National Health Service
We now come to an urgent ministerial statement by Susan Deacon on the national health service in Scotland. The minister will take questions at the end of the statement, so there should be no interventions.
I apologise to the minister; I have been in meetings all afternoon and have only just seen the statement—it is rather long and contains material that I do not consider to be urgent. I hope that it will be shorter in delivery than the text that I have in front of me. With that health warning, I invite the minister to deliver the statement.
Presiding Officer, I am grateful for the opportunity to make this statement. I will take your words to heart, as I had intended to. I also apologise to Opposition colleagues for the late delivery of my statement this afternoon, for which I take full responsibility.
Today, I want to set out how the Scottish Executive intends to translate some of the major spending commitments made in yesterday's budget into real improvements in the NHS in Scotland and in the health of the Scottish people.
This afternoon, the Prime Minister made a statement at Westminster on the UK Government's plans for the NHS. It is right and proper that I should take this opportunity to set out to the chamber the Scottish Executive's plans for health policy in Scotland.
As I have said consistently, the NHS is our most important public service, the most important goal of which is the health and well-being of our people. In our partnership agreement and again in our programme for government, we made clear our commitment to work together to build a healthy Scotland and to make substantial, real-terms increases in NHS spending each year for the lifetime of this Parliament. An extra £300 million has already been invested in the current year and we have already committed an additional £300 million for the 2000-01 financial year. That is—already—a record level of investment in the NHS in Scotland, but now we can do even more.
Yesterday's budget demonstrated the UK Government's commitment to the NHS and our public services. The Scottish Executive shares that commitment and we welcome the resources to support it. We recognise also that the increases in public spending, north and south of the border, have been made possible only as a result of sound management of the UK economy.
As a consequence of yesterday's budget, the assigned budget of the Scottish Executive will now receive an additional £300 million in the next financial year. We will not specify today the details of how those resources will be allocated, as that is, rightly, a matter to be considered and determined in Scotland. Next week, the Scottish Cabinet will start to discuss how this major spending boost can best be matched to the delivery of our policy priorities and further detailed announcements will be made to this Parliament.
However, I can announce to Parliament today that the Executive will direct, from within that £300 million, substantial extra investment to the NHS in Scotland—over and above what we have already committed. I stress that we will not only spend more; we will spend better, which is why the additional investment we will now direct to the NHS in Scotland must be linked to change—real change to deliver real benefits to real patients. Investment must be linked to improvement. It must be coupled with reform and it must lead to a fundamental shift in the quality and responsiveness of the health care that the NHS provides.
Let me be clear: the quality of clinical treatment and care offered in the NHS in Scotland is high. In many cases, it is world class. However, the patient's experience of the service as a whole must be improved. As I have said before to the chamber, the system lets patients down too often, with poor communication, badly designed services, old demarcations, old buildings and old ways of working, which must change. Our programme of investment in the NHS must—and will—go hand in hand with our programme of modernisation, improvement and change, which has already started. The additional new investments that we will announce will enable us to accelerate that programme radically. We are investing in change and in improvement.
I am clear that we will not simply take this extra money, give the NHS a major cash injection and sit back hoping that it hits the right target. Over the coming months, we will work in partnership with local health boards to put in place a planned and transparent programme of investment and change across the NHS in Scotland. The Scottish people rightly expect results, as do I, and I will report those results to Parliament.
Our extra investment will deliver better services and more support for NHS staff to deliver the kind of care that they—and I—want patients in Scotland to have. I want an NHS that is based on partnership and collaboration and that shares expertise across the service, across sectors, across professional boundaries and across different health board areas. That learning and willingness to share experience and ideas must extend right to the heart of Government.
This afternoon, the Prime Minister invited the devolved Administrations to join the UK Government in a Joint Ministerial Committee and to work in partnership to improve the NHS. I welcome that invitation. We are sharing experience where appropriate and developing distinctive solutions where necessary.
It is to a distinctive policy initiative—a solution to an enduring Scottish problem—that I now want to turn. An effective health policy is not just one that gets better at treating more and more sick people in hospital; it is one that gets better at enabling more people to stay well and to stay out of hospital.
Our hospitals are important, which is why we are investing in eight new state-of-the-art hospital developments—the biggest hospital building programme in the history of the NHS. However, our efforts and our investment to build a healthy Scotland go well beyond providing hospital beds and bricks and mortar. Our policy is about prevention as well as cure. Half of all Scots will die from cancer and heart disease, although a third of cases could be prevented. Scotland ranks high on the European league table of ill health and compares poorly with other parts of the UK. That must change.
On 1 September, I led a debate in this Parliament on our plans to improve the health of the Scottish people and on ways in which we can work together once and for all to rid Scotland of the tag "the sick man of Europe". Four major national health demonstration projects, backed by £15 million of investment, are now being undertaken as test beds for action on improving children's health, sexual health, cancer and heart disease. That is a start, but the problem is deep-rooted.
We all know that we need to improve Scotland's health record and change the life circumstances, lifestyles and life habits that are so deeply ingrained in Scottish society. We know that our people's quality of life will suffer, that too many people will die young and that our national resources will for ever be under strain to treat more and more sick people if we do not do that. Today, I am signalling this Executive's absolute determination to turn the situation around.
The chancellor yesterday announced details of the proposed tobacco tax on cigarettes. Today, I am pleased to confirm to Parliament that it is our intention to hypothecate Scotland's share of that money to the health budget. I am even more pleased to announce that we will direct £26 million to support the largest investment in health improvement and public health in Scotland's history. That is the biggest ever springboard for what needs to be done in Scotland: we must wage war on ill health among our people.
We will create a health promotion fund to help meet our long-term targets for better health and social justice. We will use the new resources from tobacco taxes to step up our anti-smoking measures and to tackle the habit that kills more Scots than any other. We will seek to extend screening into new areas of disease and across wider age groups. We will step up vaccination programmes to protect the vulnerable and prevent the spread of illness. We will renew health promotion in Scotland to make a real and lasting impact on lifestyles—not meddling or nannying, but, for the first time, delivering step change improvements in physical and mental health—by taking action on diet, exercise, alcohol and drug misuse as well as on smoking.
I will introduce a new national strategy group to drive forward our work in this area. It will comprise government officials, health professionals, teachers and voluntary and community representatives as well as health education and promotion experts. The new national group will play a key role in helping us to determine how best the resources can be directed. We will be aided by a new public health institute for Scotland that will provide a new focus and drive for our work.
Primary care professionals will be at the heart of our plans and their delivery, and our work will place particular emphasis on our children and young people. There is overwhelming evidence that giving babies and children a healthy start in life provides them with the foundation for good health throughout their life.
Today's announcement—a distinctive Scottish solution to the Scottish problem—indicates a radical shift in emphasis towards investing in better health, investing in the next generation and investing in Scotland's future. This is a watershed moment for the Parliament. I hope that all members will share my enthusiasm for the opportunities and challenges that lie ahead of us and that, at last, we can unite in support of measures that will enrich and extend the lives of so many ordinary people here in Scotland.
I would like to thank the minister for taking my hint.
I bet all members are very glad that they stayed on for that. It was a gey insubstantial emergency statement, even by new Labour standards. We have tried for months to secure an admission from the minister that the health service in Scotland is grossly underfunded and been unable to get it from her. We have at last secured it through the back door, by the chancellor's statement yesterday.
In his speech, the chancellor committed the UK to a 6.1 per cent increase in the health budget—this year, next year, the year after that and the year after that. Will the minister today make the same commitment to a 6.1 per cent increase over and above the rate of inflation in the budget of the health service in Scotland? To meet the chancellor's commitment to the UK, the minister owes Scotland an additional £1.1 billion. Is she prepared to commit that amount to the health service today—yes or no?
A couple of weeks ago, I picked up a major Scottish Sunday newspaper and was pleased to see the SNP health spokesperson on the front page calling for a cross-party war on ill health in Scotland. This afternoon, I have announced the biggest ever injection of resources and energy into tackling that problem. It would be helpful and mature if SNP members would have the good grace to welcome that. If they want to unite with us in tackling the real problems of Scotland, that is what they should do.
Answer the question.
We cannot have shouting when the minister is replying.
We have just said that we are going to make substantial additional investment in the NHS in Scotland. We have said that the detailed decisions will be taken here in Scotland. We have said that Scottish ministers will take them and report them to this Parliament. I am sorry, but that is what I thought Scottish democracy was about, and that is what we are about.
I thought the nearest our impartial Presiding Officer came to saying that the statement was froth and had no substance was his polite indication that it did not contain material that he considered urgent. We very much welcome that.
On its web page, the BBC reports that £173 million of additional money will be available to the NHS in Scotland. If we deal with three scandalous problems that were caused by this Administration, we will already have spent £181 million. If we use it to tackle the 1,271 unfilled vacancies for nurses, that will cost £25 million. It will cost £106 million to get rid of bed blocking, while the financial deficits in our hospitals are running at more than £50 million. Will the minister address those problems, or will the money be used to tackle other problems that the Executive is about to create?
In 1997, the Government promised that the NHS was safe in its hands. [Members: "The Tories said that."] In 1999 it promised the same thing. It is doing it again in 2000.
Twenty-four hours to save the NHS.
Absolutely—the Government has had three years.
The minister says that the investment is linked to reform. We would all welcome that, as there are serious partnerships that have to be identified in the NHS. Today, an official investigation by the Office of the Commissioner for Public Appointments has been announced into the fact that 75 per cent of appointments to health boards and health trusts are Labour political appointments. Will appointments to the new bodies to which the minister has referred be based on merit, or need only card-carrying members of the Labour party apply?
The minister announced the national strategy in September. She has had seven months to get it up and running. She is now saying not that she has put it in place, but that she will bring people together. How many strategies, focus groups, commissions, reviews and glossy brochures have to be announced before things can actually happen?
Finally, of the eight new hospitals, four were already announced under the Tories. Could we have bit of truth here?
Before you answer, minister, I would like to say that members must not bring the Presiding Officer into this argument. The minister quite properly removed parts of her prepared text, which I had. I think that the statement that was given was perfectly in order.
I do not know about ministerial statements not containing something new, but one thing is for sure: Opposition spokespeople's comments and questions in health debates certainly do not seem to contain anything new. That is a pity. We are on terrain on which we can and should unite, as we have said before. The Executive is prepared to do that. It would be helpful if Opposition members would consider doing that.
Mary Scanlon talks about our not having done enough in seven months. I remind Conservative members that they had 18 years to do some good for the NHS in Scotland and for the health of the people of Scotland. The reverse was achieved, and the very reason why we need such deep-rooted, long-term solutions now is because of the long-lasting damage that the Conservative Administration did.
Today, we have set out the targeting of £26 million for improving health. We have been clear—not just in our words, not just in our investment, but in our action—about tackling some of the real, deep-rooted changes that need to be made to deliver effective health and social care for the people of Scotland. I defy anyone in the chamber to question the Executive's commitment to that agenda. I do not think that anyone would believe the questions that have been raised by members of the Conservative party.
It is quite nice to have £300 million extra to spend, I would have thought.
The minister's statement gives me particular pleasure on two counts. My Westminster colleague Malcolm Bruce, speaking as Treasury spokesman, advocated the hypothecation of tobacco duties for health years ago. It was a Liberal Democrat manifesto commitment in 1997. A health promotion fund was in the Scottish Liberal Democrat manifesto and in the partnership agreement. I am delighted that that will come to fruition now and that we do not have to wait for 10 years to have it.
We need a question.
Does the minister agree that this new allocation of money is an excellent—even golden—opportunity to break new ground without having to take resources from on-going work? Does she agree that prevention is better than cure and that public health and preventive measures are the most effective way of spending the money?
I am glad Nora Radcliffe has raised those points. [Laughter.] I am glad because they are the real issues. So often we hear pleas from people inside and outside this chamber that we should focus on the real issues. I do not know what is more real than focusing on improving the health of the people of Scotland.
Suggesting that there is a quick fix to the problems of the NHS and to improving Scotland's health, and suggesting that there is any one package of money that could do that is either irresponsible, stupid or economical with the truth. We are being honest and open about how we are going to set about that challenge and about how we are going to pay for it. We are clear about our determination to do that.
On that point, Labour and the Liberal Democrats in this Parliament and in this Executive stand shoulder to shoulder. Devolution is about delivering real improvements to the quality of people's lives. Devolution is about making real improvements in the health of the people of Scotland. While we reach for real improvements and for real solutions, certain members seem to be able to reach only for their calculators. When will they raise their game? It is about time the Scottish people were told.
Does the minister agree with me—[Members: "Yes."] Does the minister agree that the orchestrated carping that is coming from SNP members, who want the NHS to fail so that they can use it as a political football, and from Conservative members, who want to privatise it, is extremely disappointing? We should be welcoming the investment of £26 million in public health in Scotland that the minister has announced, which will be added to the Executive's recent investment in accident and emergency services. We should congratulate the Labour Government in Westminster on the stewardship of the economy that has made those resources available.
It will come as no surprise to colleagues in the chamber that I am happy to agree with Bristow Muldoon. I would like to pick up on two of the points that he raised. It was announced this week that a further £11 million will go into the redesign of accident and emergency services in 12 different projects across Scotland—including one in Bristow Muldoon's constituency, which I know is why he takes a passionate interest in this. That is a prime example of the way in which we are linking investment to improvement. It is not about throwing money at problems; it is about targeting money on solutions.
My second point concerns something that Bristow mentioned but which I did not mention—privatisation. We know that there are huge demands on the NHS and that huge challenges face us. We are matching those demands with action, with investment and with change. We will not allow the fundamental principles of the NHS—that it should be free at the point of need and funded by general taxation—to be challenged. Certain members in the chamber should be honest and admit that they would prefer a two-tier privatised system. We will have none of it.
While we are on the subject of accident and emergency, I am beginning to think that this statement is more of an accident than an emergency.
May I drag the minister kicking and screaming all the way back to the first question? The chancellor has said that there will be a 6.1 per cent, real-terms, above-inflation increase every year until 2004. Will the minister—or will she not—give that commitment to Scotland? It was a clear and simple question, but it was clearly beyond her. If she is going to tell us that it is a matter for the Scottish Executive, will she also take the opportunity to give her personal commitment to fight for a 6.1 per cent, real-terms increase every year until 2004? Will she admit that if that 6.1 per cent increase is to happen, it will mean that the Executive owes Scotland £1.1 billion? Is she going to make that money available, or is she not? Will she tell us the truth now? Otherwise, she will be harried all the way to Kingdom come.
Fact: an extra £300 million has gone into the NHS this year and another £300 million will go in next year. Fact: an extra £300 million is going into the Scottish block as a consequence of yesterday's budget. Fact: this Scottish Executive will consider the best way of using those resources and will make the NHS a top priority. Those are the facts; the answers have been given.
While Duncan Hamilton was honing his student debating skills before he entered this Parliament, some of us were working out there, in the real world, in Scotland's public sector, in our public services. Now that we are in here, we have the chance to make a real difference and we are going to do it.
On a point of order. I am the last person who should criticise people for shouting in the chamber, but the shouting should surely not be so loud that we cannot hear a word that is being said.
I sympathise with that point. If SNP members want to be called to ask questions, they may want to be a little quieter and listen to the answers.
I would like to give a warm welcome to the news that a Labour chancellor, in the best old Labour traditions, has given a massive cash boost to the NHS in Scotland.
The minister will be aware that on 1 April Tayside University Hospitals NHS Trust will carry over a £12 million deficit to next year's budget, which already has an in-built £10 million deficit, leaving the trust facing cuts of more than £20 million over the next year. Will the minister assure us that Tayside's share of the massive increase in spending in the NHS from 1 April will be sufficient to buy enough time for the health board to carry through and fully consult on the changes arising from its acute services review and that the trust will not have to implement any changes before that consultation is completed?
The chamber has discussed the health service in Tayside on a number of occasions. It is because of my concerns about deep-rooted problems—financial and otherwise—in Tayside that an expert task force has been established and is working with the health authorities in Tayside to consider how the financial situation can be turned around and how the health service in Tayside can be restored.
I will repeat a relevant point that I made earlier. High-quality patient-centred care will be delivered not by simply throwing money at problems, but by ensuring that services and resources are managed effectively and are targeted to need. Of course the health service in Tayside will benefit from the additional resources, but it will be required to demonstrate how those resources will be put to use and how patients can reap the benefits of the additional investment that we are making.
Just like a good Labour chancellor, Gordon Brown overestimated revenue from tobacco duty last year by £3 billion. If his figures are similarly out this year and next, the hypothecated £26 million could well reduce to £18 million. Will the minister therefore assure us that, should that revenue reduce, she will make up the shortfall?
My preference would be for fewer people to be smoking. Should the tax revenue from tobacco decline, I would not weep.
We have made a commitment based on the best estimates that can be made. [Laughter.] Well, if SNP members can gaze into their crystal ball and tell me how many cigarettes will be smoked next year, I will be impressed. Maybe they could get their calculators out to help them.
We have allocated £26 million in the coming year. As that shows, the Executive is committed to improving public health. I am happy to give that assurance to the chamber.
Does the minister agree that the health service in Glasgow is in a critical condition and needs massive investment? Does she agree that today's announcement represents the proverbial sticking plaster on the gaping wound that exists in Glasgow?
Is she aware that the Greater Glasgow Health Board launched this week its consultation exercise on a massive programme of cuts? The cuts will mean that Stobhill infirmary will lose all medicine, surgery, oncology and gynaecology services; the Western infirmary will lose all medicine and surgery services; Victoria infirmary will close; the Queen Mother's hospital will close; the sick children's hospital will close; the dental hospital will close; and all accident and emergency departments apart from those at the Southern general hospital and the Glasgow royal infirmary will close. Will the minister give a commitment that money will be diverted to Glasgow to avoid those closures?
The misleading nature of Tommy Sheridan's question is reprehensible. As he well knows, the process of change that the health board has embarked upon—openly and in full public consultation—is not about a programme of cuts or service reductions but about a wide-ranging programme of service transformation and improvement for the benefit of the people of Glasgow.
The way hospital facilities in Glasgow have developed over the years reflects the needs of the people of the past, not the people of the future. Greater Glasgow Health Board has made clear that its changes will be coupled with investment totalling £400 million.
This is about improvement and change. If Tommy Sheridan or any other member wants to stand up and say that the status quo is enough and that there should be no change in the health service, they should say so. We are prepared to say that change is not only desirable but necessary, and we are backing such change with money and determination. I am sure that Greater Glasgow Health Board will do the same.
Although a lot of members want to ask questions, the time is up. However, I will take two more questions.
I strongly agree that the overriding intention behind the minister's measures is to improve the quality of health. Given that greater Glasgow has one of the poorest overall health records in Scotland, is the minister considering distributing additional resources, particularly money raised through the tobacco tax, in line with health needs? Furthermore, will there be a clear bias to ensure that areas with the poorest health benefit the most?
One of the features of this Administration's health policy is the recognition of the clear link between poverty and ill health. We are determined to tackle that. That approach not only informs our health policy but extends into the Executive's work on housing, education, transport and so on. I know that Des McNulty was involved in the Glasgow Healthy City Partnership. The work of such organisations provides a model for how agencies can come together to make a real difference to the needs of people in our poorest areas.
We are determined to allocate and direct resources to meet those needs, which is why we are embarked on a review of how we allocate the total amount of NHS funding in Scotland. I hope that we can make progress on that in the coming months, because it matters. Alongside that review, we will work with communities, other organisations and people in Glasgow and throughout Scotland to ensure that people's health improves.
I welcome the minister's statement, particularly its focus on public health and the prevention of ill health.
I have two questions. First, what is the remit of the proposed public health institute for Scotland? Secondly, people have raised concerns about the shortage of public health professionals in Scotland. Will some of this new money be used to train and employ more public health professionals to work on the ground to tackle Scotland's health problems, particularly the problems of health inequalities that Des McNulty mentioned?
I am grateful to Margaret Smith for her questions and for focusing on the substance of the issues that I have raised this afternoon. On the first question, the proposal for a public health institute derives from a report published just before Christmas by the chief medical officer, Sir David Carter. The report set out the outcome of a full review of the public health function in Scotland and, as a widely participative and consultative exercise, its findings represent the consensus of a wide range of public health professionals right across Scotland. The report recommended the creation of a public health institute in Scotland to provide a real focus for research in this area and to harness the excellent work in gathering data and evidence. That will give us the basis to inform our policy making to take action on and link investment to areas of real need.
The institute will also help us to establish the best ways of deploying resources and staff to tackle the problems we face. The work of all our health professionals—people who work in schools, directors of public health, public health nurses, health visitors, midwives and others—will be crucial to the agenda that I have outlined, and I look forward to the future to find out how we can harness such expertise and resources to make the greatest possible impact on the health of the people of Scotland.
I can see that there is a point of order. I have allowed a five-minute overrun on the normal time for statements, but I must protect the following members' business debate.
On a point of order, Presiding Officer. Will you consider referring the question of emergency statements, and the criteria for them, to the Procedures Committee? Members have experienced great difficulty getting emergency questions and debates, and what we have heard today is much closer to a party political broadcast than an emergency statement. The only emergency is the collapse of Labour party poll ratings.
It is not for me to refer to the Procedures Committee. You are a member of that committee—you are capable of raising it there yourself.