National Health Service
The next item of business is a statement by Andy Kerr on building a health service fit for the future. The minister will take questions at the end of his statement, so there should be no interventions.
First, I thank David Kerr and his advisory group, some members of which are with us in the chamber today, for their hard work and their excellent report. That work was commissioned by the Executive in April 2004, when we asked Professor Kerr to look at the future shape of the national health service in Scotland. I emphasise that the work is not just about hospitals. As I have stated previously, it is about recognising that 90 per cent of our health care is provided in local communities. We want to ensure that health services are as local as possible, and the report indicates how we can extend that approach even further.
The commissioning of the work was proactive and a genuine attempt to identify what Scotland's long-term health needs are and how we should shape our health service to meet those needs and improve health outcomes for our communities. We should recognise and welcome Professor Kerr's willingness to meet that challenge. He and his team went out on the road to meet the public and NHS staff and to listen to their views. His report was shaped around the questions that they asked. I add my thanks to the people who turned out at those meetings to offer their opinions and make their points; I am sure that they made a real difference to the report.
The final report was handed over to us only this morning, but I thought that it was important to give Parliament an early sight of its content as well as an initial indication of the Scottish Executive's response to it. In general terms, I welcome the recommendations that are made in the report, but we will clearly have to study the details more closely; I am sure that colleagues will wish to do the same. I can confirm that the Executive will set aside parliamentary time for a full debate on the report and the Executive's response to it. I would like that debate to take place as soon as possible after the recess, but that is, of course, a matter for the Parliamentary Bureau to decide.
I hope that, when we have that debate, it will be in order to find consensus and progress. The report offers us an opportunity to do so, and I think that the Scottish people would welcome a clear and shared understanding of what we want our health services to do. We should be clear that the report looks to the long term and is not a quick fix or a panacea. It builds on some of the good things that are happening in our NHS and brings forward new and innovative approaches—for example, in dealing with people with long-term chronic conditions and those in our communities who are hardest to reach.
The report is about the long term, but there is no doubt that we can start to address parts of it right now. There is much in the proposals that I would expect to be taken on board by the NHS in Scotland. In that sense, the report and the Executive's response to it should provide greater clarity and transparency around service change. However, the report is about the future; it will not be used to reopen decisions that have already been made. I expect the consultative approach that is commended in the report to be replicated as boards engage with the public. A take-it-or-leave-it approach will not do. I expect people to be consulted about the case for change, and the options for change, long before a preferred solution is reached.
In considering how the Executive should respond, I want to start by reflecting on what can be done more locally. I share the view that is expressed in the report and I very much welcome Professor Kerr's assertion that local care is about delivering high-quality services as close to the patient's home as possible. Professor Kerr recognises that the debate about local care is about much more than the bricks and mortar of the district general hospital; it is about using the wide range of skills of all those who work in the NHS to provide the personal, continuous and integrated care that people will need in the future. Professor Kerr recognises that there are many challenges and opportunities for the NHS in Scotland. There are changes in the public's expectation of the NHS, and there are issues around the workforce, which the Parliament's Health Committee helpfully reinforced in its recent report.
However, David Kerr focuses—quite rightly, in my view—on how the needs of patients are likely to change. He picks out three key factors, the first of which is the growth in the number of older people and, in particular, in the number of relatively frail and vulnerable older people. The second is the emergence of chronic disease as the main challenge facing the health service. The third is the growth in emergency admissions. All three require a response that is based on partnership between the patient, their carers and the health service.
I am sure that Professor Kerr is right when he says that to meet those challenges and deliver the health care that we will all need in the future, we will have to change the way in which we think about the NHS. That change will require new ways of working for staff: new skills, new roles, new thinking and new cultures. The approach must be one of shared responsibility and genuine engagement.
A different mindset will be required from politicians, the media and the public. In the future, health care should be much less about the hospital and much more about the community. In a sense, we need to start from the notion that for some people, particularly those who have long-term conditions, hospitalisation is not always the best option. Those patients usually need co-ordinated care in and close to their home rather than admission to hospital.
The role that is played by the NHS should be preventive, integrated, local and personal to the individual. The NHS must act as a partner with local government and other public services in delivering truly joined-up care and support. It is often said that we need a single seamless service and that we must break down barriers so that the service is truly interdependent. Professor Kerr's work invites us to move beyond the rhetoric. Like all change, it will be challenging, but it will be worth it for those whom we seek to serve.
An important component of that change, and a major factor in our response to it, is how we deliver services to particularly vulnerable patients. I was struck by the analysis in Professor Kerr's report that shows that 1 per cent of patients account for 16 per cent of in-patient bed days. We know that many people have multiple long-term conditions and can be in and out of hospital frequently. We also know that that is not what patients want and that that is not the level of care that they need. Therefore, in responding to Professor Kerr's report, we will give priority to identifying those patients with long-term conditions who are most at risk of hospitalisation so that boards can provide them with personal, proactive, co-ordinated care in their local community.
We will ensure that each NHS board adopts a systematic approach to providing that care. The aim of that strand of work should be to improve patients' quality of life, deliver more co-ordinated care in the community and reduce avoidable hospital admissions. That will be the case especially for the increasing number of frail elderly who, through no fault of their own, currently go in and out of hospital all too frequently. The care that we provide for older people should enable them to stay at home whenever possible and should support them in the community. Our commitment to provide systematic and co-ordinated care for people with long-term conditions is not just about older people. It applies to people with mental ill health and to children with special needs. Every family has members who need to be looked after and cared for at some time in their lives.
We will also enable self-care, which involves us as individuals taking action to maintain health, to seek and adhere to treatment and to help manage our own illnesses and conditions. Self-care can help to forge a partnership between health service users, their carers and health professionals to ensure the best health outcomes.
In particular, we will fund and develop a Scottish long-term conditions alliance to articulate patients' views and pilot self-management approaches that are supported by innovative information technology such as home monitoring equipment. That is not about simply handing over responsibility to patients; it is about recognising that, for the bulk of the time, patients with conditions such as diabetes monitor and maintain their own health. We want to give patients a voice in how their care is delivered and to build a partnership, based on good information and mutual support, between the health care provider and the patient.
I welcome the recognition in the report that the vast majority of health care is already delivered locally—whether that is done by patients themselves, their families, carers, general practitioners and their teams, or in local hospitals. However, I also welcome the ambition to enhance that still further. I am therefore attracted to the recommendation that NHS boards should establish community resource hubs in community hospitals and in expanded primary care facilities, such as those in Leith and in Easterhouse, to speed up access to routine diagnostic testing and treatment. That links well with the Executive's pledge to reduce waiting times for diagnostic tests as well as maintaining local services.
The recommendations that are aimed at ensuring quicker access to planned care are helpful and we will ensure that they are taken forward. I will expect to see regional plans for the setting up of dedicated centres for planned care. I am sure that Professor Kerr is right to assert that separating planned care from emergency care can improve services to the patient and reduce waiting. We will also set new standards for boards on day-case surgery and post-intervention follow-up, to ensure that patients are actively managed.
In addition, and central to our overall approach, I agree that we should develop referral management centres, to develop a wider range of referral options and inform patient choice about treatment. We are already piloting referral management in Glasgow and Lothian and it is clear that we need to learn from that experience. I expect the initiative to provide a stimulus for the redesign of services to provide new ways of working, for example through general practitioners with special interests, referral to nurse-led services and referral of orthopaedics patients to physiotherapists. I know from recent discussions that GPs are very much in favour of, and want to work with us to achieve, a properly structured and accredited programme for GPs with special interests.
Urgent or emergency care is one of the most difficult issues that boards face in taking forward plans for service change. Professor Kerr's work provides a helpful way through the issue, by drawing on evidence of actual need for urgent care, by confirming that a large proportion of such care can be delivered by multidisciplinary teams working in local facilities, and by providing a number of models for the future provision of urgent care. The community casualty units that the report describes can be a valuable part of local services and provide 24-hour care for the vast majority of needs.
The work on urgent care is about sustaining local services and should reduce the anxiety in local communities about access to the vast majority of urgent care. That is not to say that every hospital will undertake the whole range of complex emergency work—that would not be in the best interests of patients. However, every hospital with a community casualty unit should be able to provide most of its community's needs, 24 hours a day. In the future, some hospitals might focus on planned surgery and not take emergency admissions, but they should still be able to provide most of the urgent care that patients need, 24 hours a day. Some hospitals might admit medical emergencies but not surgical emergencies, in relation to which critical care facilities are more likely to be required. The Kerr report provides a range of options whereby NHS boards might sustain services that are as local as possible but as specialised as necessary. Again, I expect NHS boards to work together to develop regional plans for the future shape of urgent care.
The report sheds light on the difficult issue of the clinical benefit that is to be gained by concentrating resources on fewer sites. The work that underpins the Kerr report identified new evidence that high-volume surgical intervention in certain complex, high-risk procedures can bring significant benefits for patients. It is clear that for a number of cancer surgeries and heart surgery, and for a number of other procedures, the balance of risk points to the specialisation of services to ensure the best outcomes. However, for other procedures the evidence suggests that it is more appropriate and better for patients to retain local services, if the intervention can be performed safely in a well-supported local hospital. Professor Kerr's report recognises that for some procedures the position remains unclear. I welcome his proposal that Scotland should lead the international debate on the issue and we will put in place arrangements to ensure that the relevant data are collected and evaluated, in a manner that enables the cumulative data to inform future decisions about the clinical benefits of specialised interventions.
The need for enhanced information and communications technology is a recurring theme of the Kerr report. We will soon invite tenders for a national information technology system for the NHS in Scotland, which will help to provide the integration that is necessary to support access to modern and efficient care.
I do not have time to go through all the recommendations in the report, but I will pick up on one more. The idea that we should provide proactive anticipatory care in deprived areas as a means to reducing inequalities seems absolutely right. We will continue to invest in primary care to facilitate the active management of patients, which will help people in deprived communities to receive the care that they need earlier than currently happens. We will also support self-care initiatives.
Last December, we set out our vision of an NHS in Scotland that is fair to all and personal to each. I am pleased that Professor Kerr's work is consistent with those values. His report presents us with an opportunity to move forward. It recognises that a defence of the status quo will not provide the responsive and integrated care that will be required to deal with an aging population that will suffer from an increasingly complex set of long-term conditions. The report also recognises that new skills and ways of working will be required. We will need generalists as well as specialists; we will need doctors, nurses and other professionals; and patients will need to be partners in their own health care.
In responding to the report, the Executive will ensure that the measures that it contains will make a clear difference to the health of the people of Scotland. Over time, we will ensure that the services that we provide meet the changing health needs of the population. Patients can be certain that in shaping the health service of the future, we will ensure that if they are old, frail and liable to frequent hospital admission, they will get co-ordinated care that is provided locally. If they have a long-term condition, help and support will be available so that they can play an increasing role in managing that condition themselves. If they stay in a less well-off part of Scotland, their primary care team will have dedicated resources that are designed to prevent further ill health. They will have access to their own health record, and so will all the clinical staff who might need to treat them. They will be more likely to have all their health care provided in local GP practices or in their local communities.
If patients need a complex treatment on which there is evidence that the volume of activity improves outcomes, we will ensure that they get access to the right person, even if patients have to travel. If patients stay in a remote or rural area, the health service will take that into account, including by providing of a core set of services in rural general hospitals. If they have to go into hospital, they will get quicker access, tests will be done locally, and their length of stay will be planned and shorter. Their hospital appointment will be less likely to be cancelled because of an emergency or because tests are not available. Finally, if they are in urgent need of care, they will get quick access because they will see the right person with the right skills at the right time.
The report, alongside other actions that are being taken by the Executive, can help to achieve what we all want—the NHS in Scotland to be better, quicker, closer, safer and personal to patients' every need.
The minister will take questions on the issues raised in his statement, for which I will allow about 30 minutes. I shall allow the two opening speakers about a minute each, but no preambles.
I welcome the report and pay tribute to those who have been involved in its production. Does the minister agree that it is unfortunate that it has taken six years to finally have a blueprint for the NHS in Scotland? That should have been the starting point for health boards, rather than a panic measure in response to public pressure. Does the minister agree that the report is a vindication of the campaigns to keep health services local? However, given that many health boards are already quite far down the road of centralising services, which may run counter to the thrust of Professor Kerr's plan, what does the report mean for the individual hospitals in which services are under threat, but where no final decisions have been taken? How will the recommendations apply to maternity services, given that they are barely mentioned in the report but are a key concern in many communities? Finally, given the importance of the report, why will the minister not hold a full debate on it before the summer recess?
Thanks for that contribution.
I thought that it was sensible to give ourselves the summer to discuss matters with GPs, doctors, consultants, communities, those with long-term chronic conditions and people in our communities whom we seek to serve, instead of having a knee-jerk reaction to the report.
With regard to maternity services, Professor Kerr supports the continuing maternity strategy and the strategy of the expert group on acute maternity services, which is known to many members.
Many years ago, the Executive said:
"as local as possible, and as specialised as necessary."
The direction of travel in the NHS is such that more than 90 per cent of care is provided in the community. We have more allied health professionals. We have more nurse clinicians. We have doctors with a new contract, who are proactively managing patients in the community. We have day care surgery, which means that people do not need to be in an acute setting overnight. We are delivering a local health service, but some choose to scaremonger rather than address the modern issues of a modern health service.
With regard to the centralist strategy that Shona Robison mentioned—the cover for any politician on the make—there is no centralisation in the health service; there is localisation. The challenge in the Kerr report is, do we understand and accept that planned medical care is better for patients, because it means fewer cancellations and better outcomes, and that planned medical care should not be disturbed by emergency trauma services? That is what happens in health care services today, but we can get better outcomes for patients if we manage those services better.
I thank the minister for the advance copy of his statement and commend Professor Kerr for his excellent report, which looks forward to 20 years of development of the NHS. Given that that is a long time ahead, how quickly can we expect to see changes in the service and local services being put in place for patients?
I have a more specific question about the provision of enhanced information and communications technology. In some health board areas—certainly in Grampian NHS Board area—many GP surgeries have had in place for some time the basic IT infrastructure to connect them with hospital departments such as biochemistry laboratories, but, to date, sufficient funding has not been in place to connect them up. Will the Executive consider making that technology operative at the earliest opportunity, so that patients in primary care can receive their test results quickly, or is the infrastructure that is already in place likely to become redundant under the new proposals?
The decisions on the IT strategy are difficult. We must ensure that the system that we develop in Scotland provides the required functionality, interoperability and communications network. However, that is not to say that we have been standing still on the issue. We have had great successes in IT throughout Scotland with systems such as PACS—the picture archiving and communication system—which transfers digital data about examinations and scans, and many other innovations, such as those on how GPs book patients into the acute sector. Good work is being done and we have enabled much of it to happen. However, if we are to make the step change to which Professor Kerr points and which the Executive supports, we must think further about IT.
That is why, in the Executive's most recent spending review, we increased significantly the resources for IT development in the health service. We seek to provide channels of communication that will allow all that good work to happen on connecting GPs and hospitals and in relation to prescriptions and tests. That will make a better journey for patients and will ensure that, when a patient turns up to see their consultant, their notes are available. That is a big challenge, but we are ready to take it on.
As a matter of urgency, I want NHS boards actively to identify patients in their community who require better overall management, such as those with long-term chronic conditions and the elderly and frail, who, to be blunt, often come to accident and emergency units for admission when that is completely inappropriate, which means that they receive the wrong care. We need to fix that, so I will say to the health boards when I meet them on 13 June that we want steps to be taken on the matter.
Members will have seen the 60-page Kerr report and the accompanying 200-page additional report. The health service will consider those reports in thinking about the direction of travel and how to support members of the community by providing first-class health care services in Scotland.
It would be helpful if we had shorter questions and answers from now on.
I commend Professor Kerr and his team for their hard work. As Nanette Milne said, Professor Kerr's report states that a common information and communications technology system is essential and recommends that that should be in place by 2008. We talk about better integration in health care through community planning, community health partnerships and some of the innovations that are being developed, but that will depend on good IT systems being in place.
Ask a question, please.
One of the most fundamental issues remains the need for a single means of identifying patients. Given that, until we have such a means, we will not have a good IT regime, will the minister outline how work on that matter will progress?
I must say that I was surprised when, as Minister for Health and Community Care, I found out that the unique patient identifier in the health service, which is known as the community health index number, was not used as widely as it should have been. Through better training and ensuring that clinicians and all our health care team understand the absolute importance of using the CHI number, I have ensured that we now have high levels of usage and that we will have full usage by June 2006. If we wire together our health care system to allow people to communicate effectively, but they do not do that using a unique patient identifier, the system will fall apart, which would be completely pointless. I am unhappy about the present situation, but I am absolutely reassured that the message has been put across that the unique patient identifier—the CHI number—is to be used effectively for better patient care. At the end of the day, health care is not about the IT system, but the system can bring positive benefits in relation to cancelled appointments, missing notes, test results and booking appointments. I want to achieve those benefits for health care users in Scotland.
There are two parts to my question. First, the report should mark a positive turning point for the NHS in Scotland, but does the minister believe that the current medical orthodoxy in favour of increasing across-the-board specialisation in the NHS has been effectively challenged by the report? Secondly, is the minister minded to accept Professor Kerr's proposal to develop a network of rural hospitals and establish a clinical school for rural health care? What difference does he see that making to patients in rural Scotland?
We need to be careful in our use of language. As a result of Professor Kerr's work, we have additional research that shows us that when we have what I would describe as a high volume of difficult and testing operations in the health service, we can deliver better outcomes. There is a difference between high-volume and low-volume procedures—indeed, patient mortality and survival rates in those are about 10 per cent apart. That applies particularly to some procedures, as I said in my statement.
However, what Scotland will lead the world in is the grey area that worries many of our constituents, which relates to the question of why particular services should go centrally to the acute setting, where we can prove that outcomes for patients and mortality rates are better, and that we provide a much better service. Why cannot those services be provided locally? Professor Kerr's report indicates that many of Scotland's hospitals can provide those services. I see a continued role for smaller and district general hospitals in diagnostic, general medical and surgical services, and in the bulk of urgent care. There is a good balance there, but between the two ends of the debate we will decide where best those services should sit. I support Professor Kerr's views on rural hospitals and the establishment of proper institutions to support them, and I recognise the generalists who want to work in those communities.
Over the past four years, my constituents in Lochaber have harboured real fears about the future of the Belford hospital in Fort William. The minister has exhorted us to change our mindset and to think more about communities and less about hospitals. Does he agree with my constituents that the downgrading of that hospital would be a long-term threat to their community? Does he endorse the concept of a rural general hospital, which Professor Kerr supports on page 41 of his report? Will the minister take this opportunity—for the first time in Parliament—to guarantee to my constituents in Lochaber that there is a future for the Belford hospital in Fort William as a consultant-led, 24/7 local hospital that provides acute care?
I am pleased that the work of the solutions group is building the very links and the collaborative networks that Professor Kerr recommends we establish in Scotland. A collaborative network involves planning our services regionally and, as I said in response to Mike Rumbles, ensuring that there is a continued role for hospitals in diagnostic, general medical and surgical services and, indeed, the bulk of urgent care. I want to ensure that we continue to provide care as locally as possible; however, we must get our heads above the bricks and mortar and remember that the drive of the report is for personal integrated care to be provided in the community. Let us stop being fascinated with the 10 per cent of health care that is delivered in the hospital setting, and let us instead celebrate and focus on the care that is provided in the community close to people's homes, which is where they want it.
To continue the rural theme, I am pleased that the report recommended that rural general hospitals have a contribution to make, but rural general hospitals will require rural general surgeons and rural general physicians. Does the minister commit to that? Are the professional bodies on board and do they support that? To follow up on that, and going a bit further out into the rural areas, I welcome the recommendation on using community hospitals as bases for extended services. How big a community does the minister envisage will be required to support a community hospital?
As I have said on many occasions, sitting here in Edinburgh we are not in the best place to decide on locally available services. I believe strongly that it is for communities to engage with their health boards in order to ensure that services are delivered. We should not be prescriptive about such matters.
Eleanor Scott should consider the membership of Professor Kerr's group and his discussions with front-line providers, the royal colleges, Graham Teasdale and others who were on the group and who worked with it. Those institutions know that they need to respond to the challenge that is posed by communities no longer being willing to accept levels of care that they deem to be inappropriate. The professionals know that they must respond to that, which is why—to return to my answer to Mike Rumbles—I am happy to support the proposal for a network of rural hospitals and the education and training infrastructure that will support it, about which Eleanor Scott asked me and which will ensure the long-term success of those hospitals.
On behalf of a community that engaged effectively with Professor Kerr and the debate, I welcome Professor Kerr's report and the minister's statement. I look forward to that community's continued participation in the general debate over the summer; it would be wrong for that community not to have the opportunity to write to the minister or to participate in the debate over the summer after it has given a view. I also look forward to the evidence that Professor Kerr will, I hope, give to the Health Committee before the summer recess.
My first impression is that what makes the report so important is that its starting point is the patient. Does the minister agree that our health care system needs to be designed in the interests of patients rather than the interests of politicians, doctors or managers, and that it must give patients access to world-class services?
I agree that Professor David Kerr's work and the Executive's continuing work give us an opportunity to deliver such a level of personal care and service within our NHS in Scotland. That can and should be done if we properly engage with the Kerr report and seek to make policy and to deliver services through what it says. The report says that we should reduce our reliance and concentration on the acute sector and that we should get more than 90 per cent of our health care systems into our communities, because that is where people want services to be delivered. There is a very strong future for the NHS, but the people who currently work in it and those who will work in it in the future must make a cultural shift towards the idea of services being as local as possible and as specialised as necessary. We need to work on getting their support for that.
I thank the minister for the advance copy of the report, which I have been able to read. In it, I found several references to increased involvement of the private sector in one form or another, including on pages 25 and 27, where local improvement finance trust schemes are given more openings; on page 51, which advocates general practitioner fundholding; and on page 45, which refers to overseas private sector teams. Will the minister tell me what percentage increase in the private sector's share of the NHS budget Professor Kerr's report represents?
No, but we recognise that the capacity issues in our health service need to be addressed, which is what we have been doing. That is why waiting times are coming down, why more patients are being treated and why 550,000 patients have benefited from new hospitals and other facilities that have been financed by the models of public-private partnerships that we have introduced. That is patient centred. I want patients to have the best level of care, so I have invested in our public NHS in Scotland and will continue to do so, but I will not turn my back on solutions that mean less pain and stress for patients and which are good for them and their families.
Does the minister agree that Professor Kerr's recommendation that community-based facilities that are staffed by multidisciplinary teams should provide many of our urgent care needs 24 hours a day is fantastic? Will he pledge to take that recommendation particularly seriously, as the implementation of NHS 24 and the removal of GPs from out-of-hours services have largely removed such facilities from constituencies such as mine?
The recommendation is a fantastic innovation, but I must say that we did not remove GPs from out-of-hours services; they removed themselves. NHS 24 then faced a very real challenge in dealing with the situation. I acknowledge Mr Swinney's support for David Kerr, who says that we should focus GPs, paramedics and other professionals around community health care facilities. They can contribute to an effective out-of-hours service and provide the 24/7 cover that our communities need and deserve.
I congratulate the Scottish Executive on its foresight in taking a long-term view of Scotland's health services by commissioning the report from Professor Kerr. There is no doubt that the voices of the public and front-line staff have shaped the report, and I hope that those voices will continue to be heard. Perhaps my being in Parliament has in no small way helped to encourage those voices throughout Scotland. I cannot argue with the conclusions of the report, but my constituents and many others will want to know how and when the Scottish Executive plans to implement and monitor Professor Kerr's recommendations.
I have tried to indicate some of the areas where action is now being taken in community care settings, in identification of people who have long-term chronic conditions and in care of frail and elderly people. This is also about how we effectively deliver in communities through planned elective care, 24/7 cover and full accident and emergency trauma units. Those are very important challenges for us. It is easy for us to talk about those issues in here and to recognise the good work that has been done by Professor David Kerr, but communities are quite rightly passionate; I saw some of that passion at the recent meeting at Stobhill. People are passionate about the health service, and we need to engage with them effectively to reassure them that the results of implementation of the proposals will be good for them and good for Scotland.
On how we will achieve implementation, we will work through NHS boards, through the professions and through the change in culture that we need to achieve. We want to achieve collective buy-in by patients, their carers and health care professionals so that our service becomes a model for and an example to the rest of the world of how to provide health care in a modern nation.
Does the minister agree that one of the key recommendations is to develop options for change with people and to bring the general public and patients along with us when changes are made? Does he also agree that the solutions group in Lochaber has been an excellent example of how to do that? Will the minister assure me that, in his discussions on the realignment of Argyll and Clyde NHS Board, he will engage with the people of Argyll and the Highlands to ensure that the proposals that have been made, if they are introduced, are a success?
As Minister for Health and Community Care, I am never short of advice. That is challenging, because some of that advice is contradictory. On the issues that Maureen Macmillan raises, I have said that we want to improve the way in which we build in consultation with communities while ensuring that NHS boards do not approach communities with a take-it-or-leave-it agenda. That is the best way to secure trust, faith and confidence in the future of the health service.
That requires challenging agendas, however. We cannot simply agree all the time with what people say to us: those who shout loudest are not necessarily correct. There is a challenge for us all in responding to the recommendations that the Kerr report has presented to us. There are some great innovations in the Kerr report; I want them to be examined closely and I want plans to be developed around their delivery. It will not be all plain sailing because communities are passionate about their health services. Sometimes, they see things differently from others.
I note the role of the north of Scotland planning group in agreeing a list of core services for rural general hospitals. Can the minister confirm that the Belford, Oban and Caithness hospitals, as well as the three island hospitals, will be designated rural general hospitals, or will they have to meet some set of criteria?
Given the emphasis on providing care close to home, can the minister explain how the referral management scheme will make it easier for patients to see a podiatrist rather than be put on a long list to see a consultant?
Mary Scanlon answered her second question herself. I strongly believe that we need to ensure that people get access to the right level of care, provided by people who have been individually trained at the right skill level. Referral management centres are not just about choices—for example, between a consultant and a podiatrist—but about the choice of consultant and of when the patient can see them. I have seen the same innovation develop elsewhere and it works effectively for patients. We therefore manage referrals now. This is not about the old relationships in the past, in which the attitude was that a certain patient would always be sent to a certain person or place, and would therefore go there again. Referral management centres will do exactly what it says on the tin: they will manage referrals to ensure that the patient gets the best out of the service.
The member highlighted the work that is being done in the north of Scotland. The framework does not determine what should happen in every community. I believe that it sends a signal and gives a strong sense of direction to communities, but it is for communities and health boards to work together on how they see us delivering care in those communities.
There is a strong emphasis on the need to deliver more services locally. The report highlights the gearing effect whereby if we can increase the number of services that are delivered locally, that will free up time and resources in the acute sector. Does the minister have any thoughts on how we will drag out those services, whether diagnostic or aftercare services or services that ensure that patients who can be treated at GP or district hospital level are not referred into the system? How will we incentivise that and ensure that it happens? What role will the new community health partnerships play? It seems to me that there is a crucial role for them, provided that they are given the power to do so.
There are two dimensions to that. First, we need to reflect on the work that we are doing in health improvement, which is about managing patients actively by not letting people get sick. The smoking legislation that we are putting through Parliament will assist in that, as will many of the other things that we are doing. Chemotherapy, dialysis, minor operations and diagnostic services are being delivered locally. I refer to the Leith treatment centre and the Easterhouse centre which, as the member indicated, are about delivering high-quality, best-outcome services locally, and getting people out of the acute sector. Community health partnerships are a big challenge for us. We have invested a lot of faith and confidence in our CHPs, whose job it is to drag down from the acute sector the services that we seek to have in our communities.
I welcome Professor Kerr's whole-hearted endorsement of community hospitals which—I note—the minister shares. Will the minister send a clear message to Borders NHS Board not to close Jedburgh and Coldstream cottage hospitals and, as a postscript to his message, will he send them the funding that will keep them open?
The record funding that is going into our NHS in Scotland will continue under this partnership Government. I share Professor Kerr's view: we want collaborative networks involving hospitals working across boundaries to share skills, beds and the opportunities to improve the provision of services, which will allow us to plan regionally and effectively. I hope that that will be delivered in our communities.
There have been closures of hospitals that provided inappropriate care to elderly people who should not have been in that type of facility and who are better looked after in our communities. I reflect not on the specific point but on the generality of the difficult challenges that the Executive has faced in relation to hospital closures. The reason for the closure of hospitals is that they were providing inappropriate care to people who are better provided for in the community. We signed up to those closures because they were right in respect of patient needs.
The framework does not determine what should happen in every local hospital. That is best determined by communities and health boards working regionally, not by a minister sitting in Edinburgh.
On a point of order, Presiding Officer. Questions on the statement are due to last for only two more minutes, but 15 members are waiting to ask questions of the minister, given the importance of the statement. Could you use your discretion to allocate an extra 10 or 15 minutes in order to allow as many members as possible to ask questions of the minister?
I will respond to that point of order in due course. In the meantime, I will push ahead with as many members as possible.
I welcome the values that are set out in Professor Kerr's report, which place the focus firmly on the patient. I have two quick questions for the minister. In the context of emergency care, does he acknowledge that the model of integrated care that clinicians are developing at the Vale of Leven hospital is exactly the kind of sustainable and collaborative model that fits with the thrust of Professor Kerr's report? Secondly, will he confirm that the commitment to having generalist physicians applies not just to rural hospitals but to hospitals in outlying urban areas?
I am more than happy to endorse the Lomond model, as I said when I visited Vale of Leven hospital last Thursday. I have considered the model and I believe that it sits well with what Professor Kerr is saying and with what the Executive sees happening around emergency and integrated care.
I should mention the integrated care physicians. I am not sure that I recall the job title correctly, but that is a slightly jargonised description of what I think the member is asking about. She is right to say that that model of generalist should not be placed exclusively in the remote and rural environment. In fact, if I recall correctly, Professor Kerr talks about an integrated care physician as being an urban or semi-urban version of the solution that is to be found in remote and rural areas. There is a balance to be struck in order to enable that specialist and generalist activity to take place in the environment that the member asked me about.
As the minister said, we will not debate the issue until after the summer recess. What advice and guidance will he give to health boards and others in the meantime?
In the meantime, I will be talking and listening, which many people in this chamber need to do. I have tried to tell members what the priorities are. They are long-term care of chronic conditions; identifying people in our communities who suffer from chronic conditions; identifying people in our communities who too often turn to the A and E door of our hospitals instead of having planned care in the community; and proactive case management to ensure that our general practitioners and community physicians can get out on the streets, advocating and creating health care for their communities instead of sitting in GP practices. There are many ways in which I want our health service to change in the short term and, in that regard, I have also mentioned our commitment in relation to information technology.
However, the two volumes of the report are 60 pages long and 200 pages long respectively. We should consider the ideas in it and come back to the chamber for a full debate after we have talked to people and discussed matters with them. I cannot lay out in a few hours—
Pass the buck.
Somebody said, "Pass the buck." That is typical of the attitude that is being adopted by the SNP—ambulance chasers, if ever there was such as a thing.
We seek to engage with and talk to patients, professionals and communities. That is what Professor Kerr was extremely good at and that is what our job is. We should reflect on the report and come back to Parliament after the summer recess to discuss fully how to implement it.
Some 90 per cent of health care is already delivered locally; the minister has spoken of his desire to ensure that that provision is enhanced and accelerated. Does that mean that the minister will give serious consideration to the capital, revenue-funding and staffing issues, in relation to which there might need to be some front loading if that expansion is to be achieved while we pursue the acute strategies?
I believe that we need to ensure not only that we spend money on the physical infrastructure of the health service but that we make sure that the right skills agenda is played out in our colleges, universities, professional bodies and institutions. There are two aspects that will ensure that we can successfully roll out the report's recommendations: one relates to training, skills, leadership and delivery in communities by professionals; the other involves giving the professionals the right resources and the right places in which to deliver first-class health care, which we are doing all over Scotland.
Can we have an assurance that Professor Kerr's report and the minister's statement today do not alter in any way the Scottish Executive's commitment to build a new general hospital in Larbert by 2009 to serve all the people of the Forth valley?
The last question is an easy one; I can confirm that that is the case.
On the point of order that was raised by Tricia Marwick, members will notice that it is now 15:23 and 30 seconds, so I have used my discretion.
On the detailed figures, members might be interested in the breakdown of speakers. Thirty members asked to speak: eight Labour members asked to speak and five were called; 13 Scottish National Party members asked to speak and five were called; two Conservatives asked to speak and were called; two Liberal Democrats asked to speak and were called; three independents asked to speak and two were called; one Scottish Socialist Party member asked to speak and was called; and one Green member asked to speak and was called. I hope that members will agree that, given the time constraints, that represents a reasonable balance.