Health Services
Good morning. The first item of business is a debate on motion S2M-1326, In the name of David McLetchie, on health issues, and three amendments to the motion. I invite members who wish to contribute to the debate to press their request-to-speak buttons.
Health care is the issue that consistently tops the list of the public's priorities and quite rightly so; health care is often a matter of life and death. Even when it is not, every one of us deserves the reassurance of knowing that care, when we, our family and friends need it, will be provided speedily and that it will be of a high quality. Sadly, five years on from the establishment of Parliament, far too many people in Scotland do not feel that the national health service provides them with that security.
Throughout this morning's debate, my colleagues will discuss a range of health issues. Bill Aitken will talk about the proposed closures of the Queen Mother's maternity hospital and of accident and emergency services in Glasgow. Nanette Milne will look at maternity services on a Scotland-wide basis. David Mundell will talk about rural health issues and Mary Scanlon will look at the interface between health and care. I am sure that other members will want to contribute other issues to the debate.
I will focus on the broader issue of how we should deliver a national health service for our people. Although our health service too often fails to deliver quality services, that does not mean that nothing has improved. As Professor Nick Bosanquet—professor of health policy at Imperial College, London—pointed out in his excellent study for the Policy Institute entitled "A Healthy Future for Scotland", there have been positive developments. For example, mortality rates in Scotland have gone down; mortality from coronary heart disease is 40 per cent lower than it was in the early 1990s and the survival rate for stroke patients is better than it is in the rest of the United Kingdom, although we should note that the United Kingdom as a whole still compares unfavourably with other countries in that respect. Scotland has been a leader in the use of telemedicine and special access programmes—which have been of benefit to rural communities—and in the extension of the role of community pharmacies.
I do not want to pretend that all is doom and gloom. However, we should not allow those improvements to obscure the problems that mean that the health service is too often a source of concern rather than a source of security. Those problems stem from the fact that, although more money is undoubtedly going into the NHS in Scotland, it is not leading to commensurate improvements in the numbers of patients who are treated or to reductions in waiting lists and times.
Poor productivity in our health service is the problem that dares not speak its name. I welcome the recognition of that fact in the amendment that has been lodged by Shona Robison on behalf of the Scottish National Party, but I suspect that we might not agree on the cure. However, agreement on a diagnosis is a good starting point for any discussion. Poor productivity is an inevitable consequence of our nationalised system. Until we are prepared to take the necessary steps to promote choice for patients, to liberalise the supply of health care and to establish the Government as a funder but not necessarily a monopoly provider of health care, the public will never get the service that they demand, deserve and pay for.
I would not, nor would any of my colleagues, dispute the increase in funding that the NHS in Scotland has received. We have said on numerous occasions that we welcome that increase, just as we continue to hope—probably in vain—that other parties will recognise the real-terms increases in funding that occurred year on year under the previous Conservative Government.
Spending on the health service is already above the European Union average as a proportion of our gross domestic product. According to the recent and comprehensive Nuffield Trust report,
"on every measure of resource input, whether it is the availability of hospital beds, the number of doctors and nurses in hospitals and the community or the prescribing of medicines, Scotland's health care system is better resourced than any other part of the UK."
It is just that the figures show that the system is not delivering the level of patient care that we all want. A 30 per cent increase in funding since 1999 has been matched, unbelievably, by an increase of more than 20,000 in numbers on hospital waiting lists, while the number of hospital treatments has declined by 40,000 over the same period. Contrary to what the First Minister told me at the most recent First Minister's question time, that is not because more patients are being treated as out-patients. I hope that he and the Minister for Health and Community Care have the grace to acknowledge that the number of out-patients who are seen in our hospitals is also down by more than 200,000 since 1999.
I know that the minister will tell me that more patients are being treated in local clinics. If that is indeed true, it would be welcome. However, as the Audit Scotland report on out-patients indicated, figures on out-patient numbers have only just begun to be collected and no properly comparable numbers are available. In any event, the alleged increase in the number of patients who are treated locally is not leading to a reduction in the number of patients on the waiting lists. Why is it, in that case, that the extra money is not producing extra results but is instead producing quite the opposite? The answer is that the money is being poorly directed.
The health service in England is not particularly good in that respect either, but even it is outperforming the NHS in Scotland in productivity terms. Effectiveness in use of medical time as measured by finished consultant episodes per staff member is 55 per cent lower in Scotland—126 episodes compared to 196 in England. That has been combined with a rise in the cost of procedures by about 20 per cent in accident and emergency procedures, 24 per cent in acute operations, 49 per cent in treatment for day cases and an unbelievable 181 per cent in treatment for out-patients. Those figures are all up on the figures from just three years ago.
As Professor Bosanquet, whom I mentioned earlier, concludes in his study:
"the performance level of Scotland's health services reflects a tragic waste of talent and under-use of the country's excellent trained health staff."
That is an epitaph with which it is difficult to disagree.
The deep-seated problems of our health service are an intrinsic feature of its virtual monopoly status. Costs in monopolies rise because without competition there is no incentive to be efficient. In a monopoly, it does not matter whether value for money is secured because patients have no option but to accept what is on offer. It is regrettable that the Executive parties do not accept what I would say is a self-evident truth instead of retaining a Stalinist devotion to centralised planning and management of the NHS. In that, they are joined by the Scottish National Party and the Scottish Socialist Party, whose grip would be even tighter.
I have never claimed that the health service, which was inherited from us in 1997, was perfect. There was still much work to do, as there is today. However, instead of building on our reforms, which were designed to decentralise management authority in the service and to move away from top-down direction, Labour in Scotland has dismantled those reforms in an act of ideological vandalism that had no regard for patient interests.
That has not happened to anything like the same extent south of the border, which makes for an interesting contrast. In Scotland, fund holding and trusts have been abolished. In a classic piece of doublespeak of which George Orwell would have been proud, the Executive calls that decentralisation. However, many independent commentators have seen through the deception. In his comprehensive study for Civitas and the David Hume Institute that compares the NHS in England and Scotland, Benedict Irvine says:
"We see greater choice and competition on the supply-side in England, while healthcare is becoming more integrated in Scotland."
Professor Bosanquet is also sceptical about the Executive's claims. He describes its policies as "vague and ill-defined" and goes on to maintain:
"The aspiration for devolution of power has to be set against the day-to-day reality of greater ministerial intervention."
We in Scotland are moving in precisely the opposite direction from our neighbours in western Europe and even from our closest neighbour in England. In those countries, a growing consensus is emerging around the principles that are necessary for successful health care reform. The basic building block of any reform must be ready access for all patients to a Government-guaranteed high standard of care. All countries are trying to achieve that and many have discovered alternative methods of provision that have delivered more responsive and demonstratively higher-quality services than we have in Scotland. That does not mean that we should import such solutions wholesale, but we should at least try to learn from the experiences of others.
The principle of universal access is at the heart of the NHS, but there is currently no equality of access in the NHS. People in the most deprived areas wait about three weeks longer for surgery than do people in better-off areas. Therefore, those who trumpet the virtues of equality are simply deluding themselves and conning the public. Invariably, the preference of the defenders of the current system is to level down, but that merely lowers standards for those who currently enjoy quality care, while doing little for those who do not. Instead, we should encourage standards to rise for all through promotion of choice and competition.
The truth is that the NHS provides a standard of care that is considered acceptable by doctors within the budgets that are available to them. As a result, it fails in many areas to meet the standards that can be seen in other western European countries. That is why there is growing consensus that we must, if we are to put patients first, give them real choice about the services that they receive.
Our aim is to extend such choice to everyone through patient passports. Entry to the system would still be through a patient's general practitioner and consultant, but once patients have had their diagnosis, they would be able to take the standard tariff funding for their treatment anywhere within the NHS in Scotland and England, so that money would follow the patient through the system. For the first time, every patient would have access to a truly national health service, rather than to a regional health service in which access is determined by people's postcodes.
The member's argument is that the Conservatives will drain money out of the NHS budget which, as Oliver Letwin has made clear, the Conservatives do not intend to increase beyond what Labour has already pledged. The end result of money's being drained away and the subsidising of those who currently go private would be that the output capacity of current NHS services would be reduced. The system would be made worse rather than better as a result of what the member advocates.
The problem is that Mr Lyon does not look at the health service as a whole because he is obsessed with focusing on there being a single provider of health services and health care. The member should look at what happens in other European countries; he should look at ideas that are being considered by, for example, his Liberal Democrat colleague Chris Huhne, who chaired the Liberal Democrat public services policy commission. He will then see that his party south of the border is considering the sort of measures in respect of increasing the range of providers that I am advocating in the Scottish Parliament. That is the reality. The Liberal Democrats' problem in Scotland is that they are slaves to the public sector monopoly orthodoxy that bedevils the provision of health services in this country. The member should open his eyes, look abroad and go and have a wee chat with his colleagues. He would then understand what we are trying to do.
We are talking about access to a truly national health service. Undoubtedly, many patients would choose a local hospital for treatment, but others would exercise choice that is based on shorter waiting times or acknowledged expertise. What matters is not the basis for patient decisions, but the fact that the choice is in their hands.
That is why we also want to go further and extend the idea of passports so that a much higher proportion of the population can receive treatment from providers other than the NHS, and why we believe that patients should be able to take a proportion of the standard tariff with them to the voluntary, not-for-profit and private sectors for treatment. At first, such extension of choice would obviously be limited by the fact that those sectors are relatively small in this country, but one of the main benefits of our policy is that it would provide a clear incentive for greater investment in capacity, which is essential to improving health services overall and expanding patient choice.
For reform to be successful, putting patient choice at the heart of the health service must be accompanied by reform that sets providers of health care free to cater for those choices, thereby creating real competition. As we made clear in our manifesto for last year's Scottish Parliament elections, we would enable hospitals in Scotland to apply for foundation status. They would continue to be part of the NHS, but would operate as not-for-profit organisations with their own directors and far greater operational freedom. That independence would enable them more effectively to meet the needs of patients. As money would follow patients, well-run hospitals would become well-funded hospitals.
We would also open the way in Scotland for new providers in the private and voluntary sectors to be set up that are similar to the diagnostic and treatment centres that are being introduced and run by the private sector at the Government's behest south of the border. Because the choices of patients would shape the future direction of our service, it would much more accurately match supply and demand and there would also be a more co-ordinated service, if that was what patients wanted.
That is our vision of the future of the health service in Scotland. We do not expect the other parties to agree with that vision, but they are out of step with international trends. We will continue to point that out and argue for an agenda that puts patients first in order to create a health service in Scotland that our people need and deserve.
I move,
That the Parliament notes that, despite a substantial increase in funding for the NHS in Scotland, services for patients have not improved over the last five years with fewer in-patient, day case and out-patient treatments occurring and more patients waiting longer for treatment; notes that, despite the best efforts of NHS staff, the current monolithic, centrally-run system of providing healthcare is not delivering the results our people are entitled to expect; recognises that fundamental reform is needed of the NHS in Scotland to achieve the standards of many other health services in European countries and to provide value for money for our taxpayers, and calls on the Scottish Executive to give patients genuine choice over the treatment they receive, establish foundation hospitals within NHSScotland and promote the development of the independent sector.
I begin by paying tribute to the dedicated and hard-working staff of the NHS and to the whole health care team—nurses, allied health professionals, support staff and medical staff—whose productivity has been cruelly criticised by the Conservative party this morning. I would be the first to admit that continuing improvements in health services are required and I am the first to work for those, but to state—as the motion states—that services "have not improved" is a total travesty that is based on party-political dogma.
There are at least five problems with the motion. First, it is totally silent on quality; secondly, it totally ignores much of the new activity in the NHS, which has not yet been reflected in official figures; thirdly, it disregards the progress that has been made on waiting times; fourthly, it distorts and caricatures our reform agenda; and fifthly, it conceals the Conservatives' real health agenda.
On the first problem, I say frequently that the starting point for improving quality is the experience of every patient who passes through the health care system. That is why we emphasise the involvement of patients in the development of services and learning from the experience of patients over and above patient choice for all—which we support—rather than patient choice for the few, which the Conservatives advocate through patient passports. There is much more to do, but we should acknowledge the considerable progress that has been made through patient involvement; for example, in the cancer strategy, in the coronary heart disease strategy, in the stroke strategy and in the diabetes strategy.
The reduction of unacceptably long working hours is also part of the quality agenda. The days of exhausted junior doctors being expected to care for patients are over; 80 hours a week, as the figure was five years ago, has been reduced to 56 hours a week. In addition, doctors in training are now focusing more on developing their skills and experience, which means that junior doctors rightly spend less time providing a service, with more patient care being provided by trained practitioners. That, of course, has implications for activity, but it is positive in respect of quality.
To help to support quality and safety, we established the Clinical Standards Board for Scotland in 1999, and in 2003 we merged and strengthened the board to reinforce its independence by forming NHS Quality Improvement Scotland. NHS Quality Improvement Scotland is pursuing a vigorous programme of standard setting, and of reviewing and reporting publicly on performance against those standards. Representatives of patients and the public are involved in all that work.
There is considerable evidence that that programme of work is leading to improvements in patient care. For example, two weeks ago, I attended a conference of all the managed clinical networks for colon cancer in Scotland. They reported significant progress in meeting the NHS quality improvement standard for colon cancer. That could be replicated across the board in respect of many other diseases.
More generally, what has happened to surgical mortality rates? They have fallen to ever-lower levels. What has happened to rates of premature mortality from heart disease, stroke and cancer? They have fallen and continue to fall. Of course much remains to be done. Quality and safety standards do not stand still, but it is important to acknowledge the progress that is being made.
Quality improvements and a reduction in working hours to acceptable levels form the background to an apparent fall in hospital activity. I am certainly not complacent about that, so we are promoting benchmarking to help to improve efficiency. The centre for change and innovation and the national waiting times unit are sharing good practice, as are health boards.
There is more to the matter than meets the eye. The new activities that the Conservative motion ignores are performed in different locations and by different people from those who performed them in the past. Faced with the choice between spending time as an in-patient and being treated as a day case or out-patient, most people choose the day case or out-patient option. Following an illness, older people would much rather be cared for at home than in hospital. It makes good clinical sense to concentrate complex treatment in hospitals and to move rehabilitation, management of chronic disease, therapy, diagnostic testing and monitoring procedures to primary and community care and to people's homes as far as possible.
It also makes sense to ensure that care is provided by the most appropriate staff in the most appropriate way. For example, a community nurse or therapist spends more time with a patient than a hospital consultant or general practitioner can afford to. People can consult a community pharmacist about the most effective treatment for a minor ailment.
Does the minister acknowledge that the number of out-patients who are seen in hospital has fallen by 200,000 in the past four years?
That relates precisely to the point that I am describing. Of course the official figures have reduced, but my point—David McLetchie would have heard it if he had been listening to my speech—is that much activity in out-patient departments and elsewhere is not reflected in the official figures.
In February, the website of the information and statistics division of the NHS included for the first time figures for patients who were seen in nurse-led clinics. The number of patients who attended such clinics in January this year was more than 22,000 for acute specialties and another 32,000 attendances were made for non-acute specialties. The early estimate is that nurse-led clinics account for about 10 per cent of activity at consultant out-patient clinics. A significant amount of NHS activity has not previously been recorded, so the activity figures that the Conservatives quote omit those numbers.
The Conservatives' figures also do not reflect the increasing amount of treatment that used to be given in hospitals but which is now provided in primary care settings by a wide range of health care professionals. The Conservatives quoted only general practitioner consultations, but 2.6 million patients were seen by allied health professionals such as speech therapists, occupational therapists and physiotherapists in the first six months of 2003-04, which represents about 5 million patient interactions a year. New figures that were published at the end of last year provide an estimate of 10 million face-to-face contacts each year in primary care between patients and practice teams of nurses, district nurses and health visitors. Patients who have conditions including asthma, diabetes and mental health issues can expect practice team members other than GPs to see them.
All parties tend to bandy about statistics in health debates in the Parliament. We all take responsibility for that, but does not that underline the need for an in-depth root-and-branch inquiry into what lies behind those statistics and who is telling the truth?
Audit Scotland will publish the report of such an inquiry on 3 June, so the proposal in the SNP's amendment is redundant.
Will the minister give way?
I will not give way. I ask the Presiding Officer how long I have taken for my speech, because I do not have a sense of that.
You have taken eight minutes. You have another four minutes.
I will miss out some of the examples that I had intended to give of new activity.
Will the minister give way?
Obviously, I can accept no more interventions, given how long I have taken.
The many innovative ways of working are certainly not hallmarks of the monolithic, centrally run health care service that the motion describes. We are encouraging and supporting new ways of working that place patients at the centre of care and which devolve responsibility to suitably trained staff who work in wards, clinics, health centres and the community.
The new community health partnerships will help to devolve resources and decision making to the front line and will help the public and patients to become more closely involved in local NHS decisions that affect them. Community health partnerships will reinforce the joint working between the NHS and local authorities that already benefits patients. Far from operating a centrally run model, we are working with patients and the NHS to support integrated systems whereby the patient's pathway is streamlined through managed clinical networks that link primary and hospital care and which cross NHS board boundaries. Under such systems, decisions are made and resources are committed as near as possible to the front line.
I am surprised that the Conservatives have the brass neck even to mention waiting figures. Unfortunately for them, I was the Opposition health spokesperson in 1996 and I remember full well complaining about waits of more than a year for heart surgery. Next month, that figure will drop to 18 weeks in Scotland. I also remember that in the 1990s, the maximum waiting time for in-patient treatment was 18 months; it is now nine months and will fall steadily towards six months by the end of 2005. The Conservatives should at least acknowledge the progress that has been made on in-patient waiting. They quote bogus figures on waiting lists. As they know, we have adopted a single list, so the figures do not compare like with like. I also remind them that 50 per cent of in-patients do not wait at all.
My amendment acknowledges that more needs to be done on out-patient waiting, which is why I have been pleased recently to launch several initiatives. The centre for change and innovation has led those initiatives as part of its out-patient programme. The unacceptably long out-patient waits that my amendment highlights will fall in the next year.
I find the motion to be disappointing because it deals with means rather than ends. It talks about activity rather than about achievements such as reduced premature mortality from cancer and heart disease, and it talks about structures rather than about outcomes such as reduced waiting times. In the real world, structures are not the top priority for the people of Scotland. What matters is safe, high-quality health care, care and treatment as near to home as possible and shorter waiting times. All that is based on the fundamental NHS principle of care that is funded from general taxation and given according to need.
The Conservatives would fundamentally challenge all that through their patient passport and in other ways. They would provide money to supplement people's private health care payments, which would create an inequitable system that would undermine clinical priority and need, and they would give choice to those who can afford to pay, rather than provide choice for all, which we support.
I move amendment S2M-1326.4, to leave out from first "notes" to end and insert:
"commends staff across the NHS for the quality improvements achieved over the last five years, the new forms of activity such as nurse-led clinics and the progress being made towards a six-month maximum wait for in-patient treatment by the end of 2005; notes that progress has been made at the same time as the working hours of medical and other staff have been brought into line with accepted norms; commends recent initiatives to tackle long out-patient waiting times, and supports further reform of NHSScotland through the development of community health partnerships and managed clinical networks, an increasing emphasis on involving patients and learning from their experiences and a sustained drive on health improvement and the prevention of ill-health in partnership with other agencies."
Here we are again, debating problems in the health service. I place on record again the SNP's support for the efforts of hard-working staff in the NHS.
During their conference in Dundee—I hope that they enjoyed some good Dundee hospitality while they were there—the Tories said that they had learned some humility and that they would never again impose their ideas on an unwilling Scotland. However, today they are attempting to push the privatisation agenda, which shows that actions speak louder than words.
Mr McLetchie gave the game away when he was interviewed on Radio Scotland last week. Apart from insisting that the interviewer should refer to Thatcher as Lady Thatcher, he tried to extol the virtues of what Thatcher achieved for Scotland. Rather than Stalinist devotion, Mr McLetchie still has Thatcherite devotion in spades. It is clear that some Tories, including the Tory leader, have never really changed their spots.
The Tory motion repeats almost word for word a Tory motion that was debated in the chamber only six months ago and was overwhelmingly rejected as the way forward for the health service by the Parliament and by the people of Scotland, so it feels a bit like groundhog day. Only yesterday, we heard from House of Commons Health Committee members that that committee—including its Conservative members—is united in its concern about the negative impact of foundation hospitals south of the border. There is no appetite for privatisation in Scotland.
Although I do not take issue with the first part of the Tory motion, which is a statement of fact, at the end of the motion the Tories yet again try to argue that foundation hospitals and the independent sector are somehow an easy solution to the ills of the health service—even though there is absolutely no evidence to support that claim. I have no doubt that foundation hospitals would drain even more resources from the NHS, which would be paying for people to be treated in the private sector.
However, neither is the status quo acceptable for patients in Scotland. There is not simply a straight choice between the status quo and privatisation; I believe that it is possible to have a public health service that delivers for patients. For that to happen, we have to be honest about the extent of the problem. We must not pretend that everything in the garden is rosy, as does today's amendment from the Executive.
The Minister for Health and Community Care cannot ignore the facts—or, indeed, the concerns of his own back benchers, to whom I will return. In a letter to the Health Committee dated 10 May, on the subject of comments that he had made in evidence to the committee the previous week, Mr Chisholm provided information on the use of agency nurses. The information shows that, although the number of hours worked by agency nurses has declined—which we all welcome, because they cost more than NHS nurses—the overall cost of agency nurses has risen from £24.5 million in 2001-02 to more than £28 million in 2002-03. It is incredible that it is actually costing the NHS more to pay for fewer agency nurse hours—nearly 168,000 fewer hours. How can that be? Further explanation is required. If we are to look after the public purse, there must be further investigation.
I do not want to bombard people with statistics but I wish to highlight some key figures. Despite increased revenue expenditure, the total output of in-patients and day cases, of new and return out-patients, and of general practitioner consultations, declined significantly between 1998-99 and 2002-03. That also requires an explanation. The performance of the Scottish NHS declined relative to the English NHS between 1990 and 2002—despite increased funding. That also requires an explanation.
Between 1998-99 and 2002-03, revenue expenditure has increased by some £800 million in real terms. That increase has been accompanied by a 6.2 per cent fall in in-patient and day case episodes, a 4.3 per cent fall in out-patient consultations, and a 6 per cent fall in GP consultations. That cannot just be brushed under the carpet, as the minister is attempting to do. There has been a substantial fall in productivity and efficiency in NHS Scotland. This Parliament has a duty to investigate that. To move forward, the Parliament has to acknowledge the problem and then do something about it. The minister cannot dispute the facts any longer.
Looking around the chamber, I see members of all parties who have raised concerns time and again about where investment in the NHS has gone and about the fact that patients have not seen the improvements in care and treatment that that investment should have led to. It is not heresy to say that; it is merely a statement of fact. There is widespread concern across the chamber about delivery in the NHS.
My colleagues on the Health Committee have spoken about their concerns on a number of occasions. During the budget process, it has come to our attention time and again that the Executive itself cannot answer questions on what resources are spent where, and cannot give evidence to support decisions to spend in one area and not another. It also cannot say what output it expects to achieve for its investments.
The complacency of the Executive amendment is in stark contrast to the real concerns that are being expressed by Labour back benchers. The amendment takes us no further forward. The minister must know that many members sitting behind him do not believe what he is saying either. Duncan McNeil was quoted in April as saying:
"Across Scotland, from Inverclyde to Ayrshire, to the Highlands, to Glasgow, to Perth and beyond, staffing pressures are collapsing—or are being used as an excuse to collapse—maternity and paediatric services.
Communities are left outraged, MSPs frustrated, and patients short-changed."
Kate Maclean has also raised her concerns. At a Health Committee meeting she said:
"I think that your answer is a bit glib and does not acknowledge how serious the additional pressures are."—[Official Report, Health Committee, 4 May 2004; c 812.]
She was talking about pressures on health boards.
As I say, there are concerns across the chamber. That is why I make a plea to all members to join me today in taking some action to address the problems. My amendment calls for a root-and-branch inquiry by Audit Scotland into the performance of NHS Scotland. Audit Scotland is presently conducting an overview inquiry but, in informal discussions, it says that it is likely to call for a more detailed investigation of what is happening in the NHS. That is exactly what we are calling for. Rather than waste any more time, let us all agree that that is a way forward. We need to know why additional resources invested in the NHS do not appear to have improved outcomes for patients.
I move amendment S2M-1326.2, to leave out from "the current" to end and insert:
"the productivity and efficiency of NHSScotland is declining, and therefore calls on Audit Scotland to undertake a full root-and-branch inquiry into why the performance of NHSScotland has not improved given the substantial increase in funding."
My amendment is radically different from what is on offer from the main parties. I am absolutely astonished that, in all the speeches so far, not once has the private finance initiative been mentioned. I suppose that people just want to hide from it. I will come back to that point.
Our health record is damning—one in three children lives in poverty and there is increased diabetes and obesity. There are also phenomenal rates of malnutrition on admission to hospital. The four sickest constituencies in Britain are in Glasgow, yet Greater Glasgow NHS Board proposed drastic cuts to the NHS provision in the city. Treatment for serious diseases such as breast cancer is delayed. There is a problem and we should all have the honesty to acknowledge that. NHS boards are cutting, closing and centralising at a rate of knots. Organisational change is no longer an event, but part of the job description. Stressed NHS staff are struggling to cope with more pressure and less time. Yet, in Glasgow, 1,000 jobs are set to go.
Up and down the country there are complaints and campaigns. Communities are in uproar. However, strangely, there are no complaints from the PFI consortia and no complaints from the locum agencies or the pharmaceutical companies. They seem to be the only happy bunnies in the health service. When did anyone last see them packing out a public meeting?
Will the member take an intervention?
No—I have only six minutes. Sorry.
There is always the odd minute for interventions.
With the Tories, it is always a case of England, dear England. However, the increased use of the private sector in England, to which the Tory motion refers, is not so rosy. Deals involving Mercury Health Ltd and Anglo-Canadian Clinics Ltd have fallen through, casting severe doubt over whether the 24 independent—that is, private—treatment centres will be operational by 2005 as claimed. Those centres cost the NHS £2 billion—and the Tories complain about the cost of the Parliament.
Some things cost more in Scotland, and rightly so. Because of good trade union organisation, rather than any gifts from the Executive, contracts awarded by the Tories in the first wave of NHS privatisation have been brought back in-house. Sick pay has been given back to low-paid and put-upon workers, and ancillary staff and administrative and clerical staff are paid higher rates in Scotland. That is money well spent. However, the Tories would happily take us back to the days when domestics working for the NHS literally worked until they dropped dead because they could not afford to be off sick.
The Executive has underestimated the cost of NHS consultants' pay rises, which are costing up to twice as much as overpaid NHS managers estimated. For example, those pay rises are costing £8 million in Lothian, which is £5 million more than was estimated. Managers' shoddy arithmetic has saddled NHS boards with an increase in costs that they cannot afford. That is leading to cuts in front-line services. Malcolm Chisholm has already had to bail out local health boards by providing an extra £30 million. More is probably needed.
Unison estimates that consultants received an average pay rise of 15 to 18 per cent—as opposed to the 8.5 per cent that the minister claimed. The failure to plan strategically to fund that pay rise and compliance with the working time directive and the GP contract is breathtakingly incompetent. It now appears that lower-paid NHS staff—the majority of staff in the NHS—are to be asked to pay the price.
The Tories talk about their wonderful foundation hospitals. Will they agree with what Conservative health spokesperson Simon Burns said in August 2003 about the 30 per cent bonuses for foundation hospital managers? He said:
"Patients, particularly those on waiting lists, will be outraged to hear chief executives who aren't exactly badly paid are going to benefit when the money could be better spent on patient care."
Will Mr McLetchie defend those 30 per cent bonuses? Is that his vision of foundation hospitals?
Will the member take an intervention?
Mr McLetchie can respond later. I do not have enough time to let him speak just now.
After 1997, the Tories were spectacularly upstaged on PFI—the subject that dare not speak its name. Geoffrey Robinson loosened up the laws, made PFI less risky for his banker pals and became paymaster general to Peter Mandelson.
Would Comrade Leckie take an intervention from me?
Since Fergus Ewing is persistent, I will.
Fraternal greetings. Carolyn Leckie states that the pharmaceutical companies should be brought into public ownership. Does that include GlaxoSmithKline and AstraZeneca? If so, what money would be left after the value of those companies had been paid? That purchase would use up all the health budgets for the next two decades. What money would be left to fund any NHS whatsoever?
Fergus Ewing makes that point only because he accepts the idea that those companies should be paid compensation. [Laughter.] I would like those companies to be means tested in the same way as the people who suffer under the Government's regressive tax regimes. The question is political, not economic.
Lothian NHS Board is running a £95 million deficit because of PFI contracts relating to the Edinburgh royal infirmary. The PFI consortium at Hairmyres hospital has just entered into a refinancing deal. [Laughter.]
I am glad that members think that this subject is funny. It is not funny.
Despite the profits that have already been made through the PFI deals at Hairmyres, refinancing is set to deliver nearly £1 billion of additional profits to the Hairmyres consortium. Do the other parties in this chamber defend that? If they do, that illustrates that we support the NHS continuing to be a public service and that they are the privatisers.
You have one minute.
I was going to talk in detail about pharmaceutical companies and the cost of drugs, but perhaps I can return to that in my summing up.
Shona Robison mentioned the increased costs to the NHS of agency nurses, locums and so on. In 2002-03, the charge for an agency nurse was £1,600 a week. The fact that there are not enough beds leads to the establishment of evening and weekend waiting list initiatives that distort clinical priorities and cost time and wages. Core capacity needs to be increased to reduce those costs.
The NHS has been mismanaged by successive Governments and has been exploited by big business. There has been no democratic accountability. The public are at odds with NHS boards because they consistently try to disguise bad news as good while implementing Scottish Executive policies—most disgracefully PFI—in the knowledge that they are sucking the life out of the NHS while operating restrictive budgets.
The Tories constantly make an issue of postcode prescribing, but try to persuade us that an individual patient passport will lead us to a postcode-neutral paradise. That is what I call funny.
I urge members to support the SSP amendment, which is the only one rooted in reality.
I move amendment S2M-1326.3, to leave out from ", despite a" to end and insert:
"Scotland's health and quality of health services are not improving in relation to the wealth available in the fourth biggest economy in the world; further notes that the NHS has insufficient core capacity and insufficient core staffing of establishments that have increased agency, overtime and locum costs; is concerned that NHS boards have substantial deficits and plan unacceptable reductions in service provision and jobs; believes that resources that should be directly spent on patient care are diverted to ever-increasing profits for private consortia, private health providers of all kinds and pharmaceutical companies; notes that the Scottish Executive and NHS boards have repeatedly failed to strategically plan effectively; believes that all forms of privatisation in the NHS such as PFI/PPP and contracting from private providers should be stopped; further believes that the pharmaceutical companies should be brought into public ownership or, in the meantime, at the very least, the Executive should urgently introduce a drug-pricing regime that will control and deflate drug company profits, and believes that capacity and staffing establishments need to be systematically enlarged."
"Rooted in reality"—okay.
Our national health service exists to provide a safe, high level of quality care to all patients in Scotland irrespective of how much money they have or where they happen to live. I have to say that it is clear to me that the Conservative party's plans, outlined by David McLetchie, would fatally undermine those essential underpinning principles of our NHS.
The Conservatives have made it clear that they want to subsidise private health care and, in the process, siphon off much-needed NHS funding. Their proposals for the NHS are all about diverting funds from the public sector to the private sector and are clearly driven by a particular ideological approach to the provision of health care in Scotland.
The patient passport is the innovation at the heart of the Conservative proposals, but I note that it is curiously absent from the Conservative motion and was not mentioned by David McLetchie in his opening speech.
Patient passports are to be introduced to enable patients to be treated free of charge at any NHS hospital, as they are at the moment. However, it involves establishing a level of bureaucracy—yes, a level of red tape—to set up a national tariff for each and every operation and service within the NHS. Why? Because it will allow everything to be priced, which will, in turn, allow people who can afford it to take 60 per cent of that price out of the NHS and use it to pay for private treatment.
Does Mr Rumbles accept that, at present, operations in the NHS are costed? That is part of the management process that is in place in the system at present. In what way is it difficult to change a cost into a tariff?
The Conservatives want to price everything in the NHS. Of course, while they will know the price of everything, they will know the value of nothing.
The Tories claim that that innovation would save money for the NHS and ensure that better provision was available to all by shortening queues, because there will be less demand for NHS services. They also claim that it would expand the range of providers and that increasing private providers is one of their major aims. In that context, let us have a look at their proposals in detail.
The average cost of a hip-replacement operation in the NHS is just over £4,000. However, with BUPA the cost is anything between £6,000 and £10,000. Under the Tory proposals, a patient could take 60 per cent of the NHS cost—some £2,400—and use it as a payment towards BUPA treatment. That would mean that they would still have to find some £7,600 towards the operation. The proposal would provide a subsidy to those patients who are able to fund their operations privately anyway. Very nice indeed. Of course that will be welcomed by those who can afford to pay private fees anyway, but what about those who cannot? This is where the argument about the patient passport fails miserably. Let me explain why.
We have an example of the Tories trying this sort of thing before. Back in 1990, the Conservatives introduced a scheme of subsidies for private medical insurance for the over 60s that cost the taxpayer some £560 million. What did it achieve? Far from increasing private medical insurance, as the Tories claimed it would, it simply subsidised it. Those with private medical insurance gained while those without did not. There was no increased uptake of private medical insurance, according to the Inland Revenue.
Now, the Conservatives aim to extend that private subsidy across the health spectrum. The so-called NHS passport is nothing more than a passport out of the NHS. It is a subsidy for those who can and do afford private health care at the expense of those who cannot. Is this not redistribution of wealth by the state? I thought that the Tories did not accept that concept. They seem to be accepting redistribution in the situation that I have described, although it can be bizarrely but simply categorised as, "to those who have, let us give some more."
The Conservatives like to portray themselves as the party of the patient. However, they are simply the party of the private patient. There is nothing wrong in being the party of the private patient, but they should be honest about it. The Liberal Democrats believe in a strong and healthy private sector. There would be nothing worse than people having no choice at all other than a complete reliance on the state. However, we cannot accept this new right-wing philosophy of subsidising private health care at the expense of those who cannot afford it. We need and we demand a national health service that provides a safe and high-quality service, which is free for all at the point of use. Where the national health service fails to meet expectations, we need to reform it; that is exactly what the Executive is doing. What we must not do is dream up a system, as the Conservatives have done, that will drain the life blood out of our public services.
I could quote a number of organisations, but, as I am short of time, I will quote just one—the British Medical Association. In a briefing paper, the BMA says that it
"shares the view that patients should be able to access private health care services if they have the money to pay for it. However, it is our view that the Scottish Executive should continue to invest in the modernisation and development of the NHS rather than promoting the independent sector. Promoting use of the independent sector will fail to address the health needs of Scots from deprived areas, who are most likely to need access to health services. The BMA continues to support the fundamental principle of a health service for all that is free at the point of need."
It will come as no surprise that the Liberal Democrats will not support the Conservative motion at decision time. Although I have been extremely critical of the Conservative motion, I want to congratulate the Conservatives on one thing for which they deserve praise. The Conservatives have presented a health policy that is at odds with the consensus that has been dominant throughout Scottish politics for many years—and the Conservatives are proud of that fact. I do not accuse them of a failure of vision. Indeed, it is helpful that they have brought for debate today their particular vision of a health service in which the well-off are subsidised by the poor.
Conservative health policy is a novel way of looking at the policy of wealth redistribution. Surely people assume that the better-off in society should help those who are less well-off. Now the policy that is advocated by the Conservatives is for the taxpayer to subsidise those who can afford private health care. The Conservatives have provided a clear and distinctive health policy. I have no doubt that it will be roundly defeated at decision time and that, when the time comes for the next Scottish Parliament election in 2007, the people of Scotland will also roundly reject it.
At the outset I want to stress to the minister that neither I nor any of my colleagues are critical of the staff who work in the NHS. They do a stalwart job under what are sometimes extremely difficult circumstances and we all have the greatest admiration for them. We want NHS staff to be more in control of their professional lives and of their patients' care.
I want to touch on the vexed issue of maternity services in Scotland, which is of concern to our constituents right across the country, as we all know from the correspondence that crosses our desks.
Women in 21st century Scotland have a right to expect safe childbirth and their babies should have the appropriate neonatal care that will give them the best possible start in life. Quite rightly, however, mothers have come to expect to be able to choose where and how they will have their babies. Good antenatal care is key to a safe and healthy pregnancy. Part of the provision of that care is the planning for the individual needs and preferences of mothers. Good planning will ensure that giving birth is as natural and stress-free as possible while, at the same time, safeguarding the safety and well-being of the mother and baby. Most mums want to have their babies as close to home as possible; if not at home. They want to be near to their partners, families and support network at what is probably the most deeply emotional time of their entire lives.
Everyone accepts that safety is paramount and that, on occasion, if complications arise, mothers' wishes will have to be sacrificed in the interests of their own and the baby's well-being. Thankfully, the incidence of maternal mortality is low in Scotland today. Good neonatal care has ensured that infant mortality and morbidity also are at fairly minimal levels. Nobody wants to see that situation change for the worse, but there is a fear in many communities in Scotland that that is what is being faced, despite record financial investment in the NHS.
The falling birth rate in recent years, which of course might not be permanent, has led to problems in the functioning of maternity services, with some units operating below capacity. When one adds to that fact the shortage of trained obstetricians, anaesthetists and neonatal paediatricians, plus the new deal for junior hospital doctors, the effect of the European working time directive and the new consultants contract, it is not hard to see why maternity services are under threat.
That is no comfort to the mums in Wick. Despite the recent filling of locum vacancies, if the local unit in Wick is downgraded, as proposed, to a midwife-led service, those women could face a journey of over 100 miles to Inverness, over bad roads and in the winter time, if a complication meant that they needed consultant treatment.
Surely in this day and age it is not acceptable for an expectant mother to be advised to spend the five days before their expected date of delivery in hospital or in a bed and breakfast in Inverness as a precautionary measure. Not only would that be costly to the NHS, but what on earth would it do for the morale of those patients? Where was the choice and freedom from stress for the 11 mums who have given birth to their babies in ambulances en route to Glasgow and Paisley since the Vale of Leven hospital lost its maternity services in 2002? Where also is that choice for the patients who will have to be rushed up the dual carriageway from Perth to Dundee, if complications arise, when the unit in Perth loses its consultant cover? I suggest that those patients will take some convincing that their service has improved.
I accept that the problems are not easy to solve, but let us not kid ourselves that the service is altogether what patients want. The Government signed up eagerly to the European working time directive. It did not have proper regard to the consequences of that on the availability of staff. The result of the long-trumpeted new deal for junior hospital doctors somehow seems to have caught us unawares. The massive amount of extra funding that has gone into the health service has unfortunately been more successful in recruiting bureaucrats than specialists to the service.
We hear a great deal from the minister about the importance of patient involvement and public participation in planning the health service that everybody wants. Why is it that the wishes of many communities across Scotland, particularly those in the remote areas in which distances are long and road conditions poor, are not heeded when the maternity services of the future are being planned? I say to the minister that there is a great deal of dissatisfaction out there and that he will ignore it at his peril.
To avoid any problems, I will ensure that Shona Robison gets a copy of my speech and of everything that I have ever said about the national health service. Given her performance as SNP spokesperson for health, she needs all the help that she can get.
Everything?
Yes, my committee work, too.
Investment and modernisation in public services are like chopsticks—useless unless one has the pair. The Tory motion argues that we have had the former in the NHS but not the latter and it condemns us for that. Of course, I welcome the fact that the Tories have said today that they recognise the record investment that the Executive has put into our health service; in the past, they have just whinged on about us fiddling figures and so on.
The Tories are right that the NHS needs to be reformed and modernised. Where we disagree, however, is on what is meant by reform. The Tories want to reform the NHS in the same way as they reformed shipbuilding, steel and coal. I want the NHS to be reformed so that we can get a bigger bang for our buck and put patients at the centre of the service.
To be fair, the Scottish Conservative and Unionist Party has acknowledged that the Executive has gone some way towards meeting those aims. Indeed, the Executive has swept away the last vestiges of the costly and bureaucratic internal market. Moreover, the Parliament has just passed the National Health Service Reform (Scotland) Bill, which makes health boards co-operate across boundaries—something for which I have called for some time. The bill also gives ministers greater powers to intervene where health services are failing.
Duncan McNeil spoke about the sweeping away of costly bureaucracy. Will he confirm that the number of administrators in the health service has gone up by nearly 4,000 over the past four years, which is more than the number of additional doctors and nurses and other health professionals who have been employed?
I do not describe clerical assistants and the people who run the administration of the NHS as bureaucrats. It is essential that we have good managers who encourage modernisation—I would have thought that the Tories agreed with that. How do we expect to achieve modernisation and reform if we do not have excellent managers in the health service?
We have introduced new contracts for GPs and consultants and the agenda for change process is on-going. Those essential reforms were overdue. Of course, more remains to be done, as the minister acknowledged. We have invested a lot of money in the new contracts and we have great expectations, but we have yet to see the returns on our investment. Unfortunately, senior figures in the Scottish Executive Health Department are unable to tell me when we might expect patients to benefit from the new contracts.
If we are serious about moving forward, we must avoid making the mistake that the Tories and others make when they consider only what politicians are doing about the health service. We must also examine external factors, such as the role of health professionals. The problems that are being blamed on the European working time directive and the agreement on junior doctors' hours have been well documented.
Does the member agree that questions need to be asked about why the implementation of the agreement on junior doctors' hours is more expensive in Scotland than it is in England? We must also ask why the agreement, far from stopping people working overtime, has offered an incentive to work overtime.
There are problems and I am sure that the minister will refer to them when he sums up. Debates between consultants and junior doctors are taking place in hospital wards about matters such as tea breaks and overtime. Many people in the health service welcomed the reforms but think that they have gone too far—patients have certainly felt their impact. The Tories did not mention that this morning, because they presume that health professionals vote for them and that they are acting in those people's interests.
Royal college rules and guidelines appear to be arbitrary and undemocratic and have led to the collapse of services in Inverclyde and the Vale of Leven. Such guidelines should be reconsidered and I hope that the Health Committee's inquiry into work-force planning will prove to be a useful tool in that process.
The Government attempts to effect reform, but the dead hand of professional interest is slowing us down. It is time that we encouraged the professionals to face up to the realities of change. Change is always difficult. It has been difficult for public sector workers across the board to come to terms with the European working time directive and changes to their jobs. It has certainly been difficult for my constituents, who have had to go to Paisley to access consultant-led maternity services. Patients understand the impact of change, but I am not sure that the professionals understand it. It will not be easy to reform the way in which the NHS works and consultants cannot have it all their own way. We must be able to develop the skills and experience of the whole NHS work force if we are to avoid the fate to which the Tories would consign us—if they had their way, more services would be privatised. I much prefer the chopstick approach to the Tory meat cleaver.
It is strange, but I sometimes see Duncan McNeil with a meat cleaver in his hand.
I want to consider the Tory legacy of the internal market and NHS trusts. The internal market led to the privatisation of catering and cleaning services, which had an impact on the delivery of food and cleanliness. There has been an increase in hospital-acquired infections—
Will the member give way?
I will give way, but I want to get going first.
In the Borders general hospital, where services have been maintained in house, there is an esprit de corps—team spirit—and services are of a high standard.
The Tories also introduced NHS trusts. Mr McLetchie launches his great campaign to reduce bureaucracy, but his party brought in all those administrators and pen pushers who do not deliver front-line services. Now Mr McLetchie applauds the removal of such people. That is just political opportunism—I suspect that Mrs Thatcher's breath is still on the back of many Tory necks.
The Tories offer us a future with foundation hospitals. We know what the BMA thinks of those. Its briefing paper says:
"The BMA has real concerns about the consequences of the introduction of Foundation Hospitals in England and would not support their introduction in Scotland."
The Tories obviously know better than the BMA.
About a year ago, an Audit Scotland report confirmed that the lowest rates of methicillin-resistant staphylococcus aureus are to be found in hospitals where the cleaning is done by private firms and that the highest rates are to be found in hospitals that have in-house cleaning firms.
That is not always the case, as we are now discovering. It is certainly not the case in relation to catering services—Mike Pringle recently brought that issue to the Parliament's attention.
There is no doubt that patient passports will lead to the skewing of local service delivery—which is already skewed enough. It is hypocritical of the Conservatives to propose patient passports at the same time as they campaign to keep hospitals open in Scotland, because patient passports would lead to the closure of local general hospitals.
The Labour record over the past seven years is terrible, too. The health gap between the rich and the poor is worse in Scotland than it is in England. A man who is unfortunate enough to live in Glasgow can expect to die some 10 years younger than the average Scot. Strangely enough, Labour has been in power all over Glasgow for decades, but it has hardly delivered there.
We all agree that it is a good idea to put more money into the service. However, service delivery has not improved and we must consider why that is the case. During the parliamentary debate last December on the reform of public services, David McLetchie quoted from the Labour Party's 1997 election manifesto, which said:
"the level of public spending is no longer the best measure of the effectiveness of government".
That is true. The minister keeps telling us about the amount of money that he is spending, but he cannot always tell us where the money is going. I will not go into statistics, which have been dealt with elsewhere but, frankly, when the Health Committee asks the minister how he knows whether the £10 million, for example, that he puts into cancer care services is delivering any improvements, he is unable to tell us. We do not expect the minister to be able to tell us how every penny is spent, but when we are talking about millions of pounds we would like some guidance about where the money has gone.
Christine Grahame is completely wrong, as I explained at the Health Committee meeting. We receive reports every six months that detail how all the extra cancer care money—£25 million per year—is spent by each regional cancer network. The spending is itemised every six months.
Although the minister might sometimes know how the money has been spent, he cannot tell us whether the spending has had results. There is no point in investing money if it is not going to change anything. The point is that the money might be better spent elsewhere.
When the minister was asked whether the National Health Service Reform (Scotland) Bill—which we supported—would cost money, he said that it would be cost neutral. He adhered to that position despite the fact that, in its report on the bill's financial memorandum, the Finance Committee said that the bill would not be cost neutral. Costs associated with the reforms are likely to arise against a background in which three health boards are in major financial crisis—one of those is Greater Glasgow NHS Board and I have just mentioned the record of health delivery in Glasgow—and another seven boards are on the cusp of crisis, as has been said. The costs of the reforms can be paid only by using the money that was meant for service delivery, because contracts and staff payments must, quite rightly, be met. The minister must be straight with us when he does not know the answers or when he knows that things will cost money. Unfortunately, I do not think that he has been straight with us.
I have a suggestion about data, which I think would assist the minister and his team. When I conducted a search of parliamentary written questions and answers that contained the words "health" and "not held centrally", I got 337 hits, most of which related to the minister's brief. For example, one of my recent questions was:
"To ask the Scottish Executive … which NHS boards automatically offer a second trimester anomaly scan within the recommended 18 to 22 weeks gestation period and, if this is not universally offered, what steps will be taken to ensure that it will be offered".
I received a reply two weeks later, which stated that the Executive is aware that such scans are not universal, but added:
"we do not hold the requested information centrally. This is a matter for NHS boards."—[Official Report, Written Answers; 26 March 2004; S2W-6314.]
The minister sets the targets on waiting times and other matters, so he should know that information and I do not understand why he does not demand that NHS boards make it available to him.
It was ironic last night to find the UK Foreign Secretary, Jack Straw, setting out his red lines relative to the European constitution and his so-called salami approach—in particular, the need to protect Britain's interests and to ensure that we have a national veto on social policy. Surely that cannot be the same Labour Government that rushed headlong into signing up to the working time directive without any thought for its consequences for the health service and, particularly, its impact on the provision of services in rural areas. The directive brings enormous changes and, although no one would sensibly want our doctors, nurses and support staff to work incredibly long hours, the lack of flexibility and common sense in the consequent measures is a serious threat to the health service's ability to deliver in rural Scotland and is putting patients' lives at risk.
Does David Mundell support the reduction in the hours of junior doctors?
I support the reduction in the hours of junior doctors, but I do not support the rigidity and lack of flexibility that the working time directive brings to the health service, in relation to not only junior doctors but ambulance staff and everyone else who is involved in front-line services. In rural areas, a flexible approach is required.
In a letter to doctors, the medical director of Dumfries and Galloway NHS Board recently conceded that the new out-of-hours service will be less convenient for patients. So it will be, with patients having to travel miles to the nearest medical practitioner and no answers to the key questions about how travel will be managed, how we will ensure that there is no undue pressure on the Scottish Ambulance Service—which is, as I said, another victim of the working time directive—and what training will be given to the drivers of the fleet of taxis that will be required in areas such as Dumfries and Galloway.
In 1997, we were told that there were only 48 hours to save the NHS. People who live in Langholm in Dumfriesshire now have to travel 48 miles to see a doctor during the night. The situation is worse in other areas, including parts of Galloway, from where people have to travel to Stranraer. It is completely unacceptable for the changes to go ahead without substantive consultation with communities throughout Scotland. The message is: take it or leave it. The measures have to be in place by October and there is no plan B. Parliament's debate on the issue on 25 February was marked by the fact that the Deputy Minister for Health and Community Care did not answer any of the concerns raised.
The Scottish Executive has used smoke and mirrors to hide from the public the real impact of the changes. Despite Mr Rumbles's views on the outcome of the next Scottish Parliament election, I am sure that Labour and the Liberal Democrats will pay a heavy price in rural Scotland when the public wake up to what is happening to rural medical services. We need answers to the questions. When a patient has travelled 40 or 50 miles to a hospital to see a GP during the night, will the GP send them home? I think not, in these legally conscious days. The patient will be admitted, which will mean that admission wards in hospitals such as Dumfries and Galloway royal infirmary will be clogged up overnight, with a knock-on effect on the plans for the following day. There are no answers to the questions, but they need to be answered.
It is clear that the funding allocations to the rural health boards will not be sufficient to meet the costs, especially because of the number of GPs who have not signed up to provide out-of-hours services. Those costs are growing all the time and the situation will be exacerbated by the changes arising from the consultant contract and the agenda for change. Despite the universal acknowledgment that significantly more is being spent in the NHS, people in rural Scotland—who, like everyone else, are paying more and more tax for a supposedly better service—are questioning what is happening to the service. We were told that things would only get better but, for NHS patients in rural Scotland who want to see a doctor out of hours, things are most definitely going to get worse.
I am always surprised when the Tories want to debate the NHS in Scotland. For years, they systematically wore the health service down through lack of investment and the destruction of staff morale. To take any lessons from them on running the NHS would be complete folly, as I am sure every non-Tory MSP agrees. Sadly, it seems that the current crop of Tories would like to carry on the work that Margaret Thatcher started in the dark old days of the Tory Government. It was interesting to hear David McLetchie say this morning that he is keen on the SNP amendment because it provides a diagnosis. It is a pity that his party could not diagnose the terminal effect that it was having on the NHS when it was in charge.
There has always been a split right down the middle between the Tories and the Labour Party on health. Michael Howard once described the NHS as a "Stalinist creation"—an idea that David McLetchie alluded to today—and the Tories have never embraced it. As I have said before, I can attest to that personally. In my 20 years of working in the NHS under the Tories, I saw at first hand the devastation that their policies caused. Staff morale was shattered, patients were admitted to substandard Victorian hospitals and the internal market led to a system in which profit was put before patients.
Will the member take an intervention?
No. I am speaking from personal experience and, with all due respect, I do not think that the member can do that.
I wondered whether Janis Hughes was working in the health service in 1978.
There is no answer to that, Presiding Officer.
For all the rhetoric about improving patient choice, the simple truth is that the Conservatives have never believed in a national health service that is free at the point of delivery. These days, Tory proposals aim to do something that even Margaret Thatcher would not have dared to do: to abolish the NHS and privatise health care in this country. We have heard a lot of sighs from David McLetchie this morning. Perhaps he does not like to remember how things were, but the sad truth is that what happened under the Tories is a fact of life with which we are trying to deal today.
Will the member acknowledge that there were real increases in spending on the NHS in Scotland every year from 1979 to 1997? That is a matter of record. Seven of the eight new hospital developments that Labour boasted about in its manifesto at last year's election were started by the Tories. Until recently, the record number of nurses in Scotland was in 1995, when we had 53,000 nurses. That hardly represents a health service in decline.
The fact of the matter is that I worked in the NHS for 20 years while the Tories were in power and I know how bad it was. I am not standing here saying that everything is rosy, but I am saying that things are better than they were when the Tories were in power.
The Tories are not brave enough to declare openly what they aim to do. Instead, they are trying to introduce privatisation by stealth, with their part-subsidised patient passport. Under that scheme, the NHS would pay for 60 per cent of the cost of treatment, with the patient paying the remaining 40 per cent. The simple reality is that that would benefit no one except the tiny minority who can afford bills of thousands of pounds for health care. It seems that the Tory desire to create a market-driven, two-tier, failing NHS did not die with the end of compulsory competitive tendering.
Will the member take an intervention?
I think that I have already heard enough, thanks.
The Tory motion is correct in one assertion—there has been a substantial increase in investment in the NHS during the past five years. That investment has allowed us to recruit more doctors and nurses, to build eight new hospitals in Scotland, to buy the old Health Care International hospital and to start to tackle unacceptably long waiting lists.
However, as I have said, I will not stand here and pretend that the NHS is in a perfect state—far from it. Labour members do not pretend that everything in the garden is rosy. Nevertheless, the situation is improving and it is much better than when the Tories were in power.
Like many other members, I am regularly contacted by constituents who are concerned about the excessive waits that they have to endure for operations. However, there can be no doubt that the Tory travesty of the two-tier patient passport is not the answer.
I do not disagree that the NHS needs to be reformed. Those reforms have already begun. The internal market has gone, more services are being delivered at primary care level and modern techniques mean that more procedures can be carried out in day-surgery units. David McLetchie said that we should learn from the experience of others. I am pleased to say that we have taken no lessons from the Tories but are producing our own solutions to address the challenges of health provision.
We must ensure that, over the next few years, we continue to reform the NHS properly. Medicine is constantly evolving and it is important that the NHS evolves with it. We must create a system that responds to the new techniques and that gives staff the opportunity to work in modern, purpose-built facilities.
We must also get the system right for patients. I fully accept that we are not always successful in engaging with the public. Recent consultation exercises throughout Scotland have left many communities feeling that their views are not important. Change is necessary, but it is often painful. Health boards must provide better information and education in advance of consultation processes, so that the public better understand the need for that change.
The Conservatives would do well to remain silent on the NHS, as they do not have a leg to stand on. The Tory chairman, Liam Fox, has spoken of his desire to break the link between the NHS and health care. That is not what the people of Scotland want and it is yet another reminder of why the Tories should be kept as far away from office as they currently are.
Four words leap out of the Tory motion: "fundamental reform is needed". However, that is absolutely the last thing that is needed. We are just about finished dealing with the aftermath of the last time that the Tories got their hands on the health service and the fundamental damage—sorry, reform—that they inflicted on it.
In their motion, the Tories contrast the substantial increase in funding with statistics that they say demonstrate that that funding has not improved services for patients. They choose to ignore the fact that a major part of the extra money has, rightly, gone to fund the necessary restructuring to meet the requirements of the working time directive. Why should junior doctors and nursing staff work extremely long hours, with the inevitable tiredness that that brings and the increased risk of mistakes—potentially dangerous or lethal mistakes—that tiredness can bring?
The statistics that the Conservatives highlight, which are all to do with hospital treatment, must be viewed in the context of a shift in focus from service provision in a hospital setting to service provision in a community setting when that is a safe and sensible option. That is much more tailored to the patient's needs, providing the care that they need as close as possible to home and with as little inconvenience to the patient as possible. I am not a fan of statistics, as anything can be proved with figures, but facts are chiels that winna ding. If the number of premature deaths from heart disease, strokes and all cancers has fallen and is continuing to fall, that is an indication of underlying effectiveness.
Change in the health service is constant and inevitable as expectations change, science advances and demography changes. The emphasis has shifted away from hospital care to community care. There have been changes to the way in which NHS staff are deployed, with much better use being made of professionals allied to medicine and nursing staff, more local nurse-led clinics, midwife-led maternity units and nurse prescribing. Those changes are delivering in many ways a better and more patient-friendly service. External factors have also driven change. For example, the falling birth rate has made it inevitable that maternity services have had to be revised. That has not been an easy exercise, but it has been a necessary one.
Nora Radcliffe mentions the increased use of PAMs. What does she have to say about Grampian NHS Board reducing the number of chiropody appointments for elderly people and striking many elderly people off the list? That is hardly increased access to health services.
It is hardly increased access to health services, but the factors that have determined it have been well rehearsed and are to do with funding and the availability of staff.
Where is the increase going?
A lot of it has gone to fund changes in staff structure and a lot of it is to do with health service funding allocation. Both Mary Scanlon and I know the arguments about the fairness of the funding formula, but that is not what I am talking about and I am not going to go into that issue at the moment.
Achieving the necessary revisions in the NHS requires honesty and objectivity from health boards, from the Scottish Executive and from politicians. We have to take responsibility for the responses that we make to the changes. We have to represent our constituents' interests fairly by ensuring that they get the services that they need, but also by recognising that those services might not necessarily be the ones that they have had in the past or the ones that they want. The NHS is a living, evolving entity that is changing all the time under a range of drivers, both internal and external.
As Duncan McNeil said, change can be hard to manage. A lot is wrong with the health service and a lot needs to be done, as members have said. Nevertheless, there is a lot that is right. The NHS is still true to the initial concept of health care for all, free at the point of delivery. That is the choice that I would make—not the choice that the Tories would offer, which is better health care for the better-off at the expense of the old, the poor, the chronically ill and those who live in rural areas. To that I say, "No thanks."
I welcome this opportunity to debate health issues. As David McLetchie has said, it is a subject that touches everyone. Although I agree with that sentiment, I cannot agree with or support the Conservative motion, which promotes privatisation of the health service. It is a bit rich that a party that gave us the bureaucracy of the NHS trust is trying to tell us how to run our health service. That is one of the reasons why I cannot support the motion. Still, the Conservatives may have allies in new Labour. Janis Hughes mentioned what the Tories have done; however, the Tory motion may find favour with new Labour members, who also want to establish foundation hospitals—a Tory idea. It is a bit rich of new Labour members who support that idea to attack others for promoting their policies.
I want to concentrate on issues in Glasgow that have a direct effect on services throughout Scotland. Many members have mentioned the increase in funding for the NHS. Although I appreciate and acknowledge that, we must ask why Greater Glasgow NHS Board is closing hospitals, reducing the number of in-patient beds and shedding staff to save £58.8 million in order to prevent it from plunging into the red. It has been told to make those savings and we must ask questions about that. Although this is not his debate, I hope that the minister will address that point, whether in writing or otherwise.
An Executive spokesperson has reported that Glasgow received a lower than average increase in its health budget. The Executive has also stated that it is for the health board to deploy its resources as it sees fit. Well, the buck stops with the minister. It is his duty to investigate Greater Glasgow NHS Board and its handling of any moneys that it receives. I fully support the amendment in Shona Robison's name, as we need an investigation by Audit Scotland and the Executive.
Does the member agree that the minister must also say why, in September 2002, he gave specific commitments in relation to the retention of services at Stobhill hospital that he has been clearly unwilling to back up with action? Does she agree that that is deplorable?
Yes, I agree entirely. I was going to mention that later in my speech. I spoke to Jean Turner earlier, who will raise that issue if she is called to speak. We now know that Stobhill hospital is to close two years before it was due to close, according to the minister's announcement. Tommy Sheridan makes a valid point in that respect.
I would like to mention some of the other issues in Glasgow. There has been lots of publicity about the closure of the Queen Mother's hospital and lots of angry voices—MSPs' voices and the public's voices—have been heard. It is the jewel in the crown of maternity services, not just for Glasgow but for Scotland, and it should be emulated throughout the world. I find it hard to believe that, even after the letters that I have sent him and the petitions that have been submitted, the minister has still not given us an answer as to whether the Queen Mum's will be saved. Staff morale there is very low indeed. It is imperative that the minister gives us an answer as soon as possible, to stop the drip-drip effect on morale.
Let us consider what the cost savings might be if the Queen Mum's were to close. The estimated cost saving is £1.3 million. We are talking about Greater Glasgow NHS Board trying to save £58.8 million. Closure of in-patient beds at the homeopathic hospital—which is also a world leader and one of only two such hospitals in Britain—will lead to estimated cost savings of £300,000. That still does not make a big dent in the £58.8 million. The health board has said that 1,000 jobs will be shed through natural wastage. I am certain that nobody would lose any sleep if the health board people lost their jobs—I put it to the minister that that would be genuine natural wastage. However, we do not know whether any of the health board people are going to lose their jobs. Why should it be front-line workers who lose their jobs?
We have now heard the grand announcement from Greater Glasgow NHS Board that it is going to charge patients and staff car-parking charges at all hospitals. It has said that there will be a consultation, but every one of us has seen how Greater Glasgow NHS Board conducts its consultation processes. The board's press release states:
"It is planned to introduce the charges on a phased basis from April 1 2005."
So now we know how the consultation process works in Glasgow.
New Labour members are the current guardians of the health service in Scotland. They are supposed to be the Government of this country, yet we see closures, staff losses and the drip-drip effect on staff morale. We are going to lose a lot of good staff who have come to do medical research but who feel as if they cannot move on because there is not enough money or a vision for the future of health services, not just in Glasgow but throughout Scotland. What we are really seeing is the centralisation of the health service. I ask the minister, or whoever is responsible, to look at the closures and stop any closures whatsoever until the expert group on NHS service change reports back to the Parliament. If that approach is not taken, it will be too late for the Queen Mum's and for other hospitals. Centralisation may be a fine word, but it is not good for the health service.
I would like to ask ministers to acknowledge the problems in the NHS and, for once, to put some honesty and humility before their own pride and arrogance. If that was the starting point, we might just be able to make some progress.
During the passage of the Community Care and Health (Scotland) Act 2002, the Conservatives supported the principles of equity, fairness and choice. On the basis that a patient with cancer or heart disease receives free NHS care and treatment, a frail, elderly person should also receive the care necessary to their quality of life. In fact, it is the Scottish Executive that has now created a two-tier system, in which those who can afford fully to fund their care can enter a care home immediately, whether from hospital or from their own home, whereas those who are waiting for funding from the council enter the statistics of delayed discharge and bedblocking.
Those statistics are still up 20 per cent from 1999, with more than 2,000 people in hospital waiting for placement, mainly in care homes. Despite several millions being allocated for that purpose, councils still say that they do not have enough money. That is confirmed week after week by letters from Highland Council to people in the Highlands, who are told to wait for the next year's financial package to come through.
Surely it is also unfair to pay more for people who reside in council-run homes than for people who reside in homes run by the private and voluntary sector. The Church of Scotland has had to raid its social fund to subsidise homes, and the excellent Free Presbyterian Church home in Inverness is currently struggling to keep pace with the additional financial pressures.
The financial memorandum for the Community Care and Health (Scotland) Bill stated that the costs of registration and inspection would be £40 per bed for care homes, but the cost is already £120 per bed and rising. That, alongside the considerable investment needed to keep up with the new regulations, which we all support, is putting enormous financial pressure on the private and voluntary care sector. Council homes are therefore financially safe and secure for the future, while the private and voluntary sectors—particularly the churches—continue to face more closures of day centres and homes. Again we see an example of a plan by the Executive to reduce choice and turn the care home sector into a public monopoly.
We can do much to stop elderly people ending up in hospitals and care homes after a fall, for example, when people lose their self-confidence and independence. We should put greater emphasis on preventive and more positive care for the elderly. When in government, Conservative ministers in the Scottish Office introduced a regulation that stated that every person over the age of 75 should be given an annual health check. I give credit to Susannah Stone, Jamie Stone's mother and a Tory stalwart, for her continued and consistent campaigning on that issue.
Hear, hear.
If all elderly patients had that annual health MOT, which was introduced by our own Lord James Douglas-Hamilton, problems could be assessed and diagnosed at an early stage to prevent further deterioration. Unfortunately, as ministers well know, that guideline is largely ignored.
I could not talk about care of the elderly without mentioning quality foot care. A third of chiropody patients have been removed from NHS care in the Highlands, and others have had their appointments cut. Investment in foot care brings enhanced mobility and independence, and ensures that elderly people can exercise through walking and are not isolated in their own homes. By the striking of chiropody patients off NHS lists, choice is reduced and patients are forced to go private, whether they are able to pay or not.
Will Mary Scanlon accept an intervention?
I shall take Mike Rumbles's intervention when I have finished this point.
For many, the choice will be no foot care, which will lead to higher long-term costs for the NHS and a lower quality of life for elderly people. Why has that come about? The ministers with responsibility for health constantly say that it is for local health boards to make those decisions, but when they brought forward the diabetes framework and made diabetic patients the priority for chiropody and podiatry they did not increase funding for chiropody services—the diabetic patients have effectively pushed the elderly patients off the list.
Please wind up now.
I apologise to Mike Rumbles. I cannot take his intervention as I am in the last minute of my speech, but I know that he is very supportive of good chiropody care.
My final point is that entitlement to free dental treatment means nothing in the Highlands, where one cannot find an NHS dentist. Elderly patients in the Highlands have to pay the full cost of dental care.
As David McLetchie stated in his opening speech, principles of fairness and equality are becoming a thing of the past. I support the motion.
I have been listening to what everybody has said, and there is certainly a lot that I agree with. I am in great favour of the NHS. I believe that the privatisation of anything, and going to private hospitals, should be for those who can afford it and who want to have operations in their own time. I shall use the short time available to me today to speak for the patients, the public and the people who send complaints to all MSPs. The one thing that they want to see is all of us working together. They do not like party-political infighting, or using the NHS as the football, as they put it.
There are lots of things that we could do in the NHS that would make the patient journey a lot safer and easier. I know fine well that, if I had a heart attack where I stay, I would be taken to the coronary care unit in Stobhill, where I would receive the very best of attention. However, if the changes go ahead and the casualty unit at Stobhill is closed, that will have a knock-on effect. The domino effect will mean that there will be a lack of anaesthetists, which will result in early closure for the hospital. The problem is the lack of capacity. If Glasgow is to be able to cope with patients from outside the city, it must be able to look after its own.
As we all know, we have an aging population and we have many undiagnosed diabetics out there. As with many other diseases, the incidence of autism and multiple sclerosis is increasing. We should make provision for that. I do not know whether members can imagine what it is like to have hip pain, knee pain or whatever, but a patient who is in pain does not want to consider anyone else. That is not because of selfishness but because the patient wants to be able to receive attention.
Other members have mentioned statistics, so let me quote from the letter that Glasgow's orthopaedic surgeons sent to the minister, a copy of which was sent to all Glasgow MSPs:
"We, the Orthopaedic Surgeons of North Glasgow, wish to appeal to you as the Minister of Health for Scotland regarding the failure of the official process of communication with the Greater Glasgow Health Board and the Trusts.
On numerous occasions we have unsuccessfully attempted to clarify grossly inaccurate data which has resulted in the Trusts/Health Board arriving at erroneous and invalid conclusions in terms of required future investment".
After describing how the surgeons will not be able to meet their deadlines, the letter states in its last sentence:
"We, therefore, believe the future provision of Orthopaedic Services to the North Glasgow population has been significantly compromised as a consequence of misrepresentation."
Nobody seems to listen either to the doctors or to the patients.
If somebody from a posh area has to wait 72 weeks for a first appointment and ordinary people are having to buy their hip operations without any recompense, we need to start looking for solutions. Malcolm Chisholm laughed at me when I told him that patients had to pay for parking at Edinburgh royal infirmary. He assured me that patients in Glasgow would not be charged. However, the closure of Stobhill will put a strain on other hospitals in Glasgow.
We should look to solutions. None of us in the chamber has a way forward because of the situation that we have allowed to develop. We have a working time directive, but we do not have enough people to cover the work. Patients in hospital do not see many qualified nurses or doctors because those seem to be scarce.
The way in which people are discharged could be changed quite easily. People come out of hospital because they are asked whether they want to go home, but they are not asked whether they have someone at home. We should check such things. When people leave hospital, they should be given a discharge letter along with their prescription. They should also know exactly when their next appointment is, because people are at their most vulnerable when they are a patient. That issue must be fixed, and it would not cost a lot of money to do so.
Treatment for chronic pain could be provided by spending only £250,000, given that Glasgow already has the necessary set-up, with trained doctors and a building. That would free up the appointments that are currently taken by patients who have to attend general practitioners' surgeries again and again. At the moment, if the GP is not competent to deal with a patient's chronic pain complaint, the patient must be sent to a specialist, who might still not be able to deal with it. A chronic pain clinic would be ideal and would not cost a lot of money. That would free up capacity because those patients would not need to attend other clinics.
Palliative care is another example, as is triage. Gosh, we need to do something about triage. One of my constituents was sent by his doctor to an accident and emergency department in Glasgow. The patient was given a letter and the doctor had telephoned the accident and emergency department, so it is unforgivable that the patient was told to sit in the waiting room for one and a half hours. He received treatment only when he was about to expire. We have a lot to learn.
There may be more nurses in our health service, but many of them are inexperienced. For example, people can go straight into midwifery without doing their general training first. Inexperienced people are being expected to take on a great deal of responsibility. That will lower morale and people will leave. Already, experienced nurses want to work for Asda rather than stay in the health service. The changes in Glasgow will mean that we will lose more staff and lose the confidence of patients.
On the private finance initiative, when I was examining at Hairmyres hospital, one doctor asked me whether I liked the new hospital. It might look lovely, he said, but it costs £1.8 million a month in rent. Is that the right way to spend our money? It has not been proved that PFI is effective. The information and statistics division figures that I gave to the Health Committee confirm that, as many members have said today, we are not spending money in the most cost-effective way. If we were a business, we would want a change in management.
I, for one, congratulate the Tories on having the brass neck to select health as their topic for debate. It seems a curious choice for the Tories during the campaign for elections to the European Parliament, but it is probably a bold one. As a member who has previously said that Opposition parties have a duty to provide alternative policies rather than just moan on, I ought perhaps to give Mr McLetchie some credit for at least attempting to justify his flagship proposal. The patient passport is probably one of the most unpopular policies that the Tories have dreamed up since Michael Howard introduced the poll tax. That is the view not only of members of this Parliament but of bodies such as the Royal College of Nurses, which overwhelmingly rejected the policy at its recent conference.
As others have pointed out, the patient passport policy would involve the NHS subsidising private treatment to the tune of 60 per cent of what any treatment would cost under the NHS. However, if one compares the BUPA costs for common operations with the equivalent NHS costs—Mr McLetchie was right to say that there is a list of NHS costs—it becomes clear that, on average, the BUPA costs are twice those of the NHS. That means that patients would still need to be able to afford to pick up some 70 per cent of the cost of the private operation. I cannot understand how that would help people in deprived areas, who would be unlikely to be able to afford those costs.
It would bring down queues.
It would not. That is an erroneous argument. Patient passports would simply remove funds from much-needed NHS operations in order to subsidise much more expensive private treatments for those who could afford to pay some of the costs. We must recognise that the operations would be performed by the same consultants. There is no mystery bank of consultants who could suddenly be parachuted in.
Will the member give way?
Not just now, thanks.
The Tory policy would not be an effective use of public money. It would certainly not contribute to equality of access in the way that Mr McLetchie suggested.
Among other polices, the Conservatives have also recently promoted local pay bargaining for health workers. Perhaps that should come as no surprise, given Mr McLetchie's derogatory comments about the poor productivity of such workers. In three very similar press releases this year, David Davidson has stated that, under the Tories,
"hospitals would have responsibility for their own staffing decisions"
and that hospitals would have
"the ability to set pay and conditions to suit local circumstances."
However, there are already discrepancies in the way that health boards grade equivalent jobs. I know that from the health board in my area, which grades some health workers lower than their counterparts in other boards. Mr Davidson's policy would exacerbate that problem by allowing health boards to pay health workers the minimum that they could get away with. Presumably, the savings that would be made from doing that would help to provide NHS subsidies for private treatment. That would produce not just a two-tier system but a multi-tier health system.
Another worrying aspect is the Tories' ill-disguised dislike of the NHS. In his press release of 15 March, Mr Davidson described the NHS as
"a state controlled monopoly—a nationalised health service".
Today, we have heard the NHS described as "Stalinist". Mr Davidson's colleague, Mr Monteith, has been similarly dismissive. In his press release of 25 February, he stated:
"Good health begins in the home."
Many of us would agree with that, but he went on:
"the overwhelming majority of Scots would rather get on with it themselves."
It does not sound to me as if the NHS is safe in the Tories' hands.
Perhaps the Tories in this Parliament should at least be given credit for understanding that health is devolved to the Scottish Parliament. That is more than their sole Scottish colleague at Westminster seems to understand. Mr Peter Duncan MP raised a petition about the lack of NHS dental provision in his constituency of Galloway and Upper Nithsdale. Many members of this Parliament share his concerns about that issue, which we have discussed fairly frequently. However, rather than pass the petition to his Scottish Parliament colleague Alex Fergusson for presentation to Scottish ministers, Mr Duncan trundled off to Westminster to present the petition to some health committee there.
Will the member give way?
Perhaps Mr Mundell wants to swap places with Mr Duncan.
As Dr Murray well knows, many aspects of the regulation of dentistry are reserved to Westminster. Perhaps if she understood the difference between reserved and devolved powers, the 1,500 people to whom she referred in her Holyrood magazine article would not have sat on their backsides and not voted in last year's election.
That convoluted argument does not take us any further forward. I cannot understand why the issue was raised at Westminster, which has no jurisdiction in the matters that were discussed in the petition.
I will finish with a statistic. Dumfries and Galloway NHS Board's allocation has increased by 63 per cent since 1997—those are the board's figures, not ours. Money is being invested. Like ministers, I recognise that reducing the long working hours of NHS staff is a significant challenge and that issues relating to the out-of-hours service must be addressed. However, they will be addressed by sensible policy. The alternative to what has been proposed was the haemorrhaging of GPs from rural areas such as Dumfries and Galloway, the consequence of which might have been a system in which there were not enough NHS doctors in those places, just as there are not enough NHS dentists. Lists would have closed and people would have been unable to access NHS services. We had to tackle the problem of long working hours in the NHS. I am sure that sensible policy decisions will help us to overcome some of the challenges that we face as a consequence of the actions that have had to be taken.
Over the past five years, I have noticed that in debates some members have a tendency to use exaggerated, excited and overheated comparisons—they have a tendency to hyperbole. This morning, the Tories did not disappoint us when they said that other parties' approach to the NHS was "Stalinist". It occurred to me, as a simple person, that the contrast between Stalin and the NHS is not difficult to grasp. Stalin carried out mass extermination and killed people, whereas the NHS is in the business of preventing death and saving people's lives.
Jean Turner made the point that making a political football of issues such as this turns the public off more than anything else. As someone who engages in the hurly-burly of political life, I think that it behoves us all to seek a positive solution. Just this week, a manager named Richard Carey helped one of my constituents by intervening to ensure that that patient, who has a brain tumour, no longer has to travel to Glasgow—a trip that he found extremely irksome and difficult because of his condition—but can receive pioneering treatment in Inverness. It is fashionable to knock health managers, but my extensive experience of dealing with them suggests that, in most cases, they go out of their way to make the NHS work in difficult circumstances.
My first substantial point relates to one of those difficult circumstances. How can health authorities run their budget when they do not know what that is—not only at the beginning of the year, but at the end of it? It has been the practice to give health authorities extra money at the end of the year. That money is not unwelcome—no one would throw it back in the face of the Minister for Health and Community Care, were he here. However, how can authorities plan and run their budget if they do not know what it is? The situation is absolutely extraordinary. I hope that the Health Committee's budget report to the Finance Committee will pick up that point.
I want to talk about the Belford hospital, as there is a cross-party consensus that the campaign to safeguard, continue, maintain and improve the consultant-led acute services at the Belford must have the support of all. However, the local health authority does not have the jurisdiction, competence or power to deal with some of the issues that need to be addressed there. Those include new methods of training, a different approach to recruitment and retention, a more flexible interpretation of the working time directive—I have seen Lothian NHS Board's second submission to the Audit Committee, which opens the door to many positive ideas in that area—and the recognition of a new specialty, that of the rural general surgeon. If we do not recognise such a specialty, I fear for the future of hospitals in rural areas. Members such as Duncan McNeil have highlighted that issue in the past. We have a common interest in retaining such services in Oban, Fort William and elsewhere in rural Scotland.
I turn to the speeches by SSP members. In its amendment, the SSP proposes
"that the pharmaceutical companies should be brought into public ownership".
I correct a remark that I made earlier to Carolyn Leckie and take the opportunity to set the record straight. I said that it would take the budget of the next two decades to buy out just two of the leading companies, GlaxoSmithKline and AstraZeneca, but I was wrong. Since then, I have calculated the figures. To buy out just those two companies would cost £115 billion. It would take only 14 years—there would be only 14 years when there would be no NHS whatever.
I will not call Fergus Ewing comrade, because he is no comrade of mine. I refer to pharmaceutical companies' profits. Last year's NHS prescription drugs bill was £733 million. In that year, the figure rose by more than 10 per cent—more than £70 million. If Fergus Ewing does not support the visionary policy of public ownership of pharmaceutical companies, what would he do about profiteering? I will tell him what he would do—he would reduce corporation tax to 13 per cent and give the companies even more profits.
I declare an interest—I have a small holding in GlaxoSmithKline. However, I do not object to the SSP's proposal because of the fact that if Carolyn Leckie were the Minister for Finance and Public Services I would receive no compensation for my shares—
The member does not need it.
Order.
The answer to Carolyn Leckie's point is perfectly simple. The SNP is calling for an inquiry by Audit Scotland into all these issues. Today's debate has illustrated why that inquiry—one aspect of which would be drugs procurement—is needed. Everyone recognises that drugs procurement is an important issue.
This debate has been characterised by arid exchanges of statistics. The weaponry has been percentages and the only casualties have been politicians. When the heat and smoke disperse from this poorly attended battlefield, we need to get down to serious, positive business. We need to examine the work of Matthew Dunnigan, who has provided us with a serious statistical analysis, and of the people who have attended meetings of the incipient cross-party group on the loss of consultant-led services, which I hope Jean Turner will convene when we meet again on 9 June. We must consider seriously the problems that have been identified today.
As Shona Robison said, the budget for the health service has risen massively. We acknowledge that fact and, I think, all members welcome it. There has been an increase of £800 million—the cost of two Holyrood buildings—in the period from 1998 to 2002-03. Where is the money going? Are we getting best value? Should we examine whether we can get better value and more patients treated for the money? If by amending the system to tackle some of the problems that we have heard about today we can treat more patients and help to care for more people who are ill, we will be doing our job. That is why the inquiry for which we are calling is essential.
I start by highlighting the last two clauses of the motion in the name of David McLetchie. Given that time is limited, I will express my opposition to those briefly.
The last thing that the NHS in Scotland needs is more reorganisation—certainly not fundamental changes. I agree absolutely with Nora Radcliffe on that point. As a former employee of the NHS, I have spoken in previous debates about the progressive erosion of morale among NHS staff that successive so-called reforms have caused. In particular, because there is no declared end point to the reforms, no one knows where they are heading. For that reason, I oppose the changes that Mr McLetchie proposes.
I believe firmly that foundation hospitals and private health care are not the way forward for Scotland and that we should concentrate on rebuilding the NHS after the disaster of the Thatcherite distortions of its ethos and purpose. Although I support some recent changes such as getting rid of trusts, I ask the minister to make that the last major organisational change for a long time.
I want to highlight a lasting effect of loss of morale on staffing. When I trained 30 years ago, becoming a nurse or doctor was about more than simply training for a profession; it became part of a person's identity. Now, being a nurse or doctor is a job like any other. People leave those jobs to seek new careers. Doctors in particular would often stay at work past retirement age; now, doctors in their 50s are talking about early retirement. I do not believe that the number of health professionals that we are training takes account of the fact that we get fewer working years out of each of them. Surely we need to think about the future and train more people.
With regard to the first clause of Mr McLetchie's motion, the point is that inflation in the NHS will inevitably be much higher than the general level of inflation, because new and more expensive technologies and treatments are continually being developed and people—not unreasonably—want to have access to them. As a result, it is a political decision as to whether we fund them for everyone. Inequality of access of health care is totally unacceptable.
I was interested in the member's comments about inflation in the NHS. Does she think that increases in public sector and NHS pay should necessarily be higher than the increases in pay being settled in the economy generally?
As in other parts of the public sector, the level of pay has to catch up in some areas of the health service. After all, with the possible exception of doctors, people in the service have traditionally never been well paid. That said, I should point out that pay is not everything; being valued for their work can mean more to people than the amount of pay that they receive. Part of the problem is that the erosion of the influence of professionals in the health service during the Thatcher years led people, especially nurses and doctors, to feel devalued and become demotivated.
Mr McLetchie's motion states that the "centrally-run system" is not delivering. The problem is that although decisions that have financial implications for health boards are made centrally, funding does not always follow. For example, boards have been told that it is Government policy to offer breast screening to older women. I have no problem with that, but it comes at a cost. Furthermore, as Christine Grahame pointed out, it is now Government policy to offer pregnant women a second scan before 20 weeks. It is worrying that some health boards have not introduced that measure.
Oddly enough, as the debate is about health issues, I wish to talk about health. The NHS delivers health care, not health. As well as meeting the objective of treating illness promptly and effectively—whoever or wherever the patients are—we must pursue the goal of health improvement. I am happy to see that the issue figures in the Executive's amendment.
It can be argued that the NHS will never fully be able to meet demand because, after all, people want the best possible treatment, not treatment that is simply good enough. Such a situation is in no way due to poor productivity, if such a concept can be applied to a national health service—and I stress the word "service". Improving the general standard of health is the only way in which we can improve matters and ensure that demand is reduced to the extent that everyone can at least receive treatment that is good enough promptly.
As I have said, the health service delivers health care, not health. Many other public bodies make decisions that have a major impact on health. For example, we have had parliamentary debates on obesity and children's lack of physical activity and the phrase "ticking time bomb" has been used accurately to describe the long-term health effects of the situation. However, we continue to plan and build communities in which there is no scope for children to be active or to play spontaneously and in which the danger from traffic means that they cannot walk to school. Although we know that Scotland has a high incidence of asthma and that a contributory factor is air pollution, we continue to build more roads and fail to tackle traffic congestion. Although we note the increase in stress-related illnesses, we should ask ourselves whether the lifestyle and ethos that we promote in a 21st century Scotland themselves lead to good mental health and a stress-free population. Although we bemoan the falling birth rate, there is good evidence that toxic chemicals in the environment are affecting the sperm count. Furthermore, although we are aware of the increase in type 2 diabetes cases and know that they will put a burden on the health service, we should realise that the condition is also strongly related to our lifestyle.
We will improve health and reduce demand on our overstretched NHS only if we mainstream health in all our decision making and if public bodies have to factor health into their decisions as they have to do with equal opportunities and human rights. I challenge the Executive to tell us how it will deal with this most cross cutting of all issues.
This morning, David McLetchie accused the Labour Party of doublespeak. However, we remember the Tories' silence on this very issue in each of the manifestos that they produced during their 18 years in government. That was not doublespeak; the public judged it to be plain deceit.
We remember how the Tories cut 25,000 nurses and brought in 12,000 more managers—
Will the member give way?
No, I have just started. Just hold your wheesht a minute.
The Tories have committed themselves to taking at least £1 billion out of the NHS to fund their proposals for a voucher subsidy for private health care. Under those plans, money would be taken from the NHS, which is for everyone, to allow the privileged few to jump the queue. Tim Yeo himself has admitted that the health voucher would incur a deadweight cost; in other words, NHS funding would be diverted to subsidise the privatisation of health care. That comes on top of the Tories' commitment to an immediate £18 billion cut in funding for public services, which would inevitably hit the Tories hard. That was a Freudian slip—I meant that it would hit the NHS hard, but I am sure that such a commitment will also hit the Tories hard.
The Tories must start telling the truth about what would be cut from the NHS to fund their health voucher proposals. For example, how many nurses would be lost? Which hospitals would be hit? What resources would be affected? They know that their vision of cuts, charges and privatisation in the NHS is not shared by NHS nurses. The more that nurses see of the Tories' plans, the more they realise that the NHS is not safe in Conservative hands.
It is clear that the Labour Party's evidenced progress in the NHS is at risk from the Conservative party's alternative track. The Tories' proposal for a patient passport would destroy the service. It is not only unfair but inefficient and, by forcing people to pay for their operation, would destroy the fundamental principle of the NHS of providing treatment that is free at the point of need and which is not based on one's ability to pay. Moreover, the measure would cost £1 billion without producing an extra operation or ensuring that an extra nurse or doctor was hired.
Instead of investing in and reforming the NHS, the Tories want to spend taxpayers' money on subsidising the rich few who already pay to go private to jump the queue at the expense of the rest of us. They are committed to making massive spending cuts in the NHS and making patients pay for their own health care. It is clear that they have given up on the values of the NHS.
Will the member give way?
Yes.
I thank her for doing so. I had held my wheesht for too long and needed to get in.
Is the member aware that the shadow Chancellor of the Exchequer has made it clear that he will at least match NHS spending? That means that, with the continuation of the Barnett formula, funding for the NHS in Scotland will increase in line with increases in the Scottish block.
It will be very interesting to see how the sums add up when £18 billion-worth of cuts are made to public services.
Those are the member's figures, not ours.
The statisticians in London have quoted those figures. It is a fact.
The Tories' so-called patient passport is no more than a one-way ticket to privatisation. It would destroy the NHS and force patients to buy private medical insurance to cover the costs of their own health service. I find their proposals unbelievable. During the Tory party's years in government, one of its ministers, Edwina Currie, even stated that she did not believe that services should be free. The Tories want to move Britain towards a health service in which the care that people receive depends on the health of their bank balance.
Although the Tories would set targets, such targets would include introducing a system of caring for profit, in which the highest bidder would perform operations and provide services; providing major tax concessions for private medical insurance; and selling off NHS hospitals to private health-for-profit companies—which would not be the not-for-profit companies that David McLetchie mentioned. They would also ensure that private management teams would be brought in to run NHS hospitals that could not be sold off; pay the private sector for the use of equipment by the NHS; subsidise the treatment of private patients in NHS hospitals; allow more private operators to run geriatric care for the NHS; allow private hospitals to use NHS staff and equipment free of charge; sell off NHS land and property; subsidise private patients through tax concessions; and even reward GPs for prescribing fewer or cheaper drugs and for sending people to hospital less often.
We need to remind ourselves of the Tories' record in government. They slashed the death grant, which was paid at that time to 600,000 households; they axed the maternity grant, which was claimed then by 500,000 mothers; they abolished help with heating for pensioners and the poor, which was available then to 2 million households; they slashed the state earnings-related pension scheme; they banned unions altogether at Government Communications Headquarters; and they privatised a range of national assets, including the naval dockyards—even Ronald Reagan's America rejected a similar proposal there—and by doing so, left the people of Fife with the legacy of one of the highest unemployment rates in Scotland.
How bad is all that for people's health? I never want a return to the Tories being in power—no thanks—and I do not believe that the people of Scotland want the Tories in power again.
Nowhere in Scotland has the Executive's failure been seen more vividly than it has in Glasgow and the surrounding areas and nowhere is the feeling of disillusionment greater than it is in Glasgow. The blunt truth is that although the Executive can fool some of the people some of the time by legitimately quoting the additional amounts that are being poured into the health service, more and more people are questioning why the service is not getting better and, indeed, is deteriorating in many respects. Some policy decisions may well cost lives; others lying in the minister's in-tray also have the potential to impinge radically on the survival chances of critically ill patients.
Let us look first at accident and emergency services and at what is being proposed for Glasgow. Nothing can be preserved in aspic and few would argue that Glasgow's accident and emergency provision at five locations is supportable. However, what cannot be accepted is that that number can be safely reduced to two. It is worth reminding members of precisely what is being proposed. Two hospitals, the Royal infirmary and the Southern general, are to provide Glasgow's accident and emergency service, which would result in patients, some of whom might be critically ill, having to be transferred considerable distances through urban traffic. Frankly, the Southern general solution is madness and has completely flown in the face of not only public opinion but considerable clinical opinion.
Can Bill Aitken explain the mechanism by which the Tories' patient passport scheme would ensure that the accident and emergency unit at Stobhill hospital would remain open?
The patient passport would not apply to accident and emergency services. If someone were run over by a bus, they would be taken to the closest hospital, so the patient passport would not be involved. I will press on.
Again, the Executive is in danger of making a tragically wrong decision with regard to the future of the Queen Mother's hospital. There are arguments against the retention of three maternity units and for a reduction in that number. However, to suggest that the one that should close should be the one that is on the same site as a major paediatric hospital almost beggars belief.
Will the member take an intervention?
No. I must move on.
Critically ill patients would have to be moved by ambulance to the Southern general instead of simply being transported along a corridor. What sort of convoluted thinking came up with that particular option? Again, public opinion has been ignored and, most important, the view of a considerable body of medical opinion has been disregarded. If the minister accepts the current proposals, the anger in Glasgow will be intense.
Furthermore, Glasgow homeopathic hospital, which has performed well over the years and provided patients with a real choice of alternative therapies, may well be closed to in-patients. The proposed saving appears to be minimal. However, the homeopathic hospital does not fall in with the conventional thinking that Big Brother in Edinburgh dictates. Cuts will no doubt have to be made, with a consequent loss to patient choice.
The overall position is the cause of greatest concern. The North Glasgow University Hospitals NHS Trust's figures demonstrate that with painful clarity. Comparing the figures for the first quarter of 2000 with those for the last quarter of 2003, we find that the number of out-patients who were seen went down by 18 per cent; the number of in-patient and day-case discharges went down by 3 per cent; the median wait for out-patients went up from 38 to 48 days; and the total number on the waiting list went up by 16 per cent.
The situation is even worse on the south side of the city. The number of in-patients who were seen is down by 18 per cent; the number of discharges is down by 4 per cent; the wait for out-patients is up from 62 to 81 days; the wait for in-patients has increased overall from 38 to 50 days; and the total number on waiting lists has increased by 36 per cent. All that has happened at a time when ministers could justifiably claim to have increased the resources in Glasgow by 34 per cent.
Of course, Glasgow is a city with appalling health problems. Lifestyles have an impact: Glasgow has 25,000 injecting drug abusers. However, the bizarre and almost Kafkaesque situation is that the only way in which one of those drug abusers can get immediate rehabilitation is by committing more and more crime and ending up being ordered to undergo rehabilitation by the drugs court. That that should be the case is, of course, nonsense.
Glasgow patients are surely entitled to a better service and Glasgow's taxpayers—who are paying more and more tax under the Labour Government—must surely be entitled to ask why so much extra money is having so little positive effect. The answer is, of course, the Executive's hidebound thinking from the 1950s and 1960s and the view that anything innovative must be frowned on. Any modern thinking is regarded as heresy and as being against the orthodoxies by which so many in the Executive would have Scotland's people live.
Frankly, Labour has regarded the people of Glasgow as voting fodder for too long. I have news for Labour: people are waking up fast to the realities and they will not put up with such cynical disregard for much longer. The Executive must bite the bullet and recognise that the NHS generally cannot continue along the lines on which it is going, with more and more money funding less and less activity and with plummeting patient satisfaction.
As David McLetchie said, other countries have recognised that change and radical thinking are necessary. Even south of the border, a much more progressive route is being followed. Scotland must look elsewhere and follow likewise.
It is a strange day when even Bill Aitken is trying to portray himself as a cuddly Conservative and to evoke a warm glow of nostalgia—not for the Tory years perhaps, because memories are too fresh about what he and his colleagues did then. I was particularly interested in his comments about injecting drug users because I remember what happened to them during the Tory years. There have been significant improvements in the quality of treatment for such people since we came to power.
Alongside John Major's evocative vision of the past of ladies riding to church on bicycles, warm beer and cricket, David Mundell gave us a vision of Tannochbrae, with doctors in every village, who were on call day and night. One could almost hear the couthy wisdom of Janet providing reassurance. However, compared with the mythic past that the Conservatives render so warmly, the reality is that the nature of the treatment that people were offered 20 or 30 years ago was fundamentally different from what people need and expect now.
The preferences of people in rural and urban communities for GP services and, indeed, acute services on their doorstep must be set against the changing nature of the health service, which has been transformed by the application of medical and scientific research, the growth of specialism and the development of new treatments. The rate of change, especially in the treatments that are now available to patients, is the biggest challenge that we face. However, the Conservatives and the other Opposition parties have said almost nothing about that.
I say to Bill Aitken and his colleagues that some of the statistics that they have read out are virtually meaningless unless they take into account what is being delivered and the nature of the treatments that are available. If we want a modern health service—I believe that we do—that makes effective use of the skills of NHS staff and provides the best outcomes for patients, we need a more honest debate about the real choices that must be made, which is not assisted by people simply arguing for the retention of every existing service or facility. We must talk about what can be delivered, how it can best be delivered and how we can manage it more effectively.
I agree with one thing that Bill Aitken said, which is that what has happened in Glasgow over the past 20 years is unsatisfactory. Glasgow has five unmodernised acute hospitals, when it should have a modernised service like that which exists in places such as Newcastle and Leeds. We need to have an honest debate about how we move from where we are now to where I believe that we want to be. That will not be facilitated by a dishonest debate but, unfortunately, too often health debates have been dishonest.
What I welcome about the Conservatives' approach to the debate is that they offer an alternative, albeit one that has been consistently rejected in Scotland. The vision that was put forward by David McLetchie hinges on the idea of choice, but the reality is that that choice would be available for only some people. There would be a subsidised choice for some, which would inevitably be associated with reduced access and worse services for others. People in Glasgow understand that very well. The vision that the Conservatives are putting forward would not mean better facilities for the people of Shettleston, Springburn or Maryhill: it would mean a return to disorganised services and more poorly funded services for people in those areas.
Who would be subsidised? Let us consider the arithmetic of the Conservative proposals. For those who can afford to pay, the Conservatives propose a voucher that covers 60 per cent of the NHS cost for a series of elective surgical treatments. People would get a voucher for £600 for cataract removal, which in the NHS costs £1,000, but BUPA's price for the operation is £2,400 so the patient would be left with a bill for £1,800 and £600 would have disappeared from the NHS. That is the arithmetic of the proposal. For hip replacement, the 60 per cent voucher would be worth £2,640.
Will the member give way?
Let me finish the arithmetic.
The NHS cost of a hip replacement operation is £4,400, but BUPA's price is £8,000, so the bill for the patient would be £5,000. People would be paying considerable amounts to jump the queue. The Tories have not told us about that and they refuse to tell us about it. The Tories' proposal would transfer resources to profit-making organisations or to supposed not-for-profit organisations such as BUPA, which in reality would feather somebody's nest. The Tories would do that on the back of our investment in training for doctors and nurses, equipment and buildings—all things that we have bought and paid for. The Tories want that investment to be used for profit; I believe that that is unacceptable.
There has to be an honest debate. We must open out the issues about how we modernise the health service and how we produce better management, improved efficiency and better outcomes for patients. That argument is not served by putting forward false choices—especially when the Tories' watchword is choice. That is fundamentally dishonest. The Tories' approach has been rejected time and again and I believe that it will continue to be rejected in Scotland.
I give my regrets to two members who had hoped to take part in the open debate, but I now have to go to closing speeches.
It is worth repeating that, unfortunately, only Jean Turner and I have referred to PFI in the debate, yet that is the biggest pressure on capacity in the NHS, although there are other pressures. I do not apologise for hammering home the point, because the subject has been absent from the debate when it should have been the headline topic.
Professor Alyson Pollock has shown that bed numbers at the new Edinburgh royal infirmary have been reduced by 24 per cent, but the projected increase in the number of day-care admissions, which was meant to offset that reduction, has not been achieved. A 21 per cent increase in the number of in-patient and day-care admissions to all acute specialties was projected, but in fact the increase reached only 0.3 per cent. The number of in-patient admissions to surgical specialties was projected to rise by 8 per cent but in fact fell by 13 per cent due to severe capacity constraints. The maternity unit lost 19 beds when the old ERI closed and the unit moved to the new PFI hospital, yet if planned downgradings and closures of maternity units go ahead, the ERI will be responsible for even more mothers who are experiencing difficult births.
Fourteen patients from the ERI were sent 140 miles away to a private hospital in Darlington for hip operations because of bed shortages and Lothian NHS Board's need to meet national waiting time targets. Bed shortages at the ERI have also led to operations being cancelled and patients from the Lothians being sent to the Borders and to the national hospital in Clydebank.
A ward for the elderly that has 22 beds was not opened for seven months in an attempt to save money to pay for the PFI deal. As a result, bedblocking by elderly patients increased, operations had to be cancelled and patients had to be sent to other hospitals for treatment.
Surgeons at the ERI are being paid £2,400 a day to carry out operations at the weekend in an attempt to cut waiting times. That is a direct result of capacity constraints.
The ERI has its patients' meals transported 400 miles from Wales. The firm involved in supplying the meals is owned by Sodexho and was exposed in a Channel 4 "Dispatches" documentary as being guilty of 120 hygiene lapses in a week. It is not surprising that Sodexho tried to have the documentary suppressed.
Lothian NHS Board is currently running a £95 million deficit. What more cuts to hospital and community services will be required to allow the board to pay off its debt to the PFI company?
Balfour Beatty, which I said earlier was singing and dancing, announced profits of 18 per cent from its PFI projects, compared with the profits of 3 to 4 per cent that it would have got from its traditional engineering projects. The public have paid for the increased profits. When anyone asks where the money has gone, let us look at the PFI consortia as the first culprits at the top of the list.
I will come back to the pharmaceutical companies, because Fergus Ewing let the cat out of the bag. I would like to know how much he and perhaps others have pocketed as the NHS drugs bill has rocketed. I will fill members in on the issue. The NHS is currently suing seven large drug companies—perhaps including one of those in which Fergus Ewing has an interest—for £30 million, which is the amount that the NHS alleges that it has lost because of companies' fixing the price of amoxicillin, which is one of Britain's most common antibiotics. That claim follows another for £28 million against six drug companies for fixing the price of warfarin.
Are the profits that are available for the pharmaceutical companies and the PFI consortia not brilliant? Is it not interesting that those topics have not been debated in the Parliament today by anybody other than the SSP and have been mentioned only by Jean Turner? Those are the topics on which none of the members wants to tread, because the truth is that whether they are a Tory in the Conservative party, a Tory in the Labour Party, or a Tory in the SNP, they want to perpetuate the status quo and increase the private profits and opportunities for all those companies. They want to reduce corporation tax to 13 per cent and they have offered nothing to address the parasitic profiteering of those companies. Members have ignored it all—shame on them, because the debate was an opportunity to grapple with the real issues.
Why are members silent on PFI? I could not believe that Fergus Ewing, as a member of the Finance Committee, did not mention PFI.
Will the member give way?
I am sorry, but I am in my last minute.
The SSP does not apologise for being the party of public ownership, as Fergus Ewing acknowledged this morning. We are a party of vision that undoubtedly stands out from the other parties in the Parliament. [Laughter.] Members may laugh; that is fine—I can take laughter. We are a party of vision and we make no apology for our ambitions to have a socialist Scotland that puts public need before corporate greed.
The debate has centred around the fundamental question of what extra output the NHS in Scotland is providing to patients in return for the substantial increase in funding from the taxpayer. That is a legitimate question to ask, and one that I regularly hear being asked by constituents and the people who work in the NHS. Where has the money been spent? What are we getting in return for it? Where are the improvements in the service? Those people support the injection of extra investment into the NHS but, in return, they expect extra operations, shorter waiting times, better treatment, greater output, more capacity in the system and safer procedures. I do not think that anyone would demur from those expectations.
It is unfortunate that the reality at the moment is somewhat different. According to evidence that has been presented to the Audit Committee, the bulk of the extra money is being spent on rising prescribing costs and the pay modernisation costs that relate to GP contracts, junior doctors' hours, consultant contracts, the agenda for change and the European working time directive. A side issue, which I would have dealt with more fully if I had had more time, is the fact that those contracts and agreements are driving the centralisation of the health service, which is opposed, by and large, by the majority of patients in urban and rural Scotland.
It is clear from the evidence to the Audit Committee that the Scottish Executive Health Department seems to have no firm idea of how much the contracts will cost when they are eventually implemented—a fact that was highlighted by the Auditor General in his report, "Overview of the National Health Service in Scotland 2002-03". The committee heard about an example of that when it took evidence from NHS Lothian, which in 2003-04 set aside £2.9 million—an 8 per cent increase—for consultants' contracts. By the time that discussions on the contracts had concluded, the figure had risen to £8 million. A health warning will remain attached to that figure until the job sizing has been done and a work programme for the consultants has been worked out. As the Auditor General made clear, the problem with junior doctors' hours is the same—we do not have any fixed costs for the total increase that will result from the agreement.
Even more worrying was the admission by Professor Barbour of NHS Lothian that, in spite of the record increase in spending, activity levels in the NHS are declining. The Wanless report backs that up. Today, numerous references have been made to the concern that activity in our health service is declining, in spite of record investment.
According to the evidence that the Audit Committee has received, although the Scottish Executive is investing record sums of money in the NHS, the bulk of that money is being swallowed up by pay modernisation costs, of which the most significant is probably the 30 per cent increase in pay to consultants, and increased prescribing costs. At the same time, activity levels appear to be declining.
It is interesting that the SNP amendment calls on the Auditor General to carry out an in-depth study of the NHS. The Auditor General is about to publish an in-depth examination—a performance audit—of the NHS and, for the past seven weeks, the Audit Committee has been taking evidence in an effort to drill down to find out where the money is going. The SNP should perhaps be made more aware of what is going on.
During our informal discussions with Audit Scotland, we have talked to it about its investigation of the NHS. At the end of that process, Audit Scotland is likely to recommend that a far more in-depth study be conducted, to investigate all the concerns about the NHS. That is why we are calling for such an inquiry. Does the member acknowledge that that is what is required, as opposed to the current overview?
Given that the bulk of the money is being spent on the new pay agreements, which are only just being implemented, I do not understand how the Auditor General could conduct an in-depth review. We need time to find out what the results of that implementation will be.
As the minister outlined, progress has been made in a large number of areas, including quality and safety. We must acknowledge that; that is the balance in the argument. However, the evidence that the Audit Committee has taken is surely a cause for deep concern among all members of the Parliament who believe in the NHS. As Professor Barbour said in his evidence, it is clear that the real challenge is to translate the new contracts into improved productivity and better patient care. That is the agenda and it is important that it is delivered on.
I want ministers to explain how they will ensure that the pay modernisation agenda delivers greater productivity, flexibility and output for patients in Scotland; that is fundamental if the expectations of the general public in Scotland of a better NHS are to be met. I am sure that that agenda is supported by all the parties except one. Failure to support those aims will play right into the Tory party's agenda. Liam Fox has made it clear that the Tory strategy is first to destroy and undermine the credibility of the NHS, then to privatise.
The Tories argue that choice, delivered through their passport system, is the key to health heaven. For the well-off few who currently go private, the Tory proposals are the passport to heaven; for the rest of Scots, the passport is to hell. The flaw in the proposals is that the sums do not add up. Oliver Letwin would cap the NHS budget in line with the current Labour spending plans at Westminster and no extra money would be found to fund passports. The subsidy for private patients would be drained out of the current NHS budget, leading to cuts in service, longer waiting times and a second-class health system for the majority of Scots. As Peter Riddell said in The Times recently, the Tories' proposals simply do not add up and they know it. I urge members to reject the Tory motion.
Too much of today's debate has been a flight from reality, but at least it is on the record that the representatives of the Fourth International are for public confiscation rather than public ownership. There is more in the SSP amendment, which demands that contracting from private providers be stopped. So we will have NHS brickies, NHS equipment designers and builders and NHS farms on which to grow food. [Interruption.] I am so glad that I was awake when I was listening to the Trots sitting behind me.
However, numbers are not something that the Trots are terribly good at. They would spend 157 years' worth of the Scottish health service's drugs expenditure to nationalise two companies alone. Is that a return on investment that anyone in the chamber would be comfortable with? No, of course it is not.
Let us return to principles. The 1942 Beveridge report, which was entitled "The Way to Freedom from Want", stated that the aim was to abolish want, squalor, ignorance, idleness and disease. I believe that the greatest of those aims was to achieve freedom from disease. Beveridge wrote:
"Proposals for the future … should use to the full experience gathered in the past, not restricted by consideration of sectional interests."
He also wrote:
"The state should offer security for service and contribution"
but not
"stifle incentive, opportunity and responsibility."
A Gallup poll from 1943 shows that an overwhelming majority of the public endorsed a proposal to include everyone in a comprehensive scheme of medical services. That remains as true today as it was 61 years ago.
Vested interests that run against the grain of public opinion have to be confronted today as they were before the NHS started on 5 July 1948—not 1947, I point out to Mike Rumbles. On 19 February 1948, a BMA press release showed that 40,814 medical practitioners disapproved of the National Health Service Act 1946 and that a mere 4,900 of them—or just over 10 per cent—approved. The figure in Scotland was slightly higher at 12 per cent in favour. The objectors were largely, but not totally, faced down before the health service started.
The question is, what should the NHS credo be today? I make three suggestions. First, access to health care should be based solely on need. Secondly, there must be respect for the public service ideal and the contribution that public service makes to wider society. The third ideal should be value for money.
I will test the Tory plans against those ideals. The Tories want preferential access for those who can afford to pay; the passport needs to be topped up, so its operation would be denied to those who could not afford to top it up. The result would be a move away from access by health need towards access based on greed.
Respect for the public service ideal is not in great supply on the Tory benches. The Tories must accept that the private sector does not have a monopoly on succeeding and that failure is not the sole prerogative of the public service. For example, Capita Group plc and a number of its public service contracts can be considered. There is a history of failure and hardly a success in a contract in which it has been involved. One benefit of PFI—the only benefit that I have found so far—is that it shows that private companies can and do fail when they try to deliver public services.
On value for money, a number of members have referred to expensive operations. NHS surgeons moonlight at weekends and in the evenings—
Will the member give way?
No—I do not have enough time.
Often, NHS hospitals charge more for operations simply to provide people who have money with early access to a system in which access should be provided on the basis of health, not on anything else.
The Tory motion refers to international examples. The most recent edition of The Economist examines the French health service, which is largely privately provided and largely publicly funded. The service is excellent, but it is not delivering value for money and is probably heading for bankruptcy very soon. David McLetchie should read page 40 of The Economist—he will see what I mean.
Almost every member supports choice for all, rather than merely for the few. I have a challenge for the Tories, whose motion mentions supporting and developing the private sector. Which hospital in Glasgow would they close in order to develop the private sector to replace what is provided by the public sector in Glasgow?
Will the member give way?
I do not have enough time. I am sorry.
We should not let Labour escape. In 1969, the Socialist Medical Association provided a report to Richard Crossman, who was a secretary of state, which focused on the long hours and poor pay of junior hospital doctors. That was many years ago and the argument has hardly moved an inch. Hospital services and young doctors are overworked and underpaid.
The health service is a great ideal. By all means, the service needs to be revisited and refurbished, but the ideals continue as they did before. I am happy to support the amendment in my colleague's name.
We have discussed important and complicated issues, and have again seen the rise of Mr McLetchie as the master of the understatement. He said that the NHS that was inherited from the Tories was far from perfect. We can all sign up to that. In 1997, the people of Scotland signed up to that by refusing to return any Tory MPs.
Perhaps it is tempting for Opposition parties to reach quick conclusions that are based on selected numbers, but it is wrong for them to do so. A more objective analysis is the key to understanding the issues. Without such analysis, policies and priorities will not deliver the outcomes that we and the people of Scotland want. The wrong policies will, as has happened previously—Mr McLetchie gleefully acknowledged that—end up damaging the very service that we are trying to develop and support. Our aim is to develop policies and approaches in close consultation with patients and the NHS, and then to support the NHS in delivering them. Linking policy making and delivery is central to the way in which the Executive does business.
That approach is very different from the repackaged Tory dogma of undermining and selling off our precious NHS. This morning, the for-sale sign has again been held high. The price tag is covered up, but the sign says, "To the lowest bidder". The Tories want to keep that quiet. When Tories cry over the NHS, the people of Scotland know that they cry crocodile tears. The Tories scramble for an angle to continue their 18 years of contempt and they have decided that the approach should be to blame dedicated professionals in the NHS. They have learned nothing. That approach is as scandalous today as it was during those terrible 18 years.
The Executive is clear that clinical quality and safety are vital for everyone who is interested in health care, including patients and staff. Patients who face surgery or who have recently undergone emergency care will tell members their priorities. It is simply wrong to think that quality can be left to look after itself. Policy must reflect the central importance of quality and safety. That means care in the NHS, not passported out to whoever wants to pick it up. Of course the Executive itself cannot deliver quality and safety in health care, but what we can do, and are doing, is to support the national health service in advancing the quality and safety agenda—in other words, to support delivery. That is why we are clear that NHS boards should comply with measures on doctors' working hours and why we are supporting and strengthening NHS Quality Improvement Scotland.
To progress that delivery, NHS Quality Improvement Scotland is supporting NHS boards in achieving clinical standards through peer review and sharing good practice. Those standards cover cancer care, heart disease, mental health and a growing list of other health-care activities. They also address issues that are close to every NHS patient, such as food and nutrition, hospital cleaning standards and infection control. Maintaining and improving quality is relevant to everyone and the NHS is responding positively.
We have taken a clear policy lead on redesigning services and bringing care nearer to the patient. The Executive has supported managed clinical networks through pump-priming funding. We introduced the National Health Service Reform (Scotland) Bill to establish community health partnerships and we have given nurses a bigger role in prescribing drugs for patients to facilitate and encourage treatment in the community and at home.
What does that mean in practice? In Fife, nurses have been trained to undertake out-patient endoscopic examinations and to take over appropriate cases from consultants. In turn, the number of complex cases that consultants can treat has increased by 70 per cent. As a result, overall waiting times for endoscopies in Fife are down from 16 weeks to about eight weeks. Further training for nurses is planned. That is good for patients and for the NHS.
Treatment for deep vein thrombosis typically requires a five-day stay in hospital but, in Ayrshire, new drugs, new ways of working and new training for nurses mean that nurses can set up and monitor treatment and that patients can be cared for largely at home. Average hospital stays are down to a few hours. That is good for patients and the NHS and provides a good example of how the figures that the Conservatives have quoted this morning are a complete distortion of what is happening in our modern health service in Scotland.
We have introduced condition-specific waiting-time targets when they are justified clinically. In line with the Executive's targets, the NHS has made especially good progress in reducing maximum waits for heart surgery and revascularisation.
We are leading a critical health improvement agenda that will improve the health and success of every Scot. That agenda will improve life journeys and create a genuine health service, rather than what people too often call a sick service. In the debate, politicians have called for honesty, yet they refuse to acknowledge that less need to present is a success. We in Scotland need to aim to have a population that are more aware of their life choices and of their ability to turn off the tap of ill health that leads to the health service. That will allow the health service to focus on creating the conditions that will be necessary for generations to come.
Our policies are modernising the health service and revolutionising the way in which that service is delivered. Day in, day out, people are benefiting from that. The days are gone when every treatment had to be provided in an acute hospital. Thousands more procedures are now carried out in the primary care sector, and thousands more treatments can be carried out by the whole practice team rather than just by the GPs. Those teams offer support and services to patients.
Those are the changes that are making a difference to the health service, and those are the changes that the Conservatives simply cannot acknowledge. To do so would defeat their arguments and expose the way in which they wish to undermine the service. Almost every word that has been spoken by the Tories has been about undermining confidence in our most precious national asset. People in Scotland have seen through that before and they will see through it again.
We have just heard Tom McCabe talking about undermining confidence in the health service, but the two people who are most guilty of doing that are the two people on the Executive front bench.
Today we have seen clear blue water between the radical thinking of the Conservatives, who put the patient first and at the centre, and the thinking of socialists all round the chamber—including among the Liberal Democrats to my left—who put the system and the unions first. People in Europe are staggered that we have such debates. They are used to a mixed economy in health, with delivery from the voluntary sector, the independent sector and the state sector. Those sectors work hand in hand. That was supposed to be the ethos of the health service when the original National Health Service Act was passed in 1946 and the service began in 1948. However, we do not see it in action. Why is it so bad to offer patients choice here when patients have choice all over Europe and in America? Patients are even getting choice down in England. The NHS should be a national service, not a nationalised service with the system at the centre.
Will the member take an intervention?
Not yet.
We want to talk about access to care and we want to talk about hospital closures—as many Labour back benchers regularly do. We want to talk about the problems of centralisation. Who drove that agenda? The Scottish Executive—Labour backed by the Liberal Democrats.
One or two quite good comments have been made about the shortage of capacity in the health service. Labour has been in power for seven years, going on eight, and I do not see the party grasping the nettle on that issue. Labour has come along today to say, "Can we have a wee bit more time? Honest, it's getting better." That is not what the Scottish public think.
Will the member take an intervention now?
Not yet.
From the Labour ranks of three or four, we have heard a defensive response, which was about fear. The Executive has not delivered the results that it claims for taxpayers' money. It has introduced lots of initiatives and there has been lots of fine print and detail. Tom McCabe read his speech pretty well—the detail was all there, but there was no answer to any of the questions that we have asked. I suspect that Labour and the Liberal Democrats are ashamed and frightened that they have been found out.
Can the member confirm that some 20 per cent of the poorest people in the States have no meaningful access to health care? Is he able to confirm that nearly 10 per cent of people in the States are more than 100 miles from their nearest source of primary health care?
I am happy to discuss examples of best practice, but we have certainly not seen such examples from the Executive today.
Mr Chisholm gave a rather limp response at the beginning of the debate when he talked about programmes and then quoted statistics. All the statistics that we have used today came from the Scottish Executive. Tom McCabe has said that we are telling lies, but we are using the minister's statistics. We had about 10 minutes of Mr Chisholm quoting statistics and saying that this was up, that was up; that this was better and that was better. However, he did not say what he was comparing his figures with. He did not give the figures for one date and then for another, and explain the difference. When we fail to make a proper comparison, we are called nasty; when the Executive makes a proper comparison, it will be interesting.
The point is that we are talking about new activity. The figures are being counted for the first time. I was making a simple point on an issue that the Conservative motion missed.
In that case, the Executive does not really know where it is at.
Most of what George Lyon said in his winding-up speech was sensible and reasonable. He asked, correctly, where all the money had gone. Has it gone on new initiatives and contracts that are uncosted? We know that Grampian NHS Board is approximately £4 million to £5 million short of being able to deliver out-of-hours medical cover. That is just one health board—God knows what will happen with regard to the consultants' contracts. Changes to junior doctors' hours were known about seven or eight years ago, yet the Executive has done nothing to address that issue in the past five years.
Having asked where the money had gone, I used the evidence that had been presented to the Audit Committee to say where it had gone. The question that Mr Davidson must answer is: where will the money come from to fund the passports? Oliver Letwin has said that he would cap spending in the same way as the Labour chancellor has done, which means that the money must come out of the current budget. That means that there will be cuts in service. Where will those cuts be made?
Mr Lyon was clearly not listening. If a treatment can be provided for 40 per cent of the cost that the NHS would otherwise have to pay, freeing up bed space and leaving hospital staff available to carry out other work, that is a benefit to the NHS and to those who come from deprived communities.
In the health service, we have a monolithic monster that is managed by the minister, not by those on the front line. When the ministers talk about us putting down the staff, they are really saying, "It's not our fault, guv, it's those folk out there. We've given them the money." However, all that the Executive has done is to give the staff loads of interference, initiatives to do, boxes to tick and so on. That is not patient care. Why will the Executive not trust the medical staff and the good managers in the health service to design their services locally? Why can we not get away from national pay bargaining when some areas simply cannot attract the key staff?
Once again, David Davidson is saying the exact opposite of the truth. It is obvious that he is distorting what I said about staff. I praised staff for what they are doing.
We want to give more decision-making powers to front-line staff. Part of my answer to Christine Grahame should have been that the £25 million that she complained I did not have control of is controlled by the front-line cancer clinicians. They decide their priorities. That is the approach that we support.
Will that approach be applied across the health service, rather than only to the cancer services? That is the important point.
I thank the SNP for its support for our position in the first part of our amendment. I am glad that we agree that we do not have productivity in the NHS. However, once again, the SNP has offered no solutions. SNP members seem to live in a policy-free zone. During the passage of the National Health Service Reform (Scotland) Bill, the SNP's minor amendments amounted to a statement that it would swallow whatever the Labour Party wanted to dish out without coming up with any policies. Will there be a day when the SNP will come up with some policies? The people of Scotland are beginning to worry that it has none to offer.
We heard about the SSP's new policy of legalised state theft. If that is the prime part of Tommy Sheridan's future Scotland, I say, "Wow!"
We learned about that from Mrs Thatcher's theft of rail, gas—
Mr Sheridan should be careful—the NHS cannot afford a new throat for him.
Mr Rumbles talked about the Liberal Democrats' support for the private sector. He would support the private sector, as his wife delivers private chiropody care. That is perfectly good, of course. Private chiropody care is a good model.
On a point of order, Presiding Officer. Is it appropriate for one member to bring into the debate the activities of the spouse of another member?
I cannot honestly say that there is anything in the Parliament's standing orders about that. However, I would not have thought that such a matter would be a reasonable point to make in a fair debate.
Mr Davidson, you can criticise Mr Rumbles, but not his wife.
I am happy to criticise Mr Rumbles, but I was not criticising his wife. I acknowledge the fact that she provides a good service in the community.
Apologise.
I do not wish to bring Mr Rumbles's wife into any political discussion. If she feels offended by my mention of her, I apologise to her.
Mr Rumbles talks about not using NHS money to subsidise folk who can well afford to pay for their treatment. In that case, why is the Liberal Democrats' policy on free eye and dental checks, which has been accepted by the Labour Party, being implemented when the professionals concerned are quite simply not interested in it?
Helen Eadie and Christine Grahame, among other members, eventually started to wobble around the issue of value for money in the health service. The fact of the matter is that many of the inefficiencies in the health service are delivered because of the Executive's policy in that respect.
David Mundell raised important issues on out-of-hours treatment; the battling boilermaker, Duncan McNeil, came up with some good points about the European working time directive; and Pauline McNeill talked about costs and overtime. Did the minister consider those areas when implementation of the directive was rushed through?
In today's debate, the Labour Party has quite simply run: it has brought out people to yell and scream. I thank Elaine Murray for being so kind as to highlight our policies clearly, but we do that quite consistently. We are not ashamed to put the patient at the centre or to give patients choice. A constituent of mine had to be treated privately at a time when she had no insurance or money but needed to have a mammogram. She had been told that the wait in her local health board area would be two months. My constituent and her husband put their money together to go privately. Why should people like that not get the benefit of the patient passport?
I support the Conservative motion.