morale is nonsense. Has she thought for a second that she might be the reason why 3,000 nurses leave the NHS in Scotland every year?
I do not mind if Duncan Hamilton or any other member of his party criticises me every day from now until kingdom come; what I find offensive is that he refuses to engage in the real issues, which people in the NHS must face up to every day. I find it offensive that staff morale and public confidence are undermined by the hyperbole and excesses engaged in by politicians.
Will the minister give way?
If I may, Presiding Officer, I will continue, because I know that my time is limited.
Rent-a-quote politics—which is what we are talking about—may generate column inches for Opposition MSPs, but they do nothing for patients, staff or, frankly, for the standing of politicians or this Parliament. We have a choice. We can sit here making claims and counter-claims about resources and manufacturing crises, scouring for scandals, or we can get down to business.
We have an NHS of which we can be proud. The 136,000 caring professionals who work in our health service embody the very best values of public service. They are there when we need them—24 hours a day, 365 days a year—ready to cope with the pressures of millennium celebrations and the extra demands that every winter brings. They deserve our thanks and support. The
Executive is giving them that support and intends to do more.
Will the minister give way?
I will take one further intervention.
I do not want to make a party political point. I am sure that the minister is aware of the Age Concern publication, "Turning your back on us"—it is a joint Age Concern/Gallup poll—which contains case studies that show clearly that age discrimination is prevalent in the national health service. I do not expect the minister to answer this question now, but will she, at some time, write to me to tell me which of the eight recommendations contained in that document are being implemented?
It is precisely because I am determined that the NHS should give the best possible service to elderly people—and all the people of Scotland—that I want us to make progress in developing in our hospitals and in our communities the patient-centred health service that the people of Scotland need.
The Executive is determined to do that. We want to build on the foundation that we inherited from the previous Labour Administration, which drew a line under the madness of the internal market, ended the inequity of GP fundholding and so began the process of healing the health service. No one should underestimate the damage that was done by the divisiveness of the internal market and by policies that put political ideology before the needs of patients.
We have begun the process of renewal, but I am determined that we will see it through to fruition. First, we must ensure that the NHS of the future is based truly on collaboration, not on competition. I want us to increase the pace of collaboration and partnership in the NHS in Scotland, not just between trust and health board or trust and trust, but between manager and clinician, doctor and nurse and carer and cleaner. There must be a new mobilisation of all the staff who deliver our NHS services.
Through the Scottish partnership forum, we have put that philosophy into practice. We have brought together NHS staff, trade unions, management and Government, not across the table, but around it. We have worked together to deliver real improvements: the first ever education, training and lifelong learning strategy for the NHS in Scotland, the soon-to-be-launched occupational health and safety strategy for NHS staff and other products of partnership working, such as the millennium pay deal and action to reduce junior doctors' working hours. Those are real improvements for NHS employees, which in turn deliver real improvements to NHS patients.
The partnership approach is now being developed at local level and, over the months ahead, I want to ensure that partnership working becomes a reality across the NHS in Scotland. There is no one better placed to help shape the future of the NHS than the people who work in it. I want them to be at the heart of the decision- making process.
Alongside that, I will be working to bring about a step change in the way in which the NHS—locally and nationally—communicates and engages with the wider public. The NHS belongs to the people of Scotland. They must feel that it does.
It will not be easy to achieve that change in culture. It will take years, not months, to make it happen, but happen it must. Local communities and local elected representatives have a right to know who takes decisions and why they are taken and must have the opportunity to contribute to the decision-making process.
The remote and faceless NHS boardroom of the internal market must become a thing of the past. Next month, I plan to meet all NHS board and trust chairmen to discuss with them how that change can be achieved. Over the coming months, I will be taking steps to attract a far wider pool of people into NHS boardrooms.
As a first step, I am writing to every MSP of every political hue to ask them to identify people in their local communities who could make a contribution in NHS boardrooms. That new sprit of openness, accountability and inclusion must extend to patients. A patient-centred NHS must be more than just a slogan—it must become a way of life.
That is why, in our programme for government, we committed ourselves to developing the patients project, which will aim fundamentally to change and improve the way in which the NHS communicates with patients through every stage in their journey: from GP surgery to out-patient clinic, from hospital to home. That work, which will draw widely on the views and experiences of patients themselves, will start in earnest early in the new year.
As well as keeping patients informed, we must work to reduce delays throughout the system. No single issue dominates my mailbag more than that. Such delays provoke a fear of the unknown: patients and their relatives wait and worry, not knowing what will happen next or when or where it will happen.
Our investment in a modern telecommunications system, linking up all GPs and hospitals in Scotland, will mean that, by 2002, patients will be able to leave their GP practice knowing when and where their out-patient appointment will be. Early next year, we will launch the first pilots of Scottish
NHS Direct, designed here in Scotland with the active participation of GPs and nurses. It will provide high-quality expert nursing advice via the telephone, 24 hours a day.
Our work does not end there. In our programme for government, we committed ourselves to set targets for speeding up treatment and shortening waiting times. Over the past few months, an expert support force has been working with the NHS across Scotland to explore how best we can do that.
Doctors, nurses and patients' representatives have told us that we have to tackle the inequalities in waiting times across Scotland, and that we have to address all the stages of a patient's journey through the NHS, not just one part of it. They have told us to redesign that journey so that it is not only faster but better planned, with realistic timetables that are met day in, day out, so that patients can have confidence that promises will be kept. I intend to heed their advice.
That is why I can announce today that, over the coming months, we will be working with the NHS to establish national maximum waiting times to be met by March 2001 in the key clinical priorities of heart disease, cancer and, for the first time, mental illness.
Much of that work will be achieved through the redesign of existing services. It can be done. We know that because, in many cases, it has been done. For example, the cataract redesign project in Ayrshire has resulted in the waiting time being reduced from 12 months to six weeks. Think of the difference that that makes for an elderly person waiting for a cataract operation. I want that approach to be rolled out across the country. That is why we will double the number of one-stop clinics and why we will work with NHS staff to support staff in the modernisation and redesign of services.
There will be a new alliance for patients, in which the Executive will work together with staff to deliver a new type of patient-centred care where services are made to fit people, not the other way about.
To achieve such changes and to deliver services in Scotland that can be the envy of the world, we must change the way in which the NHS delivers care. We must build on success, using innovative service design, our leading-edge work in clinical standards and our new approaches to multidisciplinary working. However, that process of modernisation and improvement also requires us to tear down some of the relics of the NHS of the past, including the outdated ways of working and, sometimes, the outdated buildings and shells that house them.
That will require hard decisions: a new way of
doing things; a new alliance of interests—an alliance for patients; a modernisation of people and priorities rather than just of technology and terrain. The NHS is not just about bricks and mortar—it is about the people who provide care and the quality of care that people receive, in hospital or increasingly in their community or home.
Fifty years ago, when most of our hospitals were built, they were the home of services because there was no other way of delivering them. Today, they are a hub for many services because so much more can now be delivered away from a hospital setting—in GP surgeries, community health centres and at home, with the support of health visitors and other community-based health care professionals.
Of course, we need new facilities. That is why there will be nearly £500 million of new hospital developments between now and 2002. That is why we are developing a new generation of walk-inwalk- out hospitals that harness new technologies and the benefits of day surgery.
Throughout Scotland, a process of reviewing local facilities is now taking place, to give people the best possible quality of care. That process will draw the blueprint of a new NHS. Our aim is to deliver local, convenient services wherever possible. It will be an NHS that will not shirk from the need to provide first-class treatment of the highest quality, because quality matters.
The reviews will propose changes to services. They will be changes for the better. Let me set another challenge to members.
Briefly, minister.
As members examine the NHS in their areas and question local health authorities about their plans for change—as I hope that they will—they should demand the right services for people, and not just defend the status quo of bricks and mortar.
Will the minister give way on that point?
I have no time.
It is on that point.
The minister is not giving way.
I have taken a number of interventions.
Nissen huts, mixed-sex accommodation, drafty corridors, Nightingale wards—that is not a modern NHS. It is not what we want for our families. It is not what we should offer to the Scottish people.
As politicians, we owe it to the staff who work in our health service and to the people who use it to lead, not to react; to reassure, not to scare; and to look to the future, not to the past. My picture for the future is an NHS that is based on partnership, that is open and accountable, and that provides high-quality, modern services throughout Scotland. It should be the vision for the future of us all. As we move into the new millennium, we owe it to our children and to our children's children to deliver that modern NHS for Scotland, an NHS for the 21st century.
I move,
That the Parliament is wholeheartedly committed to the NHS in Scotland and applauds the contribution and commitment of NHS staff across Scotland; welcomes the abolition of the internal market; recognises the record levels of investment in the NHS enabling the biggest ever hospital building programme; believes that the development of a modern NHS depends on a sustained programme of service redesign, greater public accountability and involvement and true partnership working across the NHS in Scotland, and pledges to work with the Executive, NHS and the Scottish people to address constructively and imaginatively the challenges of building a 21st century NHS.
That was a substantial overrun, which I allowed because the minister was so open in taking interventions. It means, however, that one speaker will drop out.
I now call Kay Ullrich to speak to and move amendment S1M-383.1.
I am disappointed that the Minister for Health and Community Care did not see fit to use the time today to address the real problems that currently face the NHS in Scotland. Instead, we have been subjected to the most anodyne of motions, full of self-congratulation. In the light of the serious issues that surround the health service today, it is a motion that lacks humility. I know that it fits in well with new Labour's style in this Parliament, but I cannot help but wonder whether those in the ministerial health team ever talk to the health professionals, ever listen to the concerns of patients or ever read the daily newspapers. If they did, even new Labour would not have had the brass neck to present the motion.
The minister once again favours reality in favour of rhetoric.
Absolutely.
Okay, once again—I am glad that the minister gave me a chance to put it right— reality is being completely ignored in favour of rhetoric. The minister is working on the following principle: when in trouble, create a diversion.
We have heard from the minister of the need to transfer services more appropriately from hospitals to primary and community care. However, when that was proposed in "Designed to Care", the establishment of a joint investment fund was to be a key plank of that reform. We were told that a substantial proportion of health service funds would be allocated to a JIF. Now, we are advised that a JIF is not a fund for developing the service; it is simply a mechanism for shifting existing resources. To date, not one JIF has been put in place. The key issue is that it is simply not feasible to transfer resources from secondary to primary care when the whole system is under-resourced. The real need is for an additional allocation of funding to the NHS in Scotland.
Will the member give way?
No, not just now.
I would like to consider making nominations to health boards, but I admit that I am fairly sceptical about replacing one political appointee with another—albeit that they may be of a different, perhaps better, political hue.
Today, we have not heard one word from the minister about the financial crisis that faces cash- strapped health service trusts the length and breadth of Scotland. For example, four health trusts in Glasgow face a shortage of £20 million. Tayside University Hospitals NHS Trust is looking at a shortage of £12 million, while it is estimated that Grampian University Hospitals NHS Trust is more than £3 million in the red. There is a similar picture of ward closures, staffing cuts and cancellation of non-emergency operations in almost every area of Scotland. Perhaps the most alarming revelation came yesterday, in a leaked memo from Raigmore hospital's executive group, which states that
"managers will consult clinical staff on the reduction of elective work load and change case mix in favour of less expensive procedures".
In other words, patients will be chosen for surgery, based not just on their clinical need but on how much their operation costs. How does the minister feel about rationing on the ground of cost? Surely she agrees that to put any hospital clinician in that situation is quite simply reprehensible.
We have heard all about new Labour's much proclaimed priorities—rightly so—of cancer and coronary heart disease. Yet there are eminent experts, such as Professor Gordon McVie, director general of the Cancer Research Campaign, and Professor Karol Sikora of the World Health Organisation's cancer programme, who say that people are dying in Scotland because of a lack of necessary resources. Both also say that the NHS in Scotland is unable to provide cancer patients with the most effective, up-to-date treatments in terms of drugs and radiotherapy equipment and that there is a lack of cancer specialists.
I know that the minister is aware of the concerns of patients and relatives about the life-threatening delays in treatment experienced at the Beatson oncology centre at the Western infirmary in Glasgow, where waiting times for treatment are four times longer than national guidelines. Such delays can, potentially, amount to death sentences for many patients and I hope that the deputy minister will address that issue when summing up.
For the first time, the Secretary of State for Health in Westminster, Alan Milburn, has admitted that the NHS is rationing services. Will the minister inform Parliament whether that is also the case in Scotland? Then perhaps—just perhaps—we could have an open and informed debate on perceived rationing in our health service.
I am not sure whether Kay Ullrich is aware that during the finance debate yesterday, I questioned the Minister for Finance on whether rationing was beginning in the health service in Scotland. He answered, "Absolutely not." Will Kay Ullrich ask the minister whether she knows about that?
I am sure that the minister is writing that down as I speak. Certainly, Alan Milburn has admitted that there is rationing south of the border. We must try to get an answer here, as the people of Scotland are waiting for one.
The Executive motion boasts of its investment in the NHS, and talks of building a 21st-century national health service. If that is the case, can somebody tell me why, as we enter the new millennium, 2,000 elderly people are languishing in inappropriate acute hospital beds, unable to get the long-term care that they need? Why, in this day and age, are members of staff at Lennox Castle hospital being bribed to take patients into their homes, simply because the Executive will not put its money where its mouth is when it comes to patient-centred care in the community? [Interruption.] I can hear a budgie, but I do not know where it is.
Will Kay Ullrich give way?
The budgie noise has stopped and the member has a chance to take a question.
I will give way.
I thank Kay Ullrich very much. She said that staff at Lennox Castle hospital are being bribed. The staff at Lennox Castle hospital have never been bribed in their lives. They are dedicated servants of the national health service, and she should accept that.
The staff at Lennox Castle hospital are in danger of losing their jobs in 2002. Instead of being redeployed in appropriate settings, the option has been created whereby they will be paid benefits to take someone into their home. That, surely, is the wrong motivation for someone who is being asked to care 24 hours a day for somebody who is severely disabled.
We now know, from Jack McConnell's budget statement, that the real-terms increase in health spending in Scotland, next year, will amount to 0.8 per cent, although the equivalent increase in England will be 4.4 per cent. According to the UK pay review body reports on the pay increase for health service staff, that increase is likely to settle at around 3 per cent. As a result, the health service in England will be able to cope with the increase, but the health service in Scotland will not. Therefore, the Executive must either provide extra money to cover the increase or make cuts in other areas of the health budget to meet the pay settlement. Can the minister advise us which it will be?
I am running out of time, but I am sure that my colleagues will address other issues. In conclusion, I say to the minister that she should come out from behind the smoke and mirrors. She should forget the glossy brochures; it is time for the spinning to stop before it is too late. Let us have an open and honest debate about the state and, indeed, the very future of the health service in Scotland that we both value so much.
I move amendment S1M-383.1, to leave out from "recognises" to end and insert:
"regrets the lower rise in health spending in Scotland in comparison with England, in spite of the widening gap in poverty and ill health between north and south; opposes the continued reliance on PFI, and calls upon the Scottish Executive to accept its responsibility to provide adequate resources in order to support a National Health Service in Scotland fit for the 21st Century."
I fully support the Executive's commitment to the NHS and the contribution and commitment of the staff. NHS Direct moves towards seamless transfer and guaranteed waiting times.
When I read the motion, I read the words "partnership", "public accountability" and "involvement". Is that the type of partnership that is exemplified by the Minister for Health and Community Care, who reportedly called members of the Health and Community Care Committee numpties for daring to express an objective and impartial cross-party opinion on the Arbuthnott report? Is it the type of partnership whereby the Minister for Health and Community Care gives the Health and Community Care Committee a party political broadcast, followed by a refusal to answer questions that have been raised by the British Medical Association and many others who submitted evidence in the Arbuthnott review? Perhaps it is the partnership with the Minister for Health and Community Care who had death threats made against her after the Catholic Church in Scotland dared to express a point of view. The rest of that tale will go down in history. Is that the partnership the minister is talking about? She is a woman who would cause a rammie in an empty house.
What about consultation? Labour does not even consult its Liberal partners, as has been admitted in the chamber, so what chance is there for people in the rest of Scotland? We should ask the people of Angus and the Mearns about consultation and partnership. More than 25,000 of them have put their signatures on a health petition because they do not know what is happening to the health service in their area. All they know is what they have read in the columns of the local paper.
Consultation and partnership in Perth means packed public meetings because of a fear of losing accident and emergency, maternity and paediatric care—no consultation, only serious, heart-felt concern among local people that they are being ignored and their health care is being eroded. In Fife, it means more than 1,200 people trying to get into a hall that holds fewer than 200 to express their worries and concerns and to find out what is happening to their health service and which hospital is likely to close.
Will the member give way?
No.
When I visited Oban last week, local doctors asked what was happening to the health service there, what was happening to serve the islands, and whether people from Islay, Tiree and Mull will have to go to Paisley for breast cancer screening. I told them that I do not know. They do not know either. Lectures on partnership and consultation may sound grand in here, but the people outside this chamber are not hearing the minister. Consultation, partnership, accountability and involvement do not come from focus groups. That is something the minister must learn. They do not come from strategies, commitments, reviews, spin-doctors or, indeed, the latest £7.95 glossy brochure. That will do a lot to tackle the problems of women on low incomes living in Shettleston who want to stop smoking.
Will the member give way?
Is Mary Scanlon suggesting that we go back to the dark and distant Tory days when decisions were made behind
closed doors and no one was told about them? Is she suggesting that rather than the openness and accountability that the Labour party is proposing?
If I represented the Labour party, I would sit comfortably in my seat rather than waste my energy jumping up and down. The 25,000 people in Angus and the Mearns did not sign a petition in the Tory years. We never had packed halls in Fife, Perth and all over the country and we did not know about any overspend. Margaret Jamieson should not start lecturing us.
Does the member agree that the fact that thousands of people are signing petitions and turning up to public meetings—as they have done in my constituency—suggests that what we hear from the minister about accountability is nonsense and that the closed doors that we are being told used to exist are still as closed?
I never heard of people in Scotland expressing their concern during the Tory years as they are now.
The new hospital programme consists of eight hospitals, half of which had already been progressed by Michael Forsyth and Ian Lang—as the leader of the Scottish National party has already said.
That brings me on to overspend, or underfunding—two ways of looking at the same thing. The majority of acute hospital trusts in Scotland are facing severe cuts just to make ends meet. In Tayside, there is a deficit of more than £12 million and there have been suggestions that patients should pay for non-essential treatment. I would like to know what the Minister for Health and Community Care considers non-essential treatment. The Grampian trusts have an overspend of £5.6 million, which has led to ward closures and weekend closures. They cannot fill vacant posts and are reducing training. Is that a health service of which the minister is proud?
In north Glasgow there is an overspend of almost £10 million. am proud to mention Raigmore hospital in Inverness, but not proud of what it is having to do. The hospital's financial recovery plan, which was forced on it by the minister, involves
"the reduction of elective workload and change case mix in favour of less expensive procedures" and demands that the hospital
"Withdraw Consultant locum cover to Skye"
and
"Limit ‘Dressings' spend to budget".
God help staff if their uniforms are wearing thin, because there will be no further expenditure on that this year. Also, the hospital will
"Introduce differential catering pricing for staff and visitors"
It is becoming a joke.
Will the member give way?
No, I will not give way. The deputy minister will have ample opportunity to spin-doctor his ideas, but I have very little opportunity.
The member has less than one minute in which to wind up.
Across Scotland, hospitals are facing the serious problems that I have mentioned. No problems have surpassed those of the Lennox Castle hospital for the care of the elderly, which is undertaking desperate measures. It is asking staff to take patients home—as a newspaper headline said, "to ‘adopt' a patient". According to Unison, a similar system has been tried, but failed, in Liverpool, yet it will now be implemented in Scotland. The most vulnerable people in society are being touted around for a good home, which will be paid for by welfare benefits. In the week before Christmas, at the end of this century, is the minister proud of health care in Scotland under which long-term mentally ill patients will be placed in families who may have no experience of caring?
Please close.
My final point is about the gross distortion of clinical priorities, which has led to people waiting longer to see a consultant, fewer nurses, decision making being taken from general practitioners and consultants being paid thousands of pounds to do minor operations over weekends while major operations have to wait longer.
The minister's commitment to the national health service failed. Public accountability failed. Partnership failed. Working with the NHS and the Scottish people failed. Working with the Health and Community Care Committee failed, without even a mark for effort. Now is the time for the minister to accept responsibility and to address real health needs, instead of laughing at points that are seriously made. The minister has maladministered health in this country.
I move amendment S1M-383.3, to leave out from "welcomes" to end and insert:
"but condemns Labour's centralisation and increase in bureaucracy within the NHS and the Executive's folly of pursuing a raw waiting list target that has led to the negation of its promises on health; notes with concern the overspend by health boards in the current year, the increasing levels of bed blocking and the failure of the Arbuthnott Report to address inequality in health spending;
believes that the development of a modern NHS depends on a sustained programme of service redesign, greater public accountability and involvement and true partnership working across the NHS in Scotland, and calls upon the Scottish Executive to make the reduction of waiting times and access to treatment on the basis of clinical need its top priority for all the NHS in Scotland."
My ears are fair birling after the diatribes we have heard today. I confess that I have not had such a depressing experience for a long time and it was exacerbated by the fact that Kay Ullrich had the nerve to give us all that negative stuff for eight to 10 minutes and then depart—she did not have the courtesy to listen to the rest of the debate.
The NHS is an institution to whose achievements all parties in the state have contributed. It is right to recognise that at the beginning, even though that is why it is the hot stuff of ardent political debate.
It is also right to emphasise the point that Susan Deacon made: the achievements of the NHS are the achievements of its staff, often in spite of the system. They are the achievements of nurses who are paid less than they should be, of doctors who work longer than they should, of consultants who develop pioneering techniques, and even of managers who try to organise everything efficiently. I would not like to do a job burdened by the knowledge that my mistake could cost a human life.
In the 1980s, the Conservative Government tried to remodel the structure. In my view, it got it profoundly wrong. It genuinely thought that the changes would improve the structure, but it was at the price of millions of pounds in unproductive bureaucracy.
In 1997, the Labour Government came in with its fixation about waiting lists—that was a product of policy priorities being driven by spin-doctors who were concerned with electoral considerations. Labour got it wrong again, and the waiting-list obsession seriously distorted NHS priorities. However, Labour managed to get rid of the internal market structure.
Today, we are getting back on course. The minister's statement, which has not even been touched on in the speeches that have been made so far, about the importance of waiting times rather than waiting lists is welcome and right. Incidentally, it also shows the power and influence of the Liberal Democrat input to the Scottish partnership.
Our commitment to the national health service forms a solid line going from Lloyd George and Beveridge, through our support for the abolition of eye test and dental charges—on which the Executive has also made progress—to the decision on waiting times today. This is a major coup for my party and a testament to the common sense of the minister. It is also a testament to the potential for radical reform of this Parliament, fairly elected as it is, and our partnership Executive.
While Mr Brown is listing Liberal Democrat successes, will he tell us how successful his manifesto pledge to abolish the private finance initiative has been? Where are the 500 extra doctors and the 1,000 extra nurses that his party promised to employ? What has become of the manifesto commitments that were simply sold out in favour of Labour health policy?
It is worth mentioning that all parties in this chamber are minorities and have to deal with the reality of the political situation that obtains. Through the partnership agreement, my party has significant achievements to its credit, which is more than can be said for the SNP and the Tories.
The minister announced today that—
Will Mr Brown give way?
I will not accept an intervention now. I may do so later.
The minister made an announcement about the fresh air of accountability.
Will Mr Brown give way?
No. I have already indicated that I am unwilling to accept interventions. Mrs Ullrich was not here earlier to hear other members' speeches, so she should sit down now.
Why will Mr Brown not give way?
If the member does not want to give way, Mrs Ullrich, he does not have to do so. Carry on please, Mr Brown.
The minister's announcement that she wants to blow the fresh air of accountability through the health service quangos is welcome. That action will be enhanced by the forthcoming enactment of the freedom of information bill, which will enable easier access to health records and documents. It is not an easy thing to get right; there is a delicate balance to be struck between democratic accountability, managerial efficiency, the meeting of national targets for a national service, and professional considerations. Although the present structure of health boards and trusts is not the last word on the matter, neither is further tinkering with the deckchairs the first priority for health.
I return to the Opposition amendments and to
the speeches from Mrs Ullrich and Mrs Scanlon, who I note has now left the chamber. I was astonished by the gall of the Tory effort and by the phrase in the Tory amendment that reads:
"condemns Labour's centralisation and increase in bureaucracy".
Did I live in an alternative time zone when the Conservative Government introduced the huge bureaucracy of the internal market? Was I imagining that later Administrations had to spend enormous effort to sort out the mess that the Tories left and to reclaim many millions of pounds for front-line health services?
Conservative members who talk about public accountability are the ones who introduced what must surely have been the most unaccountable structure in the whole history of the NHS. They are the very people who introduced competition and divisiveness into the heart of the health service. Their amendment, to which they have not properly spoken, calls for waiting times to be the top priority for the NHS. Waiting times are undoubtedly important, but it is quite out of tune to consider it a top priority against the overriding importance of targeting health improvement and health promotion—another theme that is strongly targeted by my party and which is at the heart of the Scottish Executive's programme.
Mr Brown listed the successes of the Liberal Democrats. Presumably, one of those successes was to have the convener of the Health and Community Care Committee chosen from their ranks. Does he approve of the Executive's attitude to that committee's report?
I shall touch on that point towards the end of my speech. I shall turn now to the nationalists. Here goes Mrs Ullrich again, whinging—in the motion, I might add, not in her speech—about the lower rise in health spending in Scotland compared with England. It is manifestly clear, however, that—
Will Mr Brown give way?
I will not give way. It is manifestly clear that health investment in Scotland has traditionally been higher than in England, even allowing for the prioritisation of health resources in favour of more deprived areas, which is made possible by our membership of the United Kingdom.
Will Mr Brown give way?
I shall not give way; I want to continue with my speech. The Liberal Democrats believe that the Chancellor of the Exchequer could release funds from his somewhat bloated and growing balances to invest more resources in health services, not just in Scotland but throughout
Britain, not least to resolve the major challenges that face us in Glasgow.
What are we to make of an Opposition party that demands that the Scottish Executive provide adequate resources to support the NHS in Scotland? We have heard not one word about the extent of the resources. Perhaps we shall, later in the debate. Are the resources on top of, or a substitute for, the £1,381 million of spending commitments from the SNP, which Keith Raffan so devastatingly dealt with in yesterday's debate?
If Andrew Wilson—who also is not here today— is, in Keith's words, the jelly shadow chancellor, Kay Ullrich is Goldilocks, complaining that the evil English have eaten the porridge of health service resources. She seems unaware—in her motion, not in her speech—that there is a ravenous horde of SNP shadow ministers behind her. They may not be teddy bears, but they have certainly gobbled up an ever-increasing amount of fictitious resources in a multi-billion pound wish list.
Just look who is standing behind you [Laughter.]
Many of us are genuinely concerned about this issue. We look to Robert Brown to define the debate, but he is not doing it. He should pick one point and flog it, rather than flog the SNP, because we are not the Administration.
Margo MacDonald makes a valid point. I have succumbed to the temptation to try to respond to the Opposition's approach to the debate. The fact is that health spending under this Administration will be greater in real terms than ever before. It will also represent a greater share of national wealth than before.
There is an endless list of demands on health resources, so it is important that we get the best out of them. As a Glasgow member, I am particularly concerned about greater Glasgow. It has many Victorian buildings—not 50-year-old buildings, but Victorian buildings. Often, they are in the wrong place, which hampers the effective provision of secondary care in the city. If we are to move towards the modern system that we require, I hope that the minister will find it possible to ease the transition by providing access to more capital funding in a way that will not impose an unacceptable revenue burden on Glasgow's health services.
I will make two points to finish. The first relates to the National Audit Office report on ambulance services, which we heard about earlier this week. Is the minister prepared to look at ambulance service funding, bearing in mind the requirement on it to meet target times, and that training for paramedics in Scotland has ground to a halt?
I will finish by reverting to the main point, which
is the dedication of NHS staff and the potential of the service. The challenge for Parliament is to tap that hidden resource more effectively and productively. That would be assisted by what I cautiously call a dynamic and positive relationship with the Health and Community Care Committee. The minister's announcements today set us on the right road and I hope that later in the debate we will hear more about the real issues that face the NHS, and not the resource issue that we have had to deal with in so much detail today.
I was disappointed by the speeches of Kay Ullrich and Mary Scanlon. They are much more positive in the Health and Community Care Committee than they are in the chamber. Perhaps the chamber brings out the worst in people. Certainly, the amendments—
Will the member give way?
Not at the moment. I would rather get into my stride and then Mr Monteith can trip me up, or attempt to.
Gladly.
The amendments that have been lodged—Kay did not fully speak to hers—are nonsense. Instead of raising health issues, or proposing changes, Kay's amendment talks about the relationship to spending in England. The Conservatives' amendment talks about bureaucracy. As Robert Brown said, that is not worth responding to, after what the Conservatives did to the health service.
Will the member give way?
Not at the moment.
The SNP amendment seeks to delete the parts of the motion on public accountability, involvement and partnership. Does that mean that the SNP does not believe in them? If it does, why delete those parts of the motion? What is the SNP replacing those elements with? A better vision for health? No. A radical new policy? No. A hint of new thinking? No. It replaces that part of the motion with a long whinge about the difficult issues that are being tackled by the Executive.
If members think that we have got problems, think for a minute about the problems in the rest of the United Kingdom, because we get £250 per head more for every man, woman and child in Scotland than the average in the United Kingdom.
Will Dr Simpson give way?
Not at the moment, I will take an intervention later.
Not only that, but we are continuing to spend more. We spend considerably more than the SNP or the Tories indicated in their plans.
Yesterday, Andrew Wilson raised the question of what would happen to the Barnett formula. I will try to answer that point. If we can improve the health of the people of Scotland, the justified excess and advantage in funding that we now have should be redistributed in terms of health inequalities elsewhere in the United Kingdom. We are a partnership within the United Kingdom.
Dr Simpson is right, but on the question that Andrew Wilson asked yesterday, which nobody answered, will Dr Simpson tell us that he believes that Scotland gets an overgenerous share of UK health spending? Does he think that Scotland does better than it needs to do?
Absolutely not. At the present time, we need that spending, because we have some of the worst health records and as long as that pertains we will be able to justify that from the UK exchequer in the block grant.
If that is true, how can Dr Simpson justify next year's spending, which is a
0.8 per cent increase for Scotland as opposed to a 4.4 per cent increase for England? Dr Simpson: I do not accept Mr Hamilton's figures.
They are your figures.
I do not accept those figures. The increase in expenditure is considerably more than that. Over the next three years, the planned increase is in the region of 12 per cent cumulatively. I do not accept Mr Hamilton's figures.
Let us look at the issues that the SNP are deleting from our motion, for example "public accountability". I accept that public accountability is nothing like as good as it should be but at least this Administration is attempting to make some changes.
When I was practising medicine, the public were not genuinely involved in the proceedings on a pre-consultative basis. They were told of the decisions that were to be issued and asked, "What do you think of that?" The situation now is that, with difficulty, trusts and boards are making genuine attempts to involve the public.
Like Roseanna Cunningham, I attended the meeting in Perth when 1,200 people attended a consultation on the acute services review when Tayside Health Board had not reached decisions. If that is not involving the public, I do not know what is. I have to say that her inflammatory intervention at that meeting was self-serving,
irresponsible and made improvements in the service for her constituents less likely rather than more likely.
The member did not point out to the chamber that whatever my intervention might have been, it was agreed with by the vast majority of the 1,200 people at that meeting.
They also agreed with my intervention, which was far more measured and talked about the need for redesign. Is the SNP really telling us that it wants to stick to the current health service, with no changes, even if that means poor clinical services? The SNP is encouraging the public to be enthralled to bricks and mortar rather than considering the redesign of services.
Wind up, please.
As I have taken some interventions, can I make some final points?
Very quickly.
I have a vision of patients in partnership with professionals, in a service delivered for the most part as close to their home or community as possible. We should consider models of care such as that developed in Nairn. We should develop care that makes rare the need to go to the acute centre; care with first-class transport, where it is needed, to link patients speedily to those centres when it is needed. Patients should spend in those centres the minimum of time that is required for good, safe care.
Patients should receive care before and after in the local community hospital or local resource centre or, as has been published in the British Medical Journal this week, their hospital at home.
Come to a close, please.
Patients should be empowered by good quality information and advocacy. Accountability, public involvement and partnership in a modern service are what we should all be promoting in this Parliament—not the whingeing nonsense from the Opposition.
We are getting to the stage when some of us feel that we need a swig of milk of magnesia, or some other stomach settler, before we can endure yet another sugary, apple-pie, self-congratulatory and smug motion from the Executive.
The SNP, as the Opposition, has been accused of criticising the Executive today. We plead guilty; if we did not do that, we would be failing in our duty. We are criticised when Glasgow is represented in a new, official report by emblems of children's coffins to show its high child mortality rate. The motion is littered with the usual Orwellian newspeak, including that blancmange word "partnerships". In Glasgow, the partnership we need to dissolve is that between the public and the undertakers.
It is shocking that the motion—and very shocking that the minister's statement—contains no pledge whatever about the grievous health of Glasgow and the west, after yet more confirmation that the north-south divide is shortening lives. As we enter a new millennium, that divide shows most in the contrast between people dying early in Scotland while in London over £800 million is being blown on a temporary dome so that London can celebrate the millennium. That is some United Kingdom. We could have built 10 new hospitals for that money; £800 million could have gone some way towards saving lives. But no, Scottish taxpayers' money is being squandered on Tony Blair's delusions of grandeur. Shame on the minister for going along with that. Let them eat cake? Her smug message is, "Let them eat apple pie."
Mr Blair seeks to deny that there is a north-south divide, but its existence has been proved by the report from Bristol's Townsend Centre for International Poverty Research. It shows that the people of Glasgow are dying of bad health through political neglect. Today, we should have heard an announcement of massive emergency aid for Glasgow and the west, to stop people dying. The gap is widening under Blair. He has had two and a half years, but has done absolutely nothing radical. The Executive is doing nothing radical either.
Last year, Professor Phil Hanlon, professor of public health at the University of Glasgow, warned of the widening gap between north and south, saying that life expectancy in central Scotland was comparable to that in the former East Germany.
Bristol University's report, "The Widening Gap", found that six of Glasgow's constituencies—out of more than 600 constituencies in Britain—topped the list of the UK's most unhealthy areas. Glasgow has been confirmed as the worst place in Britain for infant mortality rates, chronic illness and early death. As the report points out, what a record that is for a Labour area.
All the Executive can do today is produce another slice of apple pie and body swerve a Scottish health disaster. What does the motion say to Shettleston?
Will the member give way?
I am sorry, I am in full steam and I will not be interrupted.
Shettleston is top of that shameful list. It is No 1. There, people are 2.3 times more likely to die before the age of 65 than are people in Wokingham or Romsey. Gordon Brown proposes to give free television licences to people aged over 75—in Glasgow, many do not live that long.
The Executive dares to rise for Christmas without pledging the massive emergency aid that it knows is necessary. Gordon Brown, son of the manse, is a disgrace, with his inhumane lack of funding to overcome ill health and poverty. That man sits atop a £15 billion war chest, rakes in billions from Scotland and wastes billions on Trident, rather than putting some of that money into Scottish health.
Come to Glasgow, minister, and try a slice of humble pie instead of apple pie.
The words "humble pie" have been used. The word "humility" was also mentioned earlier. At this time, we should show a bit of humility, because there is a real danger that the people at the centre of this debate—the patients with their experience in the health service—are being lost. That is what I want to focus on. I do that in the knowledge that some young people are here today from the organisation for which I used to work—Who Cares? Scotland. Those people taught me that the consumer of services must always be put at the centre.
I take this opportunity to support Susan Deacon's comments applauding NHS staff. It is not too dramatic to say that most people in the chamber and outside will have friends or family who are alive today only because of the dedication and hard work of the NHS staff.
Despite my well-known reservations about the private finance initiative, which have caused me differences of opinion with some of my colleagues, I want to say that my constituents welcome the fact that a new community hospital is being built in Cumnock. I welcome the fact that there have been constructive discussions—I have had some with the trade unions. Instead of going into rant mode, we should talk to the trade unions and the other people involved. I am glad that we are making progress in protecting staff conditions, as I hope the minister will confirm.
Having visited the hospital site last week, I am delighted to see that the new building will replace precisely the sort of inappropriate buildings that members have rightly condemned. We will have a living and working environment that is fit for the
21st century. I welcome the minister's commitment constructively to address the needs of 21st century health care.
I want to make a few points about the innovative work that is being done at the Ayr hospital as part of the designed health care problem. The project gives a message about how designed health care can be taken forward. It started off from the point of view of the patient and looked at the patient's journey from the initial referral through to final treatment. I have spoken to patients and to the people who deliver the service to find out what they thought about it.
Susan Deacon is right: the number of visits that patients have to make has been reduced, as have the waiting times. Previously, the process took between 10 and 12 months and involved seven visits, including some repeat visits to the outpatients department. The new project has reduced the journey time to around two months and the number of visits from seven to three. That must be progress.
Patients now go directly to the optometrist, who refers them to the hospital. The patient attends the hospital for treatment and the follow-up is carried out by the optometrist. The reduction in waiting time for surgery has been from six months to around six weeks and the reduction in the number of out-patient visits has been from three to zero, which is especially significant in a rural area, given the difficulties with transport.
The number of people who have been dealt with in the day clinics has been increased from eight to 15 per day, which potentially frees up 1,000 new and 600 repeat out-patient slots. Those figures are from Ayrshire and Arran Community Health Care NHS Trust, which says that this approach is the way forward.
A current audit of the project shows that the benefits include a reduction in the number of inappropriate referrals, a reduction in the number of people who do not turn up for appointments, a reduction in bureaucracy, less paperwork, fewer letters to and from general practitioners and fewer patient visits to GPs.
The patients surveyed report a high level of satisfaction. What is crucial is that the project did not start out as a cost-cutting exercise or as an exercise in cutting waiting lists. It started out as an attempt to find out what the patients who needed a service wanted and how that could best be delivered—it is being delivered in Ayrshire. I hope that the minister will visit the project and talk to the people of Ayrshire about what will be rolled out in future. That is the way forward; it represents the kind of constructive debate that this Parliament should be having instead of once again making patient care a political football.
I was interested in Cathy Jamieson's speech and pleased that she was so content with the East Ayrshire community hospital. I wonder whether she will draw to the attention of her constituents the fact that the invitation to tender was approved by Michael Forsyth. Donald Dewar simply signed the contract.
My constituents are very well aware of that. They are also very well aware of the damage that was done to their health during the many long years of the Tory Government, particularly during the miners' strike, when many of them ended up out of work.
That is a period during which record numbers of patients were treated by the national health service and unprecedented investment was made. I hear no acknowledgement of those facts.
In her introduction, the minister paid tribute to the national health service and its personnel. Given her political background, I can understand that she has a deep emotional attachment to the principles of the national health service. I doubt whether anyone in this chamber today does not fully support those principles.
I feel that there has been a conspiracy of silence about the state of the NHS for far too long. We see in press reports every day that the NHS is not fulfilling the role that the minister and all of us in the chamber think that it should. The level of patient care is not what we would wish. Until that point is appreciated, any debate will be sterile and negative. When the point is faced up to, we can be more constructive.
We have longer waiting times than we used to. I accept the minister's point regarding the question of waiting lists, but the length of time that a patient has to wait for important treatment is a real problem. The minister should address that. Staff morale in the NHS is undoubtedly extremely low. Every year, substantial numbers of staff vote with their feet. We have fewer nurses than we had the last time Labour was in power. I see that the minister, being unable to deal with the rationale of my argument, has left the chamber.
Robert Brown dealt with the input of the Liberals into the Executive's health proposals. Having read the Liberal party manifesto, I have to say that Robert's party sold itself cheaply. It has not fulfilled one iota of what it promised before the election. Labour promised to spend, spend, spend on the NHS. The mantra of education, education, education was replaced late in the 1997 general election campaign with promises that the NHS would have capital and revenue investment as never before.
That has not happened. There has simply been a continuation of the trend that the Conservative Government introduced in its last three years in office. I accept that there has been a marginal increase in spending, but it is in aggregated expenditure, not real expenditure. Perhaps the minister will address that in his summing-up.
We have had a rather negative debate today. Given the self-congratulatory motion that we have been debating, it could hardly have been otherwise.
I listened intently to the minister being interviewed on "Good Morning Scotland" this morning because I had not made much sense of the motion as it appeared in the business bulletin. I thought that I was listening to a snow warning because of the flurry of words that all seemed to run together. The words were reminiscent of the ones that are used in the chamber when members discuss the radical restructuring of the national health service in Scotland, which is what I think the minister was promising in her speech.
What will be the difference between this radical restructuring and that introduced by Sam Galbraith when he was the Under-Secretary of State for Health? I think it was "Designed to Care" that he introduced. Much of the same terminology was used in the minister's speech today. My question concerns the radical restructuring of the NHS and the move away from old hospitals to what will presumably be bright, shiny, community-based service providers. Will they be provided by son of PFI? Is that where the money will come from?
I see that Richard Simpson is as intrigued by this as I am. Richard, I am sure—I apologise, Presiding Officer, for speaking directly to the member. I am sure that we would all like to know whether any limit is to be put on the extent of PFI involvement in this new community service provision. None of us disagrees with that—we think that there should be a switch away from old and unsuitable hospitals—but what is the new service provision to be? We know, from what the minister and other members of the Executive have said, that there are cash limits on this brave new world. Unfortunately, those limits are not set by the minister in this chamber, but by her pal in London.
But hey, that is the downside of devolution. People have got to take the budget they are handed and fit hospitals inside its parameters. If I am to believe what I am told by the Lothian Local Medical Committee, there is not a snowball's chance of their being able to bring about the quality of community-based service that all of us— including the minister, I am sure—would like, if they are also lumbered with having to implement
the radical restructuring of Arbuthnott.
There has not been much reference to Arbuthnott today, and I hope that members will indulge me for a minute, because I represent Lothian and we are the losers. I heard the minister refer to what was to be spent on mental health and on people with learning disabilities and so on. I cannot but refer back to the effect of Arbuthnott on Lothian's spend. We will lose £5 million from the Lothian budget in terms of spending on older people and £5.5 million in terms of spending on mental health provision.
Will the member give way?
Bristow must excuse me. I am speaking for all of us, as I know that he is as worried about this as I am.
We will lose more than 22 per cent of the spend in terms of people with learning disabilities in Lothian. Those are the community-based services that the Executive is trying to introduce. There is no investment in introducing the new plan. I have no quarrel with the plan itself, but if the Executive is going to invest properly, it should invest in development. I have not heard any recognition of the need for that investment in what has been said today.
One mistaken belief about Arbuthnott needs to be clarified. It means changes in increase in expenditure; no area will lose money. To hear Lothian officials talking about slashing their learning disabilities expenditure and moving people back into hospital is utterly disgraceful and is an unbelievable misperception of what will happen. Those officials should be severely reprimanded.
I was not quoting Lothian Health officials, but referring to a letter I received from Dr Sandy Sutherland of the Lothian Local Medical Committee—one of Mr Simpson's colleagues, I am sure. He said:
"Beyond a shadow of a doubt the implementation of Arbuthnott would make that change undeliverable."
The change he is referring to is the change to community-based services. I am impressed by that, because he is a professional. Although I take very seriously what Cathy Jamieson said about concentrating on patients and seeing the issue from their point of view, we must also take into account the professionals.
In summary, when the minister comes to reply, I hope that she will give us some definitive answers on where the development money will come from to introduce two such radical restructurings at the same time.
As a member and former employee of the public sector trade union, Unison, and a former employee of the national health service, it gives me pleasure to contribute to this debate. It also gives me an opportunity to consider the amendment in the name of Mary Scanlon and express my amazement—
Will the member give way?
No, I am sorry, Tommy. I am limited in time.
The Tory amendment is a complete turnaround for a party whose policies positively encourage the chosen few to take all the decisions in closed rooms. That is currently manifest in the service. Recently, the Health and Community Care Committee took evidence about Stracathro, which continued to carry out the policies of the Tories, which amounted to "Don't tell the people until you have decided what you are going to do." The Parliament must ensure that we advise the service—by the service I mean everyone who works in the health service—that the days of decisions being made in closed rooms are finished. The national health service is open and accountable. We will talk it up, but we will also attack it if we find that individuals are abusing their positions.
Will the member give way?
No, I do not have time.
I welcome the opening up of the opportunities for people to sit on local health boards and trusts. If we are serious about accountability, it must be ordinary people who make decisions. Staff also need to be involved in the process. Rights for staff should be enshrined in the constitutions of health boards and trusts. When the minister examines the make-up of such boards, I ask her to consider setting aside a place for staff, giving them equal rights in the decision-making process.
That concludes the open debate. I call Margaret Smith to wind up on behalf of the Liberal Democrats. You have four minutes, Mrs Smith.
How do I sum up this debate in four minutes? Any members with spare time on a Wednesday morning might like to come to the Health and Community Care Committee; it is always interesting and certainly full of passion. This has been a full-steam debate. By debating the health service in our final full debate of the millennium, and by the way in which members have attacked
the issues, we have shown people across Scotland that that we care passionately about the health service.
We care passionately about the staff who work in the service—160,000 people. On behalf of the members of the Health and Community Care Committee, I must say that it has been a privilege to meet many of those people over the last few months. I hope that they have a good and peaceful millennium and continue to do the good, hard work that they carry out on our behalf. Without those people there would be no health service about which we could debate.
The Executive has set itself the task of turning the Scottish health service into the most modern in Europe. Let us have a reality check. We can do only so much. There is a bottomless pit in terms of people's expectations of the NHS; there is not a bottomless pit in terms of money, even if Gordon Brown were to open his war chest and give more to Scotland for its public services. If he did, I would say "Thank you very much" and take as much as I could. There is not a bottomless war chest. Every member could stand up and say that they want money spent on certain areas, but we must do the best we can with the available resources, at the same time as wresting as many resources for Scottish health care as we can. We need those resources.
No one in the Executive or the Parliament should be smug and complacent, sitting back and saying, "We're doing a jolly good job. Everything is perfect". We need the debate on rationing that Kay Ullrich called for. Let us get real. People know what is happening in our health service and we must start talking about it. At all times, we must remember that we should be putting the patient first. Cathy Jamieson is right. Putting patients first means redesigning services in a way that takes into account what patients want.
Mary Scanlon is absolutely right. We heard about Stracathro hospital—25,000 signatures on a petition. That is why the Health and Community Care Committee asked to speak to hospital representatives; that is why we listened to what they had to say.
Margaret Jamieson is absolutely right. If the Health and Community Care Committee can do anything to bring about a more open and accountable health service by affecting the way in which trusts and boards and other people go about their business, that is exactly what we should be doing.
Does Mrs Smith think that members of a board should be accountable to the minister, or should they be accountable to the people? That is another dilemma that needs to be examined. In the past, members of boards have considered themselves accountable to ministers rather than to the people.
I believe that we have the makings of a minister who will listen, and we need that. We need a minister and an Executive that will listen to what people want. At the end of the day, it is the minister who makes the final decisions. However, the views of the people who use the health service should be taken into account at all times. That is what the health service is there for.
I have to disagree with my colleague Robert Brown on one point. When he talked about our debt to health service staff, he said that he would not like to have a job where he held somebody's life in his hands. Well, I have news for him—he does. All of us do. Through pinpointing problems of rationing, financing of acute hospitals and so on, this chamber has rightly flagged up some of the difficulties in the health service. But for goodness' sake, as our national health service staff go into a new millennium, let us pat them on the back and say that there is a heck of a lot of good work going on in that health service. The Health and Community Care Committee will continue to work with people, whether it be with the minister or with health service professionals, to ensure that that good work continues.
I welcome this opportunity to wind up the debate on behalf of the Scottish Conservative and Unionist party. When eventually I saw the proposed motion, and I heard the health minister's snarling response to the opening interventions, I thought that she might have been auditioning for a Christmas pantomime.
The minister's motion makes no mention of the problems that are set to explode out of the health service in the new year, or of the problems that it faces today. While I agree with much of the text of her motion, I urge her to recognise the problems that exist here and now. It does not surprise me that the Executive's motion is couched in the usual flowery and woolly language—that is in line with its ambition of using the Parliament as a rubber stamp.
The minister talks about the future, but the motion, as I said, makes no mention of future problems. In her opening remarks, she spent nine minutes talking about the past—not the future that she wanted us to talk about.
Although I am aware that Santa Claus and fairy tales are what this Christmas is made of, it appears that, with her policy, the minister wants to be in one of those tales. After all, in the fairy-tale kingdom of Dewar-land, Nanny Deacon thinks all
is well. In Dewar-land, new general practitioners' co-operation is flourishing, as are joint investment funds; in the real world, joint investment funds lie empty and GPs in the Highlands and Islands and in the Borders are having to prepare for cuts.
In Dewar-land, waiting lists will come down, but in the real world, people are waiting to get on to the waiting lists. In Dewar-land, the Government insists that resources are not the issue and that health board reorganisation is delivering better services; in the real world, health boards are admitting to massive overspends and will have to close wards and reduce staff levels this winter. Indeed, on the health service, Labour spin is so far from reality that it belongs in never-never land.
The Conservative record is clear—it is not fantasy and it is not spin. The biggest ever increase in health spending came in 1990 under the Conservative party. It was not this year, nor, as Labour claims, will it be next year. Of the eight new hospitals that have been trumpeted by Labour, four were approved by Ian Lang and Michael Forsyth. There are 164 fewer nurses in the NHS than there were in 1996, and there are 1,097 nursing vacancies.
Will the member give way?
No, I am sorry. I have a lot to get through.
The Government's ambitious hospital rebuilding plan is based on the private finance initiative—the Tory private finance initiative. How the worm has turned. We have heard many comments about how incredible it is that the Tories are criticising health policies. Now Labour members know how we feel when they defend policies such as the right to buy, uniform business rates, school league tables, Scottish Enterprise, privatisation of air traffic control, PFI and the retention of prescription charges.
The Executive cannot escape the fact that its plans for the NHS are failing; no amount of fairy tales can hide that. Waiting lists are getting longer and are being manipulated. Hundreds of expensive beds across Scotland are being blocked, which increases the winter pressures. Furthermore, the minister's failure to match funding to Executive priorities on cancer and heart treatment means that drug budgets are soaking up resources that are needed elsewhere.
All those problems have surfaced at the same time as an acute services review that is designed to shake up and improve treatment. I challenge anyone to say that any improvements will not be cost-driven.
The Conservative party wants a more joined-up health service. There should be more social and health services partnerships, to ensure a fully zipped care system. We recognise that there are inequalities in the health service in Scotland and we welcome any measures to address that.
I am aware that this is one of the last debates before Christmas. Winter will soon be upon the NHS, but the Executive's total failure to recognise the problems facing the health service is reflected in its motion. The Executive's dismissal without a moment's consideration of a considered report by the Health and Community Care Committee is testament to the fact that the Executive is in never- never land.
Next year is the start of a new century, in which Susan Deacon should face up to the issues of rationing and funding. Like some ghost of Christmas future, I bring her a warning that if she does not recognise the failings of the health service today, the NHS will start the new millennium with a new crisis.
Our amendment is about the future—it recognises today's problems in the hope that they will be solved by all of us for tomorrow. I commend it to the chamber.
In trying to summarise what has been a fractured—and sometimes fractious—debate, I will concentrate on three things. First, I will consider the attitude towards the issue of not only the Executive and the Parliament, but the wider community. Secondly, I will examine the financial aspects because it is important to nail down those facts. Finally—and crucially—I will tell the chamber why all of that matters. After Susan Deacon's performance today, it is perhaps laughable that a headline in The Herald reads, "End knee-jerk reactions on health, urges Deacon". I do not know what her speech was if it was not knee-jerk and reactionary.
The minister told us that the Opposition parties must stop scaremongering and damaging staff morale. Does the minister really think that that is a fair comment? Do you really think that the 3,000 nurses who leave the NHS in Scotland have nothing to do with your responsibilities as a minister and everything to do with Opposition parties—which, apparently, have nothing positive to contribute? Is that your analysis of what the Health and Community Care Committee has told you during meetings, of what it said in its report and of the positions of the parties in the chamber? Frankly, if that is true, relations between the minister, the committee and the Parliament are reaching breakdown point.
Throughout her speech, the minister told us very patronisingly that it is time for everyone to grow up and to take a new consensual attitude to the issue.
Such an approach should start with you and your team. Members in the chamber do not want antagonistic relationships, nor do they want people in the gallery to watch what was, at one point, no more than a catfight. We all want to move forward, but you will have to take the responsibility to meet us halfway.
Susan Deacon indicated disagreement.
You shake your head and show your disapproval. However, the arrogance that you have shown both in Parliament today and to the Health and Community Care Committee, by undermining the committee convener and ignoring the committee's report before you had even read it, has not helped relations one bit. If you want to have a new relationship with us, will you accept your responsibilities, eat some humble pie and find a new approach?
Before the minister responds, Mr Hamilton should remember that all remarks have to be addressed through the chair, not directly.
Normally I never intervene in debates because, as a minister, I have an opportunity to comment elsewhere. However, I ask Mr Hamilton to correct the record. Will he confirm to the chamber that at no time did I comment to the press on the Health and Community Care Committee's report on Arbuthnott prior to its publication, and will he correct the lie that he and other members of his party have peddled today?
Mr Rafferty may have left the Executive's employment, but it does not matter whether he spoke to the press on your behalf or whether you did it yourself. I am not talking about comments made prior to publication.
That is what you just said.
No. If you listen, you will hear what I have to say. Within hours of the report being published, when you clearly had not read the report, you said that you wanted to listen to the experts from Arbuthnott and that you would not want to listen to the committee. I suggest to you that that is arrogant.
Order. Mr Hamilton, you must address your remarks through the chair and not to me.
I apologise.
The matter will rumble on, but I suggest that until you accept your part in the blame, the relationship is going nowhere. [MEMBERS: "Through the chair."] I beg your pardon. I will address my remarks through the chair.
You also talk about the need to move away from soundbite politics.
Order. You are still going on about "you". "You" is me.
I am sorry.
Ms Deacon goes on about the need to get away from soundbite politics. She talks about the need for mature debate and sensible solutions, not soundbites and scaremongering. That in itself is a soundbite, which suggests to me that the language needs to be changed. If the minister wants to have a more constructive debate, we can do it that way.
In this morning's press, the minister referred to the sterile exchange over finance. That is important. The Barnett squeeze, which is mentioned in our amendment, is at the core of the debate. Despite what some members have said, the fact is that spending on health care in Scotland in the next financial year will rise by less than 1 per cent, compared with 4.4 per cent south of the border.
Will the member give way?
I do not think that I can because of the time.
Does anybody think that Scotland receives an over-generous allocation? I do not think that any of the trusts that are in crisis or any of the people who are asking for more resources in the NHS would go along with that view. Government statistics show that by the end of 2002 there will be £400 less per capita in the health budget in Scotland than if spending were to rise at the same rate as it is rising south of the border. Those are the facts.
The minister might describe this as a sterile debate, but that is absolutely the wrong approach. Dorothy-Grace Elder talked about the north-south divide and about the reports on poverty and Glasgow's situation—which several members mentioned. The point is that the top six areas of deprivation in the United Kingdom—and nine of the top 15—are in Glasgow. That is the scale of the problem and one of the things that the Arbuthnott report sought to change.
Let us run through the list: Tayside University Hospitals NHS Trust, North Glasgow University Hospitals NHS Trust, Grampian University Hospitals NHS Trust, Argyll and Clyde Acute Hospitals NHS Trust, South Glasgow University Hospitals NHS Trust, Yorkhill NHS Trust, Highland Acute Hospitals NHS Trust and Forth Valley Acute Hospitals NHS Trust. Those are the people who need more resources. They will listen to ministerial statements that we need no more resources—they will laugh and then they will cry because they will realise that such statements are nonsense.
Why do not we accept that we will always need more money in the NHS? Why cannot we accept
that the Parliament should be doing everything to defend the Scottish interest? That is why the Scottish Parliament exists. The feeling that is coming through from the health service community is that, despite all the warm words, Susan Deacon and the Executive are no further down the road to providing the investment that the NHS needs than their predecessors were. This is a sad day.
There have been some good, important speeches in the debate. Both the Jamiesons made some tremendous points about staff. Margaret Smith also made some important points about how things can be driven forward. However, until we learn to engage in a debate—all of us, minister— we will not make progress.
We need adequate finance. We need to address the real needs in Scotland, as opposed to the Executive's perceived needs. Let us move, once and for all, above the self-congratulatory new Labour nonsense and decide that we want to put the health service—the patients and its staff—at the forefront of our thoughts.
How long do I have, Presiding Officer?
You have 10 minutes.
Thank you.
On the first day of this term—I do not know whether that is what we call the part of the year between recesses—the Parliament debated health. It is right and fitting that we should also devote this last meeting before the recess to health.
On that occasion, members united around the public health agenda, which was good. We freed that debate from the terms of the past, according to which there was no link between poverty and ill health. We all embraced the challenge of the unacceptable health inequalities in our society.
A modern, efficient and effective NHS is central to that challenge. We had the chance to embrace that challenge today. What a pity that so much of the debate has failed to free itself from the past— from narrow, party-based point scoring and from crass, personal attacks.
This debate is about people—Scotland's people. Cathy Jamieson was right when she highlighted that in her excellent speech. That is what we should have been discussing instead of the other things that have been talked about.
Let me deal with the Scottish National party's two obsessions: money and England. I am sure that visitors to the chamber will be astonished to hear how much time the SNP spends speaking about England. It is no surprise to the rest of us in the chamber—
Will Iain Gray give way?
If it is short, Tommy.
I do not want to mention England, except for comparison.
While Iain Gray is on his feet, I implore him to intervene for Greater Glasgow Health Board— [Interruption.] Just a wee minute: I know Duncan McNeil has been sitting in the lounge having a coffee—just have a wee seat, Duncan.
Given the fact that young children born in Shettleston are four times more likely to die before they are one year of age than young children in Woking in Surrey, can the deputy minister please intervene to argue against the closure of another maternity hospital in Glasgow? That is what is planned. We cannot suffer another closure.
I will come to the change in services.
As Tommy well knows, the Arbuthnott report, which members have mentioned, is about beginning to examine NHS spending and addressing the inequalities to which Tommy draws attention.
Let us get the figures out of the way. Planned health expenditure this year is £5.075 billion; next year it is £5.243 billion; and the following year it is £5.556 billion. Those are real increases. They certainly dwarf the £35 million of annual additional spending promised to the Scottish people by the SNP manifesto in 1997. Those figures mean that health spending in Scotland this year is 20 per cent higher than in England. That is the reality.
While we are on comparison, Kay Ullrich referred to Professor Gordon McVie.
Will the deputy minister give way?
No, I am sorry. I do not have enough time.
Kay Ullrich omitted to mention that Professor McVie said specifically that Scotland was ahead of England in developing cancer services. We can do better—and we are doing better.
Will the deputy minister give way?
No, there is not enough time.
The Administration's initiatives are about Scotland and about people. NHS Direct will provide people with advice 24 hours a day. Redesigned health care will slash the time that people wait for operations such as those for cataracts. One-stop clinics will give people immediate diagnosis without the agonies of waiting; walk-in-walk-out hospitals will provide
care where and when people require it, and there will be an appointments system that lets people know when they will see a consultant. Today, maximum waiting time targets were announced to ensure national standards for those waiting for treatment.
The Administration's initiatives—real initiatives— are about the technologies and developments of the future. They include a £17 million meningitis programme. The Scottish health technology advisory centre will assess properly new drugs and new procedures. The clinical standards board will ensure the standards of the future, not the past.
The biggest hospital building programme that our health service has seen will provide facilities in which the health care of the future might be delivered, instead of old buildings that build us into the health care of the past.
The Administration's initiatives are about Scotland and are accountable to Scotland. An interesting point about what that means was raised by Duncan Hamilton. What a pity that it came so late in the debate. What a pity none of his colleagues chose to address such issues.
Susan Deacon addressed those issues, however. She announced a drive to maximise grass-roots representation on NHS trust boards, in which every one of us was challenged to take part and which we were all challenged to promote. What a pity that Kay Ullrich interpreted that challenge as an invitation to put SNP placemen on health trusts. Are the SNP's roots in communities so weak that the only people it knows and can promote are its own party members?
That is the all-encompassing challenge for us today. I say to Mr Hamilton that that is what is meant by meeting us halfway and by addressing the debate. Are we big enough and grown-up enough to show the leadership and vision that will take our NHS into the next century?
Susan Deacon spoke of the giants Beveridge and Bevan. We cannot hide behind them—rather, we must stand on their shoulders better to see the way. Bevan said:
"This service must always be changing, growing and improving".
He also said:
"This is the answer I make to some of the Jeremiahs and defeatists".
We cannot allow this Parliament to be a platform for Jeremiahs and defeatists. Because the NHS must change, we must show political leadership by letting go of old, well-loved but outdated buildings, to build the new NHS.
When Mary Scanlon spoke, I was put in mind of something else that Bevan said:
"Warm gushes of self-indulgent emotion are an unreliable source of driving power in the field of health organisation."
A certain anticipation of the holidays has been evident this week in Parliament. Holiday moods can vary. We have a choice. We could have a Hallowe'en debate about our NHS— searching out the dark side, working it up to a scary horror story and painting a nightmare vision of our health service. That gets the headlines, but it is a mask. It is guising and it serves us ill. We are certainly ill served by attempts to make a scare story—[Interruption.] We are ill served by attempts to make a scare story out of proper attempts to liberate learning-disabled people from long-stay hospitals. We are ill served by those who talk about spin doctors and then wave headlines at me. I have spoken to hundreds of learning- disabled people and they all say the same thing: "Close those hospitals down." That is what we are doing.
Ben Wallace said that it is nearly Christmas. We could also have the Christmas wish-list debate, with its endless demand for resources. Duncan Hamilton admitted that the demands are endless. That wish list is unfocused and uncosted, and size is the only criterion—massive size, according to Dorothy-Grace Elder. Quality is not considered. Resentment is fuelled by endless comparisons with others: "Look what they have in England."
Look what we have here—an excellent health service, driven forward by staff—[Interruption.]
We have a health service that is driven forward by staff who will be working day and night while we are on holiday. We should acknowledge that.
On a point of order. Some of us would quite like to hear what the minister is saying—[Interruption.]
Order. I agree. The minister is in his concluding minute—he should be heard quietly. [Interruption.] Order. Members should be quiet.
Hugh can read what I said in the Official Report tomorrow. I suggest that he read what some members on other benches have said today, because it has been a disgrace.
This is our last full debate this century. That is why the holiday that we must hold to is the new year. The new year debate must be about our resolution to modernise the NHS, to make it better as well as bigger. We must make it a health
service that is delivered in modern buildings, using modern techniques that are not separate from but are in partnership with social care and social support, and which minimise anxiety as well as physical pain. The partnerships must respond to the patients' needs, not the service's procedures. I tell Tommy Sheridan that it will be a health service that addresses inequalities in health as well as inequalities in access to health.
Beveridge and Bevan built the health service for their century. If we are big enough to build our health service for our people, for our century, we will have a 21st-century service for 21st-century men and women, for that is what we will be when we return to the chamber. That is the challenge to which we must rise. I ask members to support the motion.
Before we move on to decision time, I will address Roseanna Cunningham's earlier point, which was not a point of order, but which affects the work of the Parliament. Since I spoke, I have again consulted our officials and am able to make one minor amendment.
I wish to inform the Parliament that the information technology network was specified and procured with Y2K compliance as a mandatory requirement. Therefore, we do not expect any problems with our IT system. Nevertheless, we are following best recommended practice by closing the Parliament's IT services in order to protect the network from contamination from external sources, such as e-mails that contain viruses, over the period of the millennium celebrations.
Although the website will be available to the public during that period, the Parliament's system will be unavailable from the evening of 30 December, when essential double back-up will take place. The service will resume as soon as possible on Tuesday 4 January, when, although it is a public holiday, we have asked our IT staff to come in to restart the system. Those procedures should ensure that the Parliament is fully protected against the millennium bug and against any attempt to damage the system over the holiday period. I hope that that is clear and helpful to members.