Improving Scotland's Health
Good morning. The first item of business is a debate on rising to the challenge of improving Scotland's health. The debate will be concluded without any questions being put.
There has been much action and some success in improving Scotland's health since public health was the subject of the first ever debate in the Scottish Parliament in 1999. For example, the incidence of premature mortality from coronary heart disease continues to decline and is much lower than it was one or two decades ago. The simple fact, however, is that Scotland's health is not improving fast enough. Scotland is a wealthy country and should enjoy much better health than it does.
A vision of a thriving and healthy Scotland and a plan for action were outlined in "Improving Health in Scotland—The Challenge" in March 2003. Achieving that vision presents an opportunity for the Parliament to act together in a way that the people of Scotland expect and that cuts across traditional party lines. I hope that we can have a constructive and helpful discussion of the ways of moving towards that vision. We require nothing less than a sea change in attitudes to health and health improvement, starting with the Government, but running through the whole of society.
The challenge plan is reinforced and extended by the partnership agreement, in which we make a strong commitment to long-term and sustainable improvements in Scotland's health for all our people, while particularly targeting those who are most vulnerable and disadvantaged. We are committed to stepping up action on health improvement overall. We are tackling alcohol abuse; improving diet; reducing smoking; promoting better mental health and well-being; increasing physical activity; piloting new initiatives such as personal health plans and well man clinics; and introducing free eye and dental checks.
We are taking ambitious actions to produce real change, but there is no quick fix. To change health, we also need to change the factors that influence it, such as child poverty, employment, housing and the environment. We have backed our commitment to health improvement with substantial extra new investment that moves well outside the traditional health funding routes. Health improvement is not just for the national health service; it is everyone's business.
We have committed over three years £63.5 million for promoting healthy school meals and fruit in schools; £24 million for expansion and development of the active primary schools programme and school sports co-ordinators; £15 million for the national health demonstration projects and national learning networks; £24 million towards improving mental health and well-being; £180 million for quality-of-life funding to local authorities; £108 million for sure start Scotland; £90 million for the better neighbourhood services fund; and £47 million for Glasgow homeless hostels decommissioning.
That is an impressive list of investments, but among them the minister did not mention any funds for training. Most of us recognise that there is a major hole in relation to providing well-trained, capable individuals in our hospitals and general practices. Does the minister have any comments to make on training?
The issue is mentioned in "The Challenge", with reference to health improvement. We talk about encouraging national best practice among professionals, especially in multi-agency settings, and there are wider issues of training for health professionals beyond the health improvement area.
We have introduced a duty of health improvement into the National Health Service Reform (Scotland) Bill, underlining our determination to give effective leadership to the process of improving the health of the nation. The Local Government in Scotland Act 2003 introduced a power of well-being for local authorities, which provides underpinning for community planning partnerships and the development of joint health improvement plans.
Health improvement is rather like a large and difficult jigsaw. Many disparate factors impact on health and life expectancy, including life circumstances and lifestyles, and we need to take effective action in both areas. That is a massive challenge and everyone has a role to play: the Executive and the Parliament; the NHS and local councils; the voluntary sector and the private sector; communities; and every individual in Scotland. The challenge is not just to improve the health of the nation overall. Addressing health inequalities and closing the health gap is the overarching aim of the challenge and must be central to everything that we do on health improvement.
As is well known, Glasgow suffers from the highest concentrations of deprivation and consequently has some of the starkest health inequalities. The Executive is giving financial support to the establishment of the Glasgow centre for population health, which is well placed because of the needs of Glasgow and the relevant academic expertise there. The centre is an important initiative for building a strong evidence base for future work on health improvement and health inequalities. That evidence base will be of benefit to the whole of Scotland.
Will the minister join me in congratulating Glasgow City Council on its initiatives in relation to universal free access to swimming pools, free breakfasts for primary school children and free primary school lunches? Does he agree that universality is the way of targeting all our children?
The council and the NHS board in Glasgow have made great strides in relation to health improvement and I commend them for their joint efforts. However, we are putting substantial resources in and we think that a mixture of universal and targeted provision is the best way forward.
Another important dimension is the development of more sophisticated indicators and monitoring so that we can effectively track progress towards our goal of reducing health inequalities. Experts are currently working on that for us. We are also promoting innovative and targeted approaches to health inequalities through initiatives such as integrated community schools, healthy living centres and the implementation of our health and homelessness action plan.
The minister talked about Glasgow's needs, but does he acknowledge that there are pockets of deprivation—although perhaps not as serious as that in Glasgow—scattered throughout Scotland, including in Aberdeenshire and other rural areas?
Absolutely. I said that the biggest concentrations of deprivation are in Glasgow, which led me to talk about our support for the Glasgow centre for population health. However, the same problems exist in many parts of Scotland.
I have taken three interventions, so I will skip some of what I was going to say about wider action throughout the Executive. However, I make it clear that, in general, we see health improvement as something that will be carried forward throughout the Executive, as well as more widely throughout Scotland. We must develop capacity for health improvement in all our public services, so that every public service worker is a health improvement worker. We need to move away from the idea that health improvement is just for health professionals. To accelerate that change, I will today announce funding for the appointment of health improvement staff to help to develop capacity in Sustrans and sportscotland, two organisations that can help us to deliver a more physically active Scotland.
"The Challenge" gives us a framework for moving forward and for building on and extending work that was started in the first four years of the Parliament. The document's four key themes—early years, teenage transition, the workplace and communities—allow us to move forward more rapidly, enabling more effective linkages and partnership working in support of health improvement.
I will talk briefly about each of the four themes in turn and explain how we will gauge success. For early years, success will be when every child and family receives the support that they need to ensure the opportunity to maximise their potential for health and well-being. That means access to good nutrition, both before and after birth; support for breastfeeding; smoke-free environments; safe and active play; good parenting; and a good, safe place to live. Measures to promote children's oral health, the work of the starting well national health demonstration project in Glasgow and a range of integrated services for children and families that are provided through early-years policies such as sure start Scotland are helping children to get off to a better start in life. The integrated strategy for the early years that we are working towards will be a key plank in delivering all that support in a more effective and joined-up way.
The response to parliamentary question S2W-2032, which asked what proportion of under-16s had dental decay, was that the information is not held centrally. How, therefore, will the minister measure oral health in youngsters?
We have identified several gaps in the statistics and are taking steps to address the issue. We will respond soon to the consultation paper on the oral health of children and that factor will certainly be taken on board in our detailed response.
As I have taken an intervention, I will not go through all the details of the other three themes. However, teenage transition is clearly crucial for some of the issues that we will be discussing today, such as sexual health, smoking, alcohol and mental health and well-being. The workplace is also a key area for increased action on health improvement. We have already expanded Scotland's health at work scheme and an inclusive short-life working group is informing development of an integrated programme of action for healthy working lives.
For communities, which I believe are at the very heart of health improvement, we want to build voluntary sector and community-based capacity to develop health improvement through community action, so that we can support local people in taking a lead in developing local solutions to local community problems. That is beginning to happen. In many areas, social inclusion partnerships are bringing together key local players in a series of initiatives to reduce health inequalities and promote health improvement, especially for young people. For example, the Kool Kids children's health club in the Pollok area of Glasgow makes children more aware of the healthy choices that they can make. Fifteen hundred primary 4 and 5 children from local primary schools have benefited from greatly increased activity levels and improved diet. The Scottish community diet project is also doing important work to build and develop food knowledge and skills in low-income communities and the excellent health demonstration project Have a Heart Paisley is galvanising community action in that part of Scotland.
The first specific issue that will be developed in the context of the four key theme areas is smoking. Smoking is the single greatest cause of preventable illness and premature death in Scotland and action on smoking cessation has contributed to a small decrease in the percentage of adults who smoke. We need to keep up the impetus. I am pleased to announce today that we will invest an additional £1 million per annum, through NHS boards, to expand smoking cessation services, particularly in our most disadvantaged communities. We will also shortly launch a new action plan on tobacco control designed specifically for the needs of Scotland and including a major section on smoke-free environments. Some progress has been made on smoke-free environments in public places in Scotland, but there is much more to do. We are keen to enter into a public dialogue on how best to push the boundaries further.
On alcohol, we are taking action to reduce binge drinking and harmful drinking by children and young people. Our plan for action on alcohol problems has delivered high-profile advertising to tackle binge drinking, established a national framework for service delivery and strengthened our capability to respond to alcohol problems at local level. Next week, the Deputy Minister for Health and Community Care will launch a Scottish intercollegiate guidelines network guideline on the management of harmful drinking and alcohol dependency. We have also committed ourselves in the partnership agreement to doubling resources to tackle alcohol abuse; the new resources for health that were announced last week will enable us to meet that commitment.
Diet has also been a major area of recent activity and we are taking action throughout the entire food chain. We are promoting healthy diet and food choices through the healthy living campaign and working with public and private sector caterers to improve the preparation and provision of meals. We are working with communities to increase access to healthier food choices, particularly in low-income and rural areas. We are also working with the food manufacturing, processing and retailing industries to develop and promote healthier food choices and we are ensuring that agriculture and fisheries interests contribute fully to achieving the Scottish dietary targets. Those measures illustrate the fact that our challenge is to take action across all the Executive's areas of responsibility.
Mr Rob Gibson (Highlands and Islands) (SNP):
Does the minister recognise that particular attention must be paid to delivering many of those services in remote and rural areas? Elements of a national plan must be geared specifically to the needs of those areas.
We certainly believe in having a national framework, but one of our other key messages today is about local delivery. I have seen some good, innovative projects in rural areas and I very much take on board the point that Rob Gibson has made.
We have invested in a revitalised school meals service. In Scotland, nutritional standards for school meals have been developed and are set out in "Hungry for Success: A Whole School Approach to School Meals in Scotland". I have mentioned the funding for that already.
Raising levels of physical activity is also central to improving health. We are working with key partners to implement the physical activity strategy for Scotland, developing five-year action plans for active homes, active communities, active schools and active workplaces. As I indicated, £24 million has been committed to the expansion of the active primary school programme. We also recognise the crucial role that community planning partnerships play locally in developing national policy. Initiatives such as West Lothian on the Move, Let's Make Stirling More Active and Perth and Kinross Council's liveACTIVE strategy have already established ways of implementing the physical activity strategy through community planning partnerships.
The Executive's document "Recording our Achievements" states that the Executive was unable to record the achievement of providing a sports co-ordinator in all schools by 2003 and that that aim might not be achieved because local government has not been able to afford the matched funding. Will the minister now give local government more funding to ensure that that promise is achieved?
Progress is certainly being made on that initiative and local government has been given record resources, so we expect that commitment to be delivered. We have our part of the agreement and local authorities have theirs.
I want to move on to mental health and well-being, which is an important new area for health improvement in Scotland and one that is attracting international attention. We have already made early progress in addressing stigma, in promoting greater awareness of positive mental health and in suicide prevention. Further work is in development. A central theme is the need to improve and promote increased public awareness and understanding of positive mental health and well-being. We must ensure that there is both early identification and early intervention and support when mental health problems occur.
On sexual health, I announced in August last year that I had commissioned an expert group representing a broad range of interests to guide the preparation of a national sexual health strategy for Scotland. The group was established against a background of increasing levels of sexually transmitted infections and an unacceptable number of unwanted or unintended teenage pregnancies. I have asked the group to consider in its remit the broader social context for those issues. The expert group is in the final stages of its work on the strategy, which I expect to receive shortly. Sexual health is a sensitive and complex area and I want to get the views of as many Scots as possible, young and old, so that there is full consultation on the strategy, which will be published later this autumn.
Our national health demonstration projects are proving a valuable testing ground for action to achieve improvements in a variety of areas. The starting well project promotes child health, the healthy respect project promotes the sexual health and well-being of young people and Have a Heart Paisley tackles coronary heart disease. Moreover, two weeks ago I spoke in the cancer debate about colorectal screening. We are committed to a second phase for the first three of those projects and we expect to learn valuable lessons from the work that has been done so far. That information will be captured, disseminated and shared through national learning networks.
We have also taken action to ensure that health improvement work is effectively supported at national level by a strengthened and dynamic special health board, NHS Health Scotland. Combining the skills and experience of the Public Health Institute of Scotland and the Health Education Board for Scotland, Health Scotland will play a key role in partnership with NHS boards, local authorities, the voluntary sector and all parts of Scottish society in implementing the health improvement agenda and informing future evidence-based policies and strategies.
I cannot say too often that health improvement is all about partnership. All our efforts are underpinned by the development of an effective community planning framework. Partnership working in action between local councils, the NHS, the voluntary sector, the private sector, local communities and individuals is absolutely crucial for success and I pay tribute to the valuable contribution that all our partners are making. In particular, I congratulate the voluntary sector on its unstinting work in communities throughout the country in support of health improvement.
As "The Challenge" explained, to achieve a more rapid rate of health improvement in Scotland we need to inspire, encourage and challenge the nation to achieve that vision. We need to implement policies that will transform elements of Scottish life and make a real difference to individuals' expectations of good health. We need to select a few key objectives, such as increasing physical activity and reducing fat intake, and deliver them effectively. As I indicated, we need to encourage national best practice among professionals. To make rapid progress, we perhaps most of all need to release the inner resources of individuals and communities by building social capital and improving the infrastructure of communities.
If we do all those things, we will make a real difference to the health of the nation. I hope that we can collectively meet the challenge of culture change so that we move the debate forward faster and further than ever before. We must meet the health improvement challenge for the sake of this generation and future generations, so that people experience a better quality of life, with positive health achieved through healthy lifestyles and improved life circumstances.
I think that the jury is still very much out on the new debate format, in which there is no motion or amendments. I understand the reasoning behind the new format, but it means that the debate will be extremely wide ranging and unfocused. I am not convinced that it will necessarily take us further forward or produce any outcomes. It is a bit like saying, "Health: discuss."
Nonetheless, the Scottish National Party is always happy to discuss health and how we rise to the challenge of improving our health. I bring the SNP's input to the debate in a spirit of co-operation and good will. Jack McConnell said in his acceptance speech at the beginning of the new parliamentary session that he would listen to good ideas from wherever they came. I hope that that will be true for today's debate.
We all agree that Scotland's poor health record is a matter of concern. The SNP welcomes many of the health improvement measures that are being implemented or proposed, such as free eye and dental checks, which are both long-standing SNP commitments. However, we have a different perspective on how much the Scottish Parliament can do to turn around Scotland's unenviable reputation as the sick man—or woman—of Europe. I will say more about that later.
While welcoming the free dental checks, will Shona Robison agree that in the Highlands people may get a free dental check but be unable to find a dentist or afford dental treatment?
I agree with that and will say something about it later.
The state of our nation's health is well documented. Our figures for life expectancy are dreadful, being the second lowest for men and the lowest for women in Europe. The figures for Glasgow men, of course, are getting worse. No doubt my colleague Sandra White will return to that point later.
Cancer, coronary heart disease and strokes account for 65 per cent of all deaths in Scotland each year. A high number of people suffer from mental health problems and Scotland also has high suicide rates, particularly among young men. My colleague Adam Ingram will have more to say about mental health in his speech.
To tackle our health problems and meet the targets for reduction, we need to address smoking and alcohol consumption, the lack of physical activity and poor diet and, of course, we need to use the latest available technologies and drug treatments. However, we must go further than that and address the underlying causes of ill health, which are poverty and deprivation and a lack of self-esteem and confidence. I will return to those matters later.
We know that our diet in Scotland is too high in salt, fat and sugar and that we have record levels of obesity—that situation is getting worse. Last week, Elaine Smith led a useful and important members' business debate on obesity, but that debate was not as well attended, particularly by members from the minister's side, as it should have been. We know that obesity is linked to many other diseases, such as coronary heart disease, cancer and diabetes. We also know that the rise in diabetes among young people is directly linked to obesity in children, which goes back to diet and a lack of physical activity.
We encourage children to eat healthily for the sake of their teeth and their health, but in schools all over Scotland vending machines are dispensing high-sugar drinks and snacks full of salt and sugar. We need either to get the vending machines out of schools or to change radically the content of the machines. Otherwise, we will continue to give children mixed messages about what is good and bad for them in their diet. I back Unison's call to remove the same products from vending machines in hospitals. Unison says:
"It is absurd for the Scottish executive to promote healthy living on the one hand and then allow private contractors to install vending machines which sell mainly junk food in NHS hospitals on the other."
We could not agree more.
Does Shona Robison agree with the idea of taxing companies that produce food that is injurious to the health of young people in particular? If we can tax cigarette manufacturers for that reason, why cannot we do the same to fizzy drinks manufacturers?
That idea has some merit. My only concern would be that the tax would disproportionately affect the poorest in our society, who, unfortunately, are the people who tend to buy such products. We need to change attitudes. We need to educate people and get them to change their approach to their diet. The message that we send out is important and we should not undermine it by allowing vending machines.
We need to go further. We need to extend the provision of free fruit in schools to every child in primary school. We need to extend the provision of free school meals to children whose parents are on low incomes. We need to consider, as Margo MacDonald said, how to stop the big food companies plying their unhealthy wares to our children in a multimillion pound effort to undo all the good, healthy eating messages promoted by Government.
The minister referred to the low level of physical activity. Again, we need joined-up thinking on that. Some schools are reducing the level of physical activity for children because of pressures on the curriculum and teacher time. As Mary Scanlon said, sports co-ordinators are not being appointed because of local government finance issues.
We support the idea of general practitioners being able to prescribe, where appropriate, physical activity rather than drugs. However, for that to work, the Executive must address the lack of leisure facilities in many areas. Again, the issue is the need for joined-up government.
On alcohol consumption, our binge-drinking culture is well known. The issue was discussed at length in yesterday's debate on licensing laws. Again, corporate responsibility, particularly among those marketing alcohol to young people, is crucial. The British Medical Association advocates the stricter enforcement of the advertising code on alcohol by the Independent Television Commission and the Advertising Standards Authority. We need to consider that. Moreover, as I will repeat in my comments on smoking, we need to allow test purchasing by under-18s to expose those who sell alcohol to young people; that would help to reduce young people's access to alcohol.
I agree with the minister that reducing smoking is the single most important measure that the Parliament could take and I welcome his announcement of £1 million for action on smoking cessation. However, we need to do more. I make no apology for having quite a lot to say about smoking. I gave up smoking two years ago and I am now one of those reformed smokers who bang on about other people's smoking. However, I make no apology for doing that.
The SNP was committed at the election to consulting on legislation to protect people from the effects of passive smoking. Two thirds of Scots do not smoke and they must be protected. We know that passive smoking exacerbates many conditions, such as angina, asthma and allergies. More seriously, the United Kingdom independent scientific committee on smoking and health reports that smoking increases the chance of a non-smoker developing lung cancer by between 10 and 30 per cent.
Smoking in public places is regulated by a voluntary charter, but evidence suggests that the code is not working. Only 39 per cent of bars, pubs and restaurants have smoke-free areas. I would like, as a minimum, the introduction of legislation to provide for smoke-free zones in all public places. Smoke-free areas not only protect non-smokers; research indicates that they make it easier for smokers to quit. We should not forget that about 70 per cent of smokers want to give up smoking. We should make it easier for them to do so.
I am sympathetic to the idea of going even further on measures to reduce smoking, but whether we do so remains to be seen. The tobacco action plan, which I look forward to seeing later this year, will of course deal with smoking in public places. I take this opportunity to praise my colleague Stewart Maxwell for pressing the issue and challenging all of us in the Parliament to consider a total ban on smoking in public places. Sometimes it is up to politicians to take a lead and make difficult decisions. I look forward to having that debate.
The SNP has a proud record of making smoking reduction a key priority. In the previous session, Nicola Sturgeon was instrumental in pushing forward a ban on tobacco advertising. At the recent election, we presented a number of proposals that I would like the Executive to consider, such as ensuring that the law against selling cigarettes to children is rigorously enforced; using test purchasing to catch those who flout the law and sell cigarettes illegally; and introducing a system of negative licensing, as there is no reason why retailers who flout the law should not be prohibited from selling cigarettes.
Everything that the member has said about smoking is laudable. Smoking is a bad habit, but one that I happen to have. Would the member agree that the main thing that has made smoking unacceptable in society is the banning of tobacco advertising? Does she further agree that banning alcohol advertising would also be a great benefit to the health service? The sight of little children running about in Rangers and Celtic tops with alcohol advertising on them, for example—
You have made your point, Mr Swinburne.
I would certainly support the banning of advertising that is directed towards young people and I think that there would be merit in banning alcopops.
I know that this debate is about health improvement, but we cannot divorce that issue from the issue of the health service itself, as the success of many of the initiatives that we will discuss today will depend on how able the health service is to cope, particularly at a primary care level.
Early diagnosis and treatment are equally important in improving our nation's health. The importance of screening services in early diagnosis and treatment is well known and is paying dividends in areas where those services have been extended. However, the problems of recruitment and retention, service redesign and joint working, among many other issues, all impact on the ability of the health service to push forward health improvement measures.
The question remains where the minister will find the additional 12,000 nurses and midwives that he announced would be in the NHS by 2007. At a recent recruitment fair in Scotland, not one Scottish trust bothered to turn up.
The Scottish Executive had a stand at the fair and trusts were involved in that stand.
I am pleased to hear that, but I think that the trusts should have been there as well. Many health authorities from down south were there, so why were ours not?
A shortage of radiologists could undermine the cancer strategy, particularly the ability to undertake early diagnosis and treatment. The shortage of NHS dentists will hinder the ability of the Executive to deliver free dental checks. The role of primary care is crucial, but its effectiveness is dependent on the ability of the new general practitioner contract to deliver enhanced and additional services. There are many ifs and buts and only time will tell whether those barriers can be overcome.
Health improvement initiatives are worth while, but they will not solve our health problems if we do not tackle the underlying causes of ill health. The key priority of a single mum living day to day in poverty will not be giving up smoking. That does not mean that we should not try to convince people to give up smoking, but we have to be realistic and accept that such messages will have a limited impact. We need the powers to do more to tackle poverty and deprivation, the key underlying causes of ill health. However, the Parliament does not have those powers. Earlier, the minister talked about Scotland being a wealthy nation, which is true, and said that we need to use that wealth to tackle ill health. I agree with him. I want to use Scotland's vast resources to turn the situation around, but the Scottish Parliament does not have the power to do so.
Given that Scotland has a population of only 5 million, it should be possible to turn our nation's health around, but it will be so only if we use all the same levers that were available to the Finnish Government when it set out to change radically the health of Finland. At a recent debate on health, involving the minister and a range of health professionals, it was stated time and again that health improvement measures would not be enough in themselves. Many people talked about the need to tackle the underlying causes.
One idea that was suggested at that event was the extension of child benefit to pregnant women as an important health measure for both mother and unborn child. In our election manifesto, the SNP advocated introducing a scheme to give every expectant mother on income support additional income to spend on healthy food for six months before the birth of her baby. Both those proposals are surely worthy of further consideration, but the Parliament does not have the power to implement either of them. Until it does, we will continue to have a piecemeal approach to tackling Scotland's health problems.
Something else contributes to Scotland's health problems: a lack of ambition and a dependency culture. Both are key factors in our poor health record. I suppose that I would say that the Scottish cringe is bad for our health.
The draft 2004-05 budget document says:
"The Scottish Executive has a key role in helping to bring about a healthier community. However, it is the people of Scotland, who will need to make healthy choices in all aspects of their lives, who will ensure that we succeed in our aims."
That is a statement of fact, but it also highlights the scale of the problem. Many of us point to Finland as an example of the way forward but, of course, it was the commitment of the Finnish people to change that helped to bring about that change. That same willingness appears to be missing in Scotland.
Although our health record is poor, many Scottish people view their health as being "good or better". Despite the fact that Portugal and Scotland have comparable life expectancy figures, 77 per cent of people in Scotland say that they are in good health, whereas only 31 per cent of people in Portugal do. That difference in perspectives shows a worryingly complacent attitude among Scots towards their health, despite all the evidence that would suggest that that complacency is unwise.
Dr Carol Craig, author of "The Scots' Crisis of Confidence", recently said:
"A recent health report, based on focus groups, concludes that many of Scotland's burgeoning health and social problems are due to a widespread lack of ambition throughout Scottish life and a dependency culture".
She makes a point that we should all consider.
This is an important subject area. It is about not only the current state of Scotland's health, but the measures that people can take to help themselves in later life. Such measures would remove some of the burdens on the health service, which, sadly, has become a sticking-plaster service that deals with problems that have been caused by the unhealthy lifestyle decisions that people have made due to their ignorance. We must address that situation.
Choice comes with responsibility, and we all agree that there is no such thing as a free lunch. The question is: how do we equip and empower people to make sensible lifestyle choices? The solution is not to release the thought police to control and dictate what people should do—although the Scottish Executive's approach to micro-managing Scottish life tends to favour that route. Rather, it involves ensuring that people understand what they can do to help themselves and to minimise the risks that they expose themselves to through smoking, the overuse of alcohol and highly risky sexual behaviour, which too often occurs under the influence of substance misuse. The solution relates to moderation through knowledge, not the nanny state.
This debate is also about health care options and the need to head off problems before they start. In England, unlike in Scotland, a patient consultation is being conducted. The consultation document is called, "Fair for All and Personal to You: Developing choice, responsiveness and equity in health and social care". The consultation aims to find out what people want from health care in general. Unfortunately, the two pieces of legislation that we are about to deal with—the National Health Service Reform (Scotland) Bill and the Primary Medical Services (Scotland) Bill—do not attempt to start from the patient's perspective and build upwards. I am not pretending that the Labour Government in Westminster gets things right, but that consultation process is a good start, as it moves onto Conservative ground by putting the individual and the patient at the centre of health care delivery. I can only welcome that. The only way in which health care in Scotland is going to work for the individual is if patients and their advisers act in a meaningful partnership.
The document that we are discussing today is not as glossy as the Executive's documents usually are, but it still lists 44 actions. Some of them have already been completed and are being recycled as new ones, but other issues that are mentioned in the document are worthwhile points on which we can all agree.
In many debates in recent years, we have agreed that action points need to be delivered and that we must take the Scottish people with us. "Improving Health in Scotland—The Challenge" is obviously part 1 of a long series of announcements and debates. At the very beginning, we must agree on what needs to be done and on how it might be done. We must agree to put more emphasis on prevention. Early screening—and I have said this before—is very helpful, but it creates demand on capacity with which the health service, in many cases, cannot cope. That must be dealt with in parallel with the encouragement of new programmes.
When we consider choice, we are considering the choice of ethos and structure of a health service for the 21st century. All of us in this chamber share that responsibility. Conservatives would like the patient to be the focus of all health care. The patient should be aided in making decisions about health care choices—either in routine treatment or in chronic or intervention therapy. That poses problems for the two bills that will come before Parliament. The Primary Medical Services (Scotland) Bill has avoided the issue of patient consultation. Merely altering the structures to suit the minister's management expectations is not good enough. We want a health service that responds to the needs of and gives choice to the patient. Local health professionals need to be able to design their own solutions for the delivery of health care, in accordance with the requirements of the community that they serve. That does not mean a one-size-fits-all, top-down approach to health care in Scotland.
I agree with what David Davidson has said so far. However, when he talks about choice, does he accept that we have to consider something more basic—namely access? Especially in remote and rural areas of Scotland, there is a real danger under the new GP contracts—especially because of the lack of any replacement for the inducement scheme—that on the island of Eigg, for example, there will be no general practitioner, no access and so no choice whatsoever.
I accept Fergus Ewing's point—I have made it myself in other places and in committee. I am sure that we will have long debates on it before the Primary Medical Services (Scotland) Bill goes much further.
We need to set local health bodies free to decide how they will deliver services. In our book, that would include health promotion and advice for people in the community. As has been said, there are different problems in different parts of our society. How to attract and retain staff should be for local bodies and not for some national scheme. The Government has introduced schemes to allow premiums to be paid to attract and retain people and to bring specialised services to the areas mentioned by Fergus Ewing. The golden hellos are here; it is just a shame that—judging by the written answer that we were given this week—they will not be used to attract European Union dentists to fill a gap.
Before they become patients, patients are people. They should have options and choices about what to do. We have no philosophical difficulty with suggesting to the Parliament that money should follow the patient—whether in prevention or in care. Patients should have free access to any part of the health service—including health advice on prevention—in any part of the country, if that is the best way in which they can obtain the treatment or care that they need in an appropriate time scale. If patients wish to obtain care outside the health service—because of difficulties to do with access, which Fergus Ewing mentioned, or to do with waiting times, waiting lists or capacity shortages—why can they not take with them a proportion of the NHS drug tariff cost of their treatment? If they can afford to pay the difference, they will do so and leave space in the currently stretched system for those who cannot afford it.
Is this the policy that was referred to in a previous debate as the "passport" out of NHS services? Mr Davidson denied that that was Conservative policy.
I do not recall what I said on that occasion and I do not recall denying anything like that. As far as I am concerned, we are not taking people out of the health service but helping people to access health care using their health service contributions. That would not be obligatory, but, if the health service cannot cope, we have to use every measure we can to ensure that people obtain access to care. The minister wanted blue-sky thinking, so we throw that idea on the table for his consideration.
We passionately believe that we have to empower individuals and communities to look after themselves. That will mean education about risks to health, including education about sensible smoking—I do not think that smoking is sensible at all but I support prevention programmes and welcome what the minister said. We must reduce the intake of alcohol, binge drinking and all the other things that go on. We cannot do that simply by saying no; we have to explain to people why they are doing things wrongly. As others will mention, we have major problems in this country with irrational and dangerous behaviour under the influence of drugs—and I include alcohol. Let us give people choice that is based on knowledge of lifestyle. Knowledge is the first tool that they need. We have to empower people with knowledge. I was hoping that the minister would come up with more than he did when he spoke about the schemes that he wanted to be put in place. We must let local communities use such schemes to help to sort out some of their health problems.
Other members will no doubt talk about sporting and recreational opportunities. A healthy body does indeed lead to a healthy mind. However, many parts of Scotland are deprived of such opportunities. For example, it is important that the active elderly, and not just the tiny tots and the teenagers, gain access to opportunities.
Does the Conservative party now acknowledge the link between poverty and ill health? It failed to do so in its many years in government.
I am not going to account for what other colleagues did in the past but, yes, poverty plays a major part, and nobody would argue with that. That is why we need to stimulate the Scottish economy, to get people back to work and to encourage them to become entrepreneurs. We do not see that happening through some of the Chancellor of the Exchequer's policies to dumb down the economy. He is trying to fill a black hole. What will happen in a couple of years' time when the current level of the Scottish budget vanishes? We need to get people into work. People in work are healthier, no matter what the work is. When people are in work, they will have money. We will have to educate them on what to do with the money. I know what Nanette Milne will talk about later and I wish her well.
There are issues about bringing up families in an environment in which they will think about health care and health outcomes. As Shona Robison said, that starts with the pregnant mum. Parents have to set the example. We have to educate parents, because the biggest role model for a child is the people around them in the home. We cannot deny that. We cannot simply target children; we have to target parents. The family unit must be supported all the way through. People have spoken about well man clinics and the Men's Health Forum. They represent the kind of health care and prevention system that we need. If people will not go to the doctor, we must take the clinic to them. I am sure that the minister would agree that that is the way to go.
I have not had time to say much about mental health but I know that Adam Ingram will speak about it. When members of other parties contribute this morning, I hope that we will not hear a list of claims for things that they have done for which they want credit. I hope that we will hear a genuine debate about increasing knowledge and offering choice. Services must be designed around people. I hope that we will not hear silly proposals that waste resources on those who can well afford to make a choice—be they proposals for universal free school meals or free eye and dental check-ups for the wealthy. We should distil the argument down to the principle of giving people choice and responsibility through knowledge. We should consider how we can support that as well as design health care provision that is based on patient need and choice and which takes in staff training and the attraction and retention of staff.
The question is about who can do what in health care and health promotion, not about what the state decides in splendid isolation. It is time to empower our people. It is time to give them a clear opportunity to say what they would like and to ask how we can resource that and how we can use the knowledge and talents that are out there in public services today. Do we optimise the way in which people work, or do we simply stick a health advert on television at the same time as removing gym and sports facilities in schools? That is not a balanced approach. In the long term, we should move away from the existing structures and consider how we can redesign them to meet needs.
Two bills are coming up. One is to do with GP contracts. It will have a huge impact on access to health promotion and health care in many communities. There has been no public input to that and I am sure that the Health Committee will fire a shot across the minister's bows to warn him that the situation will have to change when we come to consider regulations. As for the National Health Service Reform (Scotland) Bill, can we not examine who can do what? I hope that the minister will reflect on that and give us some ideas to select from.
"Improving Scotland's health is central to the welfare of our society. Our poor health record is well known. New initiatives are required to create a step change in improving health."
Those are the opening three sentences of the health section of the partnership agreement, signed by the Liberal Democrats and the Labour party, which forms the basis of our coalition Government in Scotland.
The Liberal Democrat manifesto for the May elections championed the health theme, which commanded its largest, most prominent section. The Scottish Liberal Democrats have three key objectives for Scottish health policy. The first is to transform the health of Scotland, with a new focus on diet, exercise, health promotion and preventing illness. The second is to put patients first. That is not unique to the Conservatives; it is a long-held Liberal Democrat tradition to put patients first and cut waiting times by treating patients more quickly and offering greater patient choice. The third objective is to improve and expand local care by promoting a greater role for the primary care sector in diagnosing and treating patients in the community.
Will Mike Rumbles explain what the Liberal Democrats mean by "patient choice"?
If David Davidson will give me a chance, I will come to that. I will take each one of our objectives in turn.
On our first objective, poor diet is a major underlying cause of poor health. We want to help people to achieve a step change in eating habits, through education and an improvement in the quality of food in schools. We want to make health promotion a key function of local authorities and to increase the health promotion budget. We want to focus on the fact that, the earlier we detect potential medical problems, the more likely that they can be successfully treated. Therefore, we want to encourage regular screening and help the prevention and cure of illness, ensuring that the availability of health services reflects people's lifestyles and takes account of their particular needs. That is why the Liberal Democrats have focused on the need to abolish charges for eye and dental check-ups—it underpins our commitment to health promotion and early intervention for everyone. A fundamental principle for us is to ensure that access to the health service is available for all, regardless of people's bank balances.
I am sure that the member would expect an intervention from me on the universal abolition of charges for check-ups, which we whole-heartedly support. Will the member comment on why his party steadfastly opposes universal free school meals for children? Would he support an expansion in entitlement to free school meals, or is he opposed to any such expansion in principle?
Of course, it is all a matter of budget. The Liberal Democrats are concentrating on the health budget, and we are in favour of universal benefits in the health budget.
There is a real argument about the best use of resources, and there is no doubt that we differ from other parties on that fundamental issue. Do we target resources by measuring the bank balances of patients and targeting only those whom we judge to be unable to pay for themselves, or do we instead raise our game and call for a step change throughout Scotland's population, with everyone benefiting from access to health care initiatives? I deliberately said "everyone benefiting", and point out that the Royal National Institute of the Blind has highlighted the fact that 40 per cent of people who have entitlement to free eye checks do not even know it. If everyone had the entitlement, it would be universal.
Just as it was right in the first session of Parliament to focus on the needs of our elderly population and to provide free personal and nursing care to all among our elderly population who require it, it is right that, in this session, we focus on providing effective screening and preventive measures for all our population, regardless of people's ability to pay.
I very much welcome the Liberals' commitment to abolish charges for eye tests and dental check-ups. Unlike his colleagues in the Labour party, can the member tell us how many people in Scotland are waiting to get on NHS dentists' lists? In response to question S2W-625, the Deputy Minister for Health and Community Care, Mr McCabe, said that he did not know.
The simple answer is that far too many people are waiting to get on those lists, and that is what we are trying to address.
We need to increase the provision of health services in readily accessible places—not just in medical centres, but in shopping centres, for example—to attract those who rarely use such services. On Monday, I was pleased to have my blood pressure taken at my local Asda store in Portlethen, as part of the Blood Pressure Association's national blood pressure testing week, and we should be thinking about that sort of measure too. We need also to address the lack of participation in health screening by men, through the development of regular men's health clinics. There are huge issues to be addressed if we are to transform the health of Scotland. That can be done by promoting healthier eating and more exercise and by developing effective screening services for earlier intervention.
The second objective of Liberal Democrat health policy is putting patients first. We accept that waiting times in hospitals are unacceptably long. Improving the efficiency of the system helps to address that, but we need to input more resources, which is what we are doing by recruiting and retaining an extra 12,000 nurses and midwives in the NHS by 2007. Taken with our commitment to recruit an additional 1,500 allied health professionals, including physiotherapists, radiographers, dieticians and chiropodists, that will enable us to tackle the most important issue for patients—having to wait too long for attention and treatment.
Will the member give way?
In a moment—I need to press on a bit.
One of the successes of the previous session was the fact that we moved away from focusing on the length of NHS waiting lists and adopted instead the Liberal Democrat policy of focusing on what is important to the individual patient—how long they have to wait to be seen. I am interested to note that Stewart Stevenson is laughing. The patient was never interested in working out how many other people were on their waiting list—that would be an academic exercise as far as they were concerned. The patient is interested in how long he or she has to wait. By making that change, we have recognised what is important for the patient.
Our third objective for the health service is to improve and expand upon local care. In 90 per cent of cases, an individual's contact with the health service is at the primary care level, through GPs and other services. We argued that the introduction of a GP contract bill should transform primary health care and reward the provision of extra services. We can significantly expand the work of the primary care sector by bringing together more treatment and diagnostic services in a single centre. People should have better access to their local health services, including physiotherapy, mental health services, health screening and dietary advice.
Will the member give way now?
In a moment. We should expand the capacity of community hospitals to provide minor surgery and to act as a resource for GPs. As an aside—and before I give way to Margo MacDonald—I was delighted to see the Princess Royal open the newly refurbished and expanded Aboyne community hospital in my constituency last month. That is a fine example of the point that I am making.
I thank the member for his courtesy. On the greatly expanded recruitment of health professionals, does he set any restrictions on the areas from which such people might be recruited? Would any such restrictions cover developing countries?
We have to be aware of what we are doing in developing countries. That might mean taking people away from working in their local services. I accept that the point is valid, but we also have a major commitment to addressing the issues for our own people.
Aside from the three objectives for improving Scotland's health that I have discussed, the Liberal Democrats have identified other initiatives to improve the system. We recognise the severe problems around accessing dental services, particularly in rural Scotland. As well as calling for the reintroduction of free dental checks for all, we have committed ourselves to transforming the remuneration system for dentistry to reward dentists for preventing dental disease as well as for treating disease and decay. We have also called for an increase in the number of dental training places in Scotland, with the establishment of a training centre in Aberdeen to tackle the shortage of NHS dentists.
We have called for the introduction of a national sexual health strategy and for measures to tackle alcohol abuse, by doubling the available resources, and to address the scourge of smoking, which accounts for around 13,000 premature deaths in Scotland each year. We have called for an end to the postcode prescribing of drugs; for the routine issue of digital hearing aids where they are the most clinically effective option; and for a review of prescription charges.
Having outlined what the Liberal Democrats have called for to rise to the challenge of improving Scotland's health, I want now to focus on the vehicle that we will use to implement our policies: the partnership agreement, which forms the basis of our coalition Government. Every single Liberal Democrat initiative that I have identified is contained in the partnership agreement. During the partnership negotiations, I was particularly pleased that the two parties reached agreement on the programme for the next four years, and I am pleased to confirm that those plans are being implemented by the Minister for Health and Community Care, Malcolm Chisholm, and the Deputy Minister for Health and Community Care, Tom McCabe.
Nothing must divert us from the important tasks that are ahead. As Liberal Democrat health spokesman, I intend to ensure that we deliver on our commitments, in partnership with the Labour party.
We move to the open part of the debate. Speeches will be limited to six minutes.
Today's debate is unusual, as we are debating not a motion, but the wide-ranging issue of health improvement, which covers many areas of health care. We have already heard about some of those.
I was pleased that my colleague Shona Robison said that she was participating in the debate in the spirit of co-operation and good will. However, she went on to mention many negative aspects of health provision. I hope that I can touch on more positive aspects, to some of which the minister alluded.
Health education and health improvement are closely linked, but they have often been the Cinderella of the wider health care agenda. In the past, when money was needed for acute front-line services, it was often taken from the health education and improvement budget, to the detriment of the long-term agenda. I am pleased that, since the advent of the Scottish Parliament, it has been recognised that money spent on health education and improvement reaps huge benefits in the long term. I agree with Shona Robison that there is a much bigger picture and that health is inextricably linked to the social justice agenda, which is a priority for the Scottish Executive.
A number of initiatives have been taken in our local communities, on which we must target the health improvement agenda if it is to be effective. This morning we have heard about breakfast clubs in community schools, which have been shown to raise children's attainment levels. Provision of free fruit in schools and nurseries has introduced many children to tastes that they have never before experienced. The physical activity task force has been created. Points have been made about school sports co-ordinators, but they are very active in my constituency and are encouraging children to take part in exercise, which is crucial to their growing-up and long-term health. Free eye and dental checks, which were announced last week, are a welcome addition to the health improvement agenda.
I want to concentrate on two main areas of health care. The first is the issue of carers. There is no need for me to elaborate on the role of carers in our communities, as that has been done many times in the chamber. What is not always considered is the impact that they have on the wider health improvement agenda. One of the most important roles that a carer can play is as a key provider, to ensure good use of resources. By that, I mean that carers are often the people who save valuable health service time by acting as advocates for the people for whom they care and by ensuring that any necessary treatment is administered properly, which reduces the need for intervention by health professionals. That positive contribution to improving the health of those in our society who need care is invaluable, but to use the old cliché—
Will the member give way?
Yes.
Does Janis Hughes agree that it is time that we had a carers register and a formal system of identifying those who could be useful in that capacity—as they already are to members of their family? It is important that their needs are taken care of, because many of them never surface.
I am coming to that issue. I did not intend to imply that David Davidson was an old cliché—I was about to ask, "Who cares for the carers?"
During the previous session, as a member of the Health and Community Care Committee, I was involved in consideration of the Community Care and Health (Scotland) Bill, which addressed the subject of carers. Although I was unsuccessful in having health care providers identify carers—I was as disappointed as anyone else about that—one of the most important and positive results of the legislation was the creation of carers' information strategies. However, there seems to be a breakdown in communication about those strategies, which go some way towards identifying carers in our community who need help, although not as far as I would have liked. I am concerned that the strategies have not been developed with health boards. I would welcome guidance from the minister on how that problem can be addressed. Carers' information strategies would go a long way towards enabling carers to be made aware of their rights and of the help that is available to them.
I know that some carers organisations such as the Princess Royal Trust for Carers, representatives of which I met recently, have already formulated good practice guides. Those organisations would be only too happy to help to expedite this matter. Carers' information strategies are vital and their introduction would enable us to improve vastly the health of our community—for those who need care and for those who care for them.
The second issue relevant to health improvement that I want to address is recruitment and retention of staff, especially nursing staff. Members have already raised that issue. We are disfranchising a large number of people who would like to work in a caring profession but who do not have the ability or inclination to do so at an academic level. When I trained, nurses did on-the-job training and were salaried while doing it. I am sure that that type of training would be attractive to a number of people and would help to address our chronic shortages of nursing staff. I would welcome hearing the minister's comments on that.
Health improvement is not a quick fix. I welcome the opportunity to hear suggestions from members from all parties about how we can improve the health of our constituents not only in the short term, but on a more strategic level, so that future generations may be much healthier than we are now.
So far this method of debate has not proved terribly interesting. I am not likely to make it any more so, but I will press on. At least members will have to listen to me for only six minutes.
We must address the broad national issue of why other European nations such as Finland have much healthier people than Scotland. I am glad to say that the Health Committee is commissioning research into comparisons with other European nations and the success of those nations' public health programmes. I do not think that I am spilling the beans on that, although colleagues are looking at me with watchful eyes.
I will narrow the focus of my contribution to the debate. Janis Hughes talked about carers, but I will focus on volunteers and on local Borders initiatives that are designed to prevent children from becoming unhealthy and which face common difficulties. The initiatives are taking place against the background of the increasing problem of drug and alcohol misuse that was referred to during yesterday's debate on the Nicholson report. The Borders has one of the highest proportions of youngsters who start to use drugs before they are 15. That statistic comes from research by the Prince's Trust. Children's alcohol addiction is the biggest problem in the Borders. Jeremy Purvis and I addressed that issue in yesterday's debate.
I want to mention two or three projects that are trying to deal with the problem and which, as I said, are facing common difficulties. The projects are manned by committed and passionate volunteers similar to those whom members will have met elsewhere in Scotland, but they are having increasing difficulty in obtaining funding from various funding streams on an annual basis. Applying for funding takes up a great deal of project workers' time, which they would otherwise use to do the work that they set out to do.
I refer first to the reiver project in Galashiels, which is run by Norrie Tate. The project takes in youngsters with alcohol problems who are referred by the reporter to the children's panel and seeks to deal with those problems head-on. It addresses issues of education, poverty and crime and disorder, because they are all linked. Idle hands lead children to use alcohol and drugs and to become involved in mischief and crime, resulting in poor health, early pregnancies and so on—we all know the horrible story. At the reiver project, staff discuss with the youngsters one-to-one the effects that alcohol and drugs have on their health and engage them in strategies for coping with their particular problems.
UP2U is a peer education project in Peebles and comes at the issue from a different angle. It was run previously by Liz Anton, whom I must mention, who died young not so long ago, and is now run by her husband David and others. I first became involved by going on a tour with the police in the Borders many years ago. It is a wonderful organisation, because it educates primary school children and young people from Peebles High School. It runs a six-week drug and alcohol education programme with all the local primary schools and is supported by Scottish Borders Council—I must say a good word about it occasionally—the education department and teaching staff.
The response from the young people is excellent. The primary 7 pupils enjoy their involvement and have said how they find it much easier to talk to someone who is nearer their age than it is to talk to oldies—that could mean the minister, other members and me, and I can imagine how that could affect them. Some of the project's targets are: to increase knowledge and awareness of the facts about drugs; to increase the number of young people making informed choices; and to reduce the number of young people taking unnecessary risks.
Like the reiver project, UP2U struggled to get funding—it needed £11,000 to rent premises. Shortly after the death of Liz Anton and after a big campaign, the group eventually managed to get the funding from the council and the police, but it had a big battle. Why are such projects not supported, given that they are effective locally?
Breaking the cycle is a youth-crime initiative that has a direct link to work on alcohol and drugs. The volunteers there told me that young people are ignorant of the impact of drink and drugs and that physical education has become academic—there is no real continuing physical education in schools. They also told me that their statistics show that 3 per cent of children leaving school do exercise only after they have left. What is the role of physical education teachers? My goodness, in my first year, my PE teacher had me out in hockey shorts in the freezing cold and told me that it was good for me.
Too true. Quite right, too.
I do not think so. I am glad to say that I am reasonably unhealthy now. We were made to take exercise then.
The final project that I want to mention is the junior acoustic music project—JAM—of which I am a patron, where there is folk singing and rowdy drumming. I visited it and although it was not my cup of tea, the kids were enthusiastic and healthy, because they were being creative, active and informed.
All the projects that I have mentioned, whether to do with physical activity or music, have something in common—they struggle for funding year after year. My suggestion is simple. We should have an index of successful projects and their funding needs, so when they ask the Executive for funding, they do not have to start from scratch every year.
I endorse what David Davidson said, but will focus primarily on the problems that people face in Ayrshire. Although the problems of Ayrshire are unique to that area, they are illustrative of the difficulties that health boards face throughout Scotland, where consultants, middle-grade doctors and junior-grade doctors are all in short supply.
In the Ayrshire and Arran NHS Board area, which includes my constituency, we face two particular issues of great concern to local people—the continuation of full accident and emergency services at Ayr hospital and the continuation of paediatric services at both Ayr hospital and Crosshouse hospital.
I will deal first with paediatric services. Ayrshire has two paediatric units, one at Crosshouse and one at Ayr. The Crosshouse unit treats about 3,000 children a year, while Ayr treats 1,800. However, Ayrshire and Arran NHS Board has just carried out a consultation exercise, which it is feared will be a prelude to the closure of the Ayr unit, despite the overwhelming opposition of local people that was demonstrated in the consultation exercise.
I am advised that nurses at Ayr hospital have already been given a date for the closure of the paediatric unit. If that is true, it shows that the consultation process was little more than a public-relations exercise. Local Labour MP George Foulkes shared that view and recently predicted at a public meeting that the Ayr hospital paediatric unit would close.
The problem lies essentially with junior doctors' hours and training and has been entirely foreseeable. Britain signed up to the European working time directive in 1997 and the consequences have been apparent ever since. If the working hours of existing staff are reduced by half, more staff—about double the number—will be required to provide the same level of service. That seems a straightforward equation and its implications are inescapable. Of course I agree that junior doctors' working hours should be reduced and I accept completely that the terms of the directive must be complied with, but we cannot allow the price of that reduction in hours to be the sacrificing of crucial health services in Ayrshire.
A similar problem exists with accident and emergency services in Ayrshire. Last week, contingency plans were revealed under which the accident and emergency unit at Ayr hospital would be closed to major trauma cases from 6pm to 8am and at weekends if sufficient staff could not be found to operate the service. In this case, the problem lies in sourcing middle-grade doctors. Although a world-wide recruitment drive has just about filled up the vacancies in Ayrshire this time, my view, and my fear, is that only part-time accident and emergency services will be available at Ayr hospital by Christmas.
I raised that matter with the minister in July this year when a Royal College of Physicians survey revealed that in England many accident and emergency units would have to close because of staffing difficulties caused by the reduction in working hours. How does the minister intend to address that nationwide problem?
I do not want there to be a debate in Ayrshire about whether Ayr hospital or Crosshouse hospital should be the winner or the loser in a carve-up of services. My constituents and I want the existing services at both sites to be retained. In addition, we want services at both hospitals to be developed and a general increase in the level of health care provision across Ayrshire. I appreciate that the issues are complex and I would like to make it clear that I do not hold the minister responsible for the problems of downsizing that are being faced at Ayr hospital. However, I believe that he bears a responsibility for helping to find practical solutions to those problems. A shortage of funding is no longer the problem; notwithstanding the large cash injections that have been given to the health service in recent years, it is clear that money will not in itself provide a solution to the problems.
On the role of money, does the member agree that Ayrshire suffers from some of the worst poverty in Scotland? Its infant mortality rate of nine in every thousand is the worst in Scotland. Surely, therefore, investment in tackling poverty is necessary in Ayrshire, as it is in other parts of Scotland.
I am happy to agree entirely with Tommy Sheridan that Ayrshire has some of the worst problems of social deprivation. The social inclusion partnership area in my constituency has dreadful problems.
Taxpayers will willingly pay more tax if they get a demonstrably better level of service. It is clear from the threats that are being faced in Ayrshire, however, that they are not seeing those improvements. The root causes of the threats to Ayr's paediatric unit and the accident and emergency service are recruitment, retention and a forecast lack of man hours. If, as I believe, those problems are also being experienced in other NHS board areas across Scotland, as I expect colleagues from all parties are finding—especially Duncan McNeil—it is apparent that some strategic thinking is required by the Scottish Executive to ensure an adequate supply of staff to maintain and expand service provision.
I do not claim that there are easy answers to the problems. It falls to all of us to work together to ensure that solutions are found. People in Ayrshire are looking to the Parliament and to the Scottish Executive to find the answers. I say to the minister that he has in his hands the reins of power to address the issues. I hope that today he will outline new proposals that will bring hope rather than despair to my constituents. I look forward to his reply to the debate.
I support this mode of debate, which gives us the time and the opportunity to say a few things over the course of the day.
I want to talk about child health and to take the opportunity to talk about concerns in my constituency.
Children's health is so important to our health strategy. At any stage of life, illness is a serious matter but illness in children merits special attention from the NHS. We have made enormous strides in the way we deliver services for children, particularly in the community.
I cannot speak highly enough of the royal hospital for sick children at Yorkhill in my constituency, which is now the national centre for many specialties, such as cardiac care, renal care and extra corporeal membrane oxygenation—ECMO—treatment. An ECMO machine is simply one that can act as a baby's lungs and heart when it is ill.
By 2005, all children in Glasgow will receive their accident and emergency care at Yorkhill children's hospital as a result of a £7 million package. There is also a new intensive treatment facility at Yorkhill. There is a lot of excitement at Yorkhill about those developments.
I take this opportunity to commend the work of Mr Doraiswamy, the accident and emergency consultant who has done so much to promote the prevention of injury to children. He pioneered the idea that devices used at airports to detect metal could be used to detect items that children have swallowed, thus avoiding more invasive procedures.
I recently helped to support Mr Doraiswamy's initiative on injuries to children's fingers, which amount to 800 per year. Many of those injuries result in amputations and could be avoided through the use of preventive measures. He suggests that we should be buying doorstoppers and that we should change Scottish building regulations to incorporate devices that can stop doors from closing and causing amputations in children. Mr Doraiswamy argues that Scotland should lead in this field because no other country has done so. He also says that we should be able to identify trends in different parts of Scotland so that we can formulate prevention strategies that accommodate those trends.
I move on to the link between child health and maternity care. The Minister for Health and Community Care would be disappointed if I did not speak about my most serious local concern. Together, Yorkhill children's hospital and the Queen Mother's hospital, which provides maternity services, offer a unique model of care in Scotland; they are admired around the world. That successful model has pioneered the use of diagnostic equipment that is commonly used today. Ian Donald is the man most credited with the quality of research at the Queen Mother's hospital because he established ultrasound as a diagnostic tool more than 22 years ago. I do not think that it is an accident that that happened at the Queen Mother's hospital.
Today the Ian Donald foetal medicine unit at the Queen Mother's hospital has the only imaging equipment in Scotland that allows us to see an almost lifelike photograph of the unborn child. That permits a multidisciplinary team to deal with the malformations that a child might have and plan for a child that might require foetal surgery or post-birth medical care.
It is important to note that 50 per cent of referrals to the Queen Mother's hospital come from outside the Greater Glasgow NHS Board area. Therefore, other MSPs might have an interest in the services provided by that hospital. It is also crucial to note that it is hard to distinguish where the role of the neonatal specialist ends and that of the paediatric specialist begins, as they work closely together in a team to care for the lives of the unborn and the newborn.
The Queen Mother's hospital admits mothers from all over Scotland. The staff can identify what we now know to be common complications. For example, the hospital is a centre for amniocentesis and for the early detection of genetic conditions, limb defects and spina bifida. Members will know that operations can be carried out in the womb—that work was pioneered at the Queen Mother's hospital. It is also the national centre for training in foetal medicine and surgery. Is it any wonder that such a set-up has made so many medical advances?
Sadly, that set-up is under threat: the review of maternity services in Glasgow could put it at risk. It is sad that Greater Glasgow NHS Board does not seem to value what it has in that service. Under the review it is prepared to break the link between maternity care and child health that has given Scotland so much through the advancement of medical care. I am furious at the thought of my constituents having no maternity service in the west of the city and I am deeply concerned by the prospect of Scotland throwing away such a significant centre where research has been thriving for almost 30 years.
If members do not believe me, they should believe Dr Alan Cameron who is the head of foetal medicine at the Queen Mother's hospital. In his opinion, if we close the Queen Mother's hospital and break the link that has existed since the 1970s, all that work will be lost. Many places around the world—Vancouver, Singapore and too many others to mention—are heading in the direction of bringing together such a model of maternity care and child health. If members do not believe me, they should listen to Dr Tom Turner, director of neonatal medicine at the Queen Mother's hospital, and paediatricians from the north and south of the city, who say that the proposed measure is a drastic one.
I thank the Executive for allowing members to hold a good debate on health. I implore the minister to listen to the points that I have made, particularly when he comes to review the issue in a few months.
I will use my time to consider rural health care briefly and then I will move on to consider health promotion.
I refer to the delivery of rural health care, having recently attended a conference, which the minister opened, where solutions to the problems of delivering health care in remote areas were discussed by delegates from Scotland, the north of Norway and elsewhere. In the Scottish context, I note the success of the remote and rural areas research initiative, which is due to come to an end soon, and I welcome the setting up of the rural health network that will follow.
In the Highlands, recruitment and retention of health professionals, especially GPs and dentists, continues to be a major issue. I echo an earlier comment that the new GP contract is problematic for very remote areas. The Norwegians have some creative solutions to the same problem, such as obliging newly qualified doctors to spend a year working in a rural area that has been chosen by ballot. Western Australia has gone further and is experimenting with sending undergraduates into rural areas for a year to study their usual subject, not just rural medicine. The idea behind that approach is that many will enjoy the experience and will choose to work in rural areas in future. We could consider similar initiatives in Scotland.
I caution against seeing the recruitment and retention of health care staff as a rural problem. Rural areas provide a barometer for what is going to happen elsewhere. Unless we tackle demoralisation in the NHS and make it the rewarding institution to work in that it once was, staffing problems will only get worse. I suggest to the minister that assuring staff that the current reforms are going to be the last for a long time would go a long way towards helping the situation.
However well-staffed, well-funded or well-motivated, the NHS cannot deliver health; it can only manage disease and disability. Health is determined by environment and lifestyle. The surest way to stay healthy in Scotland is to be born rich, and the surest way to improve our national health record is to eliminate poverty and inequality. Successive Governments will say that they are working to do just that.
Does the member agree that without the powers of independence and the ability to use all our economic levers, we cannot possibly begin to tackle the inequalities that she has raised?
I agree that our powers in the area are limited, but I argue that we should make better use of the powers that we have, pending those powers being increased—up to and including full power.
The member nearly used the I-word.
I nearly did.
Having said that the NHS cannot deliver health but only health care, I believe that it needs structures to monitor public health and advise on policy. I am concerned about that matter. The Public Health Institute of Scotland was set up in 2001 but there was a lack of clarity about its role and where it overlapped with HEBS. In April 2003, the two organisations merged and created NHS Health Scotland. I understand that that merger was not entirely trouble-free. The new Glasgow centre for population health seems to be similar to the PHIS, but it is unclear what contribution it will make that existing public health and academic bodies could not have made. Initiatives such as the national demonstration project must be rigorously evaluated because we need programmes that work.
Things could be done now to make the Scottish lifestyle healthier. The minister mentioned physical activity; other members will be talking about diet, so I will not. When I talk about physical activity, I do not mean taking part in organised sports; I am talking about being active during daily life. It could be argued that the department that has the most effect on our health is the one responsible for transport.
I skim-read the new transport consultation document that appeared on my desk yesterday and I could find the word "health" only once, on page 8. Perhaps that is inevitable, and it might be unfair for me to make that point because the document obviously focuses on longer journeys. However, we have to consider shorter journeys where walking is a realistic option, because walking is one of the things that we could start to do now. We could become a nation of walkers, and would become healthier as a result.
The lottery-funded paths for health scheme provides for walking infrastructure to be created with matched funding from local authorities, but it has proved so popular that three years' funds are fully committed, so no further money is available.
Is the member aware that although it is reported that more than £2 billion of lottery funding has been spent in Britain, the decline in the uptake of sport has continued? We must question whether we are getting the two factors in synch.
One could make a slightly convoluted argument that if people walked more, were healthier anyway and their baseline level of health and fitness was higher, they might be more inclined to participate in sport and therefore become that bit healthier yet.
That illustrates a fundamental principle: only when Scots are leading healthy lives in a healthy environment will Scotland's health improve. It is not the job of the NHS to achieve that; it is the job of every Government department, every local authority and every public agency. Any decisions that are made—I am thinking in particular of planning decisions—should factor in health by asking, "What will be the effect of this decision on the health of the population?" The minister said that he would support health improvement through community action. I hope that that means that when a community objects to a development that would be harmful to its health, such as a motorway being built adjacent to it, its voice will be listened to.
The debate has been wide-ranging and I have found it interesting. There is agreement, virtually throughout the chamber, that all of us care very much about the health of our nation and those who work in our health service. I will start by talking about those who work in our health service, because that important aspect has not been touched upon much.
I have suffered from two serious illnesses in my life, and I have spent time in hospital. I have nothing but respect for everyone who works in the NHS—for example at primary care level, which deals with referrals to hospital—and for the treatment and care that they give. I respect not just the professional ambience, but the care that is shown by people throughout the national health service. We should put our thanks on record, because people sometimes feel that they are taken for granted. They should be applauded for their discipline, dedication and unfailing commitment to patients and families, especially in times of need or distress.
That said, no system is perfect. Over many years, I have watched the various changes that various Governments have made to the national health service. That has always caused me a great deal of concern, because the resulting uncertainty does not help the morale of the staff. There will always be issues about waiting lists, waiting times, diagnosis and treatment, but the vast majority of cases—we do not spell this out often enough—are dealt with efficiently and speedily. Sometimes, for whatever reason, cases fall through the net and are highlighted by our media. I wish sometimes that we could highlight the positive results of the national health service.
Dentistry has been mentioned several times. I have lost count of the number of times that I have spoken in this chamber about dental health; my assistant believes that this is about the 50th time, but that might be a slight exaggeration. I have pursued the issue of dentistry provision for a considerable time, starting with what was happening in my constituency of Moray. It was admitted that Moray had the worst provision in the whole of Scotland, because there was no access to national health service provision. Colleagues such as Christine Grahame and Stewart Stevenson, and many other members, such as Mary Scanlon on the Conservative benches, have pursued that issue. There is a crisis in the provision of national health service dentistry. As Mary Scanlon said, what is the point of free dental checks if there is no dentist to go to?
After considerable nagging, debate, meetings with ministers and attacking Grampian NHS Board, we have an increased facility in Moray. A national health service dentist is now based at Dr Gray's hospital for three days a week. I welcome that progress because it helps, but people should not get toothache on a Friday, because they cannot see the dentist on a Friday, Saturday or Sunday; they have to wait until Monday. Toothache—the "hell o' a' diseases", as Burns called it—is not something that anyone wants to live with for three days. I acknowledge that the Executive has introduced measures such as golden hellos, and that it is examining how to attract trainees to rural areas, but there is still a sad lack of national health service provision throughout Scotland. We can talk as much as we like about oral health and dental hygiene, but if we do not have the provision, we will not get far.
Does Margaret Ewing agree that a polluting form of mass medication, such as placing fluoride in the water, would do nothing to tackle that problem?
I am not in favour of fluoridation, but it is interesting that the water in my constituency has the highest level of naturally provided fluoride in the whole of Scotland, and the children, on the whole, have better teeth. However, they still drink the fizzy drinks that were mentioned earlier.
I wish also to talk about Alzheimer's and dementia. I know that my colleague Adam Ingram will develop that theme further. I will take a personal approach, not to seek sympathy, but to express the reality that faces families when a family member suffers from dementia or Alzheimer's. That happened in my family, with my mother. I will give one or two small examples of what it was like to cope with that situation and to persuade the authorities that additional help was needed.
My mother would think that my brother and I were coming for tea. We would arrive, and find the fridge with about two dozen steak pies in it, most of them past their sell-by date. Another time, the fridge was stacked with butter because she had intended to make us a cake. One night, in November, she switched off what she thought was a light in her house but was, in fact, the central heating. At the same time, I was on my feet in the House of Commons giving it laldie about cold climate allowances for old people. If my brother had not visited her house the next day, my mother would probably have frozen. It is ridiculous.
There are 61,000 people with dementia in Scotland, and there will be 67,000 within the next 10 years. I will read to the minister the conclusions of Alzheimer Scotland, of which I am a great supporter. Under the heading "Ask not for whom the bell tolls", the organisation states:
"Alzheimer Scotland's examination of community care plans and local mental health framework plans provides no grounds for optimism. It indicates that strategic planning for dementia care services is weak … Services for people with dementia tend to be a sub-category of services for older people, or in a few cases, a sub-section of mental health service planning."
Those services should not be a sub-section.
I will close on a specific constituency point. Those of us who have had a chance to read the newspapers today will have seen the case of Emma Mackenzie, a two-year old who is fighting leukaemia and undergoing a bone marrow transplant today. She contracted hepatitis B as a result of a platelet transfusion. I lodged questions about that when the family contacted me last month. Could I please have an answer from the minister?
Some members will recall that, during the last session of Parliament, I repeatedly raised the issue of maternity services in the far north. Indeed, it is a sad fact that in his long and, we all agree, distinguished career, the last question that Donald Dewar answered was a supplementary on maternity services in Caithness. At that time, there was a question mark over the service, and there was a proposal on the table to drastically reduce it. However, that proposal went away and it was agreed that the service would be retained at the level that we enjoy today.
The Minister for Health and Community Care will know where I am coming from, because I wrote to him recently about a proposal that has emerged—to the disquiet of all members who represent the Highlands—to revisit the possibility of drastically downgrading the service. Eleanor Scott, Mary Scanlon and I were told that the two issues that underpin NHS Highland's wish to revisit the matter are the report of the Scottish Executive's expert group on acute maternity services and the working time directive, which members have talked about. The irony is that the EGAMS report contains significant caveats about midwife-led services, issues of distance and rurality, as members and ministers know. I and others have pointed that out to the minister.
I will speak briefly about the nightmare what-if scenario. We are talking about extremely large distances. If the service that Caithness enjoys were to be downgraded drastically, first-time deliveries would have to go all the way to Raigmore hospital. That would mean a round trip of more than 200 miles, which would put stress on the ambulance service and create safety concerns for mothers and unborn children making that journey.
Peer support is another consideration. Members who are parents know that when a family's first child is born, support from friends and relations in the early hours and days is important in dealing with breastfeeding, nappy changing and everything else. The poorest in society would be affected—for example, a single mother in Wick might be forced to go to Inverness for the birth of her first child. The poorest in society would be the least able to meet the cost of visiting their relation or friend in hospital, which is a serious matter.
What if the weather is as bad as it can be in the Highlands? All Highland members present know what I am talking about. What if it is the middle of winter, the A9 is blocked and the helicopter cannot fly? That is simply a tragedy waiting to happen.
We have not reached that position yet. I have sketched the blackest scenario, but it is important for me and other Highland members to go on the record about the situation. I do not ask ministers to step in yet, because I hope that sense will prevail. However, I put it to the minister that if the risk assessment that is being undertaken is not as thorough as it should be and does not take into account sparsity, distance and—above all—safety, the danger is that an aspect of the health service could go into waters that the Scottish Executive would not want it to go into. That would fly in the face of ministers' good intentions.
We have heard from politicians today and in the past who, in true Taliban style, desire to ban smoking, drinking, eating Happy Meals and probably, for all we know, sitting on the couch watching the telly. By 2045, according to my figures, such a move would reduce the incidence of ailments such as heart disease, strokes and cancer to virtually zero, principally because no one would live long enough to develop them, as people would die of boredom in their early 20s.
To be fair, the idea that health improvement is the cure for all the national health service's ills has been advanced not only by the Taliban tendency in this Parliament, but by some serious politicians. Fifty-six years ago, the architects of the NHS assumed that once the NHS was in place, ill health, and hence demand, would reduce. Their naivety is touching today. Post-war politicians had no idea about impending advances in medical science, new treatments, the rise in care standards and the rise in expectations, which have led more people to seek more health care for more illnesses.
I congratulate Duncan McNeil on bringing a welcome note of humour to the debate, but I will be serious for a moment. Is he aware that in eight hours, which is the scheduled time for the debate, on average 12 people in Scotland will die from the consequences of smoking?
I do not diminish the idea that smoking is bad, but I disdain the idea that politicians can ban everything that they dislike.
Today's politicians do not have the excuse that their predecessors had. We have only to open a newspaper to see how medical science is galloping ahead. A cursory glance at the census data shows that our population is becoming older. To continue to argue that to sort out the long-term structural issues that face today's NHS, we need more hours in the public baths and fewer hours in the public bar is, at best, little more than well-intentioned rhetoric.
If we are serious about delivering a national health service that is fit for the 21st century, we must examine the situation more deeply. We must consider the barriers to delivering the modern patient-centred service that we deserve. A host of issues that have been mentioned, such as staff recruitment and retention and accreditation, must be properly addressed. However, I fear that those matters are sidestepped when decisions are taken about the shape of our NHS. That leads to illogical and short-sighted decisions.
A case in point is the Rankin maternity unit in my constituency. Other members have described similar experiences. It is almost universally accepted that a range of factors, such as junior doctors' training, junior doctors' hours, Europewide staff shortages and the application of clinical standards, are contributing to massive pressures in the NHS. However, as the minister knows from his meeting with me and local campaigners yesterday, when those pressures forced Argyll and Clyde NHS Board to review maternity services, it ducked every issue.
The result was a crackpot plan to centralise consultant-led in-patient maternity services for the whole health board area at the Royal Alexandria hospital in Paisley. That move could affect a quarter of the Scottish female population. It could concentrate consultant-led in-patient services for more than 800,000 women and children in two hospitals—Paisley's RAH and Glasgow's Southern general hospital—that are a few miles apart.
The plan not only threatens the Rankin unit's future, but represents the beginning of the end for Paisley's RAH. Would any pregnant woman from Greenock, Largs or Tiree travel to a consultant-led unit in the RAH when she could give birth in a university-led unit a few minutes up the road? It is only a matter of time before Paisley's underused consultant-led services are closed and moved to the Southern general.
The Health Committee should conduct a major inquiry into the deep-rooted issues that have an impact on service planning in the NHS. I have no wish to pre-empt a committee decision, but I will explore the role of a strong factor in unacceptable health board decisions—artificial health board boundaries, which are the Berlin walls of the NHS. Each party sits on its own side, pretending that the other does not exist and deluding itself that it can function as a self-contained unit. Thanks to health board boundaries, neighbouring boards—Argyll and Clyde NHS Board and Greater Glasgow NHS Board—undertook two reviews and decided to put two identical services on two sites that are side by side.
If we are serious about rising to the challenge of improving Scotland's health, we must not be afraid to tackle the big issues. Of course, that will not be easy. However, if we return to the healthy living theme, anything less would be like ordering a can of Diet Coke with a black-pudding supper: a well-intentioned gesture, but a gesture nonetheless.
It is a pleasure to follow the new libertarian Duncan McNeil, although I take issue with some of his remarks. I am living proof to the chamber of the superior benefits of the public baths instead of the public bar.
I apologise to members in case I am not in the chamber this afternoon. I must attend to a very sad personal arrangement.
I wanted to take part in this debate because policy making in the area of health and fitness is central to the aspirations for our fellow Scots that we all have, regardless of our party-political or philosophical starting points. As a result, I will be only too pleased if the minister does what was suggested on Radio Scotland this morning and pinches some of my ideas.
I will not be as suggestive as Christine Grahame was in her speech—I will not refer to hockey shorts, nor even to the dance leotard that I wore when I was a physical education student. However, I will draw on the experience that I have gained. No matter whether we are on one side or the other of the great constitutional divide—or, indeed, whether we have a marked backside from sitting on the fence—we would all like Scots to be healthy, wealthy and wise. The starting point for our common ambition is a healthy Scotland.
The Executive shows commendable intent in attempting to improve the quality of the NHS, although it is for others in the chamber and elsewhere to deal with the question whether a cost-benefit analysis will vindicate its policies. I will not dwell on that question today. Instead, I will confine myself to awarding some roses and raspberries to the Executive's attempts to create a healthier nation.
Just as neither the Scottish Executive nor Scottish Enterprise can produce manufactured goods for export but must instead create the conditions that encourage and support industrialists to expand their markets, so the Executive is responsible for creating the conditions that encourage Scots to make healthy lifestyle choices. Of course, it is also the responsibility of those who would rule over us to get to grips with the health problems that poverty creates. The Parliament cannot eliminate poverty; instead, it can try only to ameliorate some of its worst effects.
Duncan McNeil was absolutely right to point out that the Executive cannot force individual adults to get healthy—after all, look at him. [Laughter.] Apart from anything else, we all go through phases in our lives. Sometimes we make sensible choices, sometimes we do not. However, just as public attitudes to drinking and driving and the infliction of passive smoking have changed—and have been changed—so we can and must change attitudes towards fitness and health. We need to realise that the responsibility for fitness and health lies in our own hands and that all of us, regardless of income, have access to the means of getting fit and staying healthy.
Does Margo MacDonald agree that the introduction of the safer routes to school initiative has proved very successful in improving the health of primary and secondary schoolchildren? Does she also agree that older people's access to free travel has enabled them to maintain—and in some cases improve—their levels of fitness? I hope that she will join me in saying that those initiatives should continue to be resourced.
I agree absolutely with Christine May's points. I think that Stewart Stevenson, in an intervention, touched on the question whether local authorities would continue to receive funding to keep up travel initiatives and programmes such as free fruit in schools. That issue must be addressed and I hope that someone will do so.
As I was saying before I was so helpfully interrupted, we should have access to the means of staying fit and healthy. On the Executive's policy of providing new schools through public-private partnerships, it has been discovered that access to the sometimes good, sometimes cramped facilities—I will not go into that particular matter at the moment—is very often constrained by commercial demands. That problem must be admitted and tackled. Although it might have been an unforeseen circumstance of levering money into education in such a way, it means that access to facilities that should be public is being restricted. In that respect, I hope that I am present this afternoon to hear the minister's summing-up speech.
Glasgow City Council has worked out that if it could increase its use of schools' sport facilities from the present 18 hours to 25 hours a week, it could also increase satisfied demand for sport from 53 to 81 per cent. We are beginning to find out how newer policies are working and are discovering that they must be tweaked. That is why blue-sky thinking is such a good idea.
The Executive has competition for the hearts, minds, stomachs and livers of Scots. The food and drinks industries spend squillions on making a mockery of what we have been saying this morning and of what the Executive's various health and fitness initiatives are trying to achieve. Money talks, and the Big Macs and the Colonel can drown out any message that the Executive tries to put across in its television advertising.
I said that I would make some suggestions—I will try to outline five of them. First, it has been proved that Gary Lineker can sell crisps and make Walkers crisps the brand leader. As a result, we need someone like Henrik Larsson to make fruit the brand leader; we need to get him into the schools and the places where the kids are. Style icons and sports idols must promote this policy. I once persuaded Billy Connolly to promote the NHS patients helpline at no cost and he did a brilliant series of radio adverts for nothing. Public figures will do that sort of thing.
My second suggestion—[Interruption.] Please bear with me, Presiding Officer. I have a couple of suggestions and I just want to outline them.
My second suggestion is that we should tax the baddies. After all, the Westminster Government started to tax the tobacco companies. I know that we in the Scottish Parliament cannot tax these industries, but we could send a wee letter to Westminster saying that we think that it would be a good idea to tax foods that are injurious to health.
Thirdly, free school meals are nothing to do with equity and everything to do with the fact that we would be able to send children to school without money in their pockets and know that they would be fed the correct stuff. Finally, we need prescription exercise on the NHS for all people, particularly elderly people. That would save a bob or two.
First, I was very touched by Margaret Ewing's comments about Alzheimer's and dementia. I think that the BBC, with its "Eastenders" storyline, is doing an excellent job in raising awareness of the fears and experiences of those who are affected by Alzheimer's. Such a storyline probably educates more people than NHS booklets.
We hear constantly that the situation in health is all the fault of the Tories. However, we should remind ourselves that the Labour party is now in its seventh year of government. During the Scottish Parliament's first session, I—along with Kay Ullrich and others—was faced almost weekly with self-congratulatory statements that welcomed everything that the Executive was doing to improve the health service. In that regard, the Minister for Health and Community Care's comment this morning that Scotland's health is not improving fast enough represents an honest change. Thank goodness that we are getting to the truth at last.
Like other members, I want to concentrate on health issues in Highland. If the minister wants to rise to challenges, he needs to know what the challenges are. In that respect, I have only two words for the health situation in the Highlands: uncertainty and instability. I cannot describe the situation there better than Jamie Stone already has done. Incidentally, I commend the work that Jamie Stone has done on maternity services in Wick. Less than two years ago, we were assured that we would have a consultant-led maternity service once a wide-ranging consultation involving numerous people had been carried out. Now, within two years of receiving that assurance, we have received letters saying that the service again faces uncertainty.
In the Highlands, there is uncertainty not only over maternity services in Wick, but over GPs and dentists. I listened to Duncan McNeil's comments about problems and uncertainty in Paisley; however, there is also uncertainty at the hospitals in Oban and Fort William, which are currently thinking about reconfiguring services on the basis that patients will go to Paisley instead. There is uncertainty across the whole country.
This week, I received a letter from a member of the Lochaber mountain rescue team. It pointed out that, although it can take several hours to evacuate casualties from the mountains while their condition is deteriorating, they can be treated by the excellent trauma service at Fort William within minutes of their arrival. Now, rescuers face the uncertainty of taking people off the mountain without knowing whether they will go to the Belford, to Oban, or even to Paisley. We must address that problem. In the Highlands, the NHS has always been a backbone that has provided certainty, stability and reassurance for people who live in remote, rural areas; now, that stability has gone. Within two years of an assurance being received about NHS services, that assurance has gone.
Another example is kidney dialysis patients, who must endure the 66-mile journey from Fort William to Inverness for dialysis—if they are lucky enough to live in Fort William. If they have to travel longer distances from Kinlochleven, Kilchoan or Mallaig, they can add an extra two hours to their journey to reach Fort William before they set out for Inverness. We need much more understanding about the fears of people in rural areas in order to give them the assurances that they have had in the past.
I fully welcome NHS 24, which is an excellent service. However, I worry when NHS 24 acts as a barrier to calling out GPs, and I worry that nurses are diagnosing patients' conditions down the phone line from Aberdeen. Although I welcome the service, it must be monitored carefully.
Not only does the minister let down Scotland, but we all have to suffer the criticism for his incompetence. Last week, someone came to my surgery in Nairn and said, "I thought that the Scottish Parliament would help me get my cataracts done quicker; why do I have to wait a year to go on a waiting list? Why is the Scottish Parliament spending more money on health, yet I have to wait longer?" I found it difficult to answer those questions. The minister must address why more taxpayers' money is going into health, yet people are waiting longer for treatment and fewer are being treated.
Last week, I was privileged to meet a Flemish delegation from the Belgian Parliament. One chap said to me that his wife, who was a member of the Belgian Parliament, was very tired because she had had to wait seven hours in accident and emergency at the Edinburgh royal infirmary. The minister is damaging the image of Scotland abroad.
Last night at the European Movement, contributors were asked to give their impressions of Scotland so that we could see ourselves as others see us. One contributor said that, 20 years ago when she came to Scotland, the NHS was an excellent service, but that she could not say that now. It is not only Scotland's patients that the minister is letting down; he is damaging this country's image.
In this world of short-lived controversies and shiny new initiatives, we often forget how we got to where we are now. I begin my remarks by taking a brief look back at history—as far back as the last century.
The big step change in policy and health improvement in Scotland did not happen this year, last year or even in this Parliament. It happened in 1999, before the Scottish Parliament was established, when the Labour Government—Donald Dewar and his Scottish Office team of ministers—launched the white paper "Towards a Healthier Scotland". That policy laid the foundation stone for a raft of investment, policy and action that has flowed from then.
Although we have heard so much in the chamber today about the issues that were set as priorities in that white paper—coronary heart disease, cancer, mental health and child health—one of the identified priorities that we have heard less about is sexual health. Work in that area has happened in fits and starts during the past few years in this Parliament. However, with the impending publication of the long-overdue and long-awaited national sexual health strategy, there is an opportunity now to put that issue at the top of the agenda, where it belongs.
The 1999 white paper stated:
"Good sexual health is a positive dimension of a healthy lifestyle and is also important for the wider community. Sexually transmitted disease, such as HIV infection, chlamydia, gonorrhoea and hepatitis, are damaging but preventable."
That is as true today as it was in 1999. The healthy respect national health demonstration project, for example, flowed directly from that white paper. That project has gone a long way to pilot new, imaginative and opportune ways of promoting positive sexual health. However, we must ensure that the lessons learned from the project are rolled out more widely throughout the country.
Let us face it, sex is the most natural thing in the world, yet too often we find it hard to talk about and harder still to legislate or make policy about. Yet try we must. Sex, like most good things, carries risks. Duncan McNeil should not worry—I do not advocate banning sex.
Thank you.
However, we must be aware of those risks. Sexually transmitted infection and unintended pregnancy are perhaps the most obvious, but sex can also be an emotional and psychological minefield. That is bad enough for adults, but worse still for adolescents who are bombarded by sexual imagery and peer-group pressure—all of that alongside hormones coursing through their bodies at a rate of knots. Perhaps that is a state that most of us can just about remember.
Sexually transmitted infections are on the increase. I commend to members the British Medical Association report that was published last year. Chlamydia is a modern-day epidemic that has consequences ranging from ectopic pregnancy and infertility to various other debilitating infections. Syphilis and gonorrhoea, which were thought to be things of the past, are on the increase again in the 21st century. Huge strides have been made in the prevention and treatment of HIV and AIDS in recent years, but they are on the up once more. It should be noted that that increase is largely in the heterosexual, non-drug-using population.
That is why education, awareness and screening are so important. The response to the AIDS epidemic in the 1980s showed what can be achieved if there is a will. However, the messages about safe sex that we heard during that period have long since subsided from the public consciousness. That is reflected in current sexual behaviour and in the rate of increase of sexually transmitted infections.
I am pleased that, in his opening speech, the minister mentioned teenage pregnancy. There has been a welcome—albeit relatively small—reduction in the number of teenage pregnancies in Scotland in recent years. However, the figure is still far too high at somewhere in the region of 9,000 or 10,000 per year. We should remember that almost half those pregnancies end in termination. That is something about which none of us can be content or complacent. The cost to the NHS is significant, but the cost to the physical and emotional well-being of individuals and their families is immense.
A lot of work has been done and is under way to tackle the rate of teenage pregnancy, but a step change, both in action and in attitudes, will be necessary if we are to turn the tide in relation to that rate or the incidence of sexually transmitted infection.
I must say that I am disappointed that ministers have ruled out making emergency contraception available in schools—even before the publication of the sexual health strategy. I remain ambivalent—but certainly open-minded—on whether that would be the right way forward, but members of the Parliament and the public should have the right to examine all the options. No single group should have a veto over what we can consider and nothing should be prematurely ruled out.
We must also remember the issue of abortion, sensitive though it is. It is true that the Parliament does not have powers to make laws in that area, but it does have responsibility, through devolved health powers, for the provision of termination services. We must address variations in access to care, in the quality of care and in the availability of pre and post-abortion counselling in Scotland.
During the debate, we have heard a lot about Finland's action on cancer and coronary heart disease, but Finland has also made an impact in the area of sexual health. Successive Governments there have worked—with the support of established churches—to foster a climate in which sex is talked about and positive sexual health is promoted. That has made a difference.
Scotland can do likewise. Believe me—the public are more favourably disposed to radical measures in this area than might at first appear to be the case. Academic research has been carried out that shows that the public are open-minded and are willing to entertain such measures. I urge colleagues not to be frightened of the issue and not simply to respond to those who shout the loudest. When, in a former life, I spoke out on the issue I was astonished to be inundated with messages of positive support. Those messages might not have reached the front pages of the newspapers, but they were real and they arrived in large numbers.
This morning, the minister said on the radio that bold thinking and bold action are necessary. There has been quite a lot of bold thinking, but more bold action is now needed. I hope that we are all up for that.
I welcome any debate about the health of the people of Scotland. However, like my colleagues, I have concerns about how the debate has been conducted. There is no motion and no amendments and there will be no vote at the end of the day. I want to record in the Official Report that I hope that such debates do not become talking shops that result in all talk and no action—I fear that there is a real danger that that will happen. I will be interested to hear what the minister says about that in summing up.
I want to concentrate on Glasgow and the health of its citizens and to say something about the situation in which Glasgow finds itself. Glasgow is the powerhouse of Scotland. It is the commercial and financial centre for half the nation's population and has national and international status as a city of cultural significance. However, Glasgow's people consistently find themselves left at the bottom end of successive Governments' health league tables, whether those Governments are Labour and Lib Dem, or Tory—in other words, I am talking about unionist Governments. For a city with such wealth and the capacity to generate more wealth, Glasgow is, perversely, home to some of the worst areas of multiple deprivation not just in Scotland but in the United Kingdom. The dependence on benefits in areas such as Shettleston, Drumchapel and Ruchill is an affront to human dignity in the 21st century.
The minister mentioned healthy eating initiatives. There is a healthy eating initiative at the Annexe in Stewartville Street in Partick, and outreach staff at local health centres such as that in Drumchapel do excellent work. Such work contributes greatly to turning the tide in favour of health improvements, but we believe that such efforts are greatly constrained by funding limitations. I ask the minister to consider that matter with regard to the scale of deprivation rather than population.
Members have mentioned hospital reorganisation in Glasgow, which the Executive should also consider. We in Glasgow refer to such reorganisation as hospital closures. A city with special health needs that result from widespread deprivation, heart disease, diabetes, oral and lung cancer, childhood ailments such as leukaemia and even malnutrition should receive better rather than fewer facilities in the 21st century. Glasgow faces the closure of two of its five main hospitals and a reduction to only two fully operational accident and emergency departments from five such departments. Where does that leave the people of Glasgow when they face a significant accident or terrorist incident? Where does it leave them in the face of a flu epidemic or some other epidemic? Such closures in a city that has as poor a health record as any city in western Europe are driven by the balance sheet and not by patient need—the minister and the Executive must consider that matter.
I agree entirely with Duncan McNeil, Mary Scanlon and Jamie Stone that health boards are not listening to the very people whom they are supposed to represent. Furthermore, although the Golden Jubilee national hospital in Clydebank is innovative and worth while, it is poaching scarce medical staff from already stretched NHS hospitals in the Glasgow area. I ask the minister to reply to the various written questions that I have put to him about that matter.
Pauline McNeill mentioned Yorkhill. I have a query regarding the protection of the special status of the Royal hospital for sick children at Yorkhill. Two years ago, when Susan Deacon was Minister for Health and Community Care, she mentioned the protection of that special status in her review. I have spoken to many doctors, constituents and consultants who see the threatened closure of the Queen Mother's hospital maternity unit at Yorkhill as the beginning of the reduction in status of the sick kids hospital. Pauline McNeill and other members have mentioned that the two hospitals at Yorkhill are unique. They provide a one-stop shop of excellence for mothers and children—not just for Glasgow, but for 50 per cent of the rest of Scotland. If the maternity unit at the Queen Mother's hospital closes, there will be no maternity hospital in the west end of Glasgow and Yorkhill's uniqueness will be under threat. The minister should look closely at that matter.
Glasgow must be seen as a special case in respect of health—I make no apology for pleading that case here and at every available opportunity.
Members should excuse me while I drink some water.
Is it just water?
Yes. Duncan McNeil mentioned pubs—I am not in the pub yet.
The skill and dedication of NHS staff in Glasgow—Macmillan nurses, social workers, volunteers and so on—deserve the highest praise, but those members of staff do not need or want praise. They want investment in the health service, in wages and in better services for the people. Political will to ensure that they have a decent NHS is needed. We ask the so-called Executive for that political will and to deliver a good health service that is free at the point of need.
Mike Rumbles said that he is happy that the partnership, which he and the Lib Dems revere, is delivering. If he asks the people of Glasgow about that, they will say that it is not delivering. We in the SNP will argue for immediate change in respect of the hospital closures for the benefit of the people of Glasgow and we are determined to gain power over the tax and benefits system through an independent Parliament. That is the only way in which we will tackle the ills of the people of Scotland and the ills of the people of Glasgow in particular.
Like many members, I am not sure what we are discussing in this debate. I wonder whether it is simply an attempt to show unity and an opportunity to say that we are all in favour of improving the nation's health. Will we have an impact on policy? My experience with local health boards and the Health Department is that policy cannot be influenced.
Everybody in Scotland agrees that we should improve health and that what a person eats and drinks affects their health—that was the main thrust of what the minister said, However, our interest in what people eat and drink is aimed at improving health. Global corporations also have a keen interest in what people eat and drink, but their interest lies in wanting to make profits. The entire Executive budget is small change in comparison with the advertising campaign budgets of global corporations. Members should read Naomi Klein's iconic book "No Logo". They will then realise how much time and money is invested in ensuring that we eat what global corporations advertise.
I agree with Margo MacDonald. We should do something radical; we should stand out in Europe and ban alcohol advertising. We have heard figures relating to deaths from alcohol. We should wipe vending machines out of schools. The arguments for free school meals are overwhelming and go without saying, but I will not go there in this debate. I have a real problem with Ronald McDonald crèches and children's centres in hospitals. We should do something radical about those.
Why are we having this debate when there are many more pressing health issues on our agenda? My postbag is full of letters about such issues. Perhaps I should congratulate the Health Department for the extra exercise that I have been getting in marching, demonstrating and running about to try to prevent closures of hospital services in the area that I represent. The minister said much about
"health improvement through community action".
There is a lot of community action in the area that I represent, but it takes place in opposition to health boards' decisions to close maternity services. Members have said that it will be detrimental to pregnancies and health if maternity services are closed and women are forced to travel miles, and that that there will be stress. The effect on carers of the closure of Johnstone hospital and the removal of elderly care beds—which is another huge issue in the area—is enormous. Janis Hughes spoke about that. Families are almost forced to abandon their elderly relatives in order to get them into an elderly care bed. Guess what? In its wisdom, Argyll and Clyde NHS Board is deciding whether to cut 300 beds.
The other issue that I want to mention is the Vale of Leven hospital. I think that the minister met some local people in that community on a recent visit when they managed to stop his car. Accident and emergency, paediatrics, mental health and urinology services are being moved across the Clyde. Issues relating to health improvement cannot be dealt with if core issues are not dealt with. I am beginning to think that perhaps the Executive is so confident about the effect of its health improvement project that it thinks that, as we will not need some core services in five or 10 years, we should just cut them now.
My big question is about democracy. Many communities are up in arms about service cuts and hospital closures, but they come up against the bureaucracy of local health boards. How does the Executive expect to achieve community involvement and support and to encourage community-led voluntary organisations to improve health, when those aspects are not funded enough? Health boards want help on those issues, but when it comes to defending services, it is as if they are wearing earplugs. People are up against huge bureaucracies that are not prepared to listen.
What is the Executive's view on the fact that communities are ignored in consultations? Communities come out in opposition to measures such as cuts in maternity services, the closure of accident and emergency units and the closure of Johnstone hospital for the elderly. However, despite that community involvement, nothing happens and the decision to close or cut is taken anyway. Given that people are disillusioned and do not believe what they hear in debates such as this, they are not likely to take cognisance of the Executive's health improvement message.
What is the Executive's view on Bill Butler's proposed member's bill on the election of health boards? The unaccountable members of boards wreak havoc on communities. If this new type of Parliament is in favour of community involvement and democracy, we should introduce elections for health boards so that their members can be held accountable. Elections would mean that many of the present health board members would not be in their positions in a few years. The Executive should support the idea of more people taking to the streets because that would give people more exercise and make them healthier, which fits with the Executive's plan for health improvement.
I am surprised by the criticisms that have been made of the form of today's debate. I remind members that the idea of trying such a method emerged from the Parliament's Procedures Committee. I, for one, welcome the form and would like it to continue because it gives members the opportunity to make lengthier speeches on general subjects, while the ministers listen throughout the debate and respond at the end. This type of debate is not a substitute for debates with formal motions and amendments, but it is a useful addition.
I do not accept Duncan McNeil's comments on the irrelevance of health promotion. I accept entirely his point about hospitals in the west of Glasgow—that issue must be faced—but that does not mean that we should not concentrate on health promotion and give it considerable attention. One of the significant achievements of the Liberal Democrats in the Parliament is that, from the beginning of the Parliament, we concentrated on the importance of health promotion and achieved significant commitments to the issue in the present and previous partnership agreements.
In a country with lifestyle, diet and addiction problems that impact severely on the national health service, there is an obvious impact on the degree to which we must provide services to respond to those problems. It is entirely sensible that health promotion should be part of the solution and, to use Margo MacDonald's helpful analogy, that we should put in place a framework under which the health of the nation can be improved. The objective of health promotion is, at least in part, to empower people to achieve their full potential in our society.
I may be a member of the Taliban tendency with regard to smoking, but I do not understand how any member could avoid making the connection between smoking and health in our society.
I agree that we face certain challenges and that smoking is not a desirable pursuit—in fact, I quit smoking about 20 years ago. However, when the Scottish Parliamentary Corporate Body considered the issue of smoking recently, Robert Brown was not of the Taliban tendency. He recognised that politicians cannot ban things, although that does not mean that we should not encourage people to stop smoking and to lead a healthier lifestyle. In my earlier speech, I was sounding a cautionary note for politicians who seem to think that the solution to all problems is simply to ban something. That is not the case.
The problem with Duncan McNeil's earlier speech was that he seemed to condemn the whole basket of health promotion as a worthless operation.
The partnership agreement contains a commitment to
"consult on an action plan to achieve considerably more smoke free restaurants and pubs"
and to examine more effectively the issue of smoking on public transport. I frequently travel from Rutherglen in the morning on a First bus. I usually find three or four people smoking upstairs, which is to the considerable detriment of the health of other people on the bus. I am sure that other people in Glasgow find the same. Given that many people, particularly those who live in poorer areas, travel to work by bus, the issue is not insignificant and must be tackled.
I ask the minister to put a bit of flesh on the proposals to make progress towards achieving considerably more smoke-free restaurants and pubs. How quickly will a framework be put in place? Is the minister prepared to consider the important issue of possible legislation to back up the proposals? How will we deal with the growing number of young people—particularly, dare I say it, women—who smoke in our society?
In the next few months, legislation will be introduced in Ireland to deal with smoking in public places. It will be interesting to see what happens in that experiment. Norway will also introduce legislation that will concentrate on smoking in workplaces. The BMA, which is central to the issue and which knows what it is talking about, points out that approximately 3 million people—including 3 in 10 pregnant workers—are still exposed to tobacco smoke at work. The issue is a major one. I accept entirely that the Parliament does not have direct responsibility for employment procedures, but it does have a considerable part to play in improving the framework.
According to the BMA, tobacco causes 35 deaths a day in Scotland, which is why the BMA and other organisations call for legislation on that front. Second-hand smoke and direct smoke are health hazards that have a direct impact on the rates of lung cancer and coronary heart disease. If, through the activities of the Parliament and the policies of the Executive, we do something to reduce the level of smoking in Scotland, the level of bad health will go down. Let us not say anything in today's debate to mitigate or dilute that message, which is central to the matter of health promotion.
I will wind up with that point, Presiding Officer, as we are coming up to 12 o'clock.
We now hit a difficulty that I tried to anticipate by speaking to Mr Brown this morning. Members will recall that, last Thursday, the closing ministerial speaker just before midday was cut rather short because we wanted to hit First Minister's question time promptly at midday. Mr Brown was told that he might have two minutes or eight minutes for his speech. Unfortunately, he decided to go for six minutes, although I dare not comment on the reasons for that.
There will be a brief suspension, after which we will resume at midday. The debate on health issues will resume this afternoon at 10 past 3, before which the Presiding Officers and the clerking team will review the remaining time and the list of remaining speakers. We may need to reduce the time allocated to each speaker or we may need some members to drop out of the debate. We will resume this meeting at midday.
On a point of order, Presiding Officer.
Given that I have just said that I would suspend the meeting, I should not accept the point of order, but I think the mood among members is that we should hear Mr Gallie.
Given that I was about to intervene on Mr Brown before he finished his speech, Presiding Officer, will you invite him to stand up again to take my intervention?
The handbook for Presiding Officers says that the standard response to Mr Gallie is, "That is not a point of order, Mr Gallie." I am afraid that that was a point of order, but we have run out of time and we must move to First Minister's question time.