UK Budget
I welcome this opportunity to explain to the Parliament our decisions in relation to yesterday's United Kingdom budget.
The decisions that were announced yesterday by the Chancellor of the Exchequer are good news for Scotland. They are good for the health of our economy and the health of our people, and for our health care system. The budget underlines the benefits that we receive from being part of a strong United Kingdom. However, it brings with it the responsibility to make the best of the opportunities presented to us and to do so quickly.
We readily accept that challenge. The Cabinet met today and agreed the following points. We will allocate the health consequentials to health. The Minister for Enterprise, Transport and Lifelong Learning will explore options to build on the extra assistance for business and the economy that was announced yesterday and report back to the Cabinet. We anticipate additional resources being made available in July for other services. We will ensure that we are ready to make the best use of that investment. The spending review continues apace. The Minister for Finance and Public Services will be challenging his colleagues to demonstrate how additional spending will be used for maximum impact. Finally, the Cabinet backed Malcolm Chisholm in taking forward an immediate programme of work on modernisation and reform to get the best results from the best budget for Scotland.
In all, yesterday's budget brings Scotland increases that will rise to £3.2 billion by the end of five years. We have the freedom to decide how that money should be spent. That is the key strength of the devolution settlement. We are guaranteed a fair share of additional public spending, with the freedom to tailor it to meet Scotland's needs. The agreed formula delivers for each person in Scotland, pound for pound and person for person, the same increase as in England. That comes as a right.
Now is the time for action. Members will know that a spending review is under way, both in the United Kingdom and here in Scotland. We expect the chancellor to announce the results of the United Kingdom review in the summer. We will use the opportunity of the next few months to scrutinise future spending plans. Andy Kerr will challenge each service to demonstrate how it will get best value for any additional resources that it receives. He will need to be convinced that we are putting our money into the initiatives that will make the greatest difference to public services and to people's lives.
The investment that we make, in health or in any other public service, will not be wasted. We will rightly be held to account on our record of spending and results. We have agreed that Andy Kerr will introduce proposals for increasing performance and accountability to the public as part of the spending review process.
Most attention has rightly been focused on the chancellor's announcement on the future of the national health service. We have made it clear that health is one of our top priorities and I welcome the chancellor's decision to make health the centrepiece of his budget. The benefits to Scotland will be £224 million in 2003-04, £858 million in 2004-05, £1.576 billion in 2005-06, £2.341 billion in 2006-07 and £3.201 billion in 2007-08. I can confirm that when the Cabinet met this morning, we agreed to allocate all the consequentials on health spending to health in Scotland. We will set out the detailed allocations in September.
That is a massive step change in investment. It is an increase of almost 50 per cent in the budget for health over the next five years. Every individual and business in Scotland that is asked to make a contribution to that step change in health expenditure will want to see that contribution making a real difference. I guarantee that that will be the case. We will work tirelessly to secure the step change in services to match the step change in spending.
We are proud of our record of investment in health. I make no apology in the chamber, or anywhere else, for the additional levels of health spending in Scotland. That spending reflects the additional health needs of the Scottish population. More Scots live in deprived communities. Scotland has more older people to support. Rates of heart disease and cancer are historically higher. The NHS in Scotland meets additional costs in delivering health care to Scotland's many remote and rural areas.
Despite that, NHS staff in Scotland deliver health services that bear comparison—as the Wanless report shows—with anywhere in the United Kingdom. Average waiting times are the shortest in the United Kingdom. We have fewer people on a waiting list in the first place. Eight out of 10 Scottish patients are admitted to hospital within just three months. More operations per head of population are carried out in Scotland than are carried out south of the border. That is a record of investment and achievement. It is a record for Scots to be proud of.
We are not complacent, because there is much more still to do. Long waiting times need to be cut; we need to maintain short waits for priority conditions such as cancer and heart disease; access to general practitioners and practice nurses for common problems must be speeded up; and new NHS facilities must be built and maintained to the highest standards of cleanliness. Those are our priorities for further investment.
We have been presented with a once-in-a-lifetime opportunity to invest in health and health care in Scotland. We will seize that opportunity. With investment will come reform and results. Malcolm Chisholm will ensure that the investment will improve standards, shorten waiting times and improve choice for patients. All the money will be rigorously accounted for.
The Wanless report shows that no one in Scotland waits more than 12 months for in-patient care. We will go further. Not only will we continue to have the shortest waiting times in the United Kingdom, but we will concentrate on shortening times where it is clinically most important.
However, patients also need more choice. We will set up a new national database showing waiting times in every NHS area in Scotland so that patients and their doctors can ensure that they get the most appropriate treatment in the shortest possible time.
In the health service, we will show more clearly where money is spent and what results are achieved. We will bring together in one body the Scottish organisations involved in clinical audit. A new quality standards board for Scotland will set testing standards, monitor achievements against those standards, and report the findings. Audit Scotland—which is accountable to the Parliament and independent of the Executive—scrutinises NHS performance on such matters as cleaner hospitals and waiting lists. All its reports, rightly, are made public. We will ensure that consistent information about all NHS boards is collected, analysed and published so that people can see how their local NHS is performing, and how the money that has been invested is being used.
Although I have concentrated today on our health, my drive to secure reform and results from every pound of public funds extends to all our key public services. I want to make it clear that our investment to improve and reform public services, our actions to deliver social and environmental justice and our drive to secure health improvement must be targeted at the communities and the people who need them most.
The step change in health investment and our spending review will allow us to set about tackling health inequalities wherever they exist and to secure social inclusion wherever it is needed. The resources will deliver the step change in the health of our people that we so desperately need. The Cabinet agreed today to commit all those resources to health. We made that choice because we are painfully aware that we live in a country where too many people die from cancer and coronary heart disease and suffer from respiratory illness, mainly because they were born into families who live in some of the poorest communities in Scotland. Our mission is to close the gap that exists.
We have been presented with a fantastic opportunity to make a difference in Scotland. Our responsibility is to turn that into opportunities for the people of Scotland—opportunities to enjoy better health and opportunities to benefit from first-class health services in every single community. That is a challenge that I and my colleagues in the partnership will rise to, and I challenge everyone in the chamber to join us.
I thank the First Minister for his courtesy in providing me with an advance copy of his statement.
The Executive members cheered when the big numbers were announced in the First Minister's statement. I look forward to spending that money as this country's First Minister in 2003.
I ask the First Minister—[Interruption.]
Order. Let us hear the question.
I ask the First Minister whether he remembers this quotation:
"There is hardly a nurse, teacher, policeman or council worker in Scotland who won't be paying this tax increase. These are the very people"
they
"claimed they wanted to help and instead … will be hit the hardest."
Those are not the words of the Daily Mail on Gordon Brown's penny for the health service, but the words of Gordon Brown on the SNP's penny for Scotland. I am absolutely delighted that the Chancellor of the Exchequer has now accepted that progressive taxation is required to invest in the health service in Scotland, when he failed to recognise that three years ago. [Interruption.]
Order. Members listened to the First Minister; they must listen to the leader of the SNP as well.
In the light of the chancellor's conversion, is the First Minister now prepared to pay the staff in Scotland's national health service salaries that will be higher than those south of the border, to give Scotland the competitive advantage that we require to attract skilled personnel to our national health service in Scotland?
I am pleased to see that Mr Swinney shows his true colours by not even welcoming the fact that the Scottish health service budget will increase by 50 per cent in the next five years.
On Mr Swinney's final point, I do not agree that we should break up the NHS and the staffing arrangements that exist across the United Kingdom. Those arrangements directly benefit Scotland as well as the other regions of the United Kingdom and allow us to employ far more nurses, far more doctors and far more other health professionals than elsewhere in the United Kingdom—and quite rightly, because of the health needs that I identified.
Mr Swinney made a point about the so-called penny for Scotland. The penny for Scotland would have raised a pittance in comparison with the amount of money that was announced yesterday and today for the health service in Scotland. The penny for Scotland would have taxed pensioners in Scotland; the chancellor's budget does not do that for this health spending. The penny for Scotland would have taxed Scots, rather than the whole of the United Kingdom, to provide us with this money. The Scottish nationalist party wants to tax Scots more and spend less on health in Scotland. We want to ensure that the taxation regime is fair, and that the health service benefits in the same way across the whole of the United Kingdom.
I repeat Mr Swinney's thanks to the First Minister for an advance copy of the First Minister's statement, although as it arrived only eight minutes in advance, I have had to become adept at speed reading.
I have a couple of questions on the statement. First, given the brief nature of this presentation, can the First Minister assure us that other ministers will come forth and give further details of the breakdowns and allocations to their departments, once the totals have been set? It is interesting that we heard a little bit in the statement—apart from health—about what the Minister for Enterprise, Transport and Lifelong Learning is about to do with her money, but very little about anybody else. We would be particularly interested to know what will happen to the education budget, and whether direct payments will be made to schools in Scotland on the scale that the chancellor indicated will be paid to schools south of the border, as part of the capital improvement programme.
On health, which was the main thrust of the statement, why does the First Minister repeatedly confine his horizons to comparisons between ourselves and the situation south of the border? We know already, and have known for 20-odd years, that more is spent per capita on health in Scotland than in England and Wales. That was the case under the Conservative Government, and it is no different now.
Should not Mr Kerr set for his ministerial colleagues the challenge not only of having bragging rights in the United Kingdom, but of delivering a health service that is among the best in Europe? We should set ourselves that target. The present level of spending is already comparable with spending levels in European countries, yet our service standards are acknowledged to be poorer. Instead of being obsessed by what is happening in England, why do not we consider examples from abroad and find out what fundamental reform should accompany the extra spending to deliver the service standards that people have a right to expect in this country, which should be among the best in Europe, not just the United Kingdom?
I hope that Mr McLetchie will not continue the programme of running down the health service to which the Conservatives' UK health spokesperson, Mr Liam Fox, recently admitted. I hope that he will not employ the tactic that has been used elsewhere of running down the health service to discredit it, thereby ensuring that it can be further privatised or that new charges can be introduced.
It is right and proper that there is additional spending on the health service in Scotland compared with elsewhere in the United Kingdom. That reflects our geography, our demography and our long-standing health service challenges. It is also right that we compare like with like. That is why the information to which I referred in my statement is important. We must have accurate information about what we are spending the money on and the impact that the money is having.
When we make comparisons with Europe, we must remember that, in the same way as there are differences between Scotland's geography, demography and other aspects and those of other parts of the UK, there are differences within other European countries. The Scottish health service has met a series of targets, including those on waiting times, the numbers of nurses and doctors, the provision of facilities and the localisation of facilities. We can be proud of that, but we must ensure that those targets are much better.
That is why the programme of reform is important. The successful programme of reform that Malcolm Chisholm has implemented since the new year has involved initiatives such as the national waiting times unit, which has allowed hundreds of patients throughout Scotland who would not have been treated to receive treatment, and the ambulance service reforms that were announced on Tuesday, which will secure a modernised ambulance service. Those reforms are long overdue and have been supported by members of all parties. Such reforms must be pursued. We will ensure that those reforms proceed, to allow us to have the best health service in Europe. I agree with that aim and I intend to see that through.
Mr McLetchie's first question was about education. The chancellor did not announce new money for education in Scotland. In his budget speech, he referred to funding from the coming year's allocation to the Department for Education and Skills. Therefore, it should not be expected that announcements that have been made in Scotland will be repeated. We are not in the business of double announcing or double counting.
I welcome the announcement by the First Minister on additional funding. Will he reflect on the fact that during last year's election campaign, the SNP's penny for Scotland was not for health, but for fuel duties? Will he note that the Conservatives' policy is to vote against the budget and against more investment in health?
Will the First Minister confirm that 8.3 per cent of Scottish gross domestic product is spent on health and that that figure will rise because of his announcement? Investment in the modernisation and reform of the NHS, including the improvements in our national health plan, is crucial. Some people in Scotland still wait too long for hospital treatment and some people are still bedblocked. Will the First Minister ensure that the Minister for Health and Community Care's proposals show every man, woman and child in this nation how the improvements that the funds bring will provide a demonstrable return for the people of Scotland?
I am determined to provide that demonstrable return. I agree that the Opposition may be reluctant to praise the additional allocation because it feels a bit guilty about comments that it has made in the past.
The relationship between health spending and GDP will depend on Scotland's future GDP. We want that GDP to rise in addition to health spending. Given the substantial allocations that were outlined in the budget and in the allocations that we made today, I would be surprised if the percentage that is allocated to health did not rise, at least in the short term.
I agree entirely with Tavish Scott and I am sure that many members also agree. The issue should not be a party-political point. We must remember that, despite the historically high level of spending on health in Scotland and despite Scotland's efficient public health service, which has been supported by parties of different colours over the years, we have a shocking record on cancer rates, heart disease and other diseases and problems. That record is due largely to our lifestyles and some of the industrial conditions in Scotland in the 20th century. Those matters must be tackled in a range of ways, not only with faster operations, but with changes in lifestyle and campaigns for health improvements. By using both those means, we will really make a difference in Scotland in the future.
I thank the First Minister for his statement and for his announcement of record investment and proposed reforms in the NHS. Tavish Scott mentioned the SNP's penny for Scotland. As far as I remember, that was elastic—it was not only for health or transport, but for everything. The SNP's front-bench spokespersons spent that money over and over again.
In the budget, the Chancellor of the Exchequer chose to focus on families, which I welcome. Will the First Minister assure me that the money will be used to tackle the problem of child poverty in Scotland and to work towards eradicating it?
Yes. The publication of figures last Thursday showed that child poverty remains our greatest challenge. The improvements in health that are required are moving forward through, for instance, breakfast clubs, lunch provisions, additional support for families, healthy eating programmes—
What about free school meals?
It is easy to make cheap comments on this important issue. It is vital that young children in Scotland have the best possible start in life, which applies to their health as much as to other matters. That means improving the provision not only of breakfast clubs and healthy eating programmes, but of dental facilities for young children—on which our record is shocking—and of a number of other facilities. I want to ensure that that provision is developed as a priority. There is little point in our speeding up operations for today's adults if today's children replace them on the operation train. We must take the twin-track approach of speeding up operations, cutting waiting times and making hospitals and health centres more efficient, and, at the same time, ensuring that the health of the next generation is much better than ours.
I look forward to the First Minister giving more consideration to universal free, healthy and nutritious school meals.
Does the First Minister agree that it is unfortunate that yesterday's budget repeats the protection-racket economics with which Gordon Brown and Tony Blair are involved? The budget robs Peter to pay Paul. If the upper earnings limit on national insurance contributions had been abolished and if 10p had been added to the tax of those who earn in excess of £50,000 a year and 20p for those who earn in excess of £100,000, according to Dawn Primarolo, that would have generated an extra £12 billion for the Exchequer. Would not it be better to put extra taxes on those who can afford to pay, rather than putting them on workers who are already overtaxed?
Under the proposals that were made yesterday, those who earn more will pay more, which is right and proper and a fair way to secure the contributions that are required. I do not think that people in Scotland or in the rest of the United Kingdom give up their wages to taxation easily and without reluctance. As I said in my statement, there is an absolute duty on the Parliament to ensure the maximum results for those people. It is right and proper that everyone who works in the United Kingdom makes a contribution, but it is also right and proper that we ensure that the money is not wasted and that it is used to make the maximum number of changes to, and the best improvements in, our national health service.
I do not want to go too far into reserved matters, but Mr Sheridan forgets that a number of changes were announced in yesterday's budget that will benefit hundreds of thousands of Scots. Those changes will secure a future for families and young children, both in work and out of work. The changes will mean increased income for those people every week, which will ensure that they benefit from this budget, as they have benefited from the budgets since 1997.
It will be in order to return to this subject during the first three questions of First Minister's question time.