Plenary, 25 Nov 2004

Meeting date: Thursday, November 25, 2004

Official Report 721KB pdf

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First Minister's Question Time

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Prime Minister (Meetings)

To ask the First Minister when he will next meet the Prime Minister and what issues will be discussed. (S2F-1218)

I expect to meet with the Prime Minister in the near future.

I am sure that he is looking forward to that. The First Minister never tires of telling us that spending on the health service has gone up since Labour came to power. However, during that same period, according to the Executive's own figures published today, the number of patients being treated in our hospitals has fallen and the length of time that patients are waiting to be treated has increased. Will the First Minister explain why it is the case that people in Scotland are paying more and getting less?

They are not. The reason why fewer people are being treated in hospitals is that they are being treated in the community, which I think is an important modernisation of our health service, one that is appropriate for many patients right across Scotland and one that ensures that they have better treatment closer to home. That, as I understood it, was the key principle behind the policies announced by the Scottish National Party earlier this week. I hope that Miss Sturgeon is not going to contradict that today.

In addition, what we see in Scotland today is the concerted action that has been taken over recent years resulting in no one with a guarantee waiting longer than 12 months for an in-patient appointment and no one now, as today's figures show, waiting more than nine months for an in-patient appointment. Those are significant improvements for those who were waiting longest and for those who needed treatment more than others. In both cases, that has been a considerable achievement by the doctors, nurses and other professional and support staff in our national health service.

There is a great big flaw in the First Minister's argument. If it was the case that demand on hospitals was falling because more and more people were being treated in the community, surely one would expect the hospitals to be speeding up waiting times because they had fewer patients to see. It does not add up.

I can understand why the First Minister wants to gloss over the hard facts, but let me spell them out to him. There are fewer out-patients, fewer in-patients and fewer day-case patients being treated now than there were in 1999, and the time that they are waiting to be treated has got longer. Even in the language of Labour spin doctors, that is a failure. Andy Kerr told us this morning that the answer is an expansion of the private sector—not the use of existing private capacity, because we all know that that is tiny, but an expansion of the private sector in Scotland. That is something that Malcolm Chisholm said he would not do because it would be at the expense of the NHS and would draw staff away from our hospitals. Will the First Minister explain where exactly the staff will come from that the private sector will need to recruit if it is to expand?

There again we see a contradiction in just four days. On Monday, the SNP was calling for us to recruit staff from outside Scotland to help the health service in Scotland, and four days later it is protesting at the prospect of that very possibility. We need change in our national health service and we need further action on those waiting times that are still long and on those areas, such as out-patients, where not enough progress has been made. However, it would be wrong of Miss Sturgeon not to recognise the guarantees that we gave—not targets but guarantees—to ensure that waiting for in-patients stopped beyond 12 months first of all, and then stopped beyond nine months. We are now pursuing a target—not just a target but a guarantee—of ensuring that, by the end of next year, no one waits longer than six months. Those guarantees were important for those who were waiting the longest in our health service.

The choice between the different parties in this Parliament is about where we go from here. I believe that there is a clear choice. We can ensure that we put ideology to one side and do what is best for the patient in the national health service in Scotland, and we can ensure that not only do we have a quality national health service but that we use the resources of others too. Alternatively, we can do what the Scottish National Party would like us to do—fossilise the health service in Scotland into something that it perhaps once was but cannot be in the future. We need more flexibility and more choice in order to meet the needs of patients today. Finally, we can privatise the health service, as I am sure we are about to hear in a moment from the Tories. Those are the fundamental choices. Neither the Labour Party nor the Liberal Democrats will fossilise or privatise the health service; we will just work hard to make it better. That is what we should be doing for Scotland, and that is what we will do.

It is fascinating that the First Minister failed even to mention the new policy that the health minister has been trumpeting all over the media today. He failed to answer the central question: where will the extra staff come from to expand the private sector in Scotland? At a time when services throughout Scotland are being centralised because there are not enough staff to maintain them and when vacancy rates for hospital staff are at an all-time high, does the First Minister expect us to believe that extra doctors and nurses can just be magicked out of thin air? It is time that the First Minister got real. Is it not reality that the doctors and nurses that the private sector will recruit will be taken from the health service, and that the so-called announcement this morning is just a panic measure in the face of yet another set of disastrous waiting time statistics that show up the failure of the Executive to get to grips with the health service? Is it not the case that the First Minister's new policy, far from benefiting patients, will simply rob Peter to pay Paul?

We can see quite clearly here the choice that there will be in the health service in Scotland. The health minister has made it very clear this morning that the changes that he will propose in some detail next month in a paper to the Parliament will not be at the expense of the health service in Scotland. Those changes will ensure that there is additional capacity, that there are additional operations, that there are additional treatments, and therefore that additional patients are treated more quickly across the length and breadth of Scotland.

Ms Sturgeon is saying that she will be opposed to every one of those operations and treatments. She will be opposed to every one of those patients getting better care, simply because of an ideological objection to the measures that will be proposed. That is wrong. That is not putting the patients first. We will put the patients first, and we will deliver a better health service.

I am not opposed to additional operations or treatments. I am pointing out the blatantly obvious fact that additional operations and treatments will take additional doctors and nurses. The question that the First Minister has failed to answer is, if those doctors and nurses are not going to come from the national health service, where will they come from? The First Minister should answer the question and stop ducking and diving.

Perhaps I should quote from the document that the Scottish National Party produced earlier this week, in which it recommends

"Aggressive national and international recruitment campaigns".

Three days ago, Ms Sturgeon supported what we are going to propose, but today she does not because, as leader of the Opposition, she has to oppose it. The reality is that the Labour and Liberal Democrat coalition puts patients first in Scotland. We said that we would put those patients who were waiting longest first; we have done so. Those who are waiting longer than 12 months now have a firm guarantee that is being met. Those waiting longer than nine months have a firm guarantee that is being met. We said that we would ensure that waiting times and out-patients would become the focus of our activity; on both of those, we are delivering the improvements that we said we would. From last year to this year, the figures show it clearly.

We have also said that we want to go further and we will go further, not just inside the national health service, but under the control of the national health service, with it in the driving seat, using here in Scotland excess capacity from elsewhere to shorten waiting times, to deliver for patients and to put patients first. That—not putting our ideology before those patients' needs—should be the duty of the Parliament.

I think that the First Minister is aware of concerns that I have previously raised about health services at St John's hospital. However, does the First Minister agree that announcements made by Lothian NHS Board this week about the introduction at St John's of additional cardiology services, and of additional obstetricians to support the fastest growing maternity unit in Scotland, the development at St John's of a regional head and neck centre and the awarding of university teaching status to St John's, represent a positive step forward? Does the First Minister agree that that series of measures will secure a long-term viable future for St John's as one of the three main acute hospitals in Lothian? Would it not have been welcome if Ms Sturgeon had recognised that today, given the issues that she has previously raised in that connection?

First, I welcome the announcements that were made this week about St John's in Livingston. It is an important hospital and I believe that its future has been secured as a result of the announcements. It will now deliver comprehensive services to a wider catchment area and that will help to secure its future even more. It is regrettable that the Opposition is prepared to play politics with individual cases but is not prepared to welcome improvements in the health service when they happen. I hope that Opposition members will be big enough to welcome those changes today, as Fiona Hyslop has done—I name her as a member of the SNP who was big enough to do that and I hope that Ms Sturgeon will do that too.

Given that Greater Glasgow NHS Board tells us that it has 10,000 people on its orthopaedic waiting list, and given that most orthopaedic surgeons work in the NHS—only a few have small private commitments—how will the Scottish Executive's proposal to involve the private sector significantly reduce the number of people in Strathkelvin and Bearsden who are on the waiting list and who need surgery?

That is precisely the problem that we need to address. That could not be done by squeezing more capacity from the existing surgeons and the staff who support them in their work. That is precisely why we need to look at additional capacity from elsewhere and bring it into Scotland to make sure that waiting lists can come down. That is what we are doing. This morning, the Minister for Health and Community Care made clear the guarantee that health service resources will not be diverted to achieve that objective. Additional resources will be attracted to Scotland in order to secure the best possible results for patients.

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Cabinet (Meetings)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-1219)

At the next Cabinet meeting we will discuss issues that are of importance to the people of Scotland.

There is no greater issue of importance to the people of Scotland than the state of our national health service. Of all the parties in the Parliament, the Scottish Conservative party alone has consistently argued that we need to make much greater use of the independent sector for the benefit of all our patients, so today's news, if it is true, is welcome. The sinners are finally repenting. However, we should not pretend that the news is anything other than a humiliating U-turn and an admission of the abject failure of the Scottish Executive's approach. Is it not the truth that, despite all the bravado and bluster of the past five years about going it alone, the First Minister has been forced to adopt an English solution to a Scottish problem of his Executive's creation?

The Conservatives and the health service—where do we begin to talk about that? In recent years there has been a reduction in health service management and a reduction in the longest waits—in fact, there has been abolition of some of the longest waits that existed in Scotland prior to the existence of this Parliament. There has been a reduction in the waits of people who face the key killer diseases that have plagued Scotland for far too long: cancer, strokes and heart disease. With the existence of the Parliament, there has also been action on public health in Scotland. Such action was long needed and long demanded and it is now happening. Of course change is required in our health service and the considerable improvements that are already in place need to be pursued further, but key changes have taken place. The reduction in bureaucracy and management, the reduction in the longest waits, the treatments for those with the key killer diseases and the improvements in public health are key changes of which the Parliament can be proud.

The First Minister gave no answer to my first question, but if he wants to debate records, I will debate records. To give two examples, the median wait for an out-patient appointment in 1997, under the Tories, was 34 days but the median wait today, under Labour, is 55 days, which is 21 days longer. The median wait for in-patient appointments under the Tories in 1997 was 34 days but the median wait under the Labour Scottish Executive is 43 days. The people of Scotland got a far better health service from the Tories than they have ever had from Labour.

Let us test how substantial the U-turn is. Are we to have permanent, purpose-built and independently run diagnostic and treatment centres, or are Scottish patients simply to be shipped down to England for treatment? In other words, is Mr Kerr announcing a temporary fix or a long-overdue fundamental change of approach to how we run our health service?

The initiative will be a long-term improvement in provisions in the health service in Scotland and will be based here, in the interests of patients in Scotland. I assure the member that it will be significantly better than the long-term fundamental change of approach that the Conservative party would implement. That would take the resources that we will use to treat patients fairly and equally throughout the length and breadth of Scotland and use them to subsidise those who can afford to pay for private care.

We will ensure that the health service in Scotland remains free at the point of need and that people are treated when they need treatment. The Tories would use the same resources to subsidise those who can afford to pay. They would privatise use of the health service at the individual point of need. That is a fundamental divide between their and our long-term strategies.

Does the First Minister think that it takes a special kind of genius to spend much more taxpayers' money, yet have even more patients waiting even longer for treatment? That fact is indisputable. Will he and his Executive finally end the parochialism, complacency and arrogance that have characterised their health service policy from day one and recognise that people in Scotland want solutions that work in our health service, not the dogma that has been forced down our throats for the past five years?

No amount of reading out questions that were prepared before answers had been heard can hide the fundamental divide between the Conservative approach and the Government's approach to the health service in Scotland. Even when the pretence that the Conservatives maintain about health policy—that it is all about diagnostic and treatment centres—is progressed by the coalition Government in Scotland, they cannot welcome that, because their hidden agenda is to subsidise those who can afford to pay and to ignore those who cannot afford to pay. That divide would exist in the health service in Scotland if the Conservatives were in charge and we are intent on preventing it from being created.

There is one constituency question, from Karen Gillon.

Given the considerable interest in my constituency in corporate culpable homicide, I welcome the Executive's announcement that it will consult on related proposals. As businesses have considerable resources to ensure that their voices and their views are heard, what steps will the Executive take to ensure that the equally legitimate voices of ordinary Scots are heard and that their concerns are taken on board? What is the timescale for consultation and legislation likely to be?

The Minister for Justice intends to publish early in the new year a consultation paper on developing the options for implementing new laws.

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Scottish Executive (Priorities)

To ask the First Minister what the Scottish Executive's current top priorities are. (S2F-1230)

Our top priority is to improve growth in the Scottish economy in order to create the wealth and prosperity that are required to close opportunity gaps and to help to fund our public services.

The Executive sets out in the partnership agreement the policy that secondary 1 and 2 maths and English classes should have a maximum of 20 pupils by 2007 and that primary 1 classes should have a maximum of 25 pupils. Why is the First Minister backtracking on that pledge? As a former teacher, like me, he must surely be aware that smaller classes are better for pupils and teachers.

We are not backtracking on that policy. In our recent budget, we allocated resources to achieve it. Through our recent education policy statements, we have also taken actions to ensure that we have not only the right facilities available in our schools, but the appropriate number of teachers trained to deliver the commitment.

I am astonished that the First Minister believes that allowing head teachers in secondary schools to set class size limits is not backtracking. Does he accept that a flagship policy of the Executive has been reduced to ashes? Teachers will agree with me that smaller classes are vital if we are to solve problems of indiscipline and to deliver greater educational opportunities for all our young people. Will the Executive give a guarantee to the Educational Institute of Scotland that it will honour the partnership agreement and reduce class sizes as promised?

I repeat the point that I made earlier to Mr McLetchie: it would be better if the member responded to the answers that were given, instead of reading out prepared questions regardless of the answers. There are a few things in tatters in the Parliament, but our class sizes pledge is not one of them.

Teachers will be trained and recruited to deliver the commitments that we have made on class sizes. Resources have been allocated to ensure that our school buildings and the facilities that are available in our schools are in the modern state that is required to deliver the class sizes that we have pledged and the commitments that we have made to Scotland's children and to parents. It is entirely appropriate that the Minister for Education and Young People should decide to have a discussion with head teachers about how best to implement the policy.

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Children and Communities<br />(Protection from Registered Sex Offenders)

To ask the First Minister what action the Scottish Executive is considering to better protect children and communities from registered sex offenders. (S2F-1227)

We believe that there is a strong case for ending automatic early release of sex offenders and are examining the effectiveness of the sex offenders notification scheme at an operational level. We aim to deliver better public protection through closer supervision of sex offenders in the community and will legislate to promote joint working between the police, prisons and criminal justice social work in assessing, monitoring and managing the risk posed by sex offenders.

I welcome the commitments that the First Minister and the Minister for Justice have given. I seek assurances from the First Minister that the Executive will keep an open mind in dealing with a number of issues that local communities have raised. I refer in particular to housing allocation policy, which is currently appalling, and the widening of access to the sex offenders register. I seek assurances that the Parliament will have an opportunity to interrogate every possibility to ensure that registered sex offenders pose the minimum risk to our children.

These are deadly serious issues. It is vitally important that when we consider them in the Parliament we do so with the best of evidence and the best of motives. That is why we will take decisions about sex offenders, their punishments, their supervision in the community and about how information is revealed about them in the interests of the safety and security of Scotland's children and young people. In doing so, we are prepared to consider the options that Paul Martin has suggested. The Minister for Justice met Paul Martin this week and is considering those matters. All the decisions that we make will be based on the maximum safety and security, the maximum supervision of sex offenders in the community and the maximum rehabilitation of sex offenders when they are in custody.

I associate myself with the concerns that Paul Martin has expressed on behalf of his constituents in the light of the Leggate case. Does the First Minister agree that if the policy in relation to early release of sex offenders is to change, that has implications for the prison estate, as there will be a need for extra places in an already overcrowded prison estate? How does he intend to respond to that?

It is precisely because of the implications of any change in policy that we need to consider such a change carefully. If we implement the change, we must do so over an appropriate timescale. We should not make immediate announcements of an immediate change in policy if the appropriate arrangements are not yet in place. I know that Stewart Stevenson takes a serious and responsible approach to this matter and that he represents both his constituents and the facilities in his constituency powerfully in the Parliament. I respect his views on the matter and am sure that the Minister for Justice would be happy to discuss it with him in detail.

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Anti-terror Courts (Trials without Jury)

To ask the First Minister whether the Scottish Executive has had any discussions with the Home Office regarding trials without jury in anti-terror courts. (S2F-1240)

The Scottish Executive is in regular contact with the Home Office on a wide range of issues, including anti-terrorism measures.

The First Minister will be aware of the concern in the chamber about the possible impact of such trials on our distinct legal system. Does he agree that the prosecution of terrorism offences is a major challenge for our legal system and that we should not lightly abandon civil liberties that have stood us in good stead for many centuries? Will the First Minister give a commitment that, a long time before any such development is introduced in Scotland, the Scottish Law Commission will have a full review of the operation of Scottish courts in relation to terrorism offences, the Executive will conduct a consultation on the subject, and the Scottish Parliament will have an opportunity for full and proper scrutiny, a full debate and a vote on the subject?

It is important to start my answer with three facts. First, we have in recent times in Scotland had a non-jury trial in the Lockerbie case. It was held under special arrangements to deal with particular circumstances that were deemed to have been appropriate on that occasion.

Secondly, this Parliament and devolved Government rejected the option of non-jury trials that were introduced in England and Wales for some fraud and other cases in recent years.

Thirdly, I understand that the Home Secretary floated the proposal as one of a range of possibilities that might appear in an options paper from the Home Office in the near future. If the Home Secretary wishes, we will be happy to have a serious discussion about that proposal with him. However, any such suggestion would be pursued throughout the United Kingdom for consistency and I would expect it to be subject to some serious discussion by our devolved Government and by this Parliament.

The First Minister has already said that Scotland has demonstrated a robust response to acts of terrorism, as it did in the Lockerbie trial, which was set up in the Hague and held under Scots law and as a non-jury trial—but importantly, by agreement. Will the First Minister assure me that he will continue to seek discussions with the Home Secretary so that we as a Parliament are clear what those proposals mean for Scotland, because controversial issues are involved, and will he assure the Parliament that any controversial proposals will not be imposed on the Scottish system without discussion and justification?

There are a number of serious issues to consider here and that is why I would regard any suggestion from the Home Secretary on the matter as a subject worthy of serious discussion inside our devolved Government and also inside the Parliament.

Even if such trials were proposed only for another part of the United Kingdom, that would still have implications for Scotland. I am not instinctively supportive of non-jury trials, but it would be wrong of me to say never to any proposal that might help to deal with terrorism. Although we have a duty to have a serious discussion about the matter, we need to wait and see whether the Home Secretary makes such a proposal, and if so, what the nature of that proposal might be before we make assumptions or judgments about it.

Is it not the case that the proposed European constitution will open the door to non-jury trials? Will the First Minister re-examine that aspect and perhaps reassess his position on the proposed European constitution?

I never cease to be amazed by Phil Gallie's ability to bring the proposed European constitution into any discussion that takes place in this Parliament. One of the good things about the recently agreed treaty to establish a European constitution is that the constitution would protect the Scottish criminal justice system. That is one of the reasons why I will vote yes in the referendum on the constitution that will happen in Britain at some point in the next two years.

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Class Sizes<br />(Partnership Agreement Commitment)

To ask the First Minister whether the Scottish Executive intends to review the partnership agreement commitment on class sizes. (S2F-1234)

As I said earlier, in our budget announced in September 2004 and in our education policies, we have allocated the resources and agreed the actions required to meet our target of classes of 20 in secondary 1 and 2 for mathematics and English. Representations from head teachers on the implementation of that plan in individual schools are being considered.

I welcome the fact that the Government has taken up the Scottish National Party's agenda on class sizes, just as Lothian NHS Board has taken up SNP proposals for improvements to services in West Lothian, although Labour members have made not a single point about the options and we still do not have accident, emergency trauma, orthopaedics and emergency surgery—

Your question was about class sizes.

Is it not the case that the Executive knew that it would never be able to meet its pledges on class sizes and that it would have to increase intakes for teacher training in English and mathematics by 100 per cent to do so? Will the First Minister admit that those pledges represent a betrayal of the trust of parents and pupils in Scotland? Will he admit that he knew from the start that the pledges on class sizes would be broken?

A number of different education policies are pursued in the Parliament and one that the SNP has consistently supported is the abandonment of the school building and reform programme. That policy would lead to higher class sizes in old buildings that are not fit for the 21st century and the SNP should be ashamed of that.

Ms Hyslop accuses us of listening to head teachers and responding accordingly. I think that people throughout Scotland want politicians to listen more to representations from those who deliver our public services and it is entirely responsible of us to do so. That position has been adopted consistently by Labour and the Liberal Democrats in the Parliament and the people of Scotland expect us to follow that policy. Indeed, politicians of other parties called on us to follow that policy. One of those politicians said:

"We should listen to what teachers and head teachers say. Head teachers have told me that they would prefer the flexibility of making their own choices, rather than the dislocation and disruption of … classes, which result from the requirement to meet the class size target."—[Official Report, 7 February 2002; c 6182.]

The politician who said that was Fiona Hyslop.

That concludes First Minister's question time.

Meeting suspended.

On resuming—