Plenary, 16 Dec 2004

Meeting date: Thursday, December 16, 2004

Official Report 825KB pdf

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First Minister's Question Time

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Cabinet (Meetings)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-1291)

At next week's meeting of the Scottish Cabinet we will discuss our progress towards building a better Scotland.

In 2001, Susan Deacon claimed that the

"phoney war on waiting is over"

and promised to cut waiting times. A few months later, Malcolm Chisholm also promised to cut waiting times. Why should anyone believe the promise made by the current Minister for Health and Community Care to cut waiting times when the same promise has been made and broken by the previous two health ministers?

Because, in that time, we have seen dramatic reductions in the waiting times for treatment of Scotland's key killer diseases and every promise that has been made and guarantee that has been given to those who wait longest in our health service has been met by this devolved Government. Further, in addition to the targets that were set out clearly yesterday by the Minister for Health and Community Care, we have in place the investment and the reforms that we now know that the nationalists would deny Scotland but to which we are absolutely committed.

I remind the First Minister, as he witters on about targets, that the number of in-patients who are seen within six months has declined each year since he became First Minister. Never mind that, however, as we are now to have a step change in policy. I would like to ask the First Minister about one aspect in particular. Yesterday, Andy Kerr said—and had it printed in bold type, so it must be important—that he will

"bring all of the available floor space (at former HCI) into intensive clinical use".

If that really is a new policy, can the First Minister tell us how it differs from Malcolm Chisholm's promise in June 2002

"to maximise the use of the 60,000 square feet facility"

at the Health Care International hospital?

I know that the Scottish National Party has a slight problem with turning rhetoric and theory into reality, but the reality is that we want to ensure that not only do we have that building but we have the capacity to ensure that that building delivers for Scottish patients. The thousands of Scottish patients who have already benefited from that new hospital will continue to benefit in the years to come, as will many more. That is in direct contradiction to the statements that were made yesterday by members of the SNP who were opposing the very reforms that will make a difference for Scottish patients—a position that is, incidentally, in direct contradiction to promises made by their current deputy leader only 18 months ago.

The First Minister has just put his finger on his own problem.

Yesterday, Andy Kerr said that one of his never-seen-before policies was better workforce planning. However, how does that differ from Malcolm Chisholm's pledge two years ago to

"develop new workforce planning arrangements"?

As—[Laughter.] The SNP members will not be laughing in a minute. As Ms Sturgeon should be able to realise, it is possible at every stage in this journey to improve those waiting times, ensure that we bring down the longest waits and ensure that we continue to bring down the waiting times for those who are suffering or in danger of dying from the key killer diseases in Scotland. We will do that not only by maintaining the record levels of investment in our health service that we are making but by implementing the necessary reforms. As I just said, that stands in direct contradiction to the stated policies of the SNP.

Yesterday, Ms Robison, on behalf of Ms Sturgeon, told us that the SNP is totally opposed to the use of the private sector in Scotland's hospitals. However, only two years ago, Ms Sturgeon was telling us that a so-called SNP Government

"will never stand in the way of a patient receiving treatment in an empty private sector bed".

SNP members says one thing when it suits them on one occasion and another thing when it suits them on another occasion. They should be more consistent. They were not consistent on the issue of the council tax last week and they are not being consistent on the issue of the health service this week. They need to realise that the NHS in Scotland needs not only investment but reform. If it gets both, it will continue to deliver improvements for Scottish patients.

Is it not the case that the only people who stand between patients and treatment are those in the Scottish Executive? Is it not the case that the First Minister's health policy has more repeats than the Christmas television schedules and that virtually every promise made in the past five years has been broken? That is why the First Minister is now turning in desperation to the private sector—a move that expert after expert says will drain resources away from the health service. Was yesterday's announcement not simply the final admission of defeat by an Executive that, under the First Minister's leadership, has failed patients time after time?

I think that Nicola Sturgeon was pretty poor this week, too.

Three years ago, the SNP called on us to shift the focus from waiting lists to waiting times; now it calls on us to shift the focus back again. Three years ago, the SNP called on us to focus on the longest waiting times. We have done that, we have brought those waiting times down and now we will bring down the others too. Three years ago, the SNP called on us to focus on and prioritise Scotland's key killer diseases and we have saved hundreds, perhaps even thousands, of lives in that time because of the focus on cancer, heart disease and stroke. We will continue to focus on those key priorities for Scotland, but we will also ensure that all other patients get a better deal too.

I put it to the First Minister that he can spin, but he cannot hide. Out-patient waiting times are up and in-patient waiting times are higher than they have ever been. That is not progress but regress and it is the patients of Scotland who are paying the price.

The 12-month guarantee for in-patients: met. The nine-month guarantee for in-patients: met. Bringing down the waiting times for heart disease treatment: met, and lives saved. Bringing down the waiting times for cancer treatment: met, and lives saved. Bringing down the waiting times for stroke treatment: met, and lives saved. Those are the real achievements of the Scottish health service. We will build on those achievements, not just by investing resources that the Scottish nationalist party could not even dream of, never mind deliver, but by ensuring that people in Scotland get the reforms in their health service that will deliver those changes and put patients first. That is in direct contrast to promises that were made in the past by Ms Sturgeon but yesterday contradicted and abandoned by Ms Robison.

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Prime Minister (Meetings)

To ask the First Minister when he will next meet the Prime Minister and what issues will be discussed. (S2F-1292)

I have no immediate plans for a formal meeting with the Prime Minister.

When they do meet, the First Minister and the Prime Minister might like to compare notes about their respective performances in dealing with waiting lists and waiting times in the health service north and south of the border. That would be a most illuminating discussion.

Will the First Minister tell us why the targets announced yesterday by Mr Kerr are conveniently set for the end of 2007, following the next election to this Parliament? Why was the Minister for Health and Community Care remarkably reluctant to give equivalent target figures for the end of both 2005 and 2006? Why can we not have some indications of progress before we next go to the polls? Is what we heard yesterday not a case of another health minister, another waiting times initiative and another desperate attempt to cover up the failures that we have seen in the past five years?

I know that we have been in this Parliament for only five and a half years, but most members have managed to notice in that time that we have quarterly reports of progress in the national health service and that the statistics contained in those reports outline the different changes that have taken place. It is critical that those reports should be made more transparent and more able to allow the health service to be held to account. That is precisely why Mr Kerr announced the changes in those statistics yesterday. However, it is wrong to say that there will not be proper progress reports between now and the end of 2007 because the reports that are made will show that progress.

We are of course aware of the lack-of-progress reports that we have been given quarterly during the past five years on a range of issues and indicators on waiting times and waiting lists in hospitals. Is it not the case that the announcements that Mr Kerr made yesterday are, far from representing a so-called step change—to use a favourite piece of new Labour jargon—little more than a mouse? Is it not the case that the operations that will be commissioned on behalf of NHS patients from the independent sector will amount to little more than one tenth of 1 per cent of the health budget? Given that derisory statistic, is it not the truth that there is no clearly thought-out strategy on significantly increasing health capacity in Scotland to reduce waiting lists, and that all we have heard is another series of back-of-the-envelope solutions?

On Mr McLetchie's first point, I have already said that the waiting times for heart treatment, for example, are dramatically down from when the Conservatives were in power. That is saving lives in Scotland and he should not demean that achievement by the people who work hard in our health service.

It is true that we must ensure that there are further improvements, first by reorganising and improving the work of the health service and the staff who work directly for it, but also by using other capacity and other providers, which is precisely what the Minister for Health and Community Care announced yesterday. The minister will outline further progress on that as contracts are developed and signed. It is clearly possible for that to happen in addition to the existing capacity of the health service in Scotland, as providers themselves said yesterday evening. As a result, many patients in Scotland will be treated more quickly in the years to come. The Conservatives should have welcomed the initiative, but they were not big enough to do so.

We did indeed welcome the initiative, because it represents a tiny step along a road that we alone in Parliament have been advocating for the past five years. The First Minister should apologise to the patients of Scotland for the five wasted years during which tens of thousands of patients languished on Labour's waiting lists, while Labour arrogantly turned away from the improvements to capacity that could have led to treatment for many of them.

If the initiative had been carefully thought out, then instead of the vague homilies about the use of the independent sector that are in the report that the Minister for Health and Community Care presented yesterday, on which little additional light was shed during the debate, we would have a good deal more information about the diagnostic and treatment facilities that are to be brought on stream and about the new, more flexible, mobile scanning units.

Question.

If the plans have not just been dreamed up in a desperate measure to ensure that the First Minister can be seen to be doing something, why were we not presented with much more substance than was announced to Parliament yesterday?

I will not conduct negotiations with private companies in public. Mr McLetchie, of all people, should understand that principle. He talks about capacity in the health service in Scotland. I remind him that in almost every category of staff in the health service, the number of staff is up dramatically from when the Conservative Government was in power. That is because of our commitment to the national health service, as opposed to his party's commitment to privatising and breaking up the national health service. We know exactly what the Conservatives would do with the extra money that is available for the health service—if they even kept it in the budget. They would use the money to subsidise the operations of people who can already afford to pay for their operations, rather than do what we are doing and ensure that the money is used to deliver operations for patients on a basis of equity across the whole of Scotland. No matter what someone's background, income or personal financial circumstances are, in Scotland today they receive the same treatment from the health service, as the Minister for Health and Community Care outlined yesterday. Under the Conservatives, a person's ability to receive that treatment would depend on their ability to help to pay for it. That is wrong. The health service should be free at the point of need for all. That is our commitment and we will stick to it.

There is one extra question this week, from Richard Lochhead.

The First Minister will be aware that at next week's fishing talks, Scotland's fishing communities will once again be at the mercy of the unworkable and failed common fisheries policy, which is why after First Minister's question time the Cod Crusaders will hand into the Parliament their biggest ever petition, in which 160,000 Scots call for Scotland to come out of the common fisheries policy. In relation to next week's talks—

Question.

Will the First Minister ask the Prime Minister to permit Ross Finnie to officially lead the UK delegation in Brussels? At least that would increase our chances of getting a good deal for Scotland. Given that we have led on education and health talks in the past and given that Scotland has 70 per cent of the UK fishing industry, why can we not lead on fishing?

I respect those who have been campaigning locally and those who have genuinely campaigned for their own industries and communities over the past two years. It is also important to recognise that the situation has changed over that time because of the Executive's efforts in Brussels and elsewhere to improve the situation of Scotland's fishing communities.

As a result of the efforts that have been made by this devolved Government, we now have, for example, a proper regional advisory council for North sea fisheries. The North sea regional advisory council will influence the decisions that are made at European level. It will build on those decisions to ensure that we get the regional management for the North sea fisheries that all of us have been looking for.

The regional advisory council was established precisely because of the actions of this devolved Government. Instead of undermining things, as Mr Lochhead does when he goes to Brussels, we have taken action with the support of the UK Government. Year on year, we have gone to Brussels to negotiate a proper solution and to get changes to the European Commission's proposals that are in the interests of the Scottish fishing communities. Those efforts will continue. We will engage actively in the negotiations to represent Scottish fishing communities and ensure that they have a sustainable future. We are not shouting from the sidelines or trying to exploit and undermine the negotiations, as Mr Lochhead has done consistently, year after year.

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Secretary of State for Scotland (Meetings)

To ask the First Minister when he will next meet the Secretary of State for Scotland and what issues he intends to discuss. (S2F-1295)

I have no immediate plans for a formal meeting with the Secretary of State for Scotland.

The First Minister will be aware that the first session of the Parliament saw Scotland lead Europe in the implementation of the water framework directive, which was hailed as one of the most far-reaching and significant pieces of environmental legislation in 40 years. However, the Scottish Environment Protection Agency stated this week that it has a shortfall of £20 million in the budget that it needs to carry out its duties in protecting our water environment. Is the First Minister concerned that Scotland could plummet down the European league because of a lack of care for its environment? What does he propose to do about that?

No. The connection is an illogical one to make. It is natural for quangos, public bodies and others that we finance to demand more money. All of them seem to do that on a regular basis and SEPA is no exception to the rule. However, there is no direct relationship between that and our implementation of the directive, the object of which is to ensure that we in Scotland see significant improvements in the quality of our water supply.

The levels of investment that this devolved Government has pursued over the past five years prove our commitment to deliver on that overall commitment. The quality of water supply in Scotland has improved over that time and will continue to improve. The management of Scottish Water, which all members and parties in the Parliament have been critical of in the past, is now to be congratulated on the significant improvements that it is making. It is also to be congratulated on the efficiencies that allow it to make even better use of the investment.

The First Minister has not answered the question about the £20 million shortfall. The SEPA chief executive said:

"Although additional funds have been provided, they were not at the level we'd requested."

The First Minister is selling the environment short. At the very least, will he agree to look into the issue of the shortfall as a matter of urgency?

No. I do not equate the improvement of the environment in Scotland, by means of our investment in the environment, with the pumping of money into one particular body, agency or quango just because it has requested more money. The Executive has to make balanced judgments about our budget. We make those judgments because of the need for wider levels of investment.

In terms of the budget that was announced this year, what is important for the environment is not whether SEPA got every bit of money that it asked for but the fact that we will invest record amounts of money in improving how we recycle and manage Scotland's waste. It is also important that we will invest record amounts in the improvement of the quality of our water supply and in a whole range of other environmental measures that improve Scotland today and will improve Scotland in the future. SEPA should monitor that work, but it should do so within the budget that it has been allocated.

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Smoking Ban

To ask the First Minister whether the Scottish Executive still intends to introduce a comprehensive ban on smoking in public places. (S2F-1304)

Yes. The Minister for Health and Community Care signed the bill today and it will be published tomorrow.

I welcome the First Minister's reassurance. People to whom I have spoken in my constituency, particularly young people, say that whether one is young or old, rich or poor, one is entitled to be protected from the effects of smoking. Does the First Minister agree that, for that reason and for the sake of clarity, it is important that there are few—if any—exemptions to the ban on smoking in public places?

Yes. I would simply remind the chamber that, as we said in the chamber just one month ago, 13,000 people in Scotland die of smoking-related diseases every year; about 1,000 people—we know for certain—die from the effects of passive smoking; and the lives of many more may be affected by passive smoking. However, 70 per cent of those who live in Scotland do not smoke and two thirds of those who smoke want to give up. The best way to encourage those who want to give up, and the best way to reduce the impact of smoking and of passive smoking, is to implement a comprehensive ban on smoking in public places. In the interests of our country and its future, we will do that as quickly as we can.

Does the First Minister intend that the smoking room in the Scottish Parliament complex should or should not have a future?

That is not really a responsibility of the First Minister. [Laughter.]

And isn't he glad about that.

At the risk of incurring the wrath of the Presiding Officer, I say that I have been on the record from the beginning as saying that I do not believe that the Parliament building should have a smoking room. I believe that it should be closed as quickly as possible.

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Accident and Emergency Units

To ask the First Minister what recent discussions the Scottish Executive has had regarding the performance of national health service accident and emergency units. (S2F-1298)

Cabinet discussed the matter yesterday morning. Waiting times in accident and emergency have to improve and we therefore endorsed the target that was subsequently announced by the Minister for Health and Community Care yesterday afternoon. From the end of 2007, no one in Scotland will wait more than four hours from admission to an accident and emergency unit until discharge or transfer.

In announcing that target, the Executive has clearly recognised that the experience of some patients in accident and emergency is less than satisfactory, but given the totally different nature of accident and emergency from the rest of the hospital service, and given that the solutions are not covered in "Fair to All, Personal to Each", will the First Minister say what specific proposals he has for accident and emergency that will allow that target to be met?

One of the key things about the changes that are required in accident and emergency to meet that target is that we should use the best practice that exists in the many parts of Scotland where targets are being met. Tough targets have been set locally and have been met because of the way in which consultants, nurses and others are organising themselves in those accident and emergency units. One of the problems that we have in Scotland today is that there is not a consistent level of good practice throughout the country, which is why we are now setting a very clear national target, and we will ensure that that best practice is replicated in every part of Scotland.

The First Minister will be aware of the uproar in Campbeltown about the closure of the assessment ward at Campbeltown hospital and the likely impact that that will have on accident and emergency services at the hospital. The ward was closed after no consultation with local people and without any alternative service provision being put in place. I ask the First Minister to put pressure on the health board to suspend the closure until a proper consultation is carried out, and the community is satisfied that alternative provision has been put in place.

The planning and provision of services at a local level is a responsibility of the local health board, which has to take that responsibility seriously. That should include, at all times, proper consultation with local people and a proper plan to be in place when service changes are taking place.

I do not know the exact circumstances of the local situation to which George Lyon refers, but if improvements are required to the way in which the health board operates in that area, the Minister for Health and Community Care will take that up with the board.

Edinburgh's Royal Bank of Scotland infirmary has won the least coveted award for the worst accident and emergency waiting times in Britain, with 25 per cent of patients waiting for more than four hours for treatment. That is a worse performance than that of the old hospital in the city centre, which was built in 1723. Does the First Minister agree that the promises of hospital managers, who claim that the situation is better now, are clearly worthless and does he accept that critics of the private finance initiative scheme predicted the appalling record? Does he now wish that he had listened to the many warnings that bed and staff reductions would lead to the current erosion in the NHS's capacity to cope with demand?

Few people, beyond those who do not wish progress because of ideological baggage, would want to return to the previous situation in Edinburgh with the old hospital. Mr Fox might be one such person, but I suspect that those whom he represents do not agree with him.

The question partly relates to Mr Morgan's question. One improvement that can be made in accident and emergency units throughout Scotland relates to the fact that the process of registering and then seeing patients does not necessarily have to be consequential on the order in which they come through the door. One of the problems that existed at Edinburgh royal infirmary was that people were having to wait until those who required major treatment were dealt with before fairly minor issues were seen to in the course of an evening's work. That has changed in the six months since the survey was carried out, and the hospital has learned from the experience, which seems to me a good thing for it to do. I hope that Edinburgh royal infirmary will be only one hospital in Scotland to learn from that experience and improve accident and emergency performance in the months and years to come.

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Prostitution

To ask the First Minister what action the Scottish Executive plans to take on the findings and recommendations of the expert group on prostitution's stage 1 report. (S2F-1308)

Ministers do not plan to make any decisions on the expert group's report until the three-month consultation on the report has been completed and we have had a chance to consider the responses.

I thank the First Minister for his reply and comment on its wisdom. I also commend to him the expert group's findings because, as the Executive will find when it studies them, it manages to reconcile two conflicting duties of care. I ask the First Minister to consider seriously what the report says; we have managed to bridge the gap between the cities in Scotland.

I confirm that we will consider the report very seriously. We will also consider any representations that are made to us during the three-month consultation that began today.

Does the First Minister agree that if we are serious about tackling the problem of street prostitution, one of the key issues must be to tackle kerb-crawling, which is one of the most odious forms of antisocial behaviour? Will he consider what progress the Executive can make on the partnership agreement commitment to legislate to make kerb-crawling a criminal offence?

One of the reasons why we have to consider carefully the expert group's report and the responses to it is that it makes a different recommendation from that commitment, which was agreed 18 months ago. As I understand it, the report, which has been published today, recommends a different legal route for tackling kerb-crawling. That is a suggestion worthy of debate and consideration and I hope that those who have campaigned on the issue, raised it on a number of occasions and wish to see action, such as Mr McAveety, will read the report carefully and, if they disagree with the recommendation, make representations in the consultation to give us a chance to consider their point of view as well.

As there is, as Margo MacDonald indicated, a difference of opinion between different cities, will the First Minister use his influence to achieve a consensus or, if he cannot achieve that, to ensure that those cities that wish to progress in a different manner may do so?

There is an interesting policy challenge for Government in that. On the one hand, we have a desire for a consistent national approach and a strategy to tackle the problems that result from prostitution in Scotland today. On the other hand, we have legitimate demands to adopt local strategies that are felt to be more relevant or at least have some support—in the city councils in particular. We will weigh up the balance of the arguments from those two points of view. I expect the four main city councils to be among the respondents to the consultation.

Meeting suspended until 14:00.

On resuming—