Health Improvement
The next item of business is a debate on health improvement.
When I published the "Better Health, Better Care" action plan before Christmas, I gave a commitment to Parliament that we would have an opportunity to debate health and health improvement. I am pleased to deliver on that promise today.
"Better Health, Better Care" sets out this Government's plans for a mutual and truly national health service that is used, paid for and owned by the Scottish people; that is built on the values of collaboration and co-operation; that has a very secure future in the public sector, and is not distracted by division and competition; that values patients and the public as drivers of change, not as barriers or hurdles to be got over; and that is local, with a very clear presumption against hospital centralisation.
Over the past few months, the Government has set in train a range of radical proposals that bring that vision for the NHS to life and that, I believe, will shape our national health service for a generation. Those proposals include a commitment to patient rights to ensure that we are all treated as genuine partners in our care; a consultation on a local health care bill to give the public a real voice in decision making; and a commitment to robust independent scrutiny of proposals for major service change to ensure that, in future, decisions are taken openly and transparently on the basis of the best evidence available.
As members are aware, the first reports of the independent scrutiny panels have already been published, and I am pleased to report that their findings clearly back up this Government's decision to save the accident and emergency units at Ayr hospital and Monklands hospital.
There is absolutely no doubt that this Government has put the NHS on the right track. However, as we—and, I hope, all members—know, simply treating ill health is no longer enough to meet our nation's needs. We must do much more to prevent ill health and promote well-being.
Let me turn to the action that this Government is taking to improve health and tackle health inequalities. The Government and I are clear that reducing health inequalities is and must be our top priority. The gap between the richest and the poorest in our society is simply not acceptable, nor is it inevitable, but closing it will require significant action. We must take action to tackle the deep underlying causes of inequalities, to enable people to make healthy choices and to mobilise the vast range of skills and resources of the NHS to drive regeneration and social change.
"Better Health, Better Care" outlines a comprehensive programme of action to improve health and tackle inequalities. This Government will abolish prescription charges, ridding our country once and for all of a tax on ill health. We will launch a new wave of keep well pilots, which will support an additional 40,000 people in Fife, Grampian, Ayrshire and Arran, and Greater Glasgow and Clyde. We will also work with partners to introduce new and innovative approaches to anticipatory care. In April, the first of six new programmes that will offer support to around 45,000 people who live in Highland, Grampian, Shetland, Orkney and the Western Isles—the well north programme—will get under way. Those initiatives will find new ways of engaging local people and will provide targeted support to tackle cardiovascular disease and other long-term conditions.
I am pleased to inform the Parliament that this Government will back its commitment to better health with real investment. Subject to the Parliament's ultimate approval of our budget, we will invest an additional £300 million in health improvement and better public health over the next three years. That is on top of the extra £12.5 million a year to strengthen primary health care in our most deprived communities. That new investment will support new approaches to tackling drug misuse, alcohol problems and smoking.
We will invest an extra £40 million to tackle Scotland's growing obesity problem. There is no doubt that obesity poses one of the biggest threats to our nation's long-term health. That is why we will make tackling it, particularly in early years, a key priority. The investment that I have announced today will support healthy weight, healthy eating and physical activity initiatives and will fund free fruit for pregnant mothers and pre-school children. It will also allow us to roll out counterweight—the adult obesity programme that is being piloted in keep well areas—throughout the country. In the spring, the Minister for Public Health will announce more of the detail of how that new money will be spent, in a comprehensive action plan to tackle obesity in Scotland.
Good health is about much more than the absence of disease; it requires good mental health as well. This Government has already delivered on its commitment to make dementia a national priority, by setting a new target for NHS boards that will ensure earlier detection, intervention and support for everyone who is affected.
We will also do more to improve support for people who suffer from depression, anxiety and stress. We will work with NHS 24 on a three-year programme to test telephone-based mental health cognitive behavioural therapy and guided self-help. We will fund the living life to the full initiative, which provides high-quality printed and web-based materials to people with anxiety and depression, and we will continue to work with the Royal College of General Practitioners to help NHS Scotland respond to what we all recognise is the complex interrelationship between depression, diabetes and coronary heart disease.
I am also pleased to confirm that we will continue to support and promote the employment within NHS Scotland of people who have had first-hand experience of living with mental illness. Personal experiences offer a huge and unique opportunity to drive change in the way that we design, deliver and follow up care interventions.
I hope that the action that I have outlined today will have the full support of the Parliament. All of us must recognise that improving health and reducing health inequalities cannot and should not be the sole preserve of the NHS. The NHS has a leading role to play, but other partners and agencies must play their part, too.
Although I welcome the £12.5 million for the most deprived areas, does the cabinet secretary accept that that is less than the money that was allocated four years ago for unmet need in deprived areas? Will she tell the chamber whether the unmet need pilots have been evaluated? If so, what conclusions has she drawn in terms of allocating further money to disadvantaged areas?
I do not accept that we are contributing less money to the issue. The £12.5 million is additional to the baseline figure that we inherited from the previous Government. It is a sign of this Government's commitment to ensuring that we evaluate and learn lessons from the approaches that we take and that we roll them out. I spoke about extending keep well and counterweight, which have been shown to work. We want more people in Scotland to have access to those methods and approaches.
Important though the role of the NHS is, it is not the only agency that has a part to play. That is why community health partnerships throughout Scotland will be able to draw on the new fairer Scotland fund, which will provide £145 million a year within the local government settlement to tackle poverty and deprivation. It is also why Shona Robison is leading a ministerial task force on health inequalities, in order to drive a true, cross-cutting approach to that national priority. In "Better Health, Better Care", we set out some of the early conclusions of the task force's work. Today, we publish a further update on progress.
I hope that there is no doubt about the importance that the Government attaches to improving health and tackling inequalities. However, in "Better Health, Better Care" we also set out an ambitious plan for improving quality in absolutely everything that we do. It replaces the myriad of separate waiting-time targets with a simple but ambitious 18-week standard from referral to treatment; renews the focus on patient safety and tackling health-care acquired infection; and offers a new approach to providing safe and sustainable services for people in remote and rural areas.
When I launched "Better Health, Better Care", I drew attention to the fact that we are fast approaching the 60th anniversary of the NHS in Scotland. From the very start, the NHS in Scotland was different. As a distinct legal entity that was created by a separate Scottish act of Parliament, it drew on Scotland's rich medical tradition. The service was supported by the medical profession from the outset—something that was not the case in other parts of the United Kingdom.
Sixty years on, "Better Health, Better Care" reaffirms the distinct nature of the Scottish health service. It presents a plan of action to reinvigorate the founding principles of the service. Our vision is for a service that meets Scotland's needs, is run on Scottish values and is owned by the Scottish people. I hope that the strategy commands the support of all members of the Scottish Parliament.
I welcome the fact that, at last, we have a health debate. Unfortunately, it has been cut short, but it is a health debate nonetheless.
It was cut short by you.
No, I do not think so.
I was about to be gracious in my acknowledgement—
Dump that strategy, Margaret.
Do not worry; it will not last.
I was about to acknowledge the fact that the Government accepted our request for a debate on health improvement and found time for one. However, as usual, Nicola Sturgeon spoiled the atmosphere.
It is clear that the historic growth in health investment under Labour is under threat. Despite the many improvements that we have seen, once again—as Malcolm Chisholm pointed out—health expenditure faces real challenges.
I ask members to think for a moment about exactly what Labour and the Liberal Democrats achieved in terms of health expenditure when we were in power. We have to remember that Scotland was tagged as the sick man of Europe, yet Scotland led on the ban on smoking in public places. Deaths from killer diseases, with which Scotland was so identified, are all down. There have been deep and significant changes, and if I had the time I would list them all and give members the statistics.
We can all make easy jokes about deep-fried Mars bars and the like, but as a Glaswegian I want to put on record that I am fed up with them. When Labour was in power, we brought about serious cultural shifts in food, diet and lifestyle in Scotland. Independent commentators praised our leadership and direction. The significant changes were achieved by leadership, by systematic investment and by delivering a message to the Scottish people. We had to be honest about what had to be done to bring about the necessary step changes.
Can that work be sustained? Scotland is at a juncture. If our health profile is to be altered profoundly, serious questions will have to be answered. I welcome many of the cabinet secretary's announcements this morning, but she will of course appreciate that we will interrogate her on them, as Malcolm Chisholm has just done.
I have a number of serious doubts about what is happening in the health portfolio. I will begin with a preliminary list that raises deep concerns about where this health secretary is taking Scotland. The first issue is quite staggering: the threat of closure is hanging over Scotland's healthy living centres. Those centres are aimed at our most deprived communities, to tackle fundamental issues on the front line—smoking, diet and physical activity. Closures of the centres are imminent, and I am staggered that no action has been taken. Redundancy notices have been issued, future planning has been stopped, services have been withdrawn and projects are losing staff.
Some healthy living centres are in difficulty because the previous Government—of which Margaret Curran was a member—failed to put them on a sustainable footing. It has been left to this Government to examine options to help those healthy living centres, which is exactly what we are doing now. Can Margaret Curran explain how the removal of £12.5 million from the e-health budget that Labour proposed could have been catered for, given that it would have cut screening programmes and progress on waiting times?
Ms Sturgeon, that was supposed to be an intervention, not a speech.
Yes, that was a speech, but it was supposed to be a short intervention. Perhaps Nicola Sturgeon will finally realise that part of being a minister is facing up to responsibilities and not always blaming other people. As we speak, months into her Administration we have the prospect of 200 full-time jobs being lost—
Rubbish.
And 300 part-time jobs being lost. I would be careful who you accuse of lying, Nicola. In addition, 3,000 volunteers—people who give of their own time—have been told to pack up and go. I hope that when she replies to this debate, Shona Robison will agree to Labour's demand this morning that the SNP should take immediate action to save the healthy living centres. The centres have said that they need a transitional fund of £10 million over two years to provide vital services. If the SNP does not protect the healthy living centres, it cannot be serious about dealing with health inequalities.
Will the member take an intervention?
I have no time. Ms Robison can make her point later.
I have further concerns about the way in which the Administration is handling health improvement. Smoking issues are important to Scotland, and the director of Action on Smoking and Health has expressed serious concerns that the smoking cessation budget is in decline. In West Lothian, where drug and alcohol services are important and have been given much credit, redundancy notices have been issued. On Monday, I visited an innovative and effective alcohol project in Aberdeen that may now have to reduce its services, thanks to the SNP. Only last week, the BBC showed graphic images of the consequences of alcohol use in Scotland. The Aberdeen project deals directly with street drunkenness but, months into the SNP Administration, its funding is under pressure. That would not have happened if Labour had been in power. With all the talk of cuts and job losses—and I could go on—it is no wonder that the Tories supported the SNP budget. We are back on familiar territory.
Nicola Sturgeon made strong commitments on the importance of preventive measures, for example the importance of physical activity in tackling obesity. I ask Ms Robison, when she replies, to tell us about her commitment to ensure that every pupil has two hours of quality physical education every week—or is that another sports commitment that will not be honoured?
At the heart of the health improvement debate is the fact that there is no point in fine words if services are being cut. There is no point in robbing Peter to pay Paul. There is no point in putting resources into one service if resources are being cut in deprived areas. Healthy living centres have made real changes where they have been needed most. Nicola Sturgeon said that she wants to make decisions on the basis of evidence. All those projects have been strongly evaluated throughout Scotland. I think that 71 jobs are at risk in Dundee. Why is the Government not taking action? That will threaten those projects. Will the hallmark of this Administration be the abandonment of investment that would give long-term results? Is the SNP interested only in the short term? The minister has serious questions to answer. Why are redundancy notices being sent out throughout Scotland? Why are 40 healthy living centres under threat? Why is she saying that she will tackle deprivation and deprived areas, while making redundant the very people who are already doing that?
That is outrageous. Get a grip.
I remind members to be a wee bit careful about their language.
I welcome the debate on health improvement—it should always be on our agenda. I particularly welcome the extra £40 million to tackle obesity, and the increased emphasis on cognitive behavioural therapy, which will be welcome in remote and rural areas. The commitment to tackle diabetes and depression at an early stage is very good news indeed.
The SNP Government has enjoyed a honeymoon for almost nine months. It has been easy to blame Labour for health problems in Scotland—as if it did not have enough problems already. Responsibility and accountability are the hallmarks of government, and certain issues are now coming to the fore. First, there is the SNP's manifesto commitment to double the number of school nurses by 2011, which is now diluted. I quote:
"The exact number of school nurses employed in 2011 will depend on a number of factors yet to be determined."—[Official Report, Written Answers, 19 November 2007; S3W-6199.]
That is quite different from the clear manifesto commitment to double the number of school nurses.
When Mary Scanlon asked me about that previously, I told her that we are developing a school-based health resource, which will include school nurses. She has an interest in mental health, so does she recognise that other staff may be required to back up that health resource in schools?
I recognise that many staff could back up that health resource, but I also recognise the Government's clear and concise manifesto commitment to double the number of school nurses. School nurses care for, advise and support children through their school years. They promote healthy lifestyles; provide health screening; support pupils with conditions such as asthma, diabetes, epilepsy and mental health problems; and work alongside teachers, social workers and other professionals to help to protect vulnerable children. Their role is crucial. Despite the warm words about early years and positive interventions, the SNP appears to have broken another promise.
How often did we hear the SNP in opposition say that it would end postcode prescribing? Yet after eight months of the SNP in government, postcode prescribing is alive and well in Scotland. A Sunday paper revealed that of the 25 new treatments that have been recommended in the past year—during which the SNP has been in government for eight months—for conditions such as cancer, HIV, heroin addiction, osteoporosis and anaemia, a quarter are still not available in most areas. In fact, NHS Lothian is top of the list—or bottom, if you like—with 19 out of the 25 new treatments still not available. Tayside is the best, as always, with all but two of the new drugs available.
In the week in which we will debate kidney donations, a treatment for anaemic patients on kidney dialysis has been rejected by all NHS health boards except one—Grampian—despite enormous cost savings to the NHS, as well as benefit to patients.
There is also the matter of extended opening hours for general practices. Being an agreeable and consensual person, I supported the idea, although I must admit that no one had raised the issue with me before. I had assumed that the Government carried out research on the unmet needs of patients. I further assumed that there was a strong evidence base, but now I discover that there is no evidence base, at least not one that is known to GPs. In fact, all existing research comes from an English survey, which concluded that four people in every 100 said that they would like extended opening hours at evenings and weekends. The British Medical Association recognises that some people want access to their GPs outwith normal surgery hours. A BMA briefing paper on the issue states:
"The BMA was prepared to discuss a package that would have offered extended opening hours and improved quality within the current level of funding. Unfortunately Prime Minister Gordon Brown intervened and insisted on further extended doctor consultation time with limited flexibility and the sacrifice of evidence-based potential new areas of work in exchange for non-evidence-based government-driven, politically-motivated targets."
You have one minute left.
The health secretary did not tell the Parliament or the people of Scotland that the extended opening hours for GPs came at the cost of preventive health care. For example, in its briefing the BMA referred to—
Will the member give way?
I am in my last minute.
It is on a point of clarification.
The cabinet secretary will see this in the BMA's briefing, which refers to better management of fractures, earlier diagnosis and treatment of osteoporosis, more hospital admissions for fractures, better management of peripheral vascular disease and a new heart failure indicator. The SNP rejected all those new initiatives to improve the health of people in Scotland in order to pay for extended access, for which there is no sound evidence base, and just to follow Gordon Brown's line—the London line. The BMA has said that that is
"not in the spirit of collaboration and partnership".
Health improvement is important, and no one can be in any doubt that anticipatory and preventive care is one of the most important aspects of health care for us all to take into account. Although the NHS is, properly, a demand-led service, if we do not tackle the increase in ill health it will undoubtedly become unsustainable. That is why the debate on preventive and anticipatory care, in my opinion and in the opinion of the Liberal Democrats, covers one of the most important aspects of shaping our health service in Scotland today.
I welcome this debate. No doubt, we will have a debate on a motion in the future. I also welcome the publication of the Government's paper "Better Health, Better Care", although it is not so much an action plan as an action timetable. It tells us that we are going to receive a lot of important reports throughout this year, including a smoking prevention action plan some time during the year; a strategy to tackle alcohol abuse by the spring; a national drugs strategy, also in the spring; and a food and health delivery plan at some other point in the year. The report of the ministerial task force on health inequalities will be received some time in May. That is all very welcome, but the cabinet secretary will appreciate that we have to await the details before we can properly decide whether we concur with her action and the line that she takes.
Liberal Democrats share with those with whom we served the sense that the previous Government took health improvement seriously and made a substantive contribution to improving Scotland's view on it. The smoking ban was a most significant measure, in terms of changing a culture. Earlier, the cabinet secretary talked about people's rights, but the smoking ban highlighted the other side of that coin, and helped people to understand that they also have responsibilities in relation to developing their health.
I hope that the Government will be able to make progress on heart disease and free eye and dental checks, because they are important. We have an opportunity to discern and track diseases at an earlier stage because of those checks. We support the continuation of the hungry for success programme.
Liberal Democrats acknowledge, like everyone, that community health partnerships, which were introduced by the previous Government, are not working as well as they should. They can play a much more important role than they currently do. In a briefing yesterday, the BMA said that it also sees CHPs as having the capacity to play a much more important role in preventive health services.
I agree strongly with the comment that Ross Finnie has just made. Does he accept that, although they are in their infancy, there are examples of effective and properly functioning community health partnerships, and that the challenge before us is to ensure that they all grow at the same rate and that best practice is replicated?
I accept that. However, it is disappointing that the disparity in Scotland is so great. That means that the collaboration that the cabinet secretary referred to earlier is not happening as it should.
There is a raft of important health issues, some of which the cabinet secretary referred to earlier, the key to which is the fundamental question of health inequalities. That issue concerns not only the NHS and health practitioners; it goes way beyond that. At the heart of the matter is the fact that, despite the substantial investment that has been made by successive Governments—including the Government of which I was a member—we still have difficulties bridging the gap. The levels and standards of health improve, but the gap remains, which disappoints us all. The issue is challenging, and it is not one on which any Government has a monopoly of wisdom.
We want to see flesh on the bones of the outline programme that has been set out in considerable detail by the Government. Progress must be made on determining whether children will be adequately supported in schools by school nurses—as Mary Scanlon said—and on increasing physical activity and doing more than we are currently doing on smoking, alcohol and drugs. All of those issues are critical. Liberal Democrats see health inequalities as the issue that we need to tackle.
I welcome the fact that the cabinet secretary mentioned the important subject of mental health throughout the ages. For far too long, we have regarded mental health issues as affecting only the old. That has been a tragic misperception. The medical professions have always known otherwise. I also welcome the cabinet secretary's confirmation of what we all read in The Sun this morning, which is that she is launching a £40 million programme on obesity. I do not know whether that says anything about readers of The Sun—I would not wish to comment—but we know to whom the exclusive was given.
Health improvement is extraordinarily important. It is at the heart of whether we will be able to tackle the health problems in this country. I hope that the cabinet secretary will make progress on those issues and that we will have the opportunity to hold her to account in relation to the more detailed programmes that she brings forward.
We now move to the debate.
Scotland has some serious health issues, as I am sure all members agree. It is therefore incumbent on the Government of the day to work to improve the state of the nation's health. It will come as no surprise that I back the SNP Government's plans to improve the health of Scotland's citizens. I do not see how anyone could disagree with the following: a 19 per cent increase in investment in 2010-11, if the budget is passed; £90 million a year for the next three years to ensure that, by the end of 2011, nobody will wait longer than 18 weeks from referral by a general practitioner to treatment for routine conditions; £500 million a year to fund major new developments, such as the new children's hospital and the new Southern general hospital in Glasgow—
Will the member take an intervention?
I will not at the moment—maybe I will later on.
I do not see how anyone could disagree with making improvements at existing hospitals throughout Scotland, including Aberdeen royal infirmary, Borders general hospital, Raigmore hospital in Inverness and the Dumfries and Galloway infirmary; and working with partners to meet the mental health needs of serving and former armed forces personnel. That is not to mention the reduction in prescription charges leading to their abolition; the presumption against centralisation of hospital services; the creation of independent scrutiny panels; the retention of accident and emergency services at Ayr and Monklands hospitals; the increased funding for free personal care; a three-year investment of £54 million to fight the hospital superbugs; and the other announcements that the cabinet secretary made this morning.
Will the member take an intervention?
I am sorry, but I must make progress.
There are many more issues that I am sure will be discussed this morning. However, the items that I have highlighted alone prove that the SNP Government is committed to the health improvement of the nation and to the NHS in Scotland.
The member mentioned the concerns about future investment in improvements to the Borders general hospital in my constituency. What are they?
I am sure that Mr Purvis will be told in due course.
I will focus on the local health care bill, which will include provisions to implement the SNP manifesto commitment to ensure that health boards have a directly elected element. As I stay in Inverclyde, I know that the threat of services being removed from the Inverclyde royal hospital is never far away, nor is it far away in the case of the Vale of Leven hospital. The centralisation agenda for NHS Greater Glasgow and Clyde—and, before that, NHS Argyll and Clyde—has been of extreme proportions. For example, the IRH and the Vale of Leven hospital have lost the consultant-led services in the maternity units, and we now have community midwife units. The number of births at those units has not been as high as was hoped for—but if the CMUs are not marketed to the public, how will the public know about them?
The introduction of the independent scrutiny panel proved to be successful, as it listened to all the arguments and produced a report recommending that the CMUs be kept open and that there should be a community education programme to inform the public about what a CMU is. At a public meeting in Greenock, I introduced comparison figures to the scrutiny panel comparing the CMUs at the IRH and the Vale of Leven hospital with those in Arbroath and Montrose in Tayside—[Interruption.]
Will members please check their mobile phones?
I do not have one with me.
Despite the vast differences in population, the number of births in Arbroath and Montrose was still vastly higher, and I wondered whether the health board had ever considered why. The health board's response to the scrutiny panel was to thank it but to say that it was still planning to consult on closing the CMUs and centralising them in Paisley. Whether the Royal Alexandria hospital could cope with the increased centralisation agenda is another issue entirely. It would not surprise me if the health board threatened cuts at the RAH if its centralisation agenda does not take place.
A further aspect of the debate concerns parking charges at hospitals, with which I, for one, do not agree—I have said so in the chamber and in the media. I welcome the announcement that the cabinet secretary made before Christmas that if charges are to be introduced, there should be a cap of £3 a day. That is a welcome step, and it shows an understanding about the importance of the issue.
The key part of Nicola Sturgeon's statement on parking charges was that health boards must prove that such charges are required. Following the cabinet secretary's announcement, I wrote to the health board to ask it specifically about traffic studies at the IRH, Vale of Leven hospital and the RAH in Paisley. One of my SNP colleagues, Councillor Kenny MacLaren from Paisley, had also written to the health board specifically about the RAH. The response is wonderful—it says:
"No specific traffic study has been carried out at the RAH … There is also an issue with staff numbers and availability of parking spaces with the ratio being three staff members to each parking space".
That may well be the case, but there must surely be shift patterns, and not everyone works at the same time. In addition, not everyone owns or drives a car. Heaven forbid, but some people might even take public transport.
The response provided me with an answer on one location, but I will not be surprised if the responses on the IRH and the Vale of Leven hospital are similar. When will the board get the message that parking charges are not needed at the IRH, the Vale of Leven hospital or the RAH? Furthermore, the consultation took place before those three hospitals were part of NHS Greater Glasgow and Clyde, so how can the imposition of charges be justified?
I have given members a flavour of why a local health care bill that provides for the direct election of a percentage of health board members offers a way forward that will improve health care in communities. I do not for a minute suggest that the direct election of health board members will create no problems in future—very few issues are without problems. However, if people who care about the health service and want normal services to be delivered locally have a say, health services and the health of the nation will improve. We cannot let the arrogance of health boards continue.
You should finish now.
We have a duty to the electorate to ensure that the health of the nation is much improved in four years' time. The Parliament has an opportunity to ensure that Scotland takes itself out of intensive care. The many proposals of the SNP Government will go a long way towards improving Scotland's health.
Before I call Ms Eadie, I remind members that we are running short of time. You are warned when you have a minute left and I can choose to switch off your microphones if you do not finish after six minutes.
I will try to behave myself and not overrun.
Labour introduced a new approach to public health in Scotland when it came into office in 1999. Labour's policy documents were notable because they acknowledged health inequalities. The focus was on life circumstances, lifestyles and health, and topics such as cancer, heart disease, strokes and mental health were at the core of our concerns, which was right. Labour ensured that there was a single system in the health service when it legislated to abolish trusts, which was the right thing to do.
Like Margaret Curran, I welcome this debate on health, but I deplore the fact that it is the first such debate in eight months. What has the SNP been so afraid of that it has consistently refused to have a health debate? Given that health was at the core of the election campaign, the SNP has let us all down badly, particularly people in my constituency.
I agree entirely with Mary Scanlon's views about postcode prescribing, which is still evident in Scotland. I remember SNP members in the first and second sessions of the Parliament, including Shona Robison and Roseanna Cunningham, jumping up and down all over the place saying that it was outrageous that there was postcode prescribing. It is particularly concerning that postcode prescribing still happens when we consider new medicines that can transform people's lives, such as the new biologics medicines, which help people who have rheumatoid arthritis—I met a young lady who was in a wheelchair and is now able to go out and undertake a university degree, and there are many other such cases. It is evident from the e-mails in our inboxes that postcode prescribing is still taking place in Scotland.
On 16 December, there was a front page headline in Scotland on Sunday about cancer treatment. The leader article made it clear that there is a need for centralisation and centres of excellence if that leads to the best outcomes for patients. Everyone in Scotland who has a loved one who suffers from cancer is impatient to learn from the cabinet secretary how she will take forward that critical issue, but she has been silent about that and other killer diseases. There have been heart-rending cases throughout Scotland—I think that the Public Petitions Committee is about to consider one such case—and the issue's importance cannot be overemphasised.
Will the member give way?
Not at the moment.
I support and welcome the Government's view on presumed consent in relation to kidney transplants.
On more parochial matters, infection across Scotland remains rampant. The SNP said after a short time in office that it would get to grips with the issue and announced major spending, which we welcomed. However, why has ward 12 of Lynebank hospital been closed for the past week, as we read in today's Dunfermline Press and West of Fife Advertiser? Why was another ward closed on 9 January? There are concerns about that. Why are some patients with superbugs in our local hospitals being allowed to be discharged without their concerns being addressed?
The cabinet secretary's party has been economical with the truth—to put it politely—given its broken promises. In April, prior to the elections in May, the SNP put at the core of its election campaign a promise, which was reported in the Dunfermline Press and West of Fife Advertiser, that it would not downgrade the Queen Margaret hospital but would return it to its former glory. The SNP's local hospital campaigner made that promise but, subsequently, I received a letter from the cabinet secretary in which she said that the SNP had no intention of delivering on that promise. That is a broken promise to the people of west Fife, part of which I represent.
The SNP Government came to power on the basis of a promise that it would be able to manage Scotland well. However, throughout Scotland 1,008 beds have been blocked—in Fife, 167 beds have been blocked. The cost of that for September was £2.5 million and the total cost for November and December was £4.4 million—the costs escalate. If beds are blocked, other patients are denied access to hospital.
The situation has occurred because the cabinet secretary's colleagues in local government in Fife have decided to cap the budgets. They have said that that was because of Fife Council's irresponsible actions last year; they said that the council could not manage the budget, which was a deplorable state of affairs. However, in fact, Fife Council returned £2.95 million to balances under Labour's administration. It took an informed decision to overspend on its social work budgets because they were demand led. We now have a situation in Fife where the most needy people in our communities, including babies and old people, are being turned away. That is a disgrace.
I thank the Scottish Government for providing an opportunity to debate health improvement in Scotland. I also thank the staff at the Edinburgh royal infirmary for treating me so well after I spilled soup on my hand yesterday.
As we have heard, we face significant challenges in improving the health of our society and, in particular, in reducing the inequalities that exist within and between our communities. Health to me, as to others, does not simply mean physical fitness. Mental well-being and overall quality of life need to be factored in when we are measuring how healthy any individual or society is.
I will focus on aspects of health improvement among two groups: the young people of Scotland and people in rural areas, especially the South of Scotland region, which I represent. Both groups have particular vulnerabilities and challenges and I am pleased to welcome the early steps that the Scottish Government is taking to improve their health and well-being.
Getting healthy practices right in the early years has benefits that last a lifetime—and a longer, healthier lifetime at that. The budget commits £32 million to specialist children's services, including cancer care and high-dependency specialties. The Government is committed to sustaining four major children's hospitals in Scotland, including new facilities in Glasgow and Edinburgh by 2012.
Healthy exercise is one of the best forms of preventive medicine as it keeps young people fit and healthy, builds strength and improves mental well-being. The Government has adopted an aim of increasing financial investment in the let's make Scotland more active strategy, which sets a target of 80 per cent of children attaining recommended levels of activity. Currently, around 25 per cent of boys and up to a third of girls are not meeting that target, so it is vital that the Government continues to invest in indoor and outdoor facilities that make it easy for children to keep fit. As we all know, exercise can help to tackle obesity, so we need to make healthy play for young people an attractive and easy option.
We all agree that the Commonwealth games will inspire a new generation of athletes in Scotland. I am just disappointed that, at such a crucial time, many Scottish MPs at Westminster have voted to divert lottery funding away from Scotland that could have been used to tackle obesity here.
Tackling a challenge such as obesity requires us to adopt many different approaches and it is good that a consensus is building about the importance of a healthy diet. I am particularly delighted with the Government's commitment to pilot free school meals.
However, diet includes both food and drink, and it is increasingly clear that alcoholic drink poses a threat to the health and well-being of Scotland's young people. Alcohol abuse can cause both short and long-term damage to physical and mental health. I welcome the Government's commitment to take concerted action to promote better understanding of the risks that are involved in binge drinking. In that area in particular, our approach to health improvement needs to go beyond straightforward management of the NHS and related resources. We need to tackle the cultural and societal trends that encourage and glamorise alcohol intake, such as the manufacture and marketing of sweet alcoholic drinks that are targeted specifically at young people.
At present, however, the Parliament and the Government can only do so much because there are constraints from Westminster in relation to the powers to alter alcohol taxation and to regulate advertising. If other parties genuinely support Scottish solutions to the challenges that Scotland faces, I hope that their contribution to the national conversation on our constitutional future will take the matter into account.
Many health challenges are best dealt with from a Scottish perspective, not least those in our rural communities, which often seem to be overlooked when it comes to health provision and improvement. People in rural areas often face particular difficulties, especially with access to services. I strongly welcome the steps that the Government is taking to meet those challenges, including the roll-out of NHS 24 to every mainland health board and the trial of walk-in appointment services in Lanarkshire and Lothian.
The decisions to save accident and emergency services at Monklands hospital and to stop car parking fees at NHS-run car parks—as mentioned by Stuart McMillan—will also benefit people in the South of Scotland who have to travel some distance to access hospital treatment.
Will the member give way?
Okay.
Please be brief, Mr Purvis.
The member will be aware that there is currently no charging at the Borders general hospital.
It will stay that way.
I am pleased to hear that. However, if additional resources are being provided to subsidise hospitals that may well reduce charges or improve parking, should there be an equivalent arrangement for the Borders general hospital, which does not have charges at present?
The commitment from the Government is adequate. It saw that there was inequality because there were prohibitive car parking charges, including for NHS staff on lower wages.
There is undoubtedly a consensus about the need to improve the health of our nation, and there will surely be a debate about how to achieve that. I welcome the fresh approach that has been adopted by the Scottish Government which, as in all other areas of policy, is ambitious for our country's future.
Health is an area of policy in which feelings run high, in the chamber and among the public. Liberal Democrats have led the way in the policy area by advocating a preventive approach to health care to ensure much-needed improvements in the health of Scotland's people. Fortunately, other parties, including the SNP, are starting to heed the good advice that we have offered them on health improvement.
Thanks for that, Jim.
You are welcome.
The forward-thinking Liberal Democrat view is not new to the Parliament. Indeed, major sections of our 2007 manifesto highlighted our commitments to recruit an extra 200 dentists, to double the funding for drug and alcohol treatment, and to seek an hour of physical activity a day for every child in Scotland, not just in school but at other times in their day.
Our manifesto is not the only place in which the Lib Dems have led the way on health. As part of the previous Government, we were the first party to support a smoking ban, and we led the way on introducing free eye and dental checks as well as on launching the hungry for success initiative to improve the quality of school meals.
It would be remiss of me in my role as shadow minister for communities and sport not to mention the health benefits that physical activity and sport can bring to people of all ages in Scotland. I recently got back into badminton and went skiing; those activities are part of my health care as well as being great fun.
The Government has made much of the role that sport can play in delivering health improvement. It is a pity, therefore, that it made such a botch-up of its flagship sports policy—abolishing sportscotland. We told the Government that it was misguided, and many people in sport delivered the same message, yet Stewart Maxwell still had to be dragged, kicking and screaming, into an embarrassing U-turn on that key manifesto pledge. It was a Liberal Democrat-sponsored debate on 13 December that made the case for retaining sportscotland. We offered Parliament the opportunity to support the view, and it did so overwhelmingly. Rather than maturely accept the will of Parliament, Mr Maxwell threw the toys out of the pram and sacked the chairs of both sportscotland and the Scottish Institute of Sport in the most bitter and spiteful act carried out by the SNP Government—at least to date.
We have sought to focus on helping sportscotland to achieve its most important goals, not least that of encouraging participation, while the SNP has dithered, tinkered, backtracked, launched a consultation that seemed to exclude much of Scotland's sporting community and emerged with a discredited sports minister who stumbled on the right policy only after abandoning his manifesto commitment. There may be a lesson in that for the SNP.
The SNP manifesto also promised children free year-round access to council swimming pools. One would have thought that that was quite a straightforward proposal. Concerned to know whether that was still Government policy, I lodged a written question seeking confirmation on 16 November. Step forward Stewart Maxwell to provide the clarity and eloquence that have become his hallmark. I will not quote the whole 144 words of his answer—
Oh, go on.
I have the text here and Ms Sturgeon can read it later, although I am sure that she knows how to look it up.
Suffice it to say that that appears to be another ditched manifesto pledge. There is another tick in the broken-promises box.
I am pleased to discuss health improvement. The debate is welcome as it allows us to highlight good practice as well as talk about the challenges that we face when trying to improve health. Labour has always prioritised health and health improvement. The smoking ban has had the highest profile, but there are many other initiatives.
Poverty can lead to the greatest health inequalities. If we are serious about improving health, we need to deal with poverty. A recent study has shown that unemployment is as detrimental to health as smoking 200 cigarettes a day. Labour's policy of full employment has always been one of the main levers in attacking poverty and promoting equality. The study underlines the importance of that approach to promoting not only economic but health equality. Unemployment is still disproportionately high in many of our most deprived communities. It is therefore no surprise that those communities also suffer poor health. We need to grow the confidence of those communities and encourage employers to recruit there.
In my Highlands and Islands constituency, poverty is difficult to identify due to the fact that the area is predominantly rural. Those living in poverty live in the same locality as their affluent neighbours. The indicators that Governments use to identify poverty are often based on urban communities and therefore hide rural poverty. Unemployment can be low, but that often masks the fact that people are working in more than one job to make ends meet. Those can be seasonal or part-time jobs, or indeed people can be self-employed.
Promoting health improvement is challenging in rural areas because of the dispersed population. It is difficult to access fresh food at a reasonable cost. Providing sporting facilities is also difficult with a dispersed population, although many areas are an exception. In Shetland, for example, providing sporting facilities in small and sparsely populated communities has been made a priority.
Despite the challenges, there are many good examples of projects in the Highlands and Islands that encourage participation in sport. Step it up Highland, which encourages people to take up walking, and the Highland cycling campaign, which promotes the health and economic benefits of cycling to people in the Highlands, are just two.
Another good initiative is run by GPs in Elgin, who prescribe membership of the Moray leisure centre to their patients whose health problems would benefit from more exercise. That cuts down on costly drugs and does not give rise to complex side effects. That must be used more widely to promote healthy lifestyles. That initiative is used in Moray to fight existing conditions, but we also need to look imaginatively at how it can be used to prevent such conditions. Again, those who live in affluent households can afford their own sport centre membership; those who live in poverty and who are in most need cannot.
Like Margaret Curran, I am concerned that many projects that have led the way on health improvement will end unless the Government steps in. Many lottery-funded projects throughout Scotland that promote healthy lifestyles will not be mainstreamed despite their proven success. One such example is the janny's hoose healthy living centre in Inverness, which is one of three such centres in Highland that promote healthy living in some of the region's most excluded areas. The centre provides a drop-in facility that offers advice and support to the community. Unfortunately, despite a big local campaign that was backed by the Inverness Courier, the last hope for saving the centre is to go back to the Big Lottery Fund with a new plan to seek to build on the centre's existing success. Surely the beauty of lottery funding is that it allows local government and central Government to test ideas and gauge their success without making a financial commitment. However, we need to look at how projects that have been successful are mainstreamed.
What are the member's thoughts on the Scottish Labour MPs who voted to divert money away from Scotland to fund the Olympics? Does she think that the money would have been better spent in Scotland?
The SNP is promoting a myth that Scotland will not benefit from the Olympics. That is wrong. If that is the Scottish Government's attitude, there is a lot to be worried about. We can benefit from spending on the Olympics, too.
Another award-winning project in my area is the Islay healthy living centre, which has provided assistance on smoking cessation as well as other health-promoting initiatives involving exercise and welfare. Both those healthy living projects serve hugely diverse communities, but they come from the grass roots and meet the needs of local people. It is ironic that, at a time when public health is so high on the agenda, such services are being removed from local communities. Will the Government, in its lauded concordat, ensure that local government and health boards adopt best practice in their approach to such projects and arrange funding for them?
In conclusion, it is not right in a modern society that people's life chances and life expectancy still depend on where they were born. Many of the challenges are obvious—poor diet, poverty, unemployment, cigarettes and alcohol—but knowing the problems is not the same as putting them right. We need to build on good initiatives such as the healthy living centres, promote healthy diets and lifestyles and ensure that they are available not just to those that can afford them. The public purse rightly invests in acute health provision, but we need to be willing to give the same investment to health promotion to reap the financial and social rewards further down the line.
Health improvement is a massive topic, so I will concentrate only on the vexed aspect of health inequality, which Governments over the years have tried to tackle with little success. Indeed, by some measurements, the health gap between rich and poor has steadily increased over recent years.
We all recognise, I hope, that major health improvements in our deprived communities can come about only through changes that are the responsibility not only of all Government departments but of wider society. The cabinet secretary recognised that earlier. Poverty, lack of education, the breakdown of families and poor nutrition are just some of the factors involved. However, the health service also has a part to play in fighting inequalities because, although the poorest in our communities are usually the least well, they are often let down by the treatment service that we provide.
At this point, members may feel that time for reflection has been rescheduled because I wish to draw their attention to the gospel according to St John. He describes how the first person—but only the first person—to enter the pool at Bethesda after an angel had disturbed the waters was cured of his or her illness. Members might feel that little has changed today. Like the waters of Bethesda, the health service is free of charge but is often subtly rationed. At Bethesda, those with certain complaints were unfairly advantaged because they could sprint to the pool in time; today, the same happens with people who have illnesses that command media attention. At Bethesda, it helped to have influential friends or relatives who could drag the sick person to the pool and perhaps get in the way of others and impede their progress; today, those who are lucky enough to have someone to advocate their cause are likely to benefit at the expense of those who have no such support.
So how do we begin to remedy that situation? Part of the solution lies in augmenting the numbers and resources of those whose job or vocation it is to look after the health needs of the disadvantaged.
The cabinet secretary is to be congratulated on continuing the roll-out of schemes that are directed at the poorest in our communities, such as the keep well scheme, but the health divide is bound to widen while resources and staff continue to be spread on a population basis rather than according to need, while the general practitioner contract makes it undesirable for doctors to work in impoverished areas and while vital services such as drop-in mental health clinics are always the first to suffer when cash is short.
Existing services need to be tailored to benefit those who are in most need; those people should not be handicapped, which they are at the moment. In some GP practices, the process for making appointments has changed little since those days of the pool at Bethesda. Appointment desks open at 8 o'clock and all routine appointments are taken up by 8.30 or even earlier, after which time people must wait to try again the next day. In the understandable drive to reduce the number of appointments at which people fail to turn up, many hospital clinics make people go through a series of hoops that weed out not only those who no longer need an appointment but those who cannot cope with the bureaucracy that is involved. Those at the bottom of society's pile find it more difficult to get child care to cover them when they have an appointment or to remember appointments amid the chaos of a disorganised lifestyle, but that does not mean that their health needs are less than those of others. Indeed, their health needs are often much greater.
Drug abuse and alcohol abuse affect all communities, but they are especially a problem in areas of deprivation. It would take a whole day—probably much longer indeed—to explore that topic in a meaningful way, so I will concentrate on one aspect of it. A Government response to drug and alcohol problems in recent years has been spending millions of pounds on funding area drug and alcohol teams on the ground that people with a drug problem usually also have an alcohol problem. The Health and Sport Committee was told that. However, when I wrote to Lothian NHS Board recently to ask it for the percentage of those who are being treated by the community drug-problem service who are also being treated for an alcohol problem, I was refused the information that I sought on the ground that it could not be extracted without undue work. Therefore, we do not know how many people have both drug and alcohol habits. Linking the two conditions in such a way inhibits tackling either condition appropriately, as they are very different in many ways.
Does the member acknowledge that not only do many people have drug and alcohol problems, but many such people suffer from underlying mental health problems, such as depression?
I totally agree with Mary Scanlon. People with drug and alcohol problems have many different problems.
More than 20 bodies in Lothian alone deal with drug and alcohol problems, but no one seems to know which of those bodies are effective or how much duplication of work takes place. However, I acknowledge and welcome the significant steps that have been taken today.
My message is that we should take a lesson from our treatment of local government. We should wean ourselves off central initiatives, pass funding to experienced health workers who are already in the community, and let them meet the needs—including mental health needs, which Mary Scanlon mentioned—that they can clearly identify but which overwhelm them now. In 35 years of working in a deprived community, I have seen scores of outside initiatives come and go with little long-term effect. It is time for a new approach.
I am pleased to be able to participate in this debate, particularly at such a crucial time for health care in Lanarkshire.
I want to raise three issues, the first of which is the possible outsourcing of occupational health services at NHS Greater Glasgow and Clyde to an American firm. Constituents of mine who work in those services have approached me to ask for help to stop the threat of privatisation that is hanging over the excellent provision that exists. The Cabinet Secretary for Health and Wellbeing stated in "Better Health, Better Care" that the national health service in Scotland
"will remain firmly in the public sector"
and that her Government will
"distance NHSScotland still further from market orientated models."
Will she reassure my constituents that she will not allow Greater Glasgow and Clyde NHS Board to privatise that provision in effect?
I assure Elaine Smith that I am aware of the issue and that I am considering it in detail. I will be happy to come back to her on the matter in more detail later.
I thank the cabinet secretary for that.
The report that was published last week by the panel that was established by the cabinet secretary to review proposals by Lanarkshire NHS Board states that
"the board has not made a convincing case for significant changes to emergency services."
That sounds innocuous, but what lies beneath that statement is the anguish, fear and anger of my constituents who, as I did, knew that there was no case for downgrading Monklands general hospital. However, with the honourable exception of Jim McCabe, the board chose to ignore all the submissions that pointed that out to them. The panel's observations are a pretty damning indictment of NHS Lanarkshire's proposals for Monklands.
Uncannily like my own submissions, the report points to skewed evidence, bias towards preferred options and flawed financial information alongside a seeming disregard for the opinions of consultees. I trust that the board will now do the right thing and remedy the situation at its meeting on 30 January, as Monklands general hospital must remain a level 3 general hospital. I also trust that the cabinet secretary will step in if that does not happen.
Although there is an understandable focus on acute services in the panel's report, it also acknowledges that the general health of the population will not be fundamentally improved through the acute hospitals sector alone. That is something that we all know. Primary care, community services and health promotion all have a key role to play in preventing health problems such as obesity, addiction and mental ill health. Those are areas that Labour considers to be of the highest priority.
My main focus today is on infant feeding. The need to support and promote breastfeeding is an issue that I raised in my original submission to NHS Lanarkshire, and it is a matter that needs urgent attention because it is a substantial weapon in the fight against ill health. It is also recognised as being important in "Better Health, Better Care". I would be grateful if the minister could tell us when we can expect the appointment of the infant feeding adviser to continue the excellent work of Jenny Warren.
The benefits of breastfeeding are well known and were rehearsed in Parliament during its scrutiny of my member's bill, the Breastfeeding etc (Scotland) Bill, so I will not go into detail. Suffice it to say that we all know that breast is best and that it has the potential for huge health improvement, not only for mums and babies, but into later life. Unfortunately, I have heard anecdotal reports of the law being broken when women have been asked to leave premises in order to breastfeed. A campaign to raise awareness of the legislation would be welcome, and women who find themselves in that position should report the matter to the procurator fiscal.
Although the benefits of breastfeeding are well known, the perception is unfortunately that support for it is a Cinderella service in the health sector. We need more investment to encourage new mums to breastfeed and to sustain it for longer. I hope that the minister will be able to tell us what plans and funding are in place for this year's national breastfeeding awareness week, in May, which was supported by the previous Executive. I hope that she can also tell us whether the new money that has been announced will promote breastfeeding as an excellent way of tackling obesity in future generations.
One of the main threats to breastfeeding is the marketing of formula milk. I raise the topical issue of the new European Union regulations that are designed to toughen the rules on advertising infant formula and follow-on formula. Since 1995, the United Kingdom has had legislation to protect parents' right to receive objective and accurate information about feeding their babies. However, although that means that it is illegal to advertise formula milk for younger babies, it is not illegal to advertise the so-called follow-on milk for babies over six months old. By ensuring that their products for older and younger babies are almost identical, companies can automatically promote one type of milk by advertising the other. There is another loophole in that, although they are banned from putting formula milk brand names on the information that they give to mothers, they can get around that by making the logos almost identical to the brand names. Such aggressive marketing over many years must take some of the blame for the fall in the number of women who breastfeed.
In a recent debate at Westminster, David Kidney MP highlighted the way in which commercial pressure is undermining the legislation. He cited the vast sums of money that are involved and said:
"After all, the market is big money for the companies. The UK market in formula milk nearly trebled from £119 million in 1995 to £329 million in 2006."—[Official Report, House of Commons, 16 January 2008; Vol 470, c 281WH.]
There is an on-going case—which I would not have time to go into even if I were able to do so—in which the new EU regulations are being challenged. However, I am pleased to note that the negative instrument that will implement the European directives on infant formula and follow-on formula was debated and agreed at the Health and Sport Committee last week.
Obviously, parents must make up their own minds about feeding, but it is incumbent on the Government to ensure that that their choice is well informed. We could market breastfeeding to the same extent as formula milk, which would go a long way towards improving the health outcomes of future generations. I hope that the minister will give that suggestion serious consideration.
This has, by and large, been a well-tempered and informative debate, and I have listened with great interest. I will make my remarks based on the order in which we heard speeches.
The cabinet secretary talked about "Better Health, Better Care" and the spirit of collaboration and co-operation. To quote her, she said that patients and the public will be "drivers of change". Such themes should be welcomed.
I listened with interest to the points about hospital centralisation, and I see them as being entirely laudable, coming from where I come from. However, I would like to see more services being taken out of the centre and, where appropriate, being put into some of the more remote hospitals. Of course, there is a judgment to be made about which services should be more central and which should not. Perhaps that is what Helen Eadie was alluding to when she talked about cancer treatment. When it comes to oncology, there might be a debate to be had about that, if we are to be absolutely honest.
I welcome much of what Nicola Sturgeon said. I like the idea of safe and sustainable services for people who live in remote and rural areas; my constituents will welcome that.
Margaret Curran set a theme that was followed up by Ross Finnie. To be quite honest, great improvements were made to the health service during the lifetime of the previous Administration. The question is whether the current Administration can sustain and continue that. All right-thinking people will welcome its endeavours in that direction.
Mary Scanlon welcomed, as I am sure we all do, the £40 million that is being spent on tackling obesity. Mr Finnie rightly drew attention to the curious fact that that was announced in this morning's edition of The Sun, but I will draw no more conclusions from that than Mr Finnie did.
Mary Scanlon was interesting on the subject of school nurses, and although I accept the point that it is mainly a Borders issue, if we are to progress with improvements in health, we must start with the youngest people. The unfortunate spread of human head lice, which are rife in all schools—pediculus capitis is one Latin name that I know—is to do with the fact that there is no regular school nurse to check as might have been the case when older members like me were at school. That is a manifesto commitment on which the Government should strive to deliver as much as it can.
Does Jamie Stone agree that promoting breastfeeding to younger children is also important? The only breastfeeding doll that I have ever seen is the one that is sitting in my office in this building.
I concur with what Elaine Smith says.
I mentioned what Mr Finnie said earlier. He also mentioned the importance of the hungry for success programme. I have gone on record to say that it is hugely important to build on that in the future. There have been successes, particularly in primary schools, although there have not been so many in the secondary schools. I take some comfort from the fact that primary pupils will, sooner or later, become secondary pupils. The initiative has to be built on and we must continue to deliver on it. I will mention local food—I would, wouldn't I?—and its being delivered for hungry for success.
I liked Mr Finnie's phrase
"mental health throughout the ages".
That theme is worth remembering.
I commend Stuart McMillan for what he said. He struck a chord with me when he mentioned consultant-led maternity services spread throughout Scotland. I will copy Ian McKee and quote the Bible by saying: Lo! It is
"Jehu … for he driveth furiously".
If consultant-led maternity services were taken out of Caithness and sent to Raigmore, and only Raigmore, we would have a huge issue with distance and people having to drive pregnant mums there and babies being delivered in lay-bys. That was always our great fear. However, we are where we are and we have that service, which we appreciate very much.
Stuart McMillan also mentioned parking charges at hospitals. I concur with what he said and draw the cabinet secretary's attention to the fact that the number of spaces for disabled drivers is often inadequate at hospitals or, worse still, they are occupied by people who do not hold or display disabled cards. That is a cause of huge discontent in my constituency.
I have already referred to Helen Eadie's contribution about cancer. Aileen Campbell quite rightly referred to young people and people in rural areas. She particularly mentioned indoor and outdoor facilities for leisure or exercise. Coverage is patchy throughout Scotland—Caithness is certainly badly off for facilities—so I recommend that the cabinet secretary co-ordinate with her colleagues on the issue and perhaps carry out an audit.
Jim Tolson reminded Parliament that the SNP has taken up many policies that we thought up first, and he told us the interesting fact that he skis and plays badminton—I presume not simultaneously. Rhoda Grant talked about poverty and employment, and in his very thoughtful speech Ian McKee wisely pointed out that health and inequality are interlinked.
In conclusion, I must highlight an issue that I have already raised in writing with the cabinet secretary. Recently, several of my constituents who were taken for treatment—particularly heart treatment—well out of the area had to make their own way back to the north Highlands when they were allowed to leave hospital. In one case, a 76-year-old widow who was brought to Edinburgh to have a stent inserted was told that she had to make her own way home. I am not trying to be a Goody Two-shoes over this issue—it might well have been happening under the previous Administration—but I must draw it to the cabinet secretary's attention. It is utterly unacceptable that such a thing should happen in this day and age.
In my summing up, I want to highlight two themes. First, I reiterate my conviction that by introducing an independent scrutiny process the cabinet secretary has done more than any of her recent predecessors in the Scottish Parliament to re-engage with public mood and will in the delivery of critical health services. What a liberating act that move has been. After a cautious start, in which medical opinion held back in the wake of public protest, we now find—according to The Herald—a widespread change in clinical, medical and expert opinion on the former Labour-Liberal Administration's strategy and its brutally blinkered adherence to it. As a result of the cabinet secretary's courage and leadership, those who felt intimidated now feel emboldened. We should not ignore what they have to say.
The cabinet secretary's conduct since May stands in sunny contrast to that of Labour members, who have been scurrying around the country and beating their chests with magisterial indignation about problems in the health service for which their party is directly responsible. We need only witness Margaret Curran's contrived anger as she desperately tried to distance herself from her own Government's shortcomings—in a record that, I have to say, is not without merit—and to pin the blame for anything and everything on the SNP. The SNP must now be held to account, as Mary Scanlon and others have done this morning, for its own record in office, not for Labour's mistakes in government. Why does Labour continue to confuse anger at losing office with opposition?
Jackson Carlaw does not know me terribly well, so I assure him that although I might show it regularly, my anger is rarely "contrived". It is usually quite heartfelt and genuine.
My point is that Labour in government would have taken decisive action to save projects to tackle health improvement. Does Jackson Carlaw agree that, when faced with the prospect of losing 200 full-time jobs in such services, the cabinet secretary must take action?
I have already said that the Government must be held to account for its record. I have to wonder what Labour members think is the reason they lost the election. They have to wake up to the fact that it was partly because of the way in which the cabinet secretary's predecessor went around the country, beating his chest and saying, "Vote for us—we're going to close down critical primary care facilities."
Those of us in the West of Scotland who have expressed the gravest reservations about the primary care proposal that is being visited on Glasgow now have legitimate reason to wonder whether that process must be reviewed urgently. Although I accept and fear that we are too far down the road for profound change, surely we have not gone too far for significant marginal change. We need an independent scrutiny process to validate what is being done and to establish whether delivery is on schedule and is proving practical. For example, where are the detailed transport infrastructure plans on which lives will depend? Why are people in Glasgow being denied a scrutiny process that has been granted to their neighbours in the Clyde area?
I lend my party's support to aid the cabinet secretary's resolve. It seems that some health boards hope that her time in office will be brief, so that they can resume their normal, old style ivory-tower establishment practices. When the crunch comes—as it will soon enough—she must face it down. We welcomed the consultation on public participation through direct elections to health board and, when the Government made its statement before Christmas, I highlighted the issues that we feel need to be underpinned.
My second theme is men: Scottish men, in particular, their attitude to their health and, indeed, the attitude of all those who promote men in the arguments over health. In essence, men have become recklessly disengaged from the debate about their own health. Whenever they feature, they are too often portrayed as boozed-up wife or child beaters or as emaciated victims of chain smoking. With regard to sexual health, men will likely feature only if they are gay, as if only gay men are at risk. Last week, for example, when the latest statistics on chlamydia were reviewed, every newspaper that I saw accompanied the report with a picture of a woman, as if chlamydia is a sexual disease that women spread by some form of osmosis, without the involvement of men. My understanding is that that is not so.
When it comes to prostate cancer, 66 per cent of Scottish men do not even know where the prostate is. Many men cannot even say the word "prostate", but confuse it with "prostrate", a position in which some men may from time to time find themselves, but which is quite definitely a different thing.
When it comes to testicular cancer, men would sooner don their pinny for a spot of housework or learn to dance the tango than contemplate self-examination, let alone discuss it. In a nutshell—for want of a better phrase—men are dying because they have failed to get organised in anything like the way women have over the health matters that are most pressing for them.
When I raised that issue with the cabinet secretary, she sought to reassure me that all screening programmes are entered into on the basis of sound advice, but that is only partly true, I think. It would be foolish to deny that lives have been saved not only through breast cancer and cervical cancer screening, but as a result of a well-organised and sustained campaign over many years by women and on behalf of women. That is quite right, too—I make no complaint—but where are the men who are prepared to champion their cause?
One in 14 Scottish men will die of lung cancer, but one in 15 will die of prostate cancer. Every year in Scotland, some 2,000 men are diagnosed with prostate cancer, 800 of whom die. Worryingly, the increase in the disease's incidence is in men in their 50s. In the United States, 70 per cent of all men know their PSA—prostate specific antigen—score, and their partners know it, too. Any man who is over 50 should know his PSA score. It is not a perfect test—it is understood that we cannot rely on it—but it is indicative of the disease. What is stopping us promoting an investigation of prostate cancer? I do not seek to make a party-political point on the issue. Indeed, in recent years the Labour Party has been the only party to have referred to prostate cancer in an election manifesto, but it was the Labour Government that decided against screening.
A national effort to improve the health of Scotland is being prepared and embraced on numerous fronts. Scots men need to wake up and join the campaign for a culture that puts the discussion of their health and detection of the diseases that threaten their lives on an equal footing with the discussion of the health, and the detection of the life-threatening diseases, of Scots women.
The debate has two levels: to look at the development of health in Scotland and to hold the Government to account on the particulars. Over the past few days, it has become clear that we face a Government that has introduced a regressive budget and which has chosen tax cuts over development of services. What are the consequences of that for health?
The consequences are that the territorial boards face a £270 million reduction in their share of the money. Wanless reckoned that a 4 per cent increase in funding was needed to sustain growth in the health service at a reasonable level but, in real terms, the amount of cash that the territorial boards receive will increase by only 0.5 per cent. When the Cabinet Secretary for Health and Wellbeing and the Cabinet Secretary for Finance and Sustainable Growth were asked about that at the Health and Sport Committee, they said, "Oh yes, but all the ring-fenced money will go back to the boards, which will make up the difference." That might be true, were it not for the fact that the Government has announced many new initiatives—which we welcome.
We welcome the fact that it has continued Labour's commitment to the 18-week waiting-time target, which is costly to meet. Its agreement to provide the human papillomavirus vaccination programme for girls and to introduce colon cancer screening are also welcome, but they will also cost a lot of money.
Will the member take an intervention?
I am sorry, but I will not. The cabinet secretary can respond through the summing-up speech.
The provision of £85 million over four years to address alcohol issues is most welcome, as is the £40 million that will be allocated to tackling obesity. However, central services must still be maintained and that will be a problem, given the shifting of money to ring-fenced elements. Hang on—have we not been told that ring fencing is complete anathema to this Government? In health, it is introducing more ring fencing. I wonder where we are going.
Let us examine the budgets that have been flatlined or cut. The change and innovation budget is fundamental to the redesign of services, but even though Audit Scotland has told us that the up-front costs of many redesign projects are significant, that budget is being cut over the next three years. How will that produce a health improvement?
The smoking ban was the flagship of the previous Administration, which put substantial moneys into tackling smoking but, under the SNP, the relevant budget will be flatlined for three years. According to the figures that I have today received from Action on Smoking and Health, that amounts to a real-terms reduction in funding of 8 per cent. What does that say about tackling one of the greatest problems we continue to face, which is smoking? It is a real problem.
Ross Finnie referred to the community health partnerships in a thoughtful speech. The CHPs are absolutely fundamental. As the cabinet secretary said, they are still in the early stages, but she made not one substantive mention of CHPs and yet they are fundamental to the shift from acute to community care.
I turn to Kerr. Again, the Kerr report was not mentioned. Why? The answer lies in the speeches that we heard from back-bench SNP members—and from Jackson Carlaw. Kerr is now dead. It is a dead duck. The SNP Government has rebadged it as centralisation, not modernisation, and has gone public with that view. The situation is unacceptable. I accept that we must continue to modernise, but why has the Government cut the change and innovation budget?
Will the member take an intervention?
No.
I find it extraordinary that the SNP is going to adopt the English system of 24-hour access to general practice.
Rubbish!
If that is not the case, the cabinet secretary should tell me in her summing up.
The British Medical Association has told us that we will adopt 24-hour access. Scottish Government under Labour said that it would go for 48-hour access to health professionals, and that has worked extremely well. Ian McKee rightly drew attention to the central problem—the general practice booking system, which has created major difficulties. That is what we need to focus on, particularly in deprived communities.
I welcome a number of areas that the cabinet secretary addressed. Indeed, I welcome the rhetoric in "Better Health, Better Care", although I see no sign of delivery. We were not given the health indicators until after the budget document was produced, which made the document difficult to analyse.
The cabinet secretary need not wave the document at me; I have read it.
I turn to mental health. Many funds have been shifted to the local authorities. I will wait to see what outcome measure the local authorities will have to meet. The only outcome measure or indicator for mental health is the new mental well-being survey. What will it do to address severe and enduring mental illness? What will it do to address health inequalities and the significant problems of mental health, drugs and alcohol in deprived communities? What will it do to hold health boards responsible?
I turn to consultation. We have had a preview of independent scrutiny in the two independent panels that reported recently. I read the 127-page report on Monklands when I was unwell in bed recently. It did not make me feel better; it made me feel considerably worse. The report criticised NHS Lanarkshire for using references that were 20 years old and for basing its references on international experience. I would have had no problem with that criticism if the independent scrutiny committee report's authors had gone on to produce newer references and evidence, but the report contains not one piece of referenced evidence. If that is what independent scrutiny committees are going to produce in attacking health boards that have tried to do their best, we have a real problem. If the cabinet secretary is going to have such committees to protect her from having to make difficult decisions, we must have referenced evidence. That was not the case in Andrew Walker's report on NHS Lanarkshire, which I find extremely disappointing.
I turn to the healthy living alliance and healthy living centres, which the cabinet secretary did not address either, although that needs to be done. Initially, the alliance was established with lottery funding, which is appropriate in the case of pilots in which we are testing a measure. However, in Northern Ireland, which has 19 healthy living centres, all 19 centres have been retained. At present, six such centres have been closed in Scotland and another 40 are under threat. Money is needed to sustain those centres, which are often to be found in deprived communities.
The rhetoric is that we have a public health service that is free at the point of need and in which there is no competitive tendering. However, competitive tendering has just been introduced in West Lothian, where I worked for the past four years when I was out of Parliament. The process is based on outcomes of which I approve entirely. We need to move in that direction; services must be related to outcomes. However, in West Lothian, the situation is now one in which competitive tendering has produced bids of £2 million, against a fund of only £935,000.
As of this moment, the West Lothian Drug and Alcohol Service—the prime voluntary organisation in West Lothian—has given redundancy notices to half its staff. It has no idea where its funding will come from after April. Those are the realities that the minister has to grapple with and that is what being in government is about. She has allowed competitive tendering to start and to develop; I ask her now to ensure that it stops in relation to drug and alcohol services.
The Government's "Better Health, Better Care" document is very welcome. Its general approach and thrust, and its emphasis on health development and on partnership and mutuality are entirely appropriate. However, we will test the Government on the reality. The elements that we have seen so far are not great, not significant and not many—it has been only eight months—but already the cracks are beginning to appear. Government is about ensuring that rhetoric and reality match.
The only cracks that are appearing are between the Labour front bench and the Labour back bench. That is true on many issues. Independent scrutiny is just one of them, and it has been welcomed by many Labour back benchers.
Some good speeches have been made today and some pertinent issues have been addressed. Ian McKee analysed the challenges of dealing with health inequalities, as did Ross Finnie. A difficulty arises when we improve the health of the general population but the gap widens between the better-off and the least well-off. That is a challenge for every Government. Jackson Carlaw supported independent scrutiny, which is very welcome. He also gave us some food for thought on men's health.
Will the minister take an intervention?
No—not at the moment.
The debate also contained some rather ill-informed comments, to which I will return later. This Government's ambition for a healthier Scotland requires us to focus on the challenge of reducing health inequalities. Our health services have to be fair for all and sensitive to the needs of the people whom they serve. The services have to reach out to communities that might otherwise be excluded. We have to work in partnership to tackle inequalities in the broadest sense and enable people to sustain their health over the longer term. That is why we are investing £300 million. I will repeat that: we are investing an additional £300 million over the next three years for health improvement. For anyone to say that that is not a significant investment is quite incredible.
The ministerial task force that I have the privilege of leading is engaged in important work on which it will report to the Cabinet in May 2008. The progress report that we have published today reflects the focus that our work places on the early years of a child's life; on the economic, social and health burden that is imposed by mental illness, which I know is an important issue for Mary Scanlon; on the big killers such as cardiovascular disease and cancer; and on the problems that are caused by drugs and alcohol, which include their links to violence among young men. I encourage members to look at the progress report. There will be much work to do as we come up with practical ideas on how to build up the resilience and capacity among individuals, families and communities so that we can improve their health and reduce factors in the physical and social environments that would otherwise perpetuate inequalities. That will be a big challenge for us; it is a challenge on which I am privileged to be leading.
Pages of "Better Health, Better Care" very much build on the Kerr principles and show the benefits of co-ordinated action across Government. We will make progress on that. We want a mutual service in which patients, carers and staff are recognised as owners with all the rights and responsibilities that that brings: a voice in the boardroom, a voice in the treatment room, the chance to be a partner in the design and delivery of care, the right to be treated with respect and, in turn, the responsibility to respect the service that is being provided.
The further rollout of the keep well initiative represents a significant increase in the provision of primary care in our most deprived communities, and is a genuine attempt to identify and treat preventable ill health in those areas. We will shortly extend our approach to anticipatory care to remote and rural areas, with the launch of the well north programme, which I know will be of interest to many members.
I will turn to some of the speeches. I say to Margaret Curran in all sincerity that hers was, for a number of reasons, one of the most negative and ill-informed speeches I have heard from her. Not for the first time, she contradicted many of her back benchers—more, in fact, than she does the SNP. She has to get more on top of her brief.
Will you take an intervention, Shona?
I will let you in in a minute, Margaret.
I shall answer some of the specific things that she said. On smoking, I say to Margaret Curran and Richard Simpson that we are investing £11 million over the next three years to take forward the five-year action plan on tobacco control—something that has been warmly welcomed by ASH Scotland and many others. On the healthy living centres, I ask Margaret Curran to reflect for a moment on how many occasions when she was a minister did she intervene to save local projects directly. That will be an interesting one to analyse. I was told on frequent occasions that it was down to local funders to resolve such issues, whether they be health boards or local authorities. Unlike the previous Administration, we have met the healthy living centre alliance and we have given a commitment to consider the options for sustainability of their projects—far more than your Administration would ever have done, Margaret. I will let you in on that point.
I ask all front benchers to avoid using the second person.
I have two points to make. The first is about healthy living centres and the 200 jobs. The Government should take immediate action. The centres would not have been under threat if Labour had been in power. Labour prioritised deprived areas. We were the ones who did that. The Government will be judged on whether it saves those centres.
Quickly, please
I am sorry, I stand corrected. My second point is that I think that the minister said that ASH directly welcomed the funding on smoking cessation. Can I quote directly from ASH—
No, not in an intervention, Mrs Curran. I think that you have had long enough.
"No"? I am deeply disappointed. That is not fair.
Shona Robison.
Thank you—
I am deeply disappointed.
Order. The intervention was long enough.
On a point of order, Presiding Officer.
It had better be a point of order, Mrs Curran.
It is a point of order. I am very threatened by you, but it is a point of order. I do not think that it is appropriate that you stopped me when I was midway through my intervention.
I am afraid that I am the judge of what is appropriate here. Shona Robison.
I think that you are being prejudiced from the chair.
I say to Margaret Curran that I have no recollection of her Administration ever saving any project for which Big Lottery funding had ended. You have no track record on that whatever. Unlike your performance, this Government is prepared to consider the future of healthy living centres, which is why we have already met the healthy living centre alliance to discuss the options—something your Administration would never have done.
I turn to some important points that Mary Scanlon made, and will pick her up on one point. She mentioned GP contracts and negotiations. The BMA briefing that I have—it may be different from the one Mary Scanlon has—states:
"The BMA's Scottish General Practitioners Committee has been involved in discussions with the Scottish Government on the issues of flexible access to GP services in Scotland."
Those discussions have been very constructive and we intend to take them forward.
I say to Helen Eadie—not for the first time—that we expect all local partners, in Fife and elsewhere, to meet the delayed discharge target of six weeks this year. Of course, we expect that to happen in all locations.
We had that last year.
It will happen in Fife—despite Helen Eadie's scaremongering—as it will happen everywhere else.
You must finish now, minister.
I reassure Elaine Smith that the infant feeding co-ordinator job is advertised. Interviews will take place by the end of February. I am sure that she will welcome that.
On a point of order, Presiding Officer. I wonder whether it is in order for the Minister for Public Health to say that ASH welcomed her announcement, given that, in a press release on 11 December, the chief executive of ASH Scotland said:
"I am deeply disappointed that the funding for smoking cessation services in Scotland will not be increased over the next three years. An increase in funding was necessary to tackle Scotland's smoking habit, but instead in real terms the government has given us a decrease."
Is it reasonable to offer the minister an opportunity to correct what she said about ASH welcoming the announcement?
It is in order for the minister to say what she said.