Prescription Charges
Good morning. The first item of business is a debate on motion S3M-5572, in the name of Mary Scanlon, on prescription charges and national health service spending priorities, with particular reference to health visitors.
Ms Scanlon, you have around 13 minutes to speak to and move the motion.
When I raised the issue of prescription charges in the Health and Sport Committee last year, the result was an excellent debate with fellow committee members, in particular—from reading the Official Report of that meeting—with Dr Richard Simpson. I trust that today's debate will be no different, but I am not holding my breath.
We need only look at the Auditor General for Scotland's recent report on the Scottish health budget to know that, no matter which party wins this year's general election, Scotland's budget faces serious cuts—as many speakers outlined in yesterday's budget debate. Ministers consistently talk of the impending cuts from Westminster. Yesterday, the Cabinet Secretary for Finance and Sustainable Growth used the phrase
"deterioration in the public finances."—[Official Report, 20 January 2010; c 22922.]
That seems quite an understatement, given that the United Kingdom will have a debt of £1.5 trillion by 2014-15 as a result of Labour's recession.
Against that background, it would be dishonest for any party—let alone the Scottish Government—to make spending promises that it cannot keep. The Conservatives have pledged to protect the NHS budget, both at Westminster and here in Scotland. The fact is that the only time that NHS spending has been cut was when the Labour Government in the 1970s did so when it was ordered by the International Monetary Fund to reduce the national debt. Against that background, we must cut our cloth so that we do not, we hope, have to face that sort of cut in future. Cutting the NHS budget is not the intention of a Conservative Government.
Within the Scottish budget, we have supported the need for efficiency savings. Yesterday's report from the Nuffield Trust for Research and Policy Studies in Health Services compares Scotland with the north-east of England and highlights that we have 70 per cent more managers and support staff in Scotland. In my opinion, that potentially lays the ground for even more efficiency savings. The question is whether, against a dire economic background that will undoubtedly require cuts, the Scottish Government should be reducing the cost of prescriptions for those who can afford to pay, or whether that money should be used to provide, for example, a much-needed universal health visiting service for every child in Scotland.
In preparing for today's debate, I discovered that the health of our nation now seems to be based on the amount of drugs that we take. The Scottish Government records the increased use of prescription drugs as a success, whereas I think that the opposite is the case. Surely the healthier we are, the fewer drugs we need to take. Even the Government cannot argue that making more antibiotics and antidepressants available is a benefit, particularly given the link between the use of antibiotics and hospital-acquired infections—I see Jackie Baillie acknowledging that point due to the experience with HAIs in her constituency. With 10 per cent of our population already on antidepressants because mental health services are not a priority—there is a shortage of cognitive behavioural therapists and of counselling, psychotherapy, psychology and psychiatry services—the prescriptions budget is potentially another area where early diagnosis and early investment could save money as well as improve health in the long term, especially if we focused those resources on health visitors, as we suggest in our motion.
We supported the extension of prescription charge exemptions to those with long-term conditions. We acknowledge the difficulties of that issue, with which I think every party has wrestled. When free prescriptions were given to those with diabetes but not to those with asthma, there was undoubtedly an anomaly in the system. Similarly, people with epilepsy got free prescriptions but people with Parkinson's did not. We recognise that there were anomalies in the previous system.
Will the member give way?
Not at the moment.
We also supported the reduction in the charge for prepayment certificates in order to ensure compliance with medication.
It is worth pointing out that the abolition of prescription charges would not rid the NHS of the whole bureaucracy of collection, as a Scottish National Party minister previously stated. The only difference would be that the entire contribution would come from the Government. The only bureaucracy saved would be the collection of the fee and the checking of eligibility for exemptions. The number of prescriptions that are exempt from charges increased from 66 million in 2004 to more than 74 million in 2008. Even with prescription charges still in place, the cost to the NHS of prescribed items rose from £598 million at the start of this Parliament to more than £1 billion last year.
We believe that that money could be better spent on health visitors, given the increasingly patchy nature of the health visiting service throughout Scotland. I acknowledge the point that Malcolm Chisholm made in the 7 January debate about the pilot visiting service in Lothian. There is no doubt that good work is being done but, unfortunately, there is not universal access to such services throughout Scotland. Expanding the role of health visitors has been our policy for some time in Scotland and it is the policy of the Conservative party at Westminster.
A universal health visiting service was also a recommendation of the Health and Sport Committee in its recent report on child and adolescent mental health and wellbeing. Unfortunately, the recommendation received little sympathy from the Minister for Public Health and Sport, but it is appropriate to point out that there was cross-party agreement on the urgent need for a universal health visiting service in Scotland. I quote from the report:
"it is vitally important that there are standard health checks and developmental checks on every child at crucial stages of the early years."
Unfortunately, the minister chose not to address that point in the 7 January debate, but she will have another opportunity to do so today.
There was no doubting the compelling evidence that the Health and Sport Committee heard about the window of opportunity that is available at an early age to put things right when children are subject to neglect. If that window of opportunity is missed, neglect can lead to a lifetime of major mental health and other problems. No parliamentarian can ignore that. In fact, children with attachment disorders or difficulties with attachment can be identified by about 10 months to a year. However, they will be identified only if they are seen by a health visitor. My colleagues Nanette Milne and Jackson Carlaw will go into much more detail about the role that health visitors play and emphasise the urgent need for a universal service.
The Liberal Democrat amendment, in the name of Ross Finnie, raises the issue of distinction awards. I appreciate that that fits in with our budget deliberations, given the proposed increase of £2 million for such awards that is included in the budget for next year, but there is no doubt that the decision on whether there should be a distinction award scheme for consultants should, despite what we might feel about the issue, be taken on a UK-wide basis. I understand that the Cabinet Secretary for Health and Wellbeing has written to the Secretary of State for Health at Westminster making the points that she and the Health and Sport Committee have made about that issue.
The British Medical Association acknowledges the serious discord among general practitioners about the current changes to the health visiting profession. In Glasgow, some GPs were so concerned about those changes that they submitted a petition to the Parliament, in support of which they collected more than 22,000 signatures from parents and family members, all of whom were concerned about the fact that under-fives do not get the health checks that they get in other countries, with the result that problems are not picked up early on.
I take it from Mary Scanlon's remarks that she is not minded to support our amendment. My mind is genuinely open on the Conservative motion. Will she elaborate on how health visitors might co-ordinate with social work, as that is crucial to tackling problems such as those that relate to the under-fives that she has outlined?
I would be delighted to do that. I have made a few visits to the health centre in Tain, the member's home town. The health visitors there made it clear to me that they are health visitors, not social workers. They want to retain their training so that they can carry out health and development checks on every child. Of course I hope that they work closely with social workers, but the system in Tain and in the rest of Scotland, whereby health visitors are closely aligned with GP surgeries, GP health centres and doctors such as Dr Brian Fitzsimons—Jamie Stone's doctor, who is fully committed to retaining the health visitor service—works very well. I would be happy to go on, but perhaps Jamie Stone could ask for an extended consultation next time; I think that Dr Fitzsimons would be happy to tell him about his commitment to retaining health visitors as part of the practice. I am grateful for being given the opportunity to mention that—I thought that I would be too short of time to do so.
The Health and Sport Committee also uncovered evidence that the under-fives were neglected by our services. Professor Law told the committee that the chances of children with needs being picked up without their parents coming forward were "non-existent". In recommending that the standard health and development checks be carried out on every child in the early years, the committee recognised
"the tension between universal and targeted screening, caused by inevitable limitations on resources."
The allocation of resources to the health visiting profession would right that wrong and give all children in Scotland the opportunities in life that they deserve.
I move,
That the Parliament calls on the Scottish Government to withdraw its proposals for further reductions in prescription charges and, having regard to current pressures on public spending, believes that the money saved would be better spent on other NHS and care priorities, such as the health visitor service.
I welcome members of the Health and Sport Committee back from their travels—they were much missed last week during health questions. I welcome the debate and, like Mary Scanlon, hope that it will be constructive. It gives me the opportunity to reiterate the Government's commitment to abolish prescription charges and, more than that, to remind members of why that policy is so important to so many people across Scotland.
As a Government, we are committed to building a healthier nation. We want to tackle the deep health inequalities that have blighted our country for far too long; to support people to live longer and healthier lives; and to ensure that people have access to the health and care services that they need. Removing prescription charges is a fundamental part of delivering that vision.
Make no mistake—prescription charges are a barrier between patients and the health care that they need. They prevent many patients from collecting their prescription medication and put some people off visiting a doctor in the first place. If we want to deliver world-class health care in Scotland, we should not be prepared to sit back and tolerate that state of affairs. I say to Mary Scanlon that our policy is not about encouraging people to take drugs that they do not need; it is about ensuring that everyone in Scotland can access the medicine that they do need.
I will return to a number of specific points, but I make it clear at the outset that the abolition of prescription charges is above all a matter of principle. Our aim is to remove the tax on ill health and to restore the NHS to its founding principles. We believe that the NHS should meet the needs of everyone, that the services that it provides should be free at the point of delivery and that such provision should be based on clinical need, not ability to pay. This Government is not prepared to compromise on those principles.
On that basis, can we take it that all charges for all other aspects of the health service, including dentistry, will be removed?
The key question that the Tories must answer, not just in Scotland but across the UK—because we know that their commitment to the NHS has been lukewarm at best—is, what other services do they want to charge people for? [Interruption.]
Order.
We are talking about a point of principle. The Tories can disagree if they want to, but it is a point of principle on which this Government will stand firm.
Will the minister give way?
Not just now.
Behind the principles lie real practical benefits for patients. First and foremost, the policy is intended to ensure that patients with long-term conditions, including cancer patients, are not prevented from collecting their prescription medication because of prescription charges. We are halfway to removing that barrier for all patients, but we know from the data on sales of prepayment certificates that patients with long-term conditions are benefiting most from our policy so far. The cost of PPCs has come down faster than the cost of single prescriptions.
Will the minister take an intervention?
I will come back to the member.
As a result, sales of PPCs are up by 150 per cent, which is benefiting those who need multiple medications.
At this stage, I want to address the Labour amendment. I welcome the move of the Labour Government in England, which is its first recognition of the deep unfairness of prescription charges, but it does not go nearly far enough. The approach that is being taken in England, which Labour would have us emulate here, certainly benefits patients with cancer, but it does nothing at all for the many thousands of people who have other long-term conditions that are not currently exempt.
Will the minister give way?
Let me remind Jackie Baillie of some of those conditions. Multiple sclerosis, Parkinson's disease, asthma, chronic obstructive pulmonary disease, osteoarthritis, rheumatoid arthritis, congenital heart disease, heart failure, chronic kidney disease and dementia are just some of the many long-term conditions that people have to pay prescription charges to treat. Labour's approach would leave everyone with those conditions struggling to pay the full price for prescriptions. In contrast, our approach benefits everyone with a long-term condition, including cancer, and it will ensure that such charges are abolished for all.
I said that I would come back to Marlyn Glen.
I go back to the matter of principle. We need to have a serious debate about whether we want health services to be free at the point of delivery. Do car parking charges at hospitals put people off visiting? That is a serious question. If prescription charges put people off going to the doctor, what do car parking charges do?
I remind members that the debate is about prescription charges.
As own goals go, that one was fairly spectacular. Labour introduced hospital car parking charges and the SNP Government abolished them, except those at Labour's private finance initiative-funded hospitals, which we cannot remove, so I will take no lectures from Labour on that issue.
The Tories seem to be arguing that we should not abolish prescription charges, but I think that they are arguing that we should extend the list of exempt conditions. That approach is fraught with difficulty. When we considered our approach to prescription charges in the early days of our Government, many concerns were expressed to us about the difficulty and delay that would be associated with defining a list that was comprehensive and complete and which avoided the creation of new anomalies and a host of invidious choices. At least two thirds of the items that are dispensed to patients are directly related to the treatment of long-term conditions. If one adds to that the fact that patients with long-term conditions are more likely to require other medication for secondary conditions, one quickly realises that such an approach would leave in place a system whose administrative burden would not be justified by the small number of prescriptions that were still charged for.
I have a condition that means that I have to take a tablet every day—I presume that Mary Scanlon knows what that condition is, given how well she knows my doctor. [Laughter.] It is a serious point. The straightforward question that people are asking—on which my mind is genuinely open—is, "Why shouldn't I pay for my prescription, because I can afford to?"
Jamie Stone takes me to the next point that I wanted to make. Another myth at the heart of the debate that is regularly peddled by the Tories is that only people who can afford to pay for prescriptions are currently charged for them. That is manifestly untrue. Many patients in Scotland who are not eligible for exemption from paying prescription charges cannot afford to pay them. Some 600,000 adults who live in families throughout Scotland earn less than £16,000 but marginally more than the exemption level. Low-income families are currently not exempt from paying prescription charges. Currently, 25 per cent of all non-exempt patients earn less than £16,000 a year. Some 600,000 adults are often forced to choose between paying for medication or food. That is not acceptable.
Will the cabinet secretary give way?
I must make progress.
For all of those reasons, I believe as a matter of principle and in practice that complete abolition of prescription charges is the fairest, most cost-effective and sensible approach to take.
In response to the Labour position in England, the chairman of the BMA council, Hamish Meldrum, said:
"Free prescriptions for people with long-term conditions … does not go far enough … Making the list of exemptions longer will not make it fairer. Ultimately, we could end up with a situation where only a tiny proportion of prescriptions attract a charge, which would be nonsensical. Abolishing prescription charges altogether is the fairest and the simplest option."
That is precisely why we continue to maintain that our policy is right for Scotland, just as the Labour Administration in Wales and the Administration in Northern Ireland have decided that such a policy is right for their people as well.
The cabinet secretary continually refers to a point of principle. A constituent of mine requires a prosthetic limb, and she wants one that will be on display, because she wants to wear a skirt rather than trousers all the time. Under the NHS, she will be charged for that, and the Scottish Government refuses to make any alterations to that approach. Where in that case is the point of principle to which the cabinet secretary continually refers?
If Jeremy Purvis wants to write to me about his specific constituency case, I will consider it, but I will not get into the details of a particular case now.
The final issue that I want to address is the Tories' false assertion that, by reneging on the prescription charges policy, we will somehow be able to solve at a stroke a whole host of other health issues. The Tories are trying to confront us with a false choice. I agree with some points that Mary Scanlon made. We must use tight and ever-tightening resources well, and that will be challenging. In that context, as Cabinet Secretary for Health and Wellbeing, I cannot place enough value on the role of health visitors, who provide a central and unique contribution to the health of vulnerable groups in Scotland, including children, families and teenagers. The recently established modernising nursing board will work with NHS boards and stakeholders to ensure that a modern and sustainable approach to community nursing care is taken in Scotland. However, the response to tight finances should not be to force a false choice between one deserving health priority and another deserving health priority.
If the Tories want to talk about real choices, let me suggest some choices that we should be making. How about we choose investment in health over the inheritance tax breaks for the rich that the Tories favour, or over the obscenity of new Trident nuclear missiles in the Clyde? Those are the real choices that we need to make rather than denying free prescriptions to the most vulnerable and poorest in our society.
As I have said, the Tories' commitment to the NHS has perhaps always been lukewarm, so we might not be surprised by their position, but the Liberals' position is more difficult to fathom. Many people will wonder about the party of William Beveridge now taking such a hostile position to free health care.
I hope that members reject the Tory attempt to play off one part of health funding against another, and that they support free health care for all.
I move amendment S3M-5572.3, to leave out from "calls" to end and insert:
"recognises that the progress towards abolishing prescription charges is already benefiting all those patients with long-term conditions and on low incomes who are not entitled to exemption and ensuring that fewer patients face having to choose between buying their prescriptions or paying for other necessities and that total abolition is the simplest and fairest way of ensuring that nobody in Scotland has to make such a choice and that healthcare is free at the point of use."
I welcome the opportunity to debate prescription charges and consider the NHS's spending priorities. Given the short time that is available to me, I will focus on prescription charges. I hope that there will be further opportunities in the months to come for us to debate priorities for the NHS at greater length.
It is no secret that, in the previous session, Labour members did not favour the complete abolition of prescription charges; rather, we preferred an incremental approach that would have meant extending free prescriptions to those with long-term chronic conditions and those on a range of top-up benefits as a result of low incomes. Some have questioned—it has happened again today—why MSPs should be given free prescriptions, given that we can afford to pay for them. Currently, 92 per cent of all prescriptions in Scotland are issued free, but there is an issue: a proportion of the remaining 8 per cent of people have chronic conditions and may require substantial levels of medication, which some might struggle to afford—I agree with the cabinet secretary on that.
We could spend a lot of time rehearsing old arguments today, but I do not want to do that. The cabinet secretary and the Scottish Government have reached a judgment about the value and affordability of prescription charges. I confess that that flies in the face of John Swinney's speech on the budget yesterday, but they have reached a judgment, and we will not stand in the way of the policy. Some £32 million has been provided in the budget for the policy for the coming financial year, £45 million has been provided for the next financial year, and the total recurring cost has been set at £57 million from April 2011. As I said, we will not stand in the way of the policy, but that does not mean that we will suspend our critical capacity to consider how it is developed.
I want to focus on three issues. The first is how sustainable the policy is. We know that it is likely that demand for medicines will grow, and I understand that the cabinet secretary has factored that in, but I cannot tell at what level. What percentage growth has been allowed for? What will the costs be as we move forward to 2012, 2013 and 2014 and the financial belt begins to tighten? We need to know how sustainable the policy is so that we can base our views on that.
Secondly, can the cabinet secretary guarantee that the policy will not compromise patient care? I am sure that members understand the concern that already exists that the so-called efficiency savings that health boards are making are having an impact on front-line services. If the cost of funding free prescriptions continually rises, that will have an impact on money for other priorities. I am sure that no member would want that, and am therefore interested in the cabinet secretary's view on the matter.
Will the member explain why her party never considered abolishing prescription charges in the more than 10 years for which her party was responsible for the health service in Scotland and health expenditure was rising, but it is suddenly not standing in the way of that when health expenditure is likely to flat line?
The member will recognise that health spending in Scotland is at an historic, all-time high and that it is above the per capita level in the rest of the United Kingdom. The Tories and Labour have maintained that over our history. As I explained earlier, we were moving to extend the coverage of free prescriptions.
The third issue that I want to consider is the impact of free prescriptions on the minor ailments service. That issue has been raised several times with ministers, but I regret that no clear response has been given.
Will the member give way?
I will develop my point, after which I will be happy to let in the cabinet secretary.
The minor ailments service applies to people who do not pay for prescriptions. People can go to their local pharmacist for advice or to get medicine for a minor illness without needing to make an appointment with their GP. That service is tremendous: it is convenient and it frees up GP appointments. Of course, we will all have free prescriptions soon. Does that mean that we will be able to get free medicines for minor ailments directly from pharmacists? I will give members an idea of some of the minor ailments that I am talking about: they include backache, earache, hay fever, headache, indigestion, mouth ulcers, pain—that is a general term—and sore throat. The list goes on and on. On 5 December 2007, the cabinet secretary told members that the Government was considering the implications of abolishing prescription charges and that announcements would be made. I am not clear that those announcements have been made, but perhaps I missed them; I would welcome clarification on that. I do not think that any member wants the unintended consequence to be that, rather than using pharmacists, people revert to cluttering up GP surgeries, because the prescriptions that GPs issue will be free.
I am happy to give way to the cabinet secretary if she can clarify that point.
I apologise if Jackie Baillie has not seen the clarification of that. I may be wrong, but I am sure that it has been given to her colleagues in the past. There is no evidence, from our experience so far, that the number of GP appointments is increasing in that way because of prescription charges. We have made it clear that the eligibility criteria for the minor ailments system, which are currently based on the eligibility criteria for free prescriptions, will remain the same after prescription charges have been abolished. We gave that clarification some time ago, and I am happy to provide it to Jackie Baillie in writing.
I just looked at Mary Scanlon and Richard Simpson, who have held the health brief for much longer than I have, and they do not recall that clarification being given either.
Is it the case, as the cabinet secretary has just said, that everybody who is in the minor ailments scheme will be eligible for free prescriptions for all the services that are offered?
Nicola Sturgeon indicated agreement.
I take that as a yes from a sedentary position.
I am conscious of the time, so I turn finally to the consequences of the Tory motion. Members will know that we have encouraged the Scottish Government to bring prescriptions for cancer patients in Scotland into line with those in England and Wales. We are not asking for that to be done instead of addressing prescription charges for other chronic conditions, and it is wrong of the cabinet secretary to suggest that. Ours is not an either/or amendment. Charges for cancer patients were scrapped by the UK Government last April, yet cancer patients in Scotland are still waiting for that. It was absolutely right to abolish charges for cancer patients, and it has transformed the lives of around 150,000 people who have benefited by saving up to £100 a year. Voting for the Tory motion would put that in jeopardy, never mind the benefits to the other categories of people who would qualify in the roll-out of free prescriptions. We, on this side of the chamber, will not do that. The challenge for the Government is to include cancer patients now and to ensure that concerns about the sustainability of the extension of free prescriptions are addressed.
I move amendment S3M-5572.1, to leave out from "withdraw" to end and insert:
"immediately implement free prescriptions for cancer patients as has been the case in England since April 2009."
The Liberal Democrats approach the debate on prescription charges and spending priorities from a slightly different perspective. We are quite clear that a discussion on prescription charges in the context of a Parliament and a Government that are debating the way in which the budget must be determined is a debate about the Government having to make difficult choices—which is what government is about. Changed economic circumstances call for different approaches to be taken and, in some cases, that means making even more difficult choices.
This morning's debate focuses on just one element in respect of which, in a very different financial climate, the Scottish Government is being asked not necessarily to abandon its long-term aspirations but to recognise that, in a tight financial settlement, a reordering and retiming of priorities is called for in certain circumstances. I am sure that the Cabinet Secretary for Health and Wellbeing will want to read Beveridge's biography. It is clear from her comments that she has not studied it with care, as he made it absolutely clear that, in difficult financial circumstances, difficult choices must be made. We cannot simply take a one-size-fits-all approach. Against that background—and for different reasons—Liberal Democrats will support the first part of the Conservative motion calling for the withdrawal of the Government's proposals for further reductions in prescription charges.
The Liberal Democrats would support proposals to give protection to those who have long-term conditions. I listened with care to the cabinet secretary's remarks about how difficult and awkward the situation is and how her solution is better. With respect to the cabinet secretary, however, her speech was largely one that she could have made one, two, three or even four years ago.
Does that make it wrong?
No, indeed. However, it means that the Government has not tried to reorder its priorities in changed financial circumstances—that is the issue. We are not talking about abandoning principles; we are talking about recognising the need to change priorities.
Does Ross Finnie concede that I was making the point that, if we went down the road of exempting all long-term conditions—if we could overcome the difficulties in doing that—the difference between that and complete abolition, in financial and administrative terms, would not justify the retention of prescription charges for the small number of people who would still have to pay?
In changed financial circumstances, we are asking for a degree of fairness because some people can afford to pay and some cannot. That is the priority that the Government must address.
We are unable to support the Labour amendment because, although we could all make a case for providing relief for cancer patients, that would perpetuate the unfairness of giving further support to those who do not need financial assistance. The amendment also happens to be worded in terms that pre-empt our amendment. Some parts of the cabinet secretary's case, which propose support for other persons who are in difficulties, may have merit. Nevertheless, if we are trying to decide who should and who should not receive financial support, in an economic crisis, those who can afford to pay do not come into the Liberal Democrat definition of fairness.
On the basis of using the current financial crisis to promote a fairer society, the Liberal Democrats have also been vociferous in our condemnation of bonus payments in the private sector, particularly the banking sector. In a similar vein, we have called for pay restraint in the private sector, especially among the higher paid. We have also—as my colleague Jeremy Purvis has made absolutely clear—called for a 5 per cent cut in the public sector fat cat pay bill. At a time when everyone is having to tighten their belts, a fair society demands that such cuts are made in both the private and the public sector. We therefore believe that there is no justification for making consultants distinction and clinical excellence awards in 2010-11, including under the new Scottish clinical leadership and excellence awards scheme.
Does the member acknowledge that the chancellor has reduced the allowances for those who earn more than £100,000 a year; that he has introduced an additional 10 per cent tax on those who earn more than £150,000 a year; and that he has reduced those people's pension allowances substantially so that there is already a universal tightening of belts for everybody who earns more than £100,000 a year?
I accept that, but those measures relate to standard pay—they do not address the issue of those who want bonuses. I am talking about the awarding of bonuses.
It is not a bonus.
Dr Simpson might think that anyone should be able to receive a bonus in these tightened financial times, but Liberal Democrats do not share that view. I accept that the current scheme was in operation when the Liberal Democrats were in government. Nevertheless, I repeat that it is unfair for the public sector to continue to pay bonuses this year as though nothing has changed. The principle of fairness should apply equally to payments in the public and in the private sector. I do not believe that the public will understand why, at a time when people are being critical of bonuses being paid to bankers and others, they should wake up in the morning and find that the highest earners in the NHS are also able to command bonuses of up to £75,000 a year on top of their salaries—especially when some of those who are being paid by the NHS do not even work within the NHS. Richard Simpson's point about taxation does not cover that and we do not believe that that is fair. That is why we lodged our amendment.
We would use the moneys that are available for that scheme to do what we have said consistently in the Parliament that we would do. We must make financial room to deal with the current financial crisis—in particular, the way in which it is affecting young people in this country. That is not to suggest that we do not believe that the health visitor issue, which the Conservatives have raised, is worthy of being addressed. However, across the totality of the budget, we believe that the economic crisis is bearing down particularly hard on the young, who could become a lost generation as a consequence. They are the people to whom we want to direct more resource, and we must make space to do that. We believe that withdrawing the proposals for prescription charges and consultant bonuses would reintroduce a degree of welcome fairness into our society.
I move amendment S3M-5572.2, to leave out from "the money" to end and insert:
"it is unjustifiable for the Scottish Government to continue to make consultants' distinction and clinical excellence awards in 2010-11 including under its new Scottish Clinical Leadership and Excellence Awards scheme to be introduced on 1 April 2010, and further believes that the money saved from both of these measures would be better spent on other priorities."
I resent the cabinet secretary's statement that my party's commitment to the NHS is lukewarm. My commitment to the NHS is absolute and lifelong, and I would not belong to a party that did not share that commitment. I notice that the cabinet secretary is not in the chamber to hear those remarks.
It is interesting how ideas and positions change with time. That has certainly happened with regard to prescription charging in Scotland. I was a member of the Health Committee when Colin Fox of the Scottish Socialist Party introduced his proposals for free prescriptions, and I listened carefully to the evidence that was given to us by various interested parties and experts. Given the inequity of the existing criteria for exemption from prescription charges and the difficulties of producing a fairer list of exempt categories, there is a superficial appeal in making prescriptions free for everyone. However, there were and are good counterarguments, not least of which is the significant amount of revenue that would be lost to the Government if that happened, which is currently estimated at around £33 million per year. That money could be better spent, particularly in financially straitened times, in other health care areas, hence our decision to oppose any further reduction in charges.
I remember having informal discussions with Lewis Macdonald, when he was Deputy Minister for Health and Community Care, about encouraging more people on multiple and chronic drug treatment to reduce their prescription costs by taking up prepayment certificates and about making shorter-term certificates available to those who could not afford to pay for a whole year up front. The Lib-Lab Executive was very much opposed to free prescriptions at that time, and Andy Kerr, as Minister for Health and Community Care, was outspoken in his opposition to a proposal that he saw as being
"unfair on the NHS and unfair on the patients"
and as something that would
"rob the poor and the unwell to give to the rich."—[Official Report, 25 January 2006; c 22648.]
But that was in 2006. By 2009, the Labour Party was supporting the abolition of prescription charges, while the Liberal Democrats, having switched from opposing to supporting abolition, were apparently back to opposing the policy. As I said at the outset, ideas and positions change with time—it is just that that happens more frequently in the case of the Liberal Democrats.
Is the member suggesting that the severe financial crisis that we face does not call on us all to readdress our priorities?
I do not think that that is relevant. Mr Finnie knows our position with regard to spending money in cash-straitened times. We have not changed.
With the National Assembly for Wales counting the cost of its policy on free prescriptions, and Governments across the UK having to face up to serious financial problems, now is not the time to go further down the road towards the abolition of charges. Those non-exempt people who have prepayment certificates now pay just £38 per year, which is less than half of what they used to pay. Less than 75p per week is surely a price worth paying for good health, and the resultant income could be put to much better use elsewhere, in the interests of patients. There are many areas of health care that could benefit from such money but, as we have heard, the Conservatives would as a priority develop and maintain the universal service of practice-attached health visitors, which would be of incalculable benefit to many families and young people in Scotland.
I do not always see eye to eye with the BMA, but I fully endorse its belief that any patient should have access to a health visitor who is part of the primary care team, attached to a local GP practice. I am sure that I am not the only person in the chamber who remembers and appreciates the support of a health visitor. I remember the support that was given to me as an inexperienced mum. Even though I was coping well, and did not have any real problems, the reassurance and common sense of that knowledgeable and caring professional was of enormous help and made me feel that I was doing a great job for my son. Had there been any real problems, I am sure that she would have picked up on them immediately and ensured that the necessary help was in place.
My husband was for many years a partner in a general practice that had health visitors as an integral part of the team, and the regular contact with them was of immense benefit to patients and doctors. Problems were flagged up not only at formal case conferences but over coffee in the surgery or by phone. Many families benefited from the help that they received, often before problems became entrenched and difficult to resolve.
Advice was given on the importance of immunisation, and a high proportion of patients had their children vaccinated against important childhood ailments. Developmental abnormalities and behavioural problems could be picked up early and dealt with, and family relationship issues and their effects on children were often detected before they became intractable. By and large, patients were satisfied with their care, and the morale of practice staff was high, with a very low turnover of personnel and a palpable feeling of camaraderie within the surgery.
The move a year or two ago to pilot the replacement of health visitors and district nurses with generic community nurses who have a geographic rather than a practice base was a retrograde step that has not helped patients but has destroyed morale in the service and has led to difficulty in recruiting and retaining highly trained and experienced staff.
The problem is that general practices are extremely spread out in some areas—some of them go across whole cities. If nurses are attached to general practices in an absolute way rather than being given a geographical attachment as well, they will have to travel huge distances. Because they are independent contractors, GPs have not organised themselves properly.
I understand what Richard Simpson is saying. However, I feel that the connection with a practice or perhaps even a group of practices is important.
I fully endorse the BMA's comments that health visitors are an essential part of the wider primary health care team and that having a clear link to a local practice ensures continuity of care for patients. I am delighted that my party, north and south of the border, shares that view and believes that all patients, wherever they are and whatever their social circumstances, should have access to a health visitor when necessary. That is surely a much better use of scarce money than giving free prescriptions to many people who are not only able but willing to contribute to their cost. I might say that, having paid the vet £60 the other day for a course of antibiotics for my dog's skin infection, I reckon that we are getting a pretty good deal from the NHS without reducing prescription charges any further.
I am happy to support the motion in Mary Scanlon's name.
I am rather taken aback to hear people and dogs being compared in terms of prescription charges, and I say that as an animal lover.
I return to the first principle of the NHS, which was referred to by the cabinet secretary: that it should be free at the point of delivery. Of course, the service is not free; we have paid for it all through our tax, and the fact that we are taxed according to our income means that we have already dealt with the issue of ensuring that those who can afford to are paying more into the system. In a perfect world, dentistry might also be free at the point of use, but we are not in a perfect world. Let us go back at least to the world that we started with some 60 years ago—and let us also, of course, get more dentists first.
If we accept the principle on which the NHS was founded, it follows that there should be no up-front charges for medical treatment in hospital in-patient, out-patient or accident and emergency departments. But what is different about medication, especially when we are moving towards a situation in which more people are treated in their homes? If people received that medication in hospital, they would not be charged.
While I am on the matter, I add that we should not move towards a society in which we charge people for self-inflicted illnesses, which is a consideration that might be being put into the pot elsewhere. We might start from the basis of the principle that prescriptions should not be chargeable but, if a certain treatment is to be charged for—even with certain exemptions, which I will deal with later—on the basis either of ability to pay, age or type of condition, why not extend that to other treatments?
I cannot understand why a distinction is being made between prescriptions that are to be taken at home and prescriptions that are to be taken elsewhere. It is simply a form of treatment.
The history of charges goes back to Atlee, who, in 1952—I was around even then—brought back in prescription charges, which caused the resignation of Harold Wilson and Aneurin Bevan, the great founder of the NHS. Labour was then defeated by the Conservatives, who continued what was, in essence, a Conservative policy. The policy was ditched by Harold Wilson in 1965 but reinstated in 1968. Today, in more humanitarian and social democratic times, we see that society in the UK is moving in another direction. As has been said, Wales has abolished prescription charges, Scotland is moving towards their abolition and Northern Ireland is seriously considering the matter.
The argument with regard to long-term conditions, particularly cancer, is laudable, but it is extremely flawed. I refer to the BMA's response paper, "Prescription charges for those with long term conditions", which contains a plethora of quotations that illustrate why that is the case. We start from a position in which, as the paper states,
"The current exemption categories are often illogical and unfair; extending these categories to include those with LTCs would simply add to the inequities in the system".
The BMA cannot support such an extension, and it goes on to state:
"Moves have been made to exempt patients with cancer from prescription charges, but already this looks set to create a new set of winners and losers depending on which side of an arbitrary line you fall. If the current system is to continue to exist, then we believe that consideration of more radical proposals is needed rather than a simple extension of the list of medical exemptions. For example, consideration could be given to restricting the wide-ranging nature of some of the existing exemptions. It is hard to understand why a patient with an underactive thyroid should receive treatment for a chest infection free, whilst a patient on treatment for their hypertension would have to pay for theirs."
The BMA notes with regard to exemptions that
"most professionals report that they have considered the issues very carefully and have been unable to find any fair system of exemption"
charges. It goes on to state:
"The question is whether this list, by being longer, would be any fairer. Ultimately we could end up with a situation where only a tiny percentage of prescriptions attracted a charge, and at that point, the retention of any charge seems nonsensical."
I, like Nanette Milne, do not always agree with the BMA, but it presents a sound argument about drawing lines. The same argument applies to drawing lines in relation to the ability to pay.
There is evidence to suggest that not only do patients select and filter the prescriptions that their GPs give them to decide which ones they can afford, but the GPs themselves—as they have said in discussions with the BMA—decide, sometimes with the patient, which prescriptions the patient can afford. The decision about what to prescribe is based not on what the patient requires, but on what they can afford to pay, which is rather chilling.
I move on to deal with health visitors. In fairness to Mary Scanlon, I have difficulties with the loss of the universal attendance—and the associated care and attention—of health visitors. I signed up willingly to the Health and Sport Committee's recent report on child and adolescent mental health and wellbeing, and I stand by it, as I suspect other members of the committee do. There are, as we know, extensive difficulties in the recruitment of much-valued allied professionals, which is a big issue. There are also huge difficulties in relation to demographic changes, and some areas such as the Scottish Borders may require extra district nurses to deal with an ageing population, although there are a smaller number of births.
The minister knows—and I will continue to say—that I am concerned about vulnerable families. As the evidence that the Health and Sport Committee received makes clear, the problem is that we do not know where those vulnerable families are. Only when the health visitor is a welcome guest in the house of the carer or the parent may they see something amiss that even the parent does not see. The problem is that when health visitors attend vulnerable families, they begin to slip in the perception of the public—not of myself or other members of the Health and Sport Committee—because they are viewed as social workers. As we know, a social worker on the doorstep gets a very different reception from a health visitor. We are living in the real world, and I understand the difficulties. However, I continue to hope that the Government will address the issue of universal attendance from health visitors for a period of time to babies and young children.
I welcome the opportunity to speak in the debate. I know that Mary Scanlon takes a genuine interest in all the issues that have been raised; she researches things in great detail and works extremely hard. I also defer to Nanette Milne's many years of professional knowledge of medicine. However genuine those two members may be, I am nonetheless not entirely persuaded that some of their Conservative colleagues approach the issue from the same angle. I am interested to find out whether we will hear a more ideological approach in some of the summing-up speeches.
I worry that an attempt to pitch the issue of support for prescription charges as the direct opposite of support for health visitors is in danger of missing the point. Christine Grahame made a good contribution, particularly on the importance of the universality of the health visiting service. As a former social worker who worked very closely with health visitors, I know that the roles are different. We need to understand that and ensure that people who are in both those professions get the support that they need to do their job.
Mary Scanlon talked about some of the anomalies in the previous situation, and the work that was done on that. She mentioned the anomaly whereby people with diabetes received free prescriptions while those with asthma did not. Jackie Baillie did a good job of summarising why the Labour Party has moved its position, which is not least because we are living in slightly different times.
Nicola Sturgeon talked about principles. Today is one of those rare occasions—it is a shame that she is not in the chamber to hear it—on which I agree with her, certainly more on this particular issue than on others, in that we share beliefs about the importance of the NHS and how we want it to develop in the future. However, that is the end of any agreement, because I remind the ministers of what was in the SNP's manifesto. The SNP pledged to abolish prescription charges immediately for people with chronic conditions, including people with cancer as well as those in a number of other situations, and to phase out prescription charges for others. There is an anomaly, which must be addressed, with regard to the question of why cancer patients south of the border have had their prescriptions free since April 2009, while that has not happened in Scotland.
Members might not be surprised if they consider the other pledges that were in the SNP manifesto. Pledges on grants for first-time home buyers, the dumping of student debt and the abolition of the council tax have all been scrapped, and only this week we have heard that the pledge on class sizes of 18 has also been scrapped. Ministers will no doubt say that they did not have parliamentary support for those measures. Shona Robison wants to intervene—I am interested to hear what she has to say about the pledge on prescription charges.
Is Cathy Jamieson really saying that people in England will be in a better position next year than people in Scotland, who will not have to pay for their prescriptions? That argument does not stand up to any scrutiny. When will Gordon Brown move on his pledge to abolish prescription charges for people with chronic conditions? People in England are waiting for an answer on that.
It is astonishing that Shona Robison should spend so much time focusing on what is happening south of the border, rather than dealing with the things for which she and the Cabinet Secretary for Health and Wellbeing have responsibility here. The cabinet secretary could decide now to give cancer patients in Scotland free prescriptions. There would be a parliamentary majority to support that, if the SNP back benchers were to support the Labour Party's amendment to the motion that we are debating.
It simply is not good enough that every time the ministers hear something that they do not like, they try to blame it on Westminster. They have the opportunity to act on the issue. I understand the issue about other long-term conditions, but—with respect to the Liberal Democrats on that issue—I note that we have heard a lot from cancer charities such as Macmillan Cancer Relief about the real financial difficulties that are faced by people who have cancer.
I ask the minister at least to give that issue some consideration, and perhaps tell us in her summing-up speech what work she has done on examining the cost of abolishing charges for cancer patients. Will she consider what that would cost in comparison with the significant sums of money that have been set aside to pay bonuses to consultants?
Before I hear again from the minister that the issue must be sorted out at Westminster, I tell her that it is another example of an issue on which, if there is the will in Scotland, and in the Scottish Government, the minister could act right now. The Government can do that by reprofiling—to use the jargon—the money that has been set aside for the bonuses.
I have heard what the Health and Sport Committee has said on the issue, but we should not say, "Let's wait until something happens elsewhere." We have the opportunity today, in this Parliament, to vote to give cancer patients in Scotland free prescriptions now. Of course we want people with other long-term conditions to benefit, and that will happen, but we need to take this decision today. Surely the SNP back benchers cannot be comfortable with a situation in which people in Scotland are getting less of a service than people elsewhere.
I turn first to the Lib Dem amendment. After eight years of the Lib Dems sharing Government in Scotland, during which Ross Finnie admits that they did nothing to curb distinction awards, which are discriminatory and unfair no matter what the financial climate, they have the gall to latch on to a cause that I raised in Parliament long before, I suspect, most Lib Dems had even heard of distinction awards, let alone desired their abolition. The cabinet secretary has wisely decided to fire a warning shot by freezing the level of awards for next year—the first health secretary in 61 years anywhere in the United Kingdom to do anything about the issue. I would have thought that a committed unionist such as Ross Finnie would have welcomed Nicola Sturgeon's consensual approach in attempting to work in harmony with other UK nations. The Lib Dem motion smacks of shallow opportunism.
Whatever it smacks of, I wonder whether, in view of Dr McKee's trenchant support for the abolition of distinction awards, he will vote for the Liberal amendment today.
I will not vote for the Lib Dem amendment for a simple reason. On an issue that could affect the future recruitment of consultants in Scotland it is important to work in harmony with others before working against them.
I shall now try to convince Jamie Stone, who tells us that he has an open mind and may defy his party whip tonight. If we believe in a health service free at the point of need, there can be no point of need more immediate than the need for medicine that a doctor has advised is a necessary part of treatment, so there should be no prescription charge. However, if we believe that that principle no longer applies, why stop at or even select prescription charges? If we want an improved health visitor service, as the motion suggests, why should wealthy families not pay a charge when they use it? Why should Nanette Milne not have paid for a health visitor to come to her? Why not charge for GP consultations, outpatient appointments, anything? What is so unique about prescriptions that only they are in the firing line?
Mary Scanlon argued that there are many people who could well afford a prescription charge—
Will the member give way?
I must make some progress.
The argument goes that with the country in a difficult financial situation, that is one way in which we can take some of the pressure off the public purse. The trouble is that every prescription charging regime that has been suggested has resulted in some prescriptions not being dispensed because some patients cannot afford them. In my general practice days, I regularly came across patients who told me that they could not have a prescription dispensed until pay day, which might be some days hence.
I have met many patients in Inverness and the Highlands who are constantly being given prescriptions for antidepressants, which can be difficult to come off. Many people are on them for 20, 30 or 40 years. Does the member agree that it is not all about prescription charges and that we should be giving more consideration to the talking therapies?
I agree with that point, and I will deal with it later.
Local pharmacists often had the unenviable task of choosing which of several preparations prescribed by a doctor should be dispensed, as the patient could not afford all of them. Delay in taking a necessary medicine, or not taking it at all, can have serious health consequences involving not only the individual but the rest of us—delayed treatment is more expensive treatment.
To answer Mary Scanlon's point that prescriptions are given out too easily and that a charge could have a rationing effect, the illogicality there is that, as far as the patient is concerned, the doctor has said that the treatment is necessary and it is dangerous to expect the patient to have the knowledge to choose which medicine not to take. If a doctor is prescribing irrationally, the remedy is to tackle that directly, as is done already by various effective mechanisms.
Those are not the only objections to prescription charges. As they were previously operated in Scotland, and are still operated in England, the charges are often a monstrous swindle that would easily fall foul of the regulators, or even the law, if they were initiated by other than a public body. That is because a huge and growing number of prescription items are much cheaper than the standard prescription charge. In the year to April 2009, in Scotland, even with the prescription charge reduced to £5, a massive 42 per cent of prescriptions had ingredients that cost less than £5.
By reducing and eventually abolishing the charge, our Government is doing something about that, but successive Governments in England have increased the prescription charge year on year by roughly the rate of inflation until it is now £7.20. Just about every medicine used a few years ago is much cheaper today than it was then. For example, the cost of ingredients of a standard course of penicillin today is about £1.25, but it was once so expensive that it was extracted from the urine of patients being prescribed the antibiotic so that it could be used again. Nowadays, the English NHS prescription charge is a massive 576 per cent more than ingredient costs. Even private patients pay much less than that, but it is illegal for a doctor to write a private prescription for an NHS patient. I am sure that Mary Scanlon's party, when in Government, will continue that robbery from ordinary citizens in England. We must not let it happen here. Shame on them. I support the Government amendment.
I am pleased to take part in the debate. It could be viewed as a debate on two separate topics, unless one agrees with the Conservatives that one policy directly influences the other. I do not, but both issues are important and I am grateful for the opportunity to debate them.
As my colleagues outlined earlier, the Labour Party in Scotland has long advocated that the Government should make prescriptions free for cancer sufferers. That is the case in England and Wales, and we believe that that should be a priority for Scotland. It should happen now rather than be phased in. It is unacceptable that, due to the Government's policy, cancer sufferers north of the border still have to pay prescription charges.
I do not know what the member's message is to all those organisations that have launched a campaign for England to follow the lead of the Scottish Government to abolish charges for all the other chronic conditions. Will she back them rather than trying to create artificial divisions?
I am not creating artificial divisions. I am not talking about stopping the minister's policy of free prescriptions for all; I am talking about rebalancing her policy and phasing it in differently, in a way that would allow cancer patients to have free prescriptions now. It would mean that people like me would have to wait a little longer to get free prescriptions, but I, for one, would be willing to do that so that cancer patients could be prioritised.
Cathy Jamieson mentioned the well-known fact that cancer patients suffer economically due to lengthy periods off work and the cost of their illness. Macmillan Cancer Support and Citizens Advice Scotland have considered the issue of fuel poverty, but there are many other costs—a point that a CAB report a couple of years ago made strongly. Free prescriptions would alleviate some of that financial pressure at a difficult time.
No one would dispute the importance of ensuring that cancer patients receive proper treatment, but is the member really saying that people with other chronic conditions would be better served by having to continue to pay for prescriptions?
I do not think that the member has listened to a word I have said. I suggest free ear syringing for him.
The motion talks about health visitors, and suggests that the money that would be used to reduce the prescription charge could instead be used to increase health visitor numbers. As Christine Grahame mentioned, the Health and Sport Committee recently carried out an inquiry into child and adolescent mental health services. It became obvious that health visitors had a crucial role to play, both by identifying children in their early years who were developing mental health issues and by identifying mothers who were suffering from post-natal depression. I think that most of us would agree that we need more health visitors. Those resources need to be targeted towards families in most need, and the current policy needs to be refocused to ensure that it is universal for longer. Families need a minimum service throughout the early years. At the moment, some families fall through the safety net because of where they live or because their family is seen as not being in a priority group. It is obvious that a family needs a high level of intervention if they live in deprivation or have a drug or alcohol problem, but the universal service lasts only eight weeks, which means that families who develop problems after eight weeks have little or no support.
One of the problems is that the number of people training as health visitors has fallen. Although we had a high in 2001-02, it has been falling steadily ever since. Unless we increase the number of people in training, we will not be able to fill any additional posts that we create. In places such as Highland, no health visitors are being trained because of the review of nursing in the community pilot, which seeks to assimilate the health visitor role into the new community nurse role. Fewer people will consider health visiting as a career because of the uncertainty hanging over the profession.
Does Rhoda Grant agree that there is considerable disquiet among the medical and nursing professions about the changes that she just outlined?
Yes, there certainly is. I ask the minister to intervene to ensure that health boards that have stopped training reverse that retrograde step so that the career of health visitor is retained and recognised.
Our nursing and health visiting professions have an age profile that means that large numbers will retire at the same time in the near future. I have raised that with the minister to ensure that we have enough training places for newly trained midwives to fill the gap. We need to do the same with health visitors.
I return to the review of nursing in the community pilots. I am puzzled that health visitors were included when community midwives were not, although their roles are interlinked. Rather than creating a new community nurse role, I suggest that we look at developing a team that works closely together and includes social workers, midwives, community nurses and health visitors. That would be more challenging in rural areas, but we have heard of GPs and nurses who are highly skilled generalists working in that way.
I ask the minister to look at how highly skilled generalists are rewarded and how their careers can progress. Specialists with similar levels of training have that recognised in their qualifications and therefore their pay, but skilled generalists are not recognised in a qualification, which means that they do not have the same career progression or pay. I ask the minister to reflect on those issues and hope that she will find a solution for rural areas.
Mary Scanlon began her contribution by highlighting the funding constraints that will face the Scottish budget in the coming years. She made some fair points about the impact of the recession. This Parliament is tasked with looking at the priorities in the budget, asking where and how our services are provided and making sure that that happens in the most equitable way. I recall from last year the Conservatives thumping their benches and claiming that they had an extra quarter of a billion pounds in the budget. Indeed, Mary Scanlon and others were probably campaigning throughout the country for an additional £60 million town centre regeneration fund without knowing where the money would come from. Nevertheless, we are now being told by the Conservatives that we are in a situation where restraint is required.
The Conservatives have said two things this morning. One is that they fully support health visitors, which is a correct and principled position and I do not criticise them for it in any way. Secondly, Annabel Goldie said on the radio this morning that those same health visitors who will start in the NHS band 6 salary range on £24,831, will receive a £500 pay cut under Tory proposals to freeze the salaries of anyone earning over £18,000 from 2011—if we anticipate reasonably that inflation will be 2 per cent, that will be the consequence. In a debate on spending choices and constraint in the budget, we have to be open and honest about that.
In that spirit of openness, will the member tell us whether the Liberal Democrats support the principle of a pay freeze for those earning more than £18,000?
No, we do not. We favour a £400 flat increase, which will be approximately 2 per cent for a health worker. That is the normal uplift on inflation. A £400 flat increase for all public sector workers means that those at the lower end of the salary scale, including health visitors, will have the reasonable uplift that we would expect. Those who are higher up the scale, about whom I will speak in a moment, such as managers and those at the most senior levels, do not receive that uplift. I hope that that helps Mr Fraser. I hope that that sensible solution will garner support from the Conservatives.
We have identified the principles behind expenditure in the budget. Christine Grahame argued her case extremely well this morning. Although some elements of her speech had some unintended consequences, she mentioned one aspect that was relevant to the debate. She spoke about the things that she would like to do in an ideal world. The cabinet secretary's entire speech gave the impression that we were already in an ideal world where we provide universal free services. I asked a question in an earlier intervention about a constituent, who is not alone in being charged for prosthetics, and Derek Brownlee asked about dental care, but the questions were sidestepped. When I asked my question, I overheard an SNP member, who was clearly pleased with his verbal skills, describing me as "pathetic raising prosthetics". The point is that if the SNP is contributing to a debate about principles, what about the other areas where charges apply? Could the Government move on those areas if a point of principle were involved? The Government is not moving on those and there will still be a framework of charges under the NHS that many people would argue is connected directly to the health treatments provided. The real debate today should be about looking at what is fair, broadly equitable and affordable. That was Ross Finnie's point.
What I have just said is relevant to the Liberal Democrat amendment. During scrutiny of the current and previous budgets we have asked about the payment of bonuses as well as, I say to Dr McKee, the pay of the most senior staff pay in the public sector. It is absolutely right to do so. Under the existing scheme, ministers in this Administration signed off 27 additional awards, including three A-plus bonuses of £75,000 in 2008. In 2009, ministers signed off 26 additional awards that were utterly at their discretion. Ministers received advice from a self-nominated panel, but they did not need to take it. The cabinet secretary told us that the Government's current position is that when it receives recommendations on new additional awards, it does not accept any.
Dr McKee said that we have no right to raise questions about such bonuses. As an SNP member who believes in independence for Scotland, he feels strongly about the issue and believes passionately that there should be only a UK solution to the problem. It is perverse to take that position when he is perfectly aware that a different scheme from the one in England has been in operation in Scotland since 2003.
I am grateful to the member for taking an intervention so late in his speech. I point out that being in favour of independence for Scotland does not mean that we have to fight against everything that another nation does. Working in harmony on a mutual scheme is in the interests of both countries.
Dr McKee said that he had been scrutinising the issue closely, but he is perfectly aware that a separate scheme has been operating in Scotland since 2003. Indeed, that separate operation will change further from April this year when a new scheme is put in place by this Government. That new scheme will give discretionary powers to health boards to provide a grade 9 award of £28,000 and a grade 10 award of £32,000 that were not in the previous scheme. If the member is arguing that there should be one scheme throughout the United Kingdom, it seems slightly odd that he wants a separate NHS altogether.
Of course, the question of the sustainability of the highest pay is relevant. I have been encouraged by the SNP Government listening—in today's debate and yesterday's—to what has been said about the pay of the most senior public sector staff, particularly in the NHS, not being sustainable.
I think that our proposition on bonuses reflects Dr McKee's thoughts, although it is unfortunate that he does not support a separate Scottish scheme; nor, indeed, do the Conservatives. I hope that we will send a signal that the sustainability of the pay of the most senior staff is probably the thing to be looking at if we are to free up resource for those who need it most. We are asking the broadest shoulders to take a greater stake in ensuring that our public services are provided for those who need them most.
I thank the Tories for bringing this debate to Parliament. It is always a deeply reassuring sensation to have one's deepest prejudices and suspicions confirmed and vindicated.
I am sad that it is necessary to have this debate at all and that some in the Conservative party evidently still do not appreciate the central and fundamental aim of the national health service. As others have said, the NHS exists to treat all those who ask for assistance, irrespective of their ability to pay, whether for health care or prescriptions. As of this week, the Tory stance on health care might be one vote more popular in the United States Senate, but I doubt whether it is one vote more popular in Scotland.
I will meet the Tory argument head on. If, as the Tories argue, people with a decent income should not get free prescriptions, where does that argument end? Should such people be debarred from receiving surgery, too? If so, what kind of surgery and what kind of incomes are we talking about?
The NHS is not founded on the principle of there being a deserving poor; it is founded on the idea that everyone should contribute according to their ability to pay and benefit according to their degree of need. I had understood that the Tories had previously reassured us that that principle was safe in their hands, although I am not quite sure how to read Nanette Milne's comment that the Tories "have not changed."
It is simply untrue to suggest that, as things are, everyone who really needs a free prescription can get one.
Does the member believe that that should apply to NHS dentistry, too?
I can only observe the example of my small constituency, where, under the previous Government, a dental waiting list of 4,000 emerged and where the current Government is providing a new dental centre.
It is worth saying that a significant number of people with chronic conditions still continue to pay for medication—a problem that particularly affects people who need multiple prescriptions. In my constituency, 2,623 prescription prepayment certificates were purchased in 2008-09. Given the small population, that is a huge number of people who still have to pay for essential medication. Perhaps the Conservatives would like to explain their position to those people directly. One has to wonder whether the Tories are planning to campaign up and down the land for their constituents' right to pay for prescriptions.
As the Cabinet Secretary for Health and Wellbeing has indicated, around 600,000 adults who live in families with an annual income of less than £16,000 will benefit from the abolition of prescription charges. The Minister for Public Health and Sport provided that figure in response to a written question from Johann Lamont on 28 October 2008. By no stretch of the imagination are those 600,000 families well off. Overwhelmingly, they are ordinary Scots who are working to earn a living. If there is any suggestion—and there is—that some families in that situation are deterred from buying what their doctor has prescribed for them, how can we say that we are serious about improving Scotland's health? In fact, there is more than a suggestion of that. The purchase of prescription prepayment certificates has more than doubled since April 2008, when the process of reducing charges began.
As regards health visitors, who the Tories have arbitrarily decided are somehow the victims of the Scottish Government's decision to abolish prescription charges, I know of few who would advocate our continuing with a system that creates a disincentive for a patient to get the prescription that he or she needs. In fact, we still have more doctors, nurses and other health professionals working in Scotland than ever before. All that is at a time when the Scottish budget is under more pressure than ever before from unprecedented budget cuts from the London Government.
The Scottish Government has committed to protecting NHS budgets, even under that strain. Meanwhile, the Scottish Tories dropped a hint to the Scottish Government last week to prepare a stand-by budget
"in case they have to make further cuts after the election."
The Conservative party says that it wants to look at saving money to be reinvested in front-line services, which might well be a laudable aim. If that is the case, rather than cutting a measure that is aimed at helping everyone in society, including those who need help most, it should look at some of its own UK fiscal policies, which, in true Tory style, are aimed solely at helping the very wealthiest in society. Such policies include increasing the threshold of inheritance tax, which it is estimated would cost £1.5 billion, and abolishing the top rate of income tax for all those who earn more than £150,000.
While Labour and the Conservatives vie with each other about who can cut most from Scotland's budget, Scotland's Government will get on with the task of making health care free at the point of need. As long as the Conservatives in Scotland argue against free prescriptions, they will struggle to be taken into the hearts of the people of Scotland. Perhaps, as an election approaches, we have further evidence that the Conservatives in Scotland are once more ruthlessly courting unpopularity.
I start by expressing my disagreement with the motion and with the whole notion of stopping the reduction of prescription charges, particularly in the light of the SNP's early promise to abolish prescription charges for cancer patients and those with chronic conditions. Those were the first election promises that the SNP broke on entering office. Its manifesto stated:
"We will immediately abolish prescription charges for people with chronic health conditions and people with cancer."
The only thing that happened immediately was that the promise was broken. Today, people with chronic health conditions and cancer are still paying for their prescriptions, albeit at a reduced rate.
A number of Labour members have talked about the pressing need to abolish prescription charges for cancer patients immediately. Why, in eight years, did they not do that, given that they feel so strongly about it today?
That is an interesting question coming from the SNP. People absolutely have the right to change their minds and I understand the progress of policy.
I take the minister back to the promises that the SNP made, because to have broken a promise is a serious charge. Broken promises seem to be a recurring theme of this session. What makes this particular breach so serious is that it was a promise made to a particularly vulnerable group of people. It was the only part of the SNP's 2007 manifesto where the word "immediately" appeared. It was a new promise that was not mentioned in 2003. Those patients have been badly let down by this Administration, which has not kept its promise.
To indicate the scale of the problem, we can look at the 2008 figures for the number of prescriptions issued for cancer drugs. In NHS Tayside, the number was 18,000 and in NHS Grampian it was 24,000. Overall, there was a grand total of more than 236,000 prescriptions for cancer drugs throughout Scotland, which involved more than 14 million items being dispensed. Cancer is an expensive disease that often needs multiple drugs. It brings additional worry and increased health risks and frequent visits to hospital are required.
I am still outraged that patients and visitors continue to be required to pay car parking charges at hospitals such as Ninewells in Dundee. It is highly contentious that patients are charged £1.70 per visit on top of other costs—that is neither free nor targeted.
In December 2007, the health secretary made the excuse that it would take too long to compile a list of chronic conditions. I understand that difficulty, but what was the excuse for not abolishing charges for cancer patients immediately? As the Labour amendment says, in England, cancer patients began receiving prescriptions for their treatment free of charge almost a year ago. I welcome the reduction in the cost of prescriptions and prepayment certificates, but phasing out prescription charges by 2011 is very different to immediate abolition.
The Conservative motion calls for more money to be spent on health visitors in Scotland, to be funded directly by withdrawing the proposals for further reductions in prescription charges. I disagree with that premise, but I welcome the opportunity to have a debate about health visitors, who are key professionals. I agree that their work should be seen as a priority—there is no disagreement in the Parliament about that.
I am concerned about health visitor vacancies in NHS Tayside, where four posts were unfilled for three months at the end of last year. Health visitors are key professionals, whose expertise is vital in matters such as the assessment of child protection. Unfilled vacancies place additional pressures on existing nursing staff, particularly when they are in addition to other nursing post vacancies. Between April and October last year, bank nurses worked more than 162,000 hours in Tayside.
Of course budgeting is difficult—priorities such as screening babies, tackling health care associated infections or paying £30 million in distinction awards for consultants must be balanced—but choices must be made and with the utmost care.
Scotland has the umbrella organisation the Scottish cancer coalition, but some cancer charities, such as Macmillan Cancer Support, are cross-border organisations because of the nature of their work. Macmillan now has a different message for cancer patients in Scotland from that in England. On 20 January 2009, Macmillan welcomed on its website the UK Government's announcement that cancer patients would receive free prescriptions by April 2009. It said:
"This was absolutely the right thing to do. Cancer not only threatens your life, but can also make you poor. Free prescriptions will transform the lives of thousands of people living with cancer who were struggling to pay for drugs."
Macmillan pointed out that
"most people's income drops significantly after a cancer diagnosis … the extra costs mount up."
Labour's amendment does not ask the SNP to do something that it has not promised to do. Cancer has afflicted, does afflict and will afflict many Scots. One in nine males and one in seven females develop some form of cancer before 65. After 65, the risks rise to one in three for males and one in four for females. They are the people whom the amendment would help. I support the Labour amendment and call on others to do so, too.
Many people who are ill and cannot work face a financial penalty through having their wages docked by their employer. That means a treble whammy—people worry about their health, their job and the cost of getting better. Of course, people who are in employment have already paid for their prescriptions through their wages. The amount that is deducted from pay cheques in national insurance contributions is going through the roof so, in essence, people will have been charged double for their prescriptions.
The benefit from a universal service can be fundamental to many. When someone's income is on the margins, even a short illness can have a major impact on their ability to balance the books. If an illness attacks over a longish period, choices must be made. At a time of economic recession, that is an even more difficult situation for many families to be in.
When someone is pressed financially, I bet that the medicine that is prescribed for them is what will be dropped. That makes the situation even worse not only for the individual who is unwell but for the health service, because instead of early intervention through prescriptions, more costs add up as a minor illness becomes major.
My main reason for supporting universal free prescriptions is that no one who is ill should fall through the safety net of health care, no matter what their financial circumstances are or the length and intensity of their illness.
I well remember that, when Jackson Carlaw of the Tories spoke in a members' business debate on car parking charges at NHS hospitals, I was mighty impressed. During his speech, I thought that the Tories were finally coming back into the light of mainstream Scottish public opinion and that they were returning to the position that they occupied before the reign of Margaret Thatcher—they were reoccupying the ground of the old Scottish Conservative party and talking about community.
Jackson Carlaw's speech—which I am sure that he meant—was about concern for others and not for himself. However, with the Tories' stance on prescription charges, I am afraid that they are still in the shadows of Scottish public opinion. Most people in Scotland believe that there should be no barriers to getting better when someone is ill, particularly with a long-term condition. Most people in Scotland are totally against taxing the ill. They believe in a national health service that is free at the point of delivery, and that includes prescriptions.
The whole Parliament recognises Gil Paterson's commitment to palliative care. Does that mean that he supports our view that, no matter what the Government is doing generally, cancer patients should be exempt from paying charges now, because they are made poor and have little time to change their economic status to obtain free prescriptions? The whole arrangement is far too difficult, so they should have free prescriptions now.
I will address that in a few moments.
Free prescriptions for all would cater for people who are reluctant to seek or who avoid seeking medical attention because of the sheer cost of prescriptions. They would no longer fear the financial burden that prescription charges bring and they would no longer be penalised for being on the margins.
Dr Simpson's point was that cancer patients should qualify automatically for free prescriptions. I have great sympathy with that, but I would go much further. I believe that all people who have long-term illnesses should have free prescriptions and that we should not single out one illness—that would be entirely wrong. If, because of a long-term illness, prescriptions cost families or individuals a fortune, I want to help them all, no matter what the condition is. That is exactly what the Government proposes.
The SNP pledged in its 2007 manifesto to remove prescription charges for cancer patients "immediately". Was that manifesto wrong?
No—the manifesto was not wrong at all. The mere fact that the motion that we are debating tries to restrict the promise that we made proves that point. I am sure that that commitment will be met and the promise kept. That might take a bit longer, for which I make no apologies, but I am sure—I certainly hope—that it will happen.
I travel to the United States of America regularly but, because of the health system there, I always have a worry at the back of my mind that members of my family might become ill. I much prefer and value the stronger Scottish system of care from a community-paid health service. Those are the principles on which the national health service was established. The Government will meet its commitment and will bring about exactly what the health service should provide—free health care for people who are in need, when they need it.
My Conservative colleagues and I have long held the view that it is not a good use of money from a hard-pressed health budget to provide free prescriptions to people such as me, who can well afford to pay for them. A mere 6 per cent of all prescriptions that are issued must be paid for in full. They are paid for by people such as me who, when we need the odd prescription, have no difficulty whatever with paying the £5 charge that accompanies it. Indeed, many people who are richer than me, including no less a person than the First Minister—a man in receipt of three salaries—can well afford to pay. It hardly seems to make good sense to take money out of the health budget to put it into the pockets of people such as Mr Salmond, particularly at the time of a squeeze on the public finances, as we heard yesterday afternoon in the budget debate.
It saddens me to know that some SNP members take a different view from me. However, I was delighted and encouraged to hear the comments of my good friend the Minister for Housing and Communities, Mr Alex Neil, on "Good Morning Scotland" just last week.
Mr Neil, a man who is well known for his robust and outspoken opinions, was being quizzed on the Scottish Government's opposition to a general boiler scrappage scheme and its favouring of an approach that is targeted at those in low-income groups. He said:
"Why should people earning £50, £60, £90, £100 grand get a bigger share of the cake when we have got so many people in fuel poverty?"
In taking my stance against universal benefits, I did not expect to be able to pray in aid a Government minister of Mr Neil's standing. Clearly, he has seen the sense of a targeted approach, not one that lines the pockets of those who are already on high salaries. What a pity the cabinet secretary cannot similarly see sense.
The member is in favour of people who are on high salaries having to pay prescription charges. Is it his party's policy to extend that to people on high incomes who are over the age of 60?
We think that it is perfectly legitimate that those who are retired and no longer earning an income should get free prescriptions. We support the current exemptions, but our view is that, at a time of pressed resources, we should not extend exemptions to people such as Dr McKee and me, who can pay—
I am over 60!
I had not realised that Dr McKee had achieved that age. I congratulate him on that and on doing so well.
Later in the interview, Mr Neil seemed to become rather confused. When pressed by Aileen Clarke on why the same principle should not apply to free prescriptions, he said:
"Well, er, one of the reasons for that is, er, because, er, the cost actually of administrating a discriminatory pay prescription scheme has become so expensive. We are actually probably saving money and the evidence so far actually shows in terms of prescriptions we are actually in the long run going to save money because we are providing free prescriptions and a lot of the bureaucracy around the current regime can be eliminated."
Almost persuaded by the powerful and articulate argument that Mr Neil put, I went to check the cost of administering the so-called "discriminatory pay prescription scheme". The latest figures that I found were from 2005, when the Scottish Executive revealed that the cost of administering the NHS prescription charging scheme was £1.54 million per year. Even allowing for inflation since then, it is hard to see that an argument can be made that the cost of administration could approach anything like the £40 million-plus that we are talking about. If the cabinet secretary has figures to support Mr Neil in his contention that the administration costs outweigh the costs that would be taken out of the health budget, I would be delighted to hear them. I note that she is not rising to her feet—[Interruption.] She is. Excellent!
The point that Mr Neil made, and the point that I made earlier, is that if, as I understand the Conservatives are arguing, we were to extend the list of exemptions further, the gap between the income from prescription charges and the cost of administering the scheme would become ever narrower and the burden of administration would fall on fewer people. In the words of the BMA, it would become nonsensical to keep the system. I am not sure what is difficult for Murdo Fraser to understand in that proposition.
Sadly, that is not what Mr Neil said. Clearly, he and the cabinet secretary are at odds on the issue. I am sure that she will put him right when they meet very shortly.
Mr Neil is not the only one who seems to be confused about his party's stance on the issue. As we have heard, while the Labour Party was in government, its members were very firm in their view that free prescriptions should be opposed. In January 2006, during the stage 1 debate on the Abolition of NHS Prescription Charges (Scotland) Bill, the then Minister for Health and Community Care, Andy Kerr, said:
"What is right is that those who can afford to contribute towards NHS dispensing costs should do so."—[Official Report, 25 January 2006; c 22646.]
In the same debate, Helen Eadie MSP argued against the proposal to provide free prescriptions for all, saying:
"We are definitely not happy to throw away £45 million when that money could be spent in some of the most deprived communities."—[Official Report, 25 January 2006; c 22665.]
The self-same Helen Eadie, at a meeting of the Health and Sport Committee last year, voted against the attempt by my colleague, Mary Scanlon, to stop further reductions in prescription charges.
I remarked in a previous debate that the appointment of Jackie Baillie as health spokesman for the Labour Party had brought a much-needed backbone to Labour's health brief. Thanks to her, Labour has developed a much more robust position against blanket minimum pricing of alcohol, as proposed by the SNP. Unfortunately, the consequence of that is that poor Cathy Jamieson is jumping off to Westminster.
I had hoped that it would not be too much to expect a similar stiffening of resolve when it comes to the provision of free prescriptions for all, but I fear disappointment in that regard. As David McLetchie pointed out, it is particularly ironic that the Labour Party opposed free prescriptions when we had a rising health budget but is supportive of the proposal now, when the budget is under severe pressure.
The confusion on the Labour benches is as nothing to what we see from our friends in the Liberal Democrats. Like Labour, when in government, the Liberal Democrats opposed the abolition of prescription charges. They subsequently supported abolition, voting against Conservative attempts to stop the process at a meeting of the Health and Sport Committee last year. At the end of 2009, however, they changed their position again and now seem to oppose abolition. Even by Liberal Democrat standards, we would be forgiven for being confused.
I was able to do a little research on the position of the Liberal Democrats in Wales. Originally the Welsh Liberal Democrats were in favour of free prescriptions, then they were against them, and now they are in favour of them again. In contrast, the Scottish Liberal Democrats were against, then they were in favour, and now they seem, again, to be against. Are members keeping up?
Winston Churchill was supposed to have said that consistency is the hobgoblin of small minds. That dictum appears to have been adopted enthusiastically by members of his former political party. It really would be helpful to get some clarity and decisiveness from both Labour and the Liberal Democrats on the issue.
In contrast, the Scottish Conservatives have at least been consistent in our view that scrapping prescription charges for those who can well afford to pay is not the best use of resources. We believe that the money can be much better spent on improving access to health visitors, for example, as we outlined earlier in the debate. I urge all parties in the chamber to follow the lead that we have taken—ably supported by Alex Neil—and to support our motion.
In welcoming the opportunity to debate the issue, I draw very different conclusions from those drawn by the Conservatives. I am puzzled by the terms of the motion. On reading it, one is led to think that the NHS is in some form of crisis and that, of necessity, we have to make some kind of choice between the Government's policy of phasing in free prescriptions and continued investment elsewhere in the NHS. That is particularly peculiar given the greater number of doctors, nurses, midwives and other health professionals who are now working in Scotland—the number is greater than ever before. Indeed, the latest statistics show that the total NHS workforce has risen by 2.1 per cent in the past year.
I accept that there has been a slight decline over the past year in the number of health visitors, but it is likely that that is the result of recruitment issues and not any planned reduction by the Scottish Government. In 2008-09, the proportion of overall NHS expenditure on prescribed drugs was 15 per cent, down from a figure of 16.1 per cent in 2005-06. The phased introduction of free prescriptions is entirely cost effective.
The main savings that were made were on improved procurement at the national and UK level. When that is taken out of the equation, the member's point is not yet proved.
As I said clearly, the figures show that the cost of prescribed drugs is going down. Improved procurement could be part of the equation—I do not knock it. We should, of course, look to make things as cost effective as we can, wherever we can. Free prescriptions, which—if I hear them correctly—those on the Labour benches support, are entirely cost effective.
The Tories are trying to make political capital by pretending that investing in NHS staff and reducing prescription charges are mutually exclusive. In fact, both are necessary for building the fairer and healthier Scotland that we all should want to see.
As other members have said, the Tories are rarely in touch with reality in Scotland. As we have seen in the debate, their health policies vividly demonstrate that. Indeed, the Tories may have lost touch with themselves. Are they not supposed to be the champions of low taxation? We call them prescription charges, but they are officially termed a prescription tax. It is not simply a euphemism to say that those charges are an attack on people who suffer from ill health; it is literally the case. Why, then, do the supposed champions of low taxation want that tax to be reintroduced? That is beyond me—I cannot understand it. Perhaps it is because the tax penalises many poorly paid people and families who are at the margins and who do not qualify for free prescriptions—people for whom the Tories traditionally have not had time.
Does the member disagree that the Scottish Parliament and the Scottish Government face a decreasing budget, and does he disagree with the cross-party view of the Health and Sport Committee that it is vitally important that every child has a health check and a developmental check? Those are premises of today's debate that illustrate that we are in touch.
As a new father, I sympathise entirely with Mary Scanlon's point. The quality of care that my family has received has been excellent—we have not wanted for any care. Her point reflects Ross Finnie's suggestion that we rebalance or reorder priorities. However, at this time of economic difficulty, it is right that we should take forward the policy of phasing out prescription charges, because that will put money back into people's pockets. It is the right type of priority for us to have at this time.
I turn to the principles of the matter. Two years ago, the Parliament held a debate to mark the 60th anniversary of the NHS. The SNP Government's policy of reducing and abolishing prescription charges reinforces the founding compact of the NHS that health care should be free at the point of access, although Christine Grahame's point that we all pay for the NHS through taxation was well made.
There is a further reason for welcoming the Government's commitment finally to abolish prescription charges.
What is the member's justification for charging for dental services?
There have been moves to reduce dental charges. Dental check-ups are now free. There are far more dentists in Scotland and there is greater provision of dental services. I am intrigued by Jeremy Purvis's approach to the debate, as he keeps intervening on this point. Given that he does not even accept the premise that prescriptions should be free, it is somewhat phoney for him to decry the fact that dental care is not free.
The facts are that prescription charges were never part of the original vision of the NHS and that the SNP Government is committed to using its powers to do all that it can to realise the vision of the NHS's founder, Nye Bevan, and many others who worked to introduce a national health service free at the point of access. Many generations of the Tory party have never reconciled themselves to that concept. I do not doubt Nanette Milne's long-standing commitment to the NHS, but many in her party are content to see people left behind in health care, as if the market's invisible hand has determined their lot. Her colleagues have no objection to the kind of health care companies that we see in the United States exploiting the most vulnerable sectors of society to make massive profits, which they go on to use to manipulate the wider political system to their advantage. David Cameron's promise to protect the NHS has a hollow ring to it.
Will the member take an intervention?
He is just finishing.
I would have given way to the member, but I am afraid that I do not time to do so.
On at least one occasion, the Tory deputy leader, Murdo Fraser, has accused me of trying to appease a lunatic fringe in the SNP, admittedly on matters that are not related to today's debate. Surely there can be no more of a lunatic fringe than those elements of the Tory party that publicly criticise our NHS and call for a return to a privatised system of medical care—a system in which families scrimped and saved and feared the day when one of their own required medical treatment. "We can't go on like this," says David Cameron. I entirely agree with that sentiment. We should have the powers of independence—the full control of our resources that will allow us to transform the national health service and to ensure that it remains free at the point of access for all those who need it, including through free prescriptions.
Christine Grahame illustrated clearly the history of prescription charges. They were not in place when the health service was established in 1948 but were introduced in 1952, with the resignation of Bevan and Wilson. Harold Wilson, as Prime Minister, abolished them in 1965 but had to restore them in 1968 because of economic circumstances.
All agree that the current system of exemptions is outdated and unfair. It is clearly nonsensical that, for some illnesses—Christine Grahame mentioned underactive thyroid—people can get free prescriptions for everything. All members can agree that the previous system of prescription charges was not fair. From its manifesto, it is clear that the SNP saw the system as unfair and intended to tackle the issue of prescriptions for those with long-term conditions. It now accepts that it would be extremely difficult to do that, because of the boundaries involved, but it agreed with the Labour Party that we should try to extend exemptions and to make the system fairer, and that we should abolish charges for cancer patients immediately. Marlyn Glen and Rhoda Grant have made clear why charges for that group should be abolished now, as our amendment proposes. When someone develops cancer, the financial consequences are often significant—Macmillan Cancer Support has made that clear in its campaign.
It is clear that Richard Simpson believes strongly in the abolition of prescription charges for cancer patients. Why, in the eight years during which the Labour Party was in power, did no one in the Government, including him, ever raise the issue, never mind introduce a proposal to achieve the abolition of such charges?
It was the SNP's manifesto promise.
Ah!
It was. The SNP promised to abolish prescription charges for cancer patients. All that we are asking today is for it to do so, as it moves towards its stated objective. It could at least make an exception for those who receive attendance allowance on special terms because they are terminally ill; it could accept our amendment without interfering with its policy in any way. The amendment does not detract from the SNP's policy—it adds to it and helps the SNP to meet a manifesto commitment.
The issue of the sustainability of the policy has been raised and identified as a problem. Why do we question whether the policy is sustainable? Already health boards are delaying the implementation of Scottish Medicine Consortium approvals and the application of SMC-approved medicines. I have asked the Cabinet Secretary for Health and Wellbeing repeatedly for a guarantee that no cancer drugs and no new drugs that the SMC approves will be delayed or not introduced because the funds associated with prescriptions are not available.
My colleague Jackie Baillie raised the issue of the minor ailments service. We have asked about that issue and are glad to have received a clear answer today. The Government has decided that, from 2011, the service will apply to all patients and that there will be no exemptions from it, because everyone will be entitled to a free prescription. I will be glad if the cabinet secretary can clarify whether that is the case.
I am happy to provide members with the information in writing. I assume that Richard Simpson is not deliberately misinterpreting what I said, so I will say it again. At the moment, the minor ailments service is based on the eligibility criteria for free prescriptions. Once prescriptions are free for everyone, the minor ailments service will continue to be based on the current eligibility system for free prescriptions. I have made that clear previously; I am sorry if members did not know that, but I hope that it is now absolutely clear to everyone. That is what I said to Jackie Baillie.
The cabinet secretary's comments are most helpful, because we had misunderstood completely—we thought that the service would be extended. When I discussed the matter with Rhodri Morgan, when he was in the process of abolishing prescription charges in Wales, I asked him about the minor ailments scheme. He told me that it had not been introduced in Wales because of the consequences when prescription charges were abolished. Today the cabinet secretary is saying that prescription charges will be abolished only for some. Those who are currently on free prescriptions will retain the right to receive free prescriptions from their pharmacist, but those who are not currently entitled to free prescriptions will not receive them. All that the cabinet secretary is doing is shifting the boundaries. This is not a principled decision but a pragmatic one. The cabinet secretary may wish to argue against that when summing up, but the decision has been made clear today. It is totally new—none of us was aware of it previously.
Jeremy Purvis and others raised the issue of co-payments. The Government likes to portray itself as taking a principled decision that all health care should be free at the point of need. That is clearly not the case, and it is clearly not the Government's intention that it should be the case. Dentistry will continue to be charged for—not one SNP member has been able to defend that. If we are to discuss co-payments, we should perhaps have a serious debate, like those that are taking place in every other European country, about an appropriate and fair system for them.
I will quote Ross Finnie commenting on prescription charges, and I would be grateful if he would say whether the quotation is accurate. An article in Healthcare Republic headed "Prescription charges in Scotland to fall to £3" said:
"Liberal Democrat health spokesman for Scotland Ross Finnie said, in the current economic climate, extending reduced or free prescriptions to all should be a priority."
That is from 7 January 2010. That must be the most rapid switch in policy, even for the Liberals—unless the article was misleading.
Consultant awards and health visitors have also been discussed in the debate. Consultant awards are outdated and have been abused by the profession, which has given them to people who are within three years of retirement, not because they have provided an excellent or additional service but simply to enhance their pensions. The awards do not take into account the new consultant contract. I am astonished that Ian McKee, with his trenchant advocacy of their abolition, is not prepared to support an amendment that calls for their abolition. That is something that he will have to justify to his own conscience.
You need to be finishing now, Dr Simpson.
However, we need to remain competitive for the best minds and talents to remain in Scotland, so we need to be careful about changing the situation.
The Tories are prepared to restrain pay for those on £18,000, but they do not support the abolition of distinction awards. Their position seems unusual. I do not have time to deal with issues concerning health visitors.
We need to balance universal care with focused care. Our attempts to do that so far have not been sufficient.
I apologise to Jamie Stone. I should have called you first, Mr Stone, but I guess I got my Jamies mixed up and forgot to call you earlier.
Thank you very much, Presiding Officer. I congratulate Murdo Fraser on an eloquent and amusing speech that was perhaps spoiled in his last sentences. So bright was it that one fears that he might be in danger of eclipsing his leader. I congratulate him.
I will try to pull out the most interesting points of the debate. Mary Scanlon correctly drew our attention to the straitened circumstances in which we live, and she referred to an Audit Scotland report that was also mentioned yesterday. I am taken by her thoughts that, the healthier we are, the fewer drugs we need, and that earlier diagnosis is all about reducing the drugs bill in later life. The reason for my intervention during her speech—to ask about co-ordination with social work—was not about my local GP practice in Tain, although co-ordination between health visitors and social work is of absolute importance. That point has been reinforced by other members. If crucial information such as the identification of families in need is kept in one service's silo, the system will not work.
Nicola Sturgeon probably made the most idealistic speech of the morning. However, the question that I and my colleagues Ross Finnie and Jeremy Purvis wish to pose is this: how idealistic can we be in the present economic situation? I will return to that point.
Jackie Baillie was right to raise the issue of compromising patient care through the abolition of prescription charges. The discussion and interventions on each side of the argument on the minor ailments service have been most interesting. I am not absolutely certain that I understand where we are with that, but I am prepared to be enlightened, perhaps after the debate.
Again and again Jackie Baillie and her colleagues returned to cancer patients, who are mentioned in their amendment. The matter has been discussed honourably.
As Dr Simpson said, Christine Grahame outlined the history of prescriptions and discussed issues around exemption versus abolition. She talked about GPs discussing with patients which prescriptions they can afford, which sends a message to us all. She also touched on a subject that I have already mentioned in the context of Mary Scanlon's speech, concerning vulnerable families.
Rhoda Grant made a correct point that is hugely relevant to the Conservative motion: the number of people who are training to be health visitors is dropping or is at a standstill in certain health board areas. That is an important background fact. She also mentioned the slight confusion about the direction in which we are heading when it comes to community nursing. There is some unhappiness about it within the service. That might just be because there has been a change—I do not know—but we need to keep an eye on that.
All I can say about my colleague Jeremy Purvis's speech and Alasdair Allan's intervention is that they exemplify—do they not?—that well-known saying that we can choose our friends but we cannot choose our family.
On what Ross Finnie said, our amendment is about reordering and retiming, which are necessary. We live in hugely changed financial circumstances, so the sheer idealism of Nicola Sturgeon's speech, which I acknowledge, might not be easy to achieve today.
We have been talking about the money that is paid out to consultants. Cathy Jamieson and Dr Simpson agreed with Ross Finnie and me, I think, that it is entirely possible to address that issue in the context of the devolved Administration in Scotland. Cathy Jamieson used the word "reprofiling", and that is exactly how it can be done. I find it ironic—as do other members—that Dr Ian McKee finds himself unable to support the approach that has been suggested, given his strong advocacy in the past for precisely such a policy. The general public are not stupid. They understand, perhaps better than many people in Government, just what a difficult situation we are in. The fat cats in the City getting their bonuses is an unhappy and unseemly sight to many people who find themselves in great financial difficulty. What we are saying—in the context of my colleague Jeremy Purvis's policy of an across-the-board, flat-rate salary increase—is that we can and should be taking money off some people. Surely a bonus of £75,000 is absolutely incredible in this day and age.
To return to my intervention on the cabinet secretary's speech, and in fairness to the case that the Conservatives have made today, it remains the position that people such as me, Murdo Fraser and Dr Ian McKee can afford prescription charges, so why should we not pay them? That is a brutal fact that will not go away, no matter how we look at the debate or which idealistic position we take. It is a difficult issue for the ordinary person who is earning less than £16,000 a year. We must reconsider the matter. If some of us can and are willing to pay, we should.
Will the member take an intervention?
I am sorry, but I am in my final minute.
I have listened to the debate with great interest. Even on the minor ailments service, the debate itself has been useful in highlighting an issue—
You just get it wrong.
From a sedentary position, the cabinet secretary says that they get it wrong—maybe they do, maybe they don't—but I look forward to being enlightened in due course.
I thank all members who have taken part in the debate. There have been a number of positive and constructive speeches, although there have been some that were otherwise, too.
Mary Scanlon mentioned some matters that I wish to refer to before I come to prescription charges. She spoke about the report on CAMHS and the supposed lack of support for its recommendations. Nothing could be further from the truth, and we have backed—not just with words but with action and resources—the report and the meeting of some of its recommendations. We have done that through more than £12.5 million of new resources over three years to make the changes happen.
I wish to respond on the important issue of health visitors. A number of members rightly said that it is wrong to conflate the two issues of health visiting and the abolition of prescription charges. I will start with health visitors, however, and respond to some of the points that Mary Scanlon made. There is a universal health visiting service at the moment, and the core programme provides that universal service. It is true that beyond the core programme it is for health visitors to use their clinical judgment to determine what additional services and support they will provide, but we need to ensure that people clearly understand that every new mother must have access to a health visitor. There is the 10 to 14 days post-natal visit, to ensure that mum and baby are doing well, there is the developmental check at six to eight weeks, and there is the immunisation schedule, thereafter. Outwith the core programme, a judgment is made about which families require support.
The Parliament debated the equally well programme, to which—I recollect—every member and every party signed up. The message from equally well is that we need to ensure that our universal and core services have the right reach to the right families. That is not happening as it should, which is why the equally well programme came about. It is important that members take a more consistent approach and acknowledge that beyond the core programme, which provides support to every new mother and baby, extra support is needed for some families. I hope that we can agree and make progress on that together.
After my granddaughter received her MMR jab at 15 months, her mother and father were told to bring her back when she starts school. Is it acceptable that for three and three quarter years a child does not see a health visitor for all the developmental and health checks that are needed?
As I said, the core programme focuses on the first 18 months of life. There are issues to do with the support that we provide to families—particularly families in need—with children aged from nought to three. The family nurse partnership programme in Lothian is so important because it considers families' further requirements for support before the child gets into the formal system of nursery and school. We need to ensure that support is given to the families that need it. All members agreed with that when they supported the equally well programme.
Jamie Stone asked several times why people who are better off should receive free prescriptions. The cabinet secretary made the point that 600,000 people on incomes that are less than £16,000 will benefit directly from the policy. Judgments have to be made. I presume that the Liberal Democrats made similar judgments when they decided to support universal free personal care and concessionary travel. Every case must be decided on its merits, but we strongly believe that when a person is suffering ill health it is their health and not their income that matters. That is why we are persuaded by the case for the abolition of prescription charges.
I am pleased that Jackie Baillie has at last acknowledged that health spending is at an all-time high, although her position is slightly at odds with her assertions that the health budget has been given a bad deal.
Ross Finnie used the argument that Jamie Stone used. He also talked about distinction awards. We have announced that we will freeze the budget for distinction awards, which is more than Labour and the Liberal Democrats did during their eight years in power. Some people seem to have come late to the issue. Actions speak louder than words: we are taking action on the matter.
Nanette Milne's speech was well considered, although I disagree profoundly with her conclusions and I think that the words, "We have not changed," might come back to haunt her.
Christine Grahame reminded us of the principles behind the need for abolition by laying them out well.
Cathy Jamieson was right when she said that, in the debate, a false link has been made between support for health visiting and the abolition of prescription charges. She also mentioned concern about consultants' bonuses and distinction awards, although she never expressed such concern when she was a minister and was able to do something about the matter. I would have thought that if her concern is heartfelt, the issue might have come to the previous Government's attention during its eight years in power. Her plea for the immediate abolition of prescription charges for cancer patients invites the same question: why is the issue of interest only now? Was it not the case that the arguments were being made to her and many of her ministerial colleagues by the charities that she mentioned in her speech? However, no action was taken during those eight years.
The SNP said in its manifesto:
"An SNP government will immediately abolish prescription charges for ... people with cancer".
The SNP's actions today suggest something different. Was the manifesto wrong?
We are delivering on our manifesto in a way that is fair to everyone. Why does Cathy Jamieson hold up the approach in England as a panacea, when all health organisations in England are campaigning for the policy that we have in Scotland?
It is absolutely clear—it always has been—that under the minor ailments scheme people get over-the-counter medicines and free prescriptions through their community pharmacies. They are already exempt. The system will continue after abolition, because it is a good and efficient service.
Will the minister give way?
I cannot because I am in my final minute. Jackie Baillie needs to sit down.
We will not extend the minor ailments scheme to other groups, because we are not going to extend the provision of free over-the-counter medicine to other groups because that would not be good use of resources. That has always been the case. We have made the position clear, and if the Labour front benchers have not picked up on that, perhaps they should have been doing their job a little better.
I am happy to support the amendment in the name of Nicola Sturgeon.
Scottish Conservatives had no qualms about bringing back to the chamber the issues of prescription charges and health visiting. I say to Jamie Hepburn that we would not have promoted the debate had we no concern for the people who we think are being left behind in health care.
The issues are related, because an unintended irony is unfolding under the SNP Government, in that by standing by and allowing the decline of Scotland's health visiting service—a service that exists to prevent future ill health and which the Health and Sport Committee identified as being crucial in early years development in its report on child and adolescent mental health services, which we debated a fortnight ago—the need for NHS intervention will increase and there will be even more prescriptions.
We should invest in health visiting, not because Scottish Conservatives are convinced of the need to do so, not because the BMA is convinced of the need to do so, not because of the compelling evidence of all witnesses to the Health and Sport Committee, and not even because Jamie Stone's doctor is profoundly supportive of health visiting. We should do so because it is manifestly clear from the evidence, and from debates that have taken place throughout the Parliament's lifetime, that we should invest our limited additional resources in people who can help to prevent ill health, rather than in taxpayer-funded additional health subsidies to the wealthiest people, including the First Minister, the cabinet secretary, me and others who are in the 6 per cent of people who paid the full prescription charge in 2008-09. This is a tax cut by the First Minister for the First Minister, which is unjustifiable and, in the current financial climate, irresponsible.
The inevitable response of the cabinet secretary and her praetorian guard involves the customary hyperbole about the need to defend the NHS from the perils that it might face under the Scottish Conservatives. However, the current health debate is not the shallow debate of old about whether there should be a national health service. All major political parties in the 21st century are committed to the NHS. The debate in the Scottish Parliament has been about how the NHS can operate flexibly to secure the wellbeing of the people whom it serves.
Throughout the life of the Parliament, we have been clear and consistent on prescription charges. We supported the reduction of the standard charge to £5 and the halving of the cost of the prepayment certificate. We acknowledged that a charge of £6.85 per item—and rising—meant that the cost of treatment, which might typically involve two or three items, was pushing 20 quid, which was on the wrong side of reasonable, even for people who were able to pay. We particularly supported the reduction in the cost of the prepayment certificate, because we accepted that the preferred option of many people, which was to expand the schedule of exempted conditions, would be difficult and potentially invidious.
However, we served notice even at that stage that, although we supported the first reduction, we were unconvinced that further reductions should be the priority spend within a limited budget. We said that we would wait and see. We did so, and I say to Jeremy Purvis—who is not in the chamber—that we opposed last year's reduction and will oppose this year's. I thank Ian McKee for his moderate condemnation of that opposition this year: this year, apparently, Mary Scanlon is merely shameful, whereas, last year, she was "pernicious and evil". At that rate of conversion, he will be back in his old Conservative fold before the end of the parliamentary session.
We oppose the reductions not because they are not a lovely idea, but because people who need to be supported should be, which is why 88 per cent of prescriptions in 2008-09 were issued without charge and a further 6 per cent with the prepayment certificate. We oppose the abolition because we cannot afford it at this time and because there are other immediate priorities.
The cabinet secretary said in her speech that only those who earned £16,000 and above had to pay. Perhaps it would have been more appropriate for her to come to Parliament earlier in the session and talk about increasing that threshold. We could have supported that proposal.
There are certainly other financial challenges facing health spending. Last week, in response to a parliamentary question, the cabinet secretary confirmed that the cost to Scotland's NHS in the year commencing April 2011 of the Westminster Government's increase in employer national insurance contributions will be £36.3 million. That is on top of the £33 million that this year's reduction and next year's proposed abolition of prescription charges will cost.
Although I disagree with Jackie Baillie's support for further reductions, I welcome the searching questions that she asked about the policy's future sustainability, particularly given the unfolding experience and increase in demand that took place in Wales. Where is the money to be found?
The cabinet secretary reminds us of the old Hollywood film star Jeanette MacDonald; she of Nelson Eddy and Jeanette MacDonald grand melodrama fame, and not only because of their shared interest in shoes. Even Jeanette MacDonald could not compete with the cabinet secretary on that point. It is best put in the words of a song:
"I never will forget how that brave Jeanette,Just stood there in the ruins and sang ... and sang".
The cabinet secretary's policy seems to be to acknowledge the huge demographic changes that are coming, but to shut the door to any future assistance from the independent sector. As the financial pillars of her health Babylon come tumbling down around her, her response is to stand there in the ruins and sing the same old song. She sings it well and she sings it true, but it is fast becoming yesterday's hit.
I make no apology for once again returning to the state of our health visiting profession in the NHS Greater Glasgow and Clyde area. I have raised previously the position in Springburn and Possil in Glasgow. The minister wrote to me. It was clear from her initial responses that she believed that all was well, but she was slightly more equivocal in her speech in the debate a fortnight ago. On the contrary, to those on the ground, all is not well.
A few months on from the Glasgow North East by-election, what is the position in Possil? The health centre there serves one of the communities that have been identified as having the greatest concentration of health inequalities. It is the type of health centre that the ending of a universal health visiting service and the creation of concentrated teams was supposed to assist. Finally, a health visitor was recruited, but she has already handed in her notice. Meanwhile, the minimum two full days that have been allocated to the practice have remained unfilled for more than three and a half years.
In Bridgeton in Glasgow—a postcode with one of the lowest household incomes in the United Kingdom—there is now no health visitor. A GP there has 150 preschool children out of a list of 2,780 patients. The area will host the Commonwealth games. It seems extraordinary to people there that the community can host the games but cannot access health visiting. Bridgeton health centre, which serves a population of 25,000 patients and has 20 GPs, has two part-time health visitors. Such situations are now commonplace, and the problem is growing and being exacerbated, as Rhoda Grant mentioned in her speech.
We cannot go on like this. The cabinet secretary has belatedly agreed to meet GPs and others in NHS Greater Glasgow and Clyde next month. It is not a moment too soon. Last autumn's complacency is now being replaced by a recognition that there may be a problem; we are certainly clear that there is.
The health secretary and the Parliament need to start singing a different song—or, at least, to rewrite the lyrics. We need leadership. The Parliament has addressed the overall burden of the prescription charge and the prepayment certificate; now is the time to respond to other challenges. The difficult financial future requires us all to be much less dogmatic and to be prepared to work with everyone who can make a difference to Scotland's health. This is the wrong time for further reductions in the prescription charge and the right time to transform Scotland's health visiting service to achieve a real improvement in Scotland's overall national health.