Patient Care
The next item of business is a debate on motion S4M-04161, in the name of Jackie Baillie, on patient care.
I remind members who wish to speak in the debate to line up their microphones, because they are directional microphones.
15:52
There are undoubtedly real and pressing challenges in our national health service, which are starting to have a significant impact on patient care and patient safety. I make it clear at the outset that the work that our NHS staff do is exceptional. Whether they are doctors, nurses, our Scottish Ambulance Service staff, our technicians who work behind the scenes or our porters and cleaners, we are grateful to the entire NHS family. It is our responsibility to ensure that they are adequately resourced to do their job. We are joined in the public gallery by paramedics, by Ambulance Service staff and by Mick Conroy and Harry Donaldson from the GMB, all of whom I welcome.
Last week, the Scottish National Party rearranged the deckchairs with its ministerial reshuffle, which moved the Deputy First Minister away from health at a time of crisis for the NHS. I say with all due respect to Alex Neil that she is probably the SNP’s most talented minister. Her move to run the referendum campaign shows the SNP Government’s real priorities. Separation is its first, last and only priority.
The faces can be changed, but the feel and substance remain the same. The SNP is out of touch with people’s concerns and is putting the NHS in Scotland on pause as it obsesses about the constitution. What is required is not new faces but a new focus, new ideas and a new direction.
However, I welcome the Cabinet Secretary for Health and Wellbeing’s announcement about the sick kids hospital in Edinburgh, although it is of course five years later than promised and it does nothing to tackle the £130 million repairs backlog or the £1 billion backlog across Scotland. The hospital estate is crumbling on the SNP’s watch.
One thing is clear. The cabinet secretary needs to get a grip on his brief quickly, because while we are on pause, patient care continues to suffer, waiting times at accident and emergency departments continue to lengthen, nurses are losing their jobs and ambulance staff are expressing concern about patient safety.
If I was to construct a charge list for Alex Neil to tackle, here is what it would say: the NHS has fewer staff than at any time since 2007; the SNP is presiding over cuts of more than 5,500 staff, almost 2,500 of whom are nurses and midwives; and nursing and midwifery numbers are at a seven-year low. We cannot strip so many people out of the NHS without there being an impact on patient care.
Despite promises to protect the health budget, the SNP is cutting it by £319 million in real terms. That is a fact. Add to that the fact that inflation in the health service runs higher and the fact that prescribing budgets are already overspent at this point in the year, and it is clear that there is real downward pressure on the budget.
Patients are going without basic provisions, such as blankets—shame on the SNP and the First Minister that it took two of my constituents coming to the Parliament for them to recognise the problem and take action. Hospital inspections have thrown up some examples recently. In one case, at Glasgow royal infirmary, there was only one working shower—with no shower curtain—shared between 15 patients; in another, an elderly man was found sitting naked on his bed, in his own urine and with no screens around him, during visiting hours. Where is the patient care and dignity in that, cabinet secretary?
Patients themselves say that wards are understaffed and that patients are being moved around the hospital. Senior NHS managers—for goodness sake—have been fiddling the waiting list figures to meet targets, and as a consequence, patients have gone without the treatment that they needed and deserved.
In the cabinet secretary’s own backyard, NHS Lanarkshire has experienced huge and substantial difficulty in recruiting junior doctors, which has created problems at Monklands hospital, at Wishaw general hospital, in neonatal care and in general medicine. The problem has led to delays in assessing patients and reduced outpatient activity and has affected cover for patients who were booked in for elective procedures. The cabinet secretary cannot tell me that there is no impact on patient safety and patient care.
Local health services are increasingly under threat and closing, despite the SNP’s promises. The mental health ward at the Vale of Leven hospital has closed. The children’s ward at St John’s hospital shut for the summer. The maternity unit at Inverclyde royal hospital is threatened with closure. There are plans to close the children’s ward at the Royal Alexandra hospital in Paisley. The winds of change are coming. Health boards are having to reorganise services because they cannot run them on the current level of resources. Where in there is the concern for patient care?
Complaints about NHS Scotland are at a record high, but what do we expect, when the SNP cuts staffing, cuts nurses and cuts support to our hospitals? We cannot keep expecting the NHS to do more and more on less and less.
Ms Baillie must recognise that there are more nurses and midwives now than there were in nine out of 10 years when Labour was in government. Is that a fact, Ms Baillie?
I am afraid that that is nonsense. The Royal College of Nursing says that the number of nurses and midwives has reduced by 2,500. It is at a seven-year low. Is the member saying that the RCN is not telling the truth? I am shocked, frankly.
Four years ago, Nicola Sturgeon promised that ambulances would be crewed by two staff, including a paramedic, in all but exceptional circumstances. However, single crewing is back, and in many cases it is almost routine. One paramedic told me that on Sunday and Monday mornings the relief shift is routinely single manned, because the staff who are coming off duty cannot safely go out again. That is not an isolated incident; there is evidence of single manning in Helensburgh, in Wick, in Dumfries, and in Glasgow—right across Scotland.
Ambulance shifts are being dropped entirely in St Andrews, Kirkcaldy, Glasgow, Paisley, Greenock, the Vale of Leven—virtually every part of Scotland. So that there is no doubt about that and so that members can appreciate the scale of the problem, let me give the numbers for the Vale of Leven. In the space of roughly a month from June, 29 shifts were dropped, six of which were urgent tier shifts, and a further 22 shifts were dropped last month. A whole paramedic response unit has been dropped for this entire week. The patient care of my constituents is not the priority. On a number of occasions, there have been two vehicles instead of three on the night shift. In Kirkintilloch, there was only one ambulance on over an entire weekend in August to cover an enormous geographical area. In addition, the use of private ambulances seems to be on the increase under the SNP.
The skills mix is being changed so that drivers—who do a valuable job—are replacing technicians. Drivers are even replacing paramedics in emergency vehicles. Patient care will suffer if skills are confused in that way. One paramedic said:
“The management are playing Russian roulette with people’s lives. Over the past few months there have been numerous instances where ambulances have been single crewed. Core shifts have been dropped to save money.”
Will the member give way?
In a second.
Another paramedic described being alone with a child with a head injury and being unable to transport him to hospital because they were waiting for a back-up vehicle.
What about the additional staff that the Government promised? I understand that a number of people who failed their exams are out in ambulances in an attempt to teach them the necessary skills. There is nothing wrong with that, as people learn in real-life situations, but the Ambulance Service counting those unqualified staff in the numbers is wrong. In one case, a student who was not yet qualified was the only person manning the entire station at Girvan. There were no paramedics or technicians—there was not even a driver. It is clear that patient care in the Ambulance Service is being sacrificed on the altar of cost cutting.
Margo MacDonald rose—
I am terribly sorry, but I cannot give way to Margo MacDonald, as I have very little time.
The picture is extremely worrying. The NHS is struggling—there is no doubt in my mind about that—and, despite the valiant efforts of dedicated staff, that is having a negative impact on patient care. The SNP simply pretends that that is not happening, and that is not good enough
Tomorrow, when the budget for the coming year is revealed, the cabinet secretary will have an opportunity to put his money where his mouth is. Concern for patient care and safety must be at the top of the agenda, or the people of Scotland will judge him and the SNP and find them to be wanting.
I move,
That the Parliament believes that the Scottish Government’s budget decisions are impacting negatively on patient care; notes with concern that the number of nurses and midwives is at its lowest since 2005, an assessment that is shared by the Royal College of Nursing; further notes with concern warnings from unions that cutbacks in the Scottish Ambulance Service are leading to ambulance staff attending emergency calls on their own and shifts not being covered; notes reports of patients going without basic provisions, such as blankets, and inspections that reveal significant failures in patient care; praises the hard work of NHS staff across Scotland, and calls on the newly-appointed Cabinet Secretary for Health and Wellbeing to support the efforts of NHS staff by making a clear commitment to prioritise patient care ahead of the campaign to separate Scotland from the rest of the UK.
16:03
It is often the case that facts do not feature heavily in Labour Party contributions in its health debates. No one should be in any doubt about the Government’s commitment to our NHS. It is worth keeping it in mind that the NHS belongs to no Government or political party; it belongs to the people of Scotland, and we as its custodians must ensure that we do the right thing to ensure that we have an NHS that serves the best interests of the people of Scotland.
I have no doubt that all members recognise the significant challenges that our public services in Scotland face as a result of the cuts that the UK Government is introducing, which have a direct impact on services such as our NHS in Scotland. The mark of a Government is how it responds to that type of challenge. Alistair Darling told us that the cuts would be tougher and deeper than Margaret Thatcher’s, and they have proven to be that. How did we—an SNP Government—respond to them? We decided to protect the NHS budget. In making that decision, we decided on a record £11.6 billion of resources for health in Scotland in 2014-15. That is £826 million more than the 2011-12 budget.
Despite the difficult economic circumstances and the challenge that they place on capital spend, over three years there will be £1.5 billion of capital investment into our NHS, securing the delivery of major projects such as a new south Glasgow hospital, the Edinburgh Royal Victoria hospital building and the Aberdeen emergency care centre.
What was the Labour Party response to those unprecedented United Kingdom cuts—the cuts that are tougher and deeper than those of Margaret Thatcher, which started under the London Labour Government? I will quote the leader of the Labour Party before the previous election, Iain Gray, on the matter. When Jackie Baillie was Labour’s health spokesperson, championing the cause of the NHS in Scotland, Iain Gray said in response to those unprecedented cuts:
“We wouldn’t ring fence the health budget.”
So, despite the huffing, the puffing, the crocodile tears and the demands for more money here and more money there—the Labour money tree—what do we get? A party that is not prepared to stand up and protect the NHS budget in Scotland.
I have made clear on a number of occasions our absolute view that the NHS budget should be protected. I am disappointed that the minister still fails to understand that.
I find it incredibly hypocritical that a Government that is stripping 2,500 nurses and midwives from the NHS says that we are crying crocodile tears. It is dissembling.
Unfortunately, Jackie Baillie’s problem is that her leader overruled her at the time that we are talking about. On “Newsnight Scotland”, Iain Gray said:
“We wouldn’t ring fence the health budget.”
We will take no lectures from a party that was not committed to protecting the NHS budget when we were prepared to do so. There is no hypocrisy on the SNP side of the chamber, but it is certainly present on the Labour side of the chamber.
I have no doubt that members across the chamber hear concerns about the NHS from their constituents. As a constituency MSP, I hear those concerns. I recognise that the NHS does not always get it right, but the Government is committed to ensuring that we further improve our NHS in Scotland.
I heard Jackie Baillie talking about patient complaints and patient satisfaction. Let us look at some of the facts that are so often missing from Labour health debates. In 2011, 88 per cent of people said that they were very satisfied or fairly satisfied with their local health service, which was up from the level of 81 per cent that we inherited from the Labour-Liberal Democrat Administration.
Jackie Baillie also talked about the issues that have been highlighted by the inspection regime in our NHS. Who introduced the inspection regime in order to drive forward the improvements that we need in our NHS and ensure that we start to get the improvements that are necessary in various areas? That is the type of positive progress that we have been making. We are taking forward policies to ensure that we drive forward further improvements.
I would like to get this right. Does the Government allege that it is spending £800 million or so more on the health service than was spent on the health service in the last Labour budget? By how much does Labour allege that the SNP has reduced the spending? I do not know that yet, so I cannot make up my mind about who is crying the crocodile tears.
I can tell Margo MacDonald that, as I said, by 2014-15, we will have a record £11.6 billion going into our NHS, which is the highest amount that the NHS has ever received and is £826 million more than was devoted to the NHS in the 2011-12 budget.
I will tackle the issue of waiting times that is often raised by Labour. In June, 92.4 per cent of patients were seen and treated within 18 weeks of initial referral, against an expected standard of 90 per cent. Members might be interested to know that Labour-controlled Wales has a 26-week target and that, in June, only 81.9 per cent of patients were treated within that timescale.
I turn to the ambulance service. I have heard the concerns that have been raised by Jackie Baillie and the trade unions. She is correct. The Government is very clear that we want the elimination of single-rostered emergency ambulance provision. We have pursued that with the Scottish Ambulance Service. In June 2012, the percentage of single-rostered crew members in Scotland was 0.7 per cent. That is a small number, but it is a number that we are determined to eliminate except in exceptional circumstances.
I do not think that such issues are helped by people like Jackie Baillie coming along and trying to give people the impression that the NHS is in some way on its knees. The NHS is not on its knees; it is facing up to the challenges that it must face and it has a Government behind it that is prepared to support it in meeting those challenges.
I move amendment S4M-04161.1, to leave out from “believes” to end and insert:
“shares the Scottish Government’s commitment to the NHS; recognises the benefits of the health budget being protected; commends NHS staff for their dedication and hard work, which has provided patients and families with high quality care, including the lowest waiting times on record, lowest infection rates and substantial improvements in patient safety; further recognises that the NHS workforce in Scotland has grown since 2006, including an increase in emergency services staff; notes the value of the inspection system brought in by the Scottish Government that both highlights high quality patient care and identifies where there are problems to be addressed, and welcomes the new Cabinet Secretary for Health and Wellbeing’s continued fundamental support for the efforts of NHS staff, including nurses, doctors and allied health professionals, and the Scottish Government’s clear and unbroken commitment to safe, sustainable and person-centred patient care.”
16:11
We are not here to debate Wales; we are not here to debate the national health service in England; and we are not even here any longer—after six years—to debate the record of the last Labour-Liberal Democrat coalition on health. We are here to debate the record of the Government that has been in office for the past six years with responsibility for health. I came to the debate minded to support the Government’s amendment, if carried, this afternoon. However, in view of the performances that I have heard from the SNP front bench and the intervention from Kevin Stewart that was, frankly, arrogant, smug and belligerent, we will now vote against the motion if it is amended.
I am not here to say that the record of the last Labour Government was wonderful. It is known that we felt that Nicola Sturgeon was an effective cabinet secretary—I still find it surprising that Nye Bevan should be removed from office, with all the challenges that the health service faces. We supported the decisions to reverse the accident and emergency department cuts that were proposed and we believe that the previous health secretary was effective in a crisis. We have paid tribute to much of the work that the previous Government did, but that is not to endorse every action and every statist, Stalinist opposition to innovation in the health service.
When the minister waxes on about the additional funds that he has made available to the health service, it is important to say that the last Labour UK Government and the current Conservative UK Government have made sure that health has been protected at Westminster and that consequentials have come to the Scottish Government that have allowed that health spending to be sustained. It has not been some great virtuous act by the Scottish Government; it has been replicated across the whole UK and has led to the UK ensuring that Scotland has had additional funding.
The Scottish Government turned its back on ways within that budget to manage its finances efficiently. We regretted the decision to reject the findings of the pilot at Stracathro hospital that was led by the last Labour-Liberal Democrat Administration, which allowed the independent sector to release £2 million to reduce waiting times exclusively for the NHS, infection free, by undertaking operations more cheaply than would otherwise have been the case. What was the objection to finding an efficiency of that character within the health service to release funds that could be reinvested in patient care? It was an objection of dogma. We also opposed—we were alone in doing so, but for good reason—moving to free prescriptions. We did so not because we objected ultimately to the principle, but because we knew that every pound that was diverted to that priority had to come from a priority elsewhere in the health service.
I will not stand here and be accused of saying that everything that the SNP Government has done on health has been bad. I do not believe that. I do not believe that Mr Neil, Mr Matheson or Shona Robison—
Will the member take an intervention?
I will at the end of my sentence, if I may.
I do not believe for a moment that what they have been doing has been designed to undermine the NHS, but it smacks of raw complacency to deny that the NHS is under pressure and that it is fraying at the edges. Simply to shout belligerently back across the chamber to the Labour front bench about what Labour did back when dinosaurs ruled the earth is not a response to the challenge that the NHS faces today.
I give way to Jamie Hepburn.
I am not sure that the end of the sentence was worth waiting for—
In that case, I will move on without letting Mr Hepburn take the intervention any further.
The challenge to the NHS is considerable. We know that a demographic time bomb is coming towards us and that there will be considerable pressure on the national health service. There are fewer nurses, and there is no point in pretending otherwise. What happened 10 years ago does not matter; what matters is the record of falling numbers of nurses now. We know that people in accident and emergency units are not receiving treatment in the suggested time and that complaints are increasing.
Last week, a close family relative of mine was admitted to one of Scotland’s and Glasgow’s busiest accident and emergency departments. I telephoned to find out how my relative was doing and was then phoned back. I thought that I was going to be told how my relative was doing but, in fact, the person had phoned me because they had worked out who I was and they wanted to plead with me to say at the first available opportunity in the Parliament that the situation in that accident and emergency department is deteriorating by the day. The department does not have sufficient beds to admit the patients who present. The demographic time bomb is materialising now. At weekends, the department is unable to cope with the number of patients who present. The person told me that people there are in tears because they cannot do the best for the patients whom they are there to serve. We must put complacency aside and face that reality.
We move to the open debate, with speeches of four minutes, please.
16:16
I congratulate Alex Neil on his new role as Cabinet Secretary for Health and Wellbeing and wish him well in taking on the portfolio. I know that, whatever colleagues in the Labour Party might say, the portfolio will receive his full and undivided attention and commitment, as it did his predecessor’s. As a new member of the Health and Sport Committee, I look forward to working constructively with colleagues from across the Parliament, particularly Jackie Baillie, Drew Smith, Jackson Carlaw and Nanette Milne. I hope that there will be occasions on which we will find common ground in the interests of the NHS and the country.
I cannot let the opportunity pass without paying tribute to Nicola Sturgeon, the longest-serving health secretary of any Scottish Executive or Government and, without question, the most successful. Nicola Sturgeon left the NHS portfolio with a reputation for absolute competence and trustworthiness, and members from across the Parliament recognise that our NHS was in safe hands.
That safe stewardship has generated a substantial track record. Accident and emergency departments have been saved; prescription charges have been abolished; and there has been investment in new infrastructure, including at the Southern General in Glasgow and the new Dumfries and Galloway royal infirmary. Waiting times are low and hospital-acquired infections are at an all-time low. All that achievement is set against increasingly draconian financial circumstances over which the Scottish Government has no control. Of course, none of that would have been possible without the dedication and professionalism of NHS staff. The praise for them is, to be frank, the only part of the Labour Party’s motion that I support.
Anyone would be proud of that track record. To repeat what the minister said, in 2014-15, there will be a record £11.6 billion in resource funding for health in Scotland, which is £826 million more than in 2011-12. I contrast the situation in Scotland with that in England and Wales. We are only too well aware of the ideological dismantling of the NHS in England by the Conservatives and Lib Dems, but is anyone aware that Labour-governed Wales will cut health spending by 8.1 per cent in real terms in the next financial year?
Will the member take an intervention?
If I thought for one second that the Labour Party had anything positive or constructive to say in this debate, I would gladly take an intervention from Jackie Baillie but, given the constant negativity and scaremongering from the Labour benches, I do not see the point of taking an intervention, not least because I know that Scotland’s health service and staff deserve better from their elected representatives.
The Government’s amendment refers to
“safe, sustainable and person-centred patient care”.
The integration of adult health and social care presents a significant opportunity to help us to achieve that. Having social services and our NHS working together in true collaboration, with their efforts concentrated on the needs of the individual, is a worthwhile prize. One way in which we can meet the challenges of future resource restrictions and increasing demand is by pooling our resources and working flexibly and collaboratively.
In Dumfries and Galloway, the region with which I am most familiar as a South Scotland list MSP, the council and the NHS are working on a positive and constructive model for integration. They have chosen to focus on how to enable care workers and council staff to work most effectively in partnership with health professionals at all levels, while improving local accountability and scrutiny. There is a real willingness on the part of councils and the NHS to make that important reform work.
Integration is one way in which we can protect the NHS and enable it to provide the best possible services for the future and continue the direction of travel that was set out by Nicola Sturgeon. It will, I have no doubt, be a key focus and priority for the Scottish Government. I support the Government’s amendment.
16:20
We have heard from colleagues who have touched on a number of areas where patient care has fallen below acceptable standards. In my brief speech, I will focus on the levels of care for elderly patients with dementia or cognitive impairment. Concerns were identified by Healthcare Improvement Scotland during its recent inspection of wards across the country and have been raised by Alzheimer Scotland—Action on Dementia and the Royal College of Physicians of Edinburgh.
I have taken time to analyse some of Healthcare Improvement Scotland’s reports and, although it is important to note that the inspection watchdog has often highlighted the positive interactions between staff and patients, unfortunately it has also underlined a number of areas where the health boards must and need to improve.
Ten inspection reports have been published so far, and I hope that the facts arising from them will not be disputed by the SNP front bench. Some concerns occur again and again. Patients are not being routinely assessed for dementia or cognitive impairment upon admission. Indeed, the Royal College of Physicians of Edinburgh recently reinforced that concern by stating that almost half of elderly patients on wards have dementia but have not been diagnosed. Care plans are not always put in place; health records are often incomplete; the number of times a patient is moved from one ward to another is not monitored; and the environment in the wards is not suited to the needs of patients with dementia.
The result of those failures is that there will be elderly patients who, during their stay in hospital, will feel confused, frightened and isolated, which culminates in, as described earlier by Jackie Baillie, a loss of dignity to them as individuals, upset to their families and great reputational risk to the national health service. Those patients will not only feel a sense of helplessness, but be put at risk. The Royal College of Physicians has warned that the 1,600 patients with dementia who are in Scotland’s hospitals at any one time are “highly vulnerable” and at higher risk of death while in hospital.
Now that I have covered some of the issues and concerns that have been raised by the reports, I will say a few words about the role of the health boards and Healthcare Improvement Scotland. Health boards need to understand the reasons for the poor level of care that has been identified by HIS, to ensure that they develop action plans that fully address the problems. However, at this time, I do not have full confidence that that is happening. HIS recently confirmed to me that it does not ask the health boards to examine the reasons for the inappropriate care that has been identified. Furthermore, HIS does not appear to monitor the action plans produced by the health boards. Moreover, it does not have the power to enforce action if the boards are failing to meet their own standards. It also appears that HIS does not have to validate the claims in the health boards’ self-assessments.
I could go on and on. The minister, in his opening remarks, said that we should judge a Government by its actions. The question is, in light of the evidence, why has there been so little response? Why is there even less action? Why are we waiting for action in what is a serious situation?
16:24
Earlier this week, the Royal College of Nursing launched a campaign called “This is nursing”, to challenge the negative publicity about patient neglect and poor conditions. One of the nurses featured in the campaign is Alan Cook, a registered nurse in the acute stroke department at Glasgow royal infirmary. He says:
“My motto is to look after someone the way I would look after my own mum or dad.”
That is a magnificent synopsis of what nursing and the NHS should be about. RCN Scotland director Theresa Fyffe says that the campaign is to inform and educate the public and celebrate the outstanding work that nurses do daily, often in extremely difficult situations.
I am not suggesting that Jackie Baillie is not genuine when she says that she recognises that the work that NHS staff do is exceptional. However, although it is right to highlight issues of concern, I am concerned that by constantly highlighting issues we are undermining such praise. I place the debate—
I have been in the chamber time after time when the SNP has essentially hidden behind the NHS staff. It is NHS staff who are coming to me with stories about the NHS fraying at the edges because the Government is cutting their numbers. We all support NHS staff. There are ambulance staff in the gallery and I invite the member to meet them afterwards and hear the real stories rather than the spin.
It may be a surprise to Jackie Baillie, but we all have constituents who work in the NHS and we all hear issues of concern, which we rightly take forward. Let us compare the record of this Administration to that of the previous Labour Administration. [Interruption.] I am not surprised that Mr Smith does not want to hear this, but he should sit there and listen.
Rather than going into the records, because we will never agree on that, could we try to find agreement on why there should be a shortfall on the wards? I spent three months in an NHS hospital this year. I know what the shortfalls are and I will tell the member if he asks me.
I would be delighted, as always, to speak to Ms MacDonald. If she does not mind, though, I will decide on the content of my speech.
I heard Jackie Baillie say that this is not the case, but it is a fact that there are more nurses and midwives in post now than in nine of the 10 years when Labour was in government. I do not doubt that the NHS is under pressure now. We will turn to the Tory record in a minute, if Mr Carlaw does not mind, because I heard him say that he does not want that debated today either.
I found it astonishing to hear Miss Baillie say, from a sedentary position, that Iain Gray did not say what the minister said he said on “Newsnight Scotland”. It beggars belief. We all heard him say that the Labour Party
“wouldn’t ring fence the health budget.”
The Labour Party cannot hide behind that fact either.
I tried to intervene on Mr Carlaw earlier. I did not know that he was such a wallflower these days, but it seems he was a little upset by my precursory remark. I am astonished to hear the Tories say today that the Scottish Government is diverting money away from the NHS front line through free prescriptions. Prescriptions are part of the NHS front line. A report has been published about what the Tories are doing south of the border. They want to funnel £20 billion in private profit away from the NHS. That is the real agenda of the Tories, supported by the Labour Party through the better together campaign.
16:28
I will concentrate my remarks on the Scottish Ambulance Service and start by paying tribute to the excellent staff who operate our ambulances and our control rooms.
However, the Scottish Ambulance Service is an emergency service that covers only urban areas. Many areas in the Highlands and Islands receive no emergency service from the Scottish Ambulance Service and it is left to NHS boards to pick up the pieces. I have a couple of examples of that. We had a recent case in Ardnamurchan in which NHS Highland had provided an on-call nurse to tend to emergencies because the nearest Scottish Ambulance Service ambulance was based more than an hour away. When the postholder left, it was NHS Highland that was left to deal with the fallout regarding emergency provision. The best that the Scottish Ambulance Service could suggest was the use of first responders. In other words, it sought to rely on unpaid members of the community to do its job for it. Indeed, it asked volunteer firefighters whether they could take on the job.
My second example concerns Glenelg, where the community raised significant concerns when their GP was seconded, because that GP had provided emergency cover. The nearest ambulance station is in Kyle, which is probably about an hour away over difficult roads, on which the conditions are dangerous in winter. Worse still, when there are staff shortages, the station in Kyle is often covered by staff who are based in Broadford in Skye. It is surely wrong that the Scottish Ambulance Service reneges on its responsibility to those communities.
In the past, single manning of ambulances was commonplace in the Highlands and Islands. Indeed, I heard tales of situations in which two ambulances and an air ambulance tried to attend to one casualty, because the distances were so large and the ambulances were inadequately staffed. Nicola Sturgeon appeared to address that issue and promised the Parliament that that would happen only in exceptional circumstances.
However, staffing shortages mean that single crewing is again becoming commonplace. Alternatively, shifts are covered by people who live some distance apart. We hear stories of delays in responding to 999 calls while the ambulance waits for back-up to arrive from the nearest station. That can take a lot of time and put people’s lives at risk. Such delays in responding to 999 calls are worse in areas in which geography means that response times are already far too long.
Will the member give way?
I will not take an intervention, because time is very short and I have many points to make.
That is not the only issue that puts patients at risk; dropped shifts do that, too. Trade unions tell us that current practice is such that when a day shift is covered by overtime, there is a risk that the on-call shift will not be covered at all. That is because the Scottish Ambulance Service is not willing to pay extra for on-call cover when it has already paid overtime. In other words, it wants people to cover such shifts for free. The trade unions tell us that some staff will make themselves available for free, while others will not.
There are also stories of situations that breach employment legislation, in which staff are being asked to work more than seven hours without a meal break and then, instead of being given a meal break, are being told to go and deal with a 999 call. Those staff are being left to take the responsibility for life-and-death decisions.
We are moving towards a single service for police and fire services, and we need to ensure that the new services are accountable and do not follow the Scottish Ambulance Service model.
You need to bring your remarks to a close.
We need to learn that Scotland-wide targets do not work for rural areas, because they hide a lack of service. We also need to build in accountability. We have not had a meeting with the Scottish Ambulance Service since 2008. Prior to that, such meetings were quarterly. The Government needs to take responsibility, as it is only to the Government that the service is responsible.
16:33
I welcome Mr Neil to his new role and I am sure that he will do exceptionally well. I mean that most sincerely, unlike some other members who have said the same thing.
I turn first to Jackson Carlaw, who obviously does not want us to discuss certain things today. I find it quite ironic that he called me “arrogant, smug and belligerent”, as he is a master of all three traits in the chamber on a daily basis. He does not want us to talk about facts or about what is happening elsewhere in the UK at the moment.
I want to provide some facts. As the minister rightly pointed out, we are about to see a record spend of £11.6 billion in Scotland’s national health service. Scotland has more qualified nurses and midwives per 1,000 members of the population than anywhere else in the UK—7.9, compared with 5.9 in England and 7.2 in Wales. Overall, there was an increase in the NHS workforce of 3,331.4 whole-time equivalents between September 2006 and June 2012, which amounts to a head count of 3,475.
I have the greatest respect for Kevin Stewart and he has fairly boned up on his figures, but the reality for me was being in hospital during a night shift when there should have been four nurses under a sister but, instead, there were two nurses, one needing a hip replacement and the other needing a knee replacement. I was better able to lift the patients than they were. That was the reality.
I know that similar situations occur quite often—we hear about that in our mail bags—but they are not the norm in hospitals in this country. We would all like to spend even more on our national health service, but the only way we will be able to do that is if we control our own affairs.
At the moment, we are constricted by a fixed budget. There may be a real decline in our NHS because of the effects of what is happening down south—I refer to a 227-page report that has just been published in England by the clinical advisory group for prescribed services. Dr Eoin Clarke, founder of the Labour think tank Labour Left, has defended Labour’s introduction of commissioning at local level, based on the argument that Labour would not have allowed monopolies to happen at a national scale. Dr Clarke said in his blog “The Green Benches” that the report
“paves the way for centralised and accelerated sell off of specialist services within the NHS at a national level”.
He adds:
“If these services (or ‘products’ as they refer to them on page 6) are to go ahead and be sold off it would represent the biggest brain drain in the history of the NHS.”
Mr Stewart, there is a point of order.
On a point of order, what has the peroration about the English health service got to do with the Scottish health service?
I will tell the member exactly what it has got to do with the—
Mr Stewart, sit down please.
I think that what Mr Stewart is doing is making a contrast. He is very briefly referring to the English health service and I would hope that he will move on from that quickly.
The report and its consequences will inevitably lead to cuts south of the border, which means that the Barnett consequentials of health spending will be cut to this Parliament. That is a fact.
The member needs to wind up.
I want to see the health service protected. We are at great risk from what is happening elsewhere. The NHS is safe in this Government’s hands, but let us keep an eye on what—
We move to the closing speeches.
16:37
I, too, congratulate the cabinet secretary on his new role and wish him well as he comes to grips with a health service that is unremittingly and increasingly under pressure as it tries to cope with the ever-rising demands of an ageing population at one extreme of life and a higher birth rate at the other.
I do not know whether the cabinet secretary expected his baptism of fire to be closing for the Government in a debate led by Jackie Baillie for Labour, but I look forward to his no doubt robust response to criticism of his Government’s management of the NHS when he gets to his feet in a few minutes’ time. However, notwithstanding the cut and thrust of political debate, I hope that none of us ever forgets that we are dealing with people’s wellbeing and lives when we discuss the NHS. It is not enough, as the First Minister and others always do when put under pressure, to deflect the criticism either on to the Westminster Government, which has continued to protect the health budget, whatever they say, or on to the health boards, which are struggling to make ends meet—it is all part, no doubt, of the SNP’s obsession with the separation agenda.
As the RCN has said to us, greater transparency and more publicly available information are needed on how the health budget is spent, so that we can properly scrutinise the impact on healthcare of decisions that are made by the Government centrally and by health boards locally. The Health and Sport Committee intends to look very carefully at the budget proposals to be announced tomorrow.
Sadly, no Government minister nowadays will admit to shortcomings in the system, but the story on the ground is often different—we have heard a number of examples of that today, from Jackie Baillie, whose speech on the Ambulance Service in particular was horrifying, from Jackson Carlaw about A and E services in Glasgow and from many others. Various issues were raised across the chamber.
The fall in nursing numbers particularly concerns me. I saw the pressures myself in the acute sector when I was in hospital last year for hip replacement surgery. Although that is a common procedure, it is major surgery and things can easily go wrong in the early days of recovery when skilled nursing is essential. I could not fault the care that I received from a dedicated and skilled team of nurses, but they were working under pressure and their morale was quite low. They knew who I was and came to me to ask me to raise the issue in Parliament because they were seriously worried about the pressure that they were under because of staff shortages.
There were adequate numbers of nurses during the day but, like Margo MacDonald, I found the situation at night to be quite concerning. During my stay in the ward, it was staffed at night by one charge nurse, who was a superb nurse, and one young auxiliary. The charge nurse told me that he was looking after six intravenous drips on the ward, there were several frail elderly patients who required help with toiletting, and, of course, there were the usual drugs and breakfasts to be dispensed. Fortunately, no serious problems arose, but it would have taken just one emergency for that to change rapidly, and I know that the staffing shortage is a concern for nurses on the ground and for senior management.
My experience is just one small example, but it is not fair to put our nursing staff under such severe pressure. The Government needs to look at how that situation can be improved. As we have heard from members across the chamber today, all is not as rosy on the ground as the Government would appear to believe.
On spending on the NHS, after the interesting session that the Health and Sport Committee had this week on the vexed issue of access to drugs in the NHS, perhaps the Government should instigate a societal debate on the issue, and consider scrutinising other healthcare interventions as rigorously as the availability of drugs. In other words, should we have an equivalent of the Scottish Medicines Consortium to assess the range of procedures that are available to patients?
As pressures on resources increase, those are the sorts of difficult issues that we will have to face up to, but we should not start with cutting front-line services such as nursing. If we continue to do so, we will have to deal with the consequences. We are not criticising for criticism’s sake; there is no doubt that the demographic time bomb is already here, and that services are finding it difficult to cope with the extra demands that are being made of them. I am part of that demographic time bomb, and I have a serious personal interest in the effective functioning of the NHS. It has never been perfect, but it is currently under greater pressure than it has ever been under before, so serious thought must be given urgently to dealing with its problems or staff will become more disillusioned and simply leave its employment.
The debate has been lively. I hope that the cabinet secretary will reflect on the issues that have been raised and give his support to NHS staff who are doing their best in difficult circumstances to maintain high standards of patient care. He is not the only one with a clear commitment to the NHS; mine goes back more than 50 years.
16:42
As this is my first speech in my new role, I thank all those who have sent cards of congratulations and best wishes. They are much appreciated. Obviously, I have a hard act to follow, but I intend to do everything I can to rise to the task in front of me.
Every member has said this today, but it is not just lip service to pay tribute to everyone who works in the national health service, and, indeed, to the many people who are not employed by the health service but whose services are essential to its success.
The NHS in Scotland is facing four major challenges in the years ahead. The first and most obvious is the budget. The fact of life is that, despite our ring fencing of the NHS budget, resources are not going up as fast as the demands on the health service. We must face the reality that with fewer resources, relatively speaking, we have to meet greater demand across the country. That is a central challenge for every one of us.
The second challenge—the ageing of the population—has also been referred to many times. The challenge is not just the overall ageing of the population but the fact that we want to be healthy and fit as we live the extra years that we might have.
The third major challenge is the costs of new technologies and medicines. Clearly, those costs are rising quickly, but we need those new technologies and medicines in order to achieve our vision and everything that we want to do for our people.
The final big challenge, which is fairly concentrated but nevertheless must not be underestimated, is presented by the levels of poverty and deprivation that we have in Scotland. If I may say so, legislation emanating from south of the border, particularly if benefits are frozen, will add to that challenge and make it even greater. If benefits are frozen, that will drive more people into poverty and create even more demands not just on the national health service but on a range of our public services in Scotland.
My attitude to the job will be to have an open door. With a £12 billion budget and a total staff of more than 150,000 people plus all the people who are, in effect, indirectly employed by the health service, I am under no illusion that we will not have areas of pressure and difficulty. Of course we will. If people come to me, as they have done, I will behave in the same way as my predecessor did. I will listen to what people say and, if there is a problem that needs sorted, I will work with the relevant people in the health service to sort that problem.
Will the cabinet secretary take an intervention?
I do not have much time and I want to finish what I have to say.
In my area, I have identified a number of issues that need to be tackled. By no means every issue is a result of a shortage of resources. Sometimes, issues are due to other factors that are not directly under the control of the NHS.
One thing that I intend to do is to make some unannounced visits, not just to go to the health boards and meet the chief executives and the chairs but to talk to practitioners such as the nurses, the doctors and the porters—people who are on the factory floor in the health service—to find out their opinions and their views on how we can do things better, with better quality and in greater quantity.
There are areas for improvement—of course there are—and my priority will be to look at them. Top of that list, I believe, is the need to integrate adult health and social care services to get more of a continuum and better-quality services for that category of people.
Will the cabinet secretary take an intervention?
I do not have time, I am afraid. I want to cover this.
As everyone knows, we are totally committed to the national health service. We will face up to areas where there are particular challenges and we will do what we can to rise to those challenges and find solutions to the problems. I say this, though, and particularly to Jackie Baillie: when a member comes across a difficulty in an area, they should not generalise from the particular and exaggerate, using phraseology such as, “The NHS is crumbling.” That is a total insult to everybody who is committed to the NHS. I say to the Labour Party, “Be responsible and be grown-up.” The fact of life is that a great deal of good is happening in the health service. One of those good things is the record spending. Despite the financial pressures, we are spending a record amount in the health service.
Let me comment on some of the particular issues that have been raised. Duncan McNeil, fairly, raised the issue of dementia. We are one of the world leaders in the treatment of dementia. Our work in Scotland is internationally recognised, and with Alzheimer’s Scotland we are jointly funding a nurse consultant for general hospitals in every health board area. There is a total of 300 dementia champions to work in general hospitals, and more will be appointed as the years go by.
Cabinet secretary, I ask you to bring your remarks to a close.
When it comes to waiting times in accident and emergency departments, had Labour’s plans to close A and Es been implemented, those waiting times would be far longer than they are today. We should recognise Labour’s failures. South of the border, it cut the health budget by £20 billion. It has no entitlement to lecture anyone about the future of the health service. Presiding Officer, let me tell you this—the NHS is safe in our hands and only in our hands.
16:50
I join others in welcoming Alex Neil to the challenges of the health part of his portfolio. He has a hard act to follow. However, he will also have to overcome what Jackson Carlaw correctly referred to as the raw complacency illustrated by Michael Matheson in his opening speech today—it was one of the worst that I have ever heard in the chamber, matched only by the repetitive, recycled speeches from back benchers.
I welcomed the initial tone of Alex Neil’s speech, which, for the first time, admitted that the health service is under severe pressure. That glimpse of reality gives me some hope that we might move forward.
This has been an interesting debate. The motion reflects a reality that is the opposite of the hyperbole of the SNP and the self-congratulation and the self-deception contained in its amendment.
I welcome the minister’s initial remarks about some of the realities. The issue of demographics will really confront us in the future—it is already happening.
Let us consider the speeches that were given. On Health Improvement Scotland inspections—we called for them and I was delighted when the previous health secretary announced them—as Duncan McNeil said in his excellent analysis, there are now ten reports. I have been calling for a thematic report that brings together such reports—as used to be done for care inspections—and is sent to health boards so that they can respond proactively. Jackie Baillie and Duncan McNeil are right that boards are waiting to be inspected before making changes; they are not making the changes that we all want to see and they are not showing improvement. The issue is vital in relation to cognitive impairment, so I hope that the minister will agree to ensure that HIS produces a thematic report.
As there have now been ten announced reports, my second request is that the cabinet secretary ensures that we now move swiftly to unannounced reports, because once a thematic report is produced, the board should be able to address the issues.
Delayed discharges are a linked problem. When patients are moved, it is commonly because they are ready—or nearly ready—for discharge. Labour tackled the problem by reducing delayed discharges from 3,000 in 2001 and promising that they would be at zero by March 2008. The SNP Government indeed achieved that, but Shona Robison and Nicola Sturgeon chose to make a further promise that the number would be kept at zero. In not a single quarter since 2008—except at the annual review in March—has that promise been kept.
Tonight, there will be 1,000 patients occupying beds, 630 of whom are on the delayed discharge database, fit to be discharged. My FOI request last year resulted in only one clear, honest and unambiguous response. That came from Fife NHS Board, which revealed that 90 patients who had been declared fit to go home had died while on the delayed discharge database. The delayed discharge situation has other effects such as increasing the number of cancellations of operations, which itself has a significant knock-on effect.
The SNP 2007 manifesto promised that the number of beds would not be reduced. The number has been reduced by just under 1,000, which is a 5 per cent reduction in staffed beds. We all agree that the debate should be put to bed. Bed numbers can be reduced by removing delayed discharges for example, so we should do that. However, we must be very careful about how closures are handled; it must be done well.
Let us turn to waiting times. A family member of mine was recently referred for possible cancer. It was diagnosed rapidly, but he then had to wait well over the target period for admission for his operation. When he was finally admitted, some 35 days after the target, his operation was cancelled due to an emergency in the preceding operation. That is entirely understandable and the entire family accepted it, but he was then offered another appointment a month further on, although he was already beyond the target date.
The 10 per cent of patients who are not being admitted in line with the referral-to-treatment-time guarantee are human beings whom we are treating badly. It is a great target, but in Wales—Michael Matheson used a Welsh comparison but is speaking at this point, Presiding Officer; perhaps he might like to listen to this—cancer targets are being achieved to a far higher degree and far more quickly than elsewhere. Cancer operations are critical.
Do we know what happens to the 10 per cent of patients for whom the target is not achieved? Does the cabinet secretary know? Do we have the statistics to understand? We do not, except in some cases. I suggest that that needs to be examined closely.
We had the waiting times scandal in NHS Lothian. Does anyone really believe that that is the only place where game playing occurred? I await Audit Scotland’s report with great interest.
I praise NHS Lothian not simply for coming clean but for its subsequent decision to establish a whistleblowers line. What happened there with waiting times was interesting in that, almost two years before I raised the subject in the Parliament, a bed manager raised it within NHS Lothian and was told not to raise it externally because an internal review would be carried out. She was refused sight of that internal review, and she eventually resigned from the health service because her complaints were not being taken—[Interruption.]
One moment, Dr Simpson. It would help if the three members on the front bench would listen to the debate.
The individual whom I mentioned resigned because she was gagged. We are getting consistent reports of that from clinicians up and down the country. I was previously a doctor, so I still have many contacts among clinicians and am repeatedly being told that health boards are gagging them—stopping them talking to MSPs and, indeed, the Health and Sport Committee, as I said in that committee yesterday. I hope that the new cabinet secretary will issue a very clear instruction to health boards that if they are caught gagging any clinician from talking to MSPs about the pressures that the health service is under, they will be dealt with extremely severely.
I turn to the workforce, which every SNP back bencher raised in a recycled way—they said that there was more, less or whatever. The fact is—Margo MacDonald will want to know this—that there are 2,500 fewer nurses. That is the reality. When the reduction occurred and who had more at which point in time are completely irrelevant points. Can we lose 5 per cent of our clinical workforce without it having any effect on the health service? I find the idea that we can unbelievable, but that is the truth that has been peddled in the chamber for the past two years. I am glad that the cabinet secretary is adopting a new tone on that and I look forward to it being maintained. We are not scaremongering; we are referring to the truth.
If Kevin Stewart wants comparisons with England, I tell him that Hansard for 12 June reports Simon Burns as saying that there were 3,700 fewer nurses in England. The statistics may be somewhat different, but a tenfold difference in cuts in Scotland is highly significant. England also had 934 more midwives.
I do not have time—
The member needs to wind up.
I have to conclude rapidly and have left the most important bit almost to last—the ambulance service. Jackie Baillie and Rhoda Grant illustrated graphically the problems in that service. It is another service under pressure. I ask the cabinet secretary to respond in the way that he suggested and to meet the trade unions from the ambulance service about that. I hope that he will do so. I would take an intervention even at this late stage.
No, you will not. You are finished, Dr Simpson, I am afraid. You need to sit down.
I will end by saying—
Dr Simpson, you do need to sit down, please.