European Union Membership Referendum
To ask the Scottish Government what its position is on the announcement of a referendum on membership of the European Union on 23 June 2016. (S4T-01323)
The Scottish Government requested that the referendum should not be held on 23 June and is concerned that the referendum campaign will cut across election campaigns for the Scottish Parliament and other devolved Administrations. However, the decision on the date has now been made, and we have to move on. The conclusion of an agreement at the European Council last week means that the focus can now shift to the bigger and much more important matter of why our continued European Union membership is overwhelmingly in Scotland’s and the United Kingdom’s best interests.
The Scottish Government will continue to make the positive case for EU membership. In making our case, we will continue to emphasise that the EU is not just an economic union—important as that is—but a means of solidarity, social protection and mutual support between members. For more than 40 years, individuals, businesses and communities across Scotland have experienced the many social, economic and cultural benefits of EU membership, which include jobs, significant investment, the opportunity for our businesses to trade across the world’s largest single market, social protections such as employment rights, and the opportunity to work in solidarity with others across the continent to tackle pressing global challenges such as the movement of refugees and migrants, energy security, and climate change.
In addition to all the benefits that the cabinet secretary mentions, surely we should all agree that the European Union is not just about economic union but is also about the social union, which has delivered many valuable social and employment protections for people across its entire territory, and that the European Union is best placed to tackle issues that do not respect national boundaries, such as climate change and the recent refugee crisis.
One of the strongest arguments for the EU is indeed social Europe. Indeed, many aspects of the social contract and the social chapter were hard fought for by those who looked for protections, maternity rights, equal pay and wider agenda items relating to the right to work and have paid holidays and the 48-hour working week. All those things are very practical and real, and leaving them in the hands of a Conservative Government outwith wider social Europe protection is a risk.
However, let us argue the positive case for developing the Europe that we want. Whether we are talking about social Europe, energy security or climate change, which I mentioned, a lot has been achieved, but a lot more could be achieved. We should remember that Europe was born out of a need for nations to co-operate rather than live in conflict. That is the Europe that we seek.
Does the cabinet secretary agree that the campaign to remain in the EU should learn lessons from Scotland’s independence referendum and be a positive campaign about why it is better for Scotland and the rest of the UK to remain in the EU, rather than lapsing into scaremongering and fear? Does she agree that everyone in this nation who has the right to vote should have the right to vote in the referendum?
I agree. Democracy is a very precious thing, and people who will vote in our elections in May this year will be denied votes in the European referendum. That is not acceptable.
In facing the European referendum, people want to see a positive vision and to hear the arguments. We can make the arguments. Indeed, we have a mature electorate in Scotland that is very politically informed, and it will not accept scaremongering from either side in the referendum campaign. In Scotland, we can conduct a positive argument that is detailed and addresses the issues but which also inspires people about the type of country that we want to be, which can contribute to a positive social Europe.
I welcome the cabinet secretary’s positive comments, but they contrast with the Scottish Government’s initial reaction to the announcement of the date. Does she agree that, with such a short timeframe for the referendum, we must make a strong positive case instead of concentrating on personalities and potential leadership bids and using one referendum to discuss another? It is time to get serious about the debate ahead.
With the leaders of Wales and Northern Ireland, our First Minister indicated the concern that we had about the date but, as I said in my first answer, we must move on. The date is now set. We can contribute to the debate on a wider canvas, and people want to hear Scotland’s views. I regularly meet Governments from across Europe and they are interested in our arguments about where Europe can and should be. In making our arguments for Europe, we will not just be making them in Scotland or further afield; people in other countries across Europe will want to hear what we are saying as well. That is the positive force of a democratic debate that is hard in its argument but also takes a view as to what we can contribute, and not just what we can get.
This should not be about personalities. We should focus on the issues and the big picture. By doing that, we will respect not just the people of Scotland but the rest of the UK as well.
The cabinet secretary will be aware that the European and External Relations Committee is undertaking a far-reaching inquiry into the implications of EU reform and the referendum, with evidence from many eminent witnesses. Does she agree with the sentiment of many of the witnesses that leaving the EU would be bad for Scottish exports to the continent, which are estimated at £11.6 billion? Also, does she agree that one of the key components of the deal that the Prime Minister has achieved is that it will increase competitiveness and reduce excessive EU regulations and red tape, which we hope will have a positive impact on small and medium-sized enterprises in Scotland?
I congratulate the committee on its extensive inquiry, which has provided a great platform to hear different arguments and perspectives. Jamie McGrigor talked about one aspect, which is to do with exports. A large number of companies want to invest in Scotland and the rest of the UK because of access to the European market. It is not just about trade or exports; 300,000 jobs are directly or indirectly involved in the European exercise.
What Jamie McGrigor says about SMEs is very important. One of the ways to improve our economic achievement is to encourage more of our SMEs to export. By exporting, they can become innovative. That is another aspect to the argument.
I hope that the Parliament will have an opportunity to debate and consider the outcome of the committee’s inquiry, which has heard from a wide range of eminent witnesses. The inquiry is another example of the Parliament conducting inquiries into the EU in a positive and constructive way.
General Practitioner Services (Funding)
To ask the Scottish Government what its position is on reports that GP funding has been reduced by £1.6 billion over the last 10 years. (S4T-01324)
Investment in GP services has increased each year under this Government, rising by almost £150 million from £704.6 million in 2007-08 to £852.6 million in 2014-15. This equates to a cumulative increase of £826 million since the Government came to power.
We are committed to supporting and developing primary care and the work of GPs, which is an indispensable part of our community health service. However, it is important that the investment that is made in general practice is seen in a broader context. We are investing in the whole of primary care, which includes increased investment in the Scottish Ambulance Service in 2016-17 and an increase in the number of health visitors, both of which will have a beneficial impact on general practice, as well as increasing our support for community-based mental health services.
Scotland has the highest number of GPs per head of population of the four United Kingdom countries, and under this Government the number of GPs who work in Scotland has increased by 7 per cent. We are transforming primary care, including developing new ways of working with multidisciplinary teams that elevate the role of GPs as medical experts in the community. That is supported by extra investment of £85 million over three years through the primary care fund.
I thank the cabinet secretary for that answer, although anyone listening to it would think that we do not have a problem with general practice at all, and that although the Royal College of General Practitioners asserts that the share of funding—as opposed to the absolute funding—has reduced by £1.6 billion, there are no consequences.
I say to the cabinet secretary that the constant reiteration of the increase in the number of GPs is distinctly unhelpful and is not welcomed by the Royal College of General Practitioners or GPs. The number of full-time equivalents, which is what is critical to the workforce, has increased by only 35 since 2009, during which time the population has increased to such an extent that even to have stood still, 110 more GPs would have been required.
There is to be a new contract. Will the cabinet secretary publish the principles that the Government will use to underpin the new contract, so that we can have an open discussion about them?
I had thought that more GPs would be a good thing that members of all parties would welcome.
Our calculations, which are based on the published GP spending outturn figures—the actual spend—show that GP spend as a percentage of the total health budget has remained relatively stable in cash and real terms over the past decade.
Richard Simpson said that it sounded as though I was saying that there are no challenges. Of course there are challenges: that is why we are in the midst of negotiations with the British Medical Association about a new contract that will deliver a new model of primary care for Scotland, along the lines of multidisciplinary teams, with the GP as the clinical expert. The discussions are going very well and are very positive. On the subject of positive discussions, I met the RCGP on 9 February, when we had a positive meeting about the new model of care and how we will work together on taking forward the new model.
On the principles of the new contract, Richard Simpson will appreciate that we are in the midst of negotiations about the contract. I am happy to keep Parliament informed of progress in the negotiations, but the member will appreciate that the negotiations are on-going and that it would be premature to give further information when there is not enough information with which to update Parliament. When there is, I will be happy to do so.
I am not asking the cabinet secretary to publish details of the contract, because I entirely understand that she is in negotiations and cannot do so. However, the principles of the contract and the general role of GPs in the new model are critical both to general practitioners’ understanding of where they will go from here and to recruitment.
The cabinet secretary said that I should welcome the fact that there are more GPs. Of course I do, but the fact is that there are now fewer GPs per head of population than there were in 2009. For the first time ever, our number of GPs per head of population is lower than that of the north-east of England, which is the region with which the Nuffield Trust normally compares us when it makes regional comparisons.
Does the cabinet secretary agree with Graham Watt, who said today that 40 per cent of practices—representing 2 million patients—are in difficulty, or does she think that he, too, is being misleading or is misspeaking? How does she reconcile the new clinical strategy’s emphasis on primary care, which is welcome, with the fact that the 2016-17 budget will cut—yet again—the share of funding that goes to primary care?
I did not accuse anyone of misleading anyone about anything; I said that Scotland has the highest number of GPs per head of population of the four UK countries. That is a fact. Under this Government, the number of GPs who are working in Scotland has increased by 7 per cent. That is a fact.
Of course, there is more to be done and, as Richard Simpson rightly pointed out, the national clinical strategy has primary care at its heart. On the principle of the new contract and the new model of care, there is no secret: the approach is based around multidisciplinary teams that have GPs as the clinical experts. We are doing widespread testing of the approach throughout Inverclyde, which will give us the detail about how the model works in practice and will inform the contract negotiations. As I said, I am more than happy to keep Richard Simpson and Parliament updated on that testing of the model and on the negotiations on the new contract.
It seems that senior GPs are queuing up to express their concern about the percentage fall in GP funding as a share of national health service resources—the latest example being Dr Ken Lawton, who is a senior partner at the Great Western medical practice in Aberdeen, who said at the weekend that as a result of the shortfall,
“There will be a deterioration of general practice and the service we can offer to patients.”
Does the cabinet secretary agree with that comment? What—if any—contribution does she think the funding issue is making to the current difficulties with GP recruitment?
I will add to what I already said to Richard Simpson. The draft budget for 2016-17 shows that we are investing an additional £45 million through the primary care fund, which means that the draft budget headline GP and primary care fund is increasing by 9.9 per cent over the year—a higher percentage than the increase in overall health spending and a higher percentage increase than territorial boards are receiving, so we are investing in primary care.
We will be tackling some of the issues in GP recruitment and retention. That is exactly what the primary care fund is for—to help to overcome some of those issues. It is important that we have a positive vision for primary care, which is why the new model is important, because we want Scotland to become an attractive place for GPs to come to work.
We also want young medical students to choose general practice as their specialty, which is why we are working hard with both the RCGP and the British Medical Association to develop the new model of care, which will put Scotland at the forefront—leading the way with our vision for primary care.
I call Jim Hume. You will need to be brief, Mr Hume.
The cabinet secretary said that GPs are indispensable, but in January the RCGP stated that it believes that the “Government deems” general practice “to be ‘dispensable’”. Those were its words. It is the RCGP that is stating that the budget has been reduced over the past 10 years by £1.6 billion. Does the minister not believe that GPs need more than warm words if we are to avoid in four years a shortfall of 700 GPs, as forecast by the RCGP?
We will get on with the job of reforming primary care here in Scotland, and we will work with the RCGP and with the BMA on the new contract to deliver that vision. Far from eroding the role of GPs, the new model will ensure that the role of the GP is as a clinical expert, which will allow GPs to spend more time with their patients. Surely that is something on which all of us can agree.
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