Health
The next item of business is a debate on motion S1M-3944, in the name of Mary Scanlon, on health.
First, I should like to comment on the Scottish Executive's amendment to the motion.
Over the past four years, we have been deluged by health motions congratulating the Labour and Liberal Democrat management of the health service. Today, the tone has changed. The amendment includes phrases such as "concerned about waiting times" and "tackling unacceptably long waits"; it also refers to looking forward to further reductions in the number of patients waiting longest for treatment. We all look forward to those reductions. The 107,382 people on the true and deferred waiting list are very much looking forward to a reduction in their wait. At least the failure is admitted; the Executive cannot argue against its own figures.
The Conservatives welcome the fact that the Executive now supports the strengthening of the primary health care sector—better a sinner who repenteth. We also agree with that part of the amendment that congratulates staff throughout the national health service in Scotland on their hard work, dedication and commitment. Providing such a service against the odds and lacking support has to be commended.
However, let us be fair. What has been done? A waiting times database has been set up, which, according to weekend press reports, promised one wait of four weeks, but which takes up to 18 months. That tool to improve patient choice and to drive waiting times down has resulted in one Aberdeen GP saying that most people have looked at the website, fallen about laughing and not looked again. Inventive as ever, our Scottish Executive admitted that it had filled the gaps with what it called "historic information". Historic information, in particular from the Tory years, might be what patients would like to see, but, after six years, it is time for ministers to admit the Executive's figures.
In 1999, Labour promised to cut waiting lists by 10,000; instead they increased by 12,000. It promised to end mixed-sex wards; 36 still exist at the last count. It promised to reduce bureaucracy, but that has increased. It promised to reduce waiting times for in-patient care from 12 to nine months; 6,500 people are still waiting more than nine months for treatment. The average waiting time to see a consultant is up by 12 days.
Last week in Inverness, we heard that a person could wait up to 86 weeks for a diagnosis of diabetes. Some 7 per cent fewer patients are seen within 26 weeks. Bedblocking has increased by more than 1,000, and cancelled operations are up by 4,000. The number of beds has fallen by 637 and the number of administrators has risen by 1,190. The total number of out-patients who are seen is down by 9,000 and more than 15,000 patients were turned away from surgery last year. A recent Audit Scotland report found that 50 per cent of wards were understaffed, and that money spent on bank and agency nurses had risen by £10 million.
Another promise was to increase heart bypass operations by at least 500; the Executive has managed an increase of 67. The Arbuthnott funding was welcomed in the Highlands until it was discovered, as I read last week, that 30 per cent of that funding will pay for financial deficits.
It takes amazing incompetence to spend £2 billion extra and achieve longer waiting lists, longer waiting times, more hospital-acquired infections, more rotten teeth and the worst life expectancy in Europe.
Does Mary Scanlon agree that the delivery of Arbuthnott, with or without the 30 per cent, is patchy in the Highlands? Some bits of the Highlands are doing better than others, which is a cause for concern for the area that we represent.
The main cause for concern is undoubtedly in the area that the member represents—Caithness and Sutherland—and Arbuthnott is very much needed there. When we read how much it could help, and that 30 per cent of funds has gone into balancing the books, people in the area have a right to feel let down.
All is not lost; things can get better. Indeed, the situation was getting better under the Conservatives—[Interruption.] The figures speak for themselves. General practitioner fundholding empowered GPs in the primary care sector to offer more services nearer to the patient's home. More chronic disease management could be carried out for epilepsy, asthma, heart disease and diabetes. The Conservatives would make greater use of Scotland's community hospitals instead of ignoring their potential. We would give GPs the power to respond to the priorities of their patients rather than to centrally imposed targets and directives—not to mention the "initiative of the week".
Only 15 per cent of GPs believe that local health care co-operatives have improved the quality of care; however, small practices or LHCCs could manage budgets and develop services if they were only given the chance. It seems incredible that the primary care team is expected to provide access to a health professional within 48 hours while a six or a 12-month wait for secondary care is deemed acceptable.
Moreover, given that the whole world is online and that IT systems in all businesses are integrated, why does it take four weeks for a consultant to get an asthma patient's discharge letter typed and sent out to the GP? A communications system has to be a priority.
By making more information and choice available, the Scottish Conservatives would empower not only GPs and the primary care team, but the patient. We should tell people that flu and childhood vaccines contain mercury, inform them of potential side effects and the efficacy of the vaccine, and let them make the choice. Empowered patients will soon become the most effective standards of quality. The Conservatives would allow patients to choose the hospital in which they wish to be treated and then let the money follow the patient to reward hard work and patient care. We would also involve NHS staff in the decision-making process.
Furthermore, we would let the independent sector bid to provide health care, as long as the quality and the price were right. However, that approach should not be used as a panic measure two months before an election when the waiting figures become an electoral embarrassment. Instead, we would put out tenders in advance, take advantage of economies of scale and negotiation and allow the independent sector to plan ahead and the patient to plan for surgery—in short, there would be forward planning, not crisis management.
The Scottish Conservatives would introduce greater autonomy for hospitals to apply for foundation status. Quite honestly, if such a step is all right with new Labour in England, why can it not be introduced in Scotland? Such hospitals would continue to be part of the NHS and would operate as not-for-profit companies with their own directors and with far greater freedom to make clinical judgments. They would be able to set their own pay scales, borrow money and keep the proceeds of land sales. Money would follow the patient, which would ensure that well-run hospitals were well-funded hospitals.
The single budget in community care—which is a measure that I supported throughout the passage of the Community Care and Health (Scotland) Act 2002—would ensure that patients were appropriately cared for in accordance with their needs. In the Highlands, the level of bedblocking has risen for the past three months. At every surgery that I hold, I see more cases of families at their wits' end, desperate to fight the bureaucratic system that stops elderly parents receiving care for their needs.
As for drug and alcohol treatments, we need better integration of services and access to detoxification and rehabilitation facilities where needed. There is no point in sending patients away for a few weeks or months and telling them to come back when the NHS is ready. In this case, what should count is when the patient is ready.
Finally, according to the British Medical Association Scotland, Scotland's tradition of training and exporting doctors also seems to be at risk. Funding for better teaching facilities is needed, and more attention must be given to the recruitment and retention of suitably qualified academic staff. Furthermore, we must address the competing demands of NHS work, medical research and teaching commitments. The BMA has said that unless these issues are addressed quickly, the future training of Scotland's doctors and medical advances will be jeopardised.
This devolved Scottish Parliament has always been proud of the country's medical history and faculties. I am pleased to have brought this matter to the minister's attention, and I hope that he will enable doctors to do their job. After all, we have been so proud of that job in the past.
I move,
That the Parliament acknowledges that funding for the NHS in Scotland has continued to increase since the Parliament was established; regrets, however, that this increase in funding has only come about as a result of an increase in the tax burden imposed on everyone in Scotland and that it has not led to an improvement in the service for patients, who have to wait longer for treatment and face the prospect of being forced to go abroad to get the treatment they need in a reasonable time; believes that the Scottish Executive's centralising approach is not working because, despite the best efforts of NHS staff, the current centralised, monopoly system of providing healthcare wastes too much money and therefore does not result in an improvement in front-line patient care, and calls on the Executive to match the extra investment with a sustained and coherent programme of reform that builds on the NHS's fundamental values of high-quality healthcare available to all, irrespective of their ability to pay, and seeks to realise these values by putting the needs and expectations of patients at the heart of the service by ensuring that money follows patients so that they have real choice over the treatment they receive, creating a partnership between the NHS and the independent sector so that all our facilities are used to cut waiting lists and times for NHS patients and devolving power to GPs and local hospitals so that NHS staff have far more say in how the health service is run so that it responds to the real needs of patients.
I congratulate Mary Scanlon on securing the debate. Indeed, it is the first debate that an Opposition party has called on national health issues in this parliamentary session, although I accept that the SNP secured a debate on health issues in Glasgow.
However, I deplore the wording of Mary Scanlon's motion for at least three reasons. First, the Conservatives have created a fiction in order to have something to attack. For example, they talk about the Executive's centralising approach. If they had listened to anything that I had said about health over the past 15 months, they would know that that was a piece of fiction. Of course, there is a case for having such an approach, for example in relation to national standards. We are the first Government to have introduced national standards and inspections in Scotland, and are proud to have done so.
That said, I have consistently believed in devolving powers to ensure that NHS staff have more say in how the health service is run. That approach has already been well demonstrated by the way in which the cancer strategy has moved forward with some success over the past year. Indeed, the cancer world has admitted as much.
Mary Scanlon said that she now supports the strengthening of the primary health care sector. I refer her to the debate on primary care on 25 April last year, in which every word was about strengthening primary health care and devolving more power and resources to those services. In fact, we will talk about many of those themes tomorrow.
Moreover, Mary Scanlon said that we do not put the needs and expectations of patients at the heart of the service. However, those issues are at the very foundation of our health policy. Indeed, we have already introduced a whole series of initiatives that address patient focus and public involvement. That said, I accept that more needs to be done, and that point will form an absolutely central theme tomorrow.
Mary Scanlon has said that we do not support choice. If she does not listen to what I say in debates, perhaps she should read the detailed interview that I gave in The Herald on 31 January, in which I make it absolutely clear that I believe in choice. However, choice is part of a bigger picture, because what patients want at the end of the day are high-quality services.
Finally, Mary Scanlon mentioned the independent sector. Perhaps she should have noticed the announcement that we made last week of £5 million for orthopaedic operations in the private sector. Five hundred and ninety patients will be grateful for that. I should also point out that that is not an about-turn; I was being criticised in my first month in office for my willingness to use the independent sector. Indeed, I can refer her to those sources.
Why did the minister not allow patients on the longer waiting list to exercise choice three years ago and let the NHS purchase on their behalf spaces in independent hospitals or from not-for-profit providers?
I have already answered that point. I refer Mr Wallace to what I said in December 2001. [Interruption.]
Order.
The second reason why I object to the motion centres on its claim that funding for the NHS
"has not led to an improvement in the service for patients, who have to wait longer for treatment".
The general charge is that the funding has not led to improvements.
Mary Scanlon accused me of changing my tone. I have never changed my tone; I have always said that there are problems, and I have been more willing than most politicians to face up to that fact. However, many good things and improvements are happening in the health service and I object fundamentally to the fact that, in her motion and her speech, Mary Scanlon did not acknowledge any of those. What she said does not accord with the experience of patients; I acknowledge that too many people wait too long, but the majority of patients that one speaks to have a good experience of the health service.
Moreover, the relentless negativity that we have heard once again from Mary Scanlon demoralises staff.
Will the minister give way?
Not at the moment. [Interruption.]
Order.
I want to deal with three things that Mary Scanlon mentioned. Of course we still have problems with delayed discharge, but she knows that the figures are coming down significantly. Frank McAveety will probably say more about that in his closing speech.
Mary Scanlon also repeated an assertion about administration. However, she knows full well that the number of senior administrators is down because we do not have the bureaucracy of the Conservatives' internal market. The administration figures include ambulance staff and people from the blood transfusion service. Does she want to lay those people off as well?
Mary Scanlon also mentioned heart bypass operations. We know that the median waiting time for those operations has fallen from more than 150 days to less than 50 days. Finally, she has the brass neck to criticise an in-patient wait of between six and 12 months when she knows that under the Conservative Government patients waited 15 months for in-patient treatment. Obviously, I will address waiting. We must look at the long waiters. The figures will come out tomorrow and I invite Nicola Sturgeon and others to consider the long waiters, because that is who we are targeting.
I have been willing to admit our failings in relation to waiting. I am the first to admit that we have not adopted radical enough solutions to out-patient waiting. That is why out-patient waiting has been my top priority over the past few months and why the first major task of the centre for change and innovation is the out-patients project, which will examine the problems in a far more radical and fundamental way. We cannot deal with the fundamental problems of waiting unless we are into redesigning services and consider how to deliver them differently. That is precisely what we are doing, but I accept that we have not dealt with the matter radically enough. I have no problem admitting that.
The First Minister made a significant advance on waiting last week when he gave guarantees that go far further than the guarantee on heart surgery that has been given in England, which politicians have referred to in the media. We are saying that, by the end of this year, if someone has waited longer than nine months for their in-patient treatment, we guarantee that they will get the treatment in another hospital or in the private sector or—in extreme circumstances—somewhere else in Europe. That shows that we are confident that we can reach the targets that we have established for ourselves.
There have been problems with the database. We knew that we did not have the information. That is why the system is currently being piloted; it will go fully public when all the information is up to date. The idea of the database is still to support patient choice. It is a major step forward. There are teething problems; we often get bad publicity about teething problems. An example of such problems was a certain group of patients from Glasgow at the Golden Jubilee national hospital, but the reality is that the fundamental story of the Golden Jubilee hospital is a good one. It is exceeding its targets and it is treating thousands of patients who otherwise would have had to wait longer.
I admit freely that there are problems, but we are focused on dealing with them. Let us remember the success stories of the health service and take a balanced approach. Politicians will not do themselves any favours over the next two months if they take a one-sided approach to those issues. It does not surprise me that such an approach is taken by the Conservative party, which has no policies on health except to provide fewer resources and have more people paying for their own health care.
I move amendment S1M-3944.1, to leave out from "acknowledges" to end and insert:
"welcomes the further increases in the Scottish Executive's investment in health and health promotion announced earlier this month; notes that these extra resources must be balanced by reform in the NHS for full benefits to flow to service users; supports the on-going work to put patients at the centre of service planning and quality improvement in the NHS; supports the strengthening of the primary healthcare sector and decentralisation of decision-making; is concerned about waiting times for some out-patients; agrees with the priority given to tackling unacceptably long waits; commends the new maximum hospital waiting times guarantees for NHS patients given by the Executive; looks forward to further reductions in the number of patients waiting longest for treatment; welcomes the recent reduction in the number of delayed discharges from Scottish hospitals and the active collaboration between health and community care services in achieving this, and congratulates staff across the NHS in Scotland on their hard work and dedication to a highly regarded public service."
I was beginning to wonder whether I should offer to hold the jackets of the two parties that are united only in their failure to deliver improvements in the national health service.
I find Tory health debates a wee bit difficult to stomach. Frankly, having to listen to the Tory party—that for 18 years underfunded and divided the national health service, cut the service's capacity and sowed the seeds of many of the problems that the service faces today—tell us that it has all the answers is more than anybody should have to face on a fine Wednesday morning.
Behind the cuddly language of the Tory motion lies that party's real intent. The key phrase in the motion is:
"creating a partnership between the NHS and the independent sector".
That is, the private sector. What does that mean? The Tories have a duty to be honest about what it means.
I will not take an intervention just now.
If we are being charitable to the Tories, all it means is using all the spare private capacity to do NHS operations, but to present that as a panacea for the problems in the health service is dishonest. There is limited private capacity in Scotland. There are three times the number of blocked beds than private beds. Staff shortages mean that every time that a consultant does an operation in the private sector, they are not doing one on the NHS. Of course, that is not what the Tories mean by talking about a partnership with the private sector. The real Tory agenda is to expand the role of the private sector in the health service.
Ben Wallace will get his chance; it is his turn to listen to somebody else.
The Tories want to let the private sector run our hospitals. Of course, if the private sector runs our hospitals, it does so for profit. That means an inevitable increase in charging for health care and a two-tier health service. That is the real agenda of the Conservative party. It would be better for the Conservative party to be honest about that and let the Scottish people cast their verdict in a few weeks' time.
If the Tory solution is not the right one—and let us be emphatic that it is not—what is? Things are not getting better. Eighteen years of Tory failure have been followed by six years of Labour failure. In many ways, this is a debate between the Conservative party and the Labour party—with the Liberal Democrats having to take some responsibility—about who has failed most in the health service. Waiting times are 18 days longer than they were in 1999. The Executive insists on tinkering around the edges. The waiting times database, which is tinkering around the edges, is not even accurate.
The central point, which is missed in the Tory motion and is the point that Labour refuses to face up to, is that the problem in the health service is not fundamentally one of structure, although structural changes should be made. For example, I want to see the abolition of trusts, which were created by the Tories and are now redundant to the management of the national health service. The fundamental problem is one of undercapacity. There are too few beds and too few front-line doctors and nurses. There are 600 fewer hospital beds than there were in 1999 and occupancy rates are 85 per cent and above. That is crisis management. The result is that wards are frequently closed and operations are cancelled; 15,500 operations were cancelled last year.
The Minister for Health and Community Care now freely admits that we have an either/or health service. We can have an NHS that can deal with emergency admissions or one that can deal with planned admissions; we cannot have one that can do both to the standard that is required to meet demand. We need a planned approach to beds; that would start with a national review, the kind of exercise that is already carried out in England, the Republic of Ireland and Wales, to name a few.
The Minister for Health and Community Care crows about a record number of nursing posts. He ignores the fact that posts do not treat patients—nurses treat patients. Three per cent of nursing posts are currently vacant.
I am in my last minute.
Vacancies are at an all-time high, but the Executive refuses to deal with the problem. Nurses are leaving the NHS; some 2,500 have left the health service to go to England or further afield since 1997. We need a solution here in Scotland to deal with that. That is why I say that there should be an 11 per cent pay rise for nurses to reward them better and to give Scotland the competitive edge in nurse recruitment that we so badly need.
Let us have less rhetoric from the Tories and fewer excuses from Labour. There must be a focus on the core problems in the health service and some solutions to tackle them. That is what the SNP offers.
I am pleased that Mary Scanlon at least acknowledges that the Scottish Executive is increasing investment in the NHS and our country's health. The health budget has risen from £4.6 billion in 1998 to £6.7 billion this year. The 1 per cent increase in national insurance that will be levied from April will fund unprecedented spending—£8 billion will be spent on Scotland's health in 2005-06.
I agree that the increased investment must be seen to deliver real and sustained improvement and change. There must be a new emphasis on long-term health improvement, a greater emphasis on patient choice and the patient's voice, an end to restrictive working practices, better use of technology and a streamlined service that is stripped of unnecessary bureaucracy. Decision making should be devolved to front-line staff as much as possible and the service should put the rights and responsibilities of patients at its heart.
The Liberal Democrats believe in increased investment in the NHS and in Scotland's health; it is clear that the Tories do not. The record investment over the next few years would not have been available had the Tories been in power. On health, as on so many other matters, the Tories are out of step with the people of Scotland. Nicola Sturgeon is right that the Tory motion is a Trojan horse. It is not honest about what the Tories really want to do to the health service. They want to privatise it—not to improve patient care, but to increase private profit.
The Liberal Democrats took an honest approach at the last general election. We believe in public services and believe that those services need to be paid for. People care about the NHS. I am happy to defend that position, because we will make a difference to people's health. That is what my constituents and other members' constituents want.
The NHS needs to invest in more than bricks and mortar; it must invest in equipment and staff and it must highlight health in a more general sense. Health improvement and illness prevention are central to Liberal Democrat thinking on health. It is a pity that, in the motion, the Tories are as usual concentrating on short-term results and issues, such as opening up the Scottish health service to the independent sector. The motion does not even mention the need for wider health promotion. I am glad that Mary Scanlon mentioned drug and alcohol treatments, but this country's health suffers as a result of two decades of neglect by the Tory party, which has been more interested in the internal market than in patient care.
The Liberal Democrats believe that the Scottish Executive is right not only to concentrate on the NHS, but to invest in health promotion and in measures to tackle health inequalities. We look forward to focusing on the action to improve health that will be outlined in the white paper that is due out tomorrow.
We applaud the Executive's healthy living campaign, which was launched in January. We also applaud the introduction of nutritional standards for school meals and the scheme for free fruit in schools in particular. Healthy living and a healthy diet are habits and it is important that we give such habits to our children when they are young, particularly if we want to tackle the problem of childhood obesity. The message is clear. If we invest in the diet of our children today, we will save in the long run through reduced levels of coronary heart disease, stroke, cancer and diabetes.
We need to balance investment with reform and we need to target resources. It is important that we invest properly in the NHS so as to reward innovation, to encourage the effective redesign of services—with full clinical and patient input—and to enforce clinical standards.
Yesterday, the Health and Community Care Committee heard that the Scottish intercollegiate guidelines network guidelines on epilepsy are being put into practice in four—
Who are you? I will not take an intervention.
It is obvious that staff are at the heart of an improved service. Recently, there has been a nurses' settlement and there have been deals to begin to tackle low pay. In the past week, an announcement has been made about the new GP contract that has been agreed between the BMA's general medical practitioners committee and the NHS Confederation. If the contract is accepted, it will be accompanied by substantial additional resources for the development of primary care services. Payment will be linked to the quality of care that is provided to patients—that should go a long way towards ending the current disincentives in the system, whereby those who provide extra clinics and services that improve patient care and ease the burden on the secondary health sector often find themselves penalised for doing so.
It is important that the contract links investment to the specific health needs of local communities rather than involving simple payments to doctors in the old one-size-fits-all approach. We want a scheme that rewards incentive and innovation. The primary care sector delivers 90 per cent of this country's health care and has a similar satisfaction rating. People believe that their GPs and other practice staff are doing a good job. The new contract will assist the primary health care team to expand its role even further and I hope that Scotland's doctors will accept it.
It is right to focus on the wider health picture and the primary care arena, but it is also important that we continue to invest in the acute sector. We agree that the patient should be at the heart of NHS decision making and that what is best for the patient should be the driving force behind investment. The delivery of patient care is more important than who delivers it. Therefore, we welcome the recent announcement that the Executive is putting a further £5 million into an initiative to provide 590 orthopaedic operations for NHS patients in private hospitals. I know that my constituents will welcome the £680,000 that is earmarked for Lothian.
Malcolm Chisholm has been refreshingly frank today about waiting times, as he has been in the past, and we welcome the First Minister's recent comments on the matter. We are not saying that there are no problems in the NHS. However, through the waiting times initiatives, the national waiting times unit, the delayed discharged action plan and other initiatives, we believe that the Scottish Executive is on the right track to improve our country's health care. Many of the approaches that I have outlined will not be delivered overnight, but that does not mean that we are not right to take forward a health agenda that is wide in its scope and focuses increasingly on the patient.
Eight members wish to speak in the open debate. They may all speak if members are disciplined about sticking to the four minutes that they are allocated.
It is nice to see a Tory motion again provoking vociferous debate in the Scottish Parliament. It takes the issue of health to get temperatures up in the Parliament and I am delighted that that is again happening, especially when we consider the performance of the Minister for Health and Community Care, who is not in the chamber at the moment.
In dealing with the motion, the minister was on the defensive from start to finish. He admitted his guilt in respect of all Mary Scanlon's accusations and accepted his responsibility for virtually all the bad figures that were quoted. He realises only now—with an election staring him in the face—that the time has come to try to address those figures.
We need to consider seriously what we should do. Mary Scanlon made a positive speech in which she outlined Conservative policy and what the Conservatives would do—many others can be criticised for not outlining their policies on the subject. Her proposals would genuinely increase the performance of the health service.
I am prepared to defend issues such as the internal market as an important part of the Conservatives' contribution to the health service. However, the issue that is most often raised with me is GP fundholding. GPs would like to return to that system, if possible. Local health care co-operatives have resulted in the centralisation of power in larger groups and the removal of powers from individual GPs. Malcolm Chisholm would deny that such centralisation has happened, but it has. GPs want that power back and we want to consider policies that will deliver it.
Mary Scanlon went to great lengths to explain our policy on hospitals, including the establishment of foundation hospitals. What she said is not new, even to the Labour party—I am talking about Labour party policy south of the border. The potential for improving health provision in Scotland and the Labour party's policy in the south have been ignored in the dogmatic pursuit of what we can only describe as a pre-1979 attitude to health care provision.
On policy, we heard something from Malcolm Chisholm and we heard a great deal from Mary Scanlon, but we heard absolutely nothing from the SNP. Nicola Sturgeon criticised our policy and Labour's policy, but she did not say what SNP policy was. The SNP was not even prepared to lodge an amendment to the motion. It makes the naive assumption that mair tax will inevitably result in better provision and that independence will solve all Scotland's ills, but we cannot accept that naivety any longer.
Will the member take an intervention?
I am afraid that I cannot, as I am coming to the end of my speech.
It would be a friendly intervention.
I cannot accept even a friendly intervention.
It is absolutely essential that we accept the need for greater autonomy for hospitals. We should allow them to apply for foundation status so that they can set their own pay and conditions and plan on their own behalf in response to local demand. That would be particularly helpful in recruiting doctors, nurses and other NHS staff. The minister identified problems in that respect.
We would create a partnership between the NHS and the independent sector so that all our facilities were used to cut waiting lists and waiting times in the NHS. That would not be a desperate response and a desperate measure that resulted simply from the proximity of the forthcoming election.
Yet again, I am truly staggered by the fact that the Tories have chosen to debate the health service. I cannot believe that Mary Scanlon and the Conservatives have not realised after four years that they are skating on thin ice. For a representative of a party that almost decimated our health service over 18 years to tell us that the Government's initiatives have not led to an improvement in the service is just gross hypocrisy.
The Conservative motion states that the NHS should have
"far more say in how the health service is run".
When the Conservatives were in power, they thought that NHS staff amounted to doctors and nurses and they forgot that other NHS staff should have had a say in how the service was run. The Conservatives privatised the jobs of those staff and it is hypocritical of them to come to the chamber and say that NHS staff should have
"far more say in how the health service is run".
I worked in the NHS for 18 years under Tory rule—I am fed up with saying that in the chamber—and believe in quality health care for all. I believe in a system that is free at the point of delivery and that caters for everyone in our society, regardless of ability to pay. I believe in the NHS and am proud to belong to a party that believes in it. The Tories do not believe, will not believe and have never believed in the NHS.
I am glad that the motion struck one positive note, in acknowledging that the Executive is investing record amounts in the NHS. Thanks to Labour's sound management of the economy and our commitment to public services, the NHS has never been in better shape financially—in sharp contrast to the lean years under the Tories. However, Nicola Sturgeon is right to say that the issue is not just about money.
Will the member give way?
I am sorry, but the Conservative party has nothing to say on this matter. I have heard it all.
I am only too willing to accept that we must ensure that reform takes place. Such reform is necessary because of the mess in which the Tories left us when the people of this country decided that enough was enough.
Mary Scanlon may remember that in last year's debate on the health service we focused on reform of the NHS. The Parliament heard how we are reforming the NHS by improving accountability and governance, working to reduce waiting times and improving choice for patients. Malcolm Chisholm was honest in saying that we have not got things right yet and are still working on them. However, when the Tories were in power, they did not manage to do the things that I have mentioned.
Would the Tories have tried to bring the Health Care International hospital at Clydebank into the NHS? Of course not. It is infinitely more likely that they would have dispatched NHS hospitals to the private sector, which they believe in doing.
We must give credit to the Executive for daring to think outside the box. The decision to purchase the HCI hospital in Clydebank to create a national waiting list centre was bold, but I hope that time will show it to have been correct. Similarly, our commitment to reducing waiting times through the creation of ambulatory care and diagnostic centres or by allowing people to be treated in other health board areas is a welcome step—much more welcome than anything that we have ever heard from the Tories.
I defy anyone to condemn the £700 million investment in Greater Glasgow NHS Board, which will lead to major changes in service provision across Glasgow. Although change is never welcomed by everyone, if we are to modernise and to continue to improve the NHS, change is necessary.
To be fair, the Tories tried to change the NHS. They introduced the internal market, which ushered in the two-tier health service and destroyed staff morale. I was one of the staff whose morale was destroyed during that time. The Tories' current planned reforms are all aimed at bringing about what even Margaret Thatcher could not achieve—the destruction of the NHS and the proliferation of private health care. I will not take any lessons from the Tories on how to reform the NHS.
The Executive has a good story to tell—of eight new hospitals built, of more doctors and of more nurses. As I have said many times, we are not complacent. Everything in the garden is not rosy, but it is certainly much rosier than it was during the dark Tory years. For that, we should all be thankful.
I am delighted that Malcolm Chisholm's amendment indicates that he is concerned about waiting times for out-patients. Recently, I was involved with the case of one out-patient, Audrey Doig, who has allowed her name to be used in this debate. She wanted to have a minor operation at the Victoria hospital. On arriving there, she—along with eight or nine others—was told that there were no beds and that she would have to be invited back to have the operation. She then wrote a number of letters, including to Malcolm Chisholm, who replied to her.
Audrey Doig was told that there was no guarantee that when she turned up for her next appointment she would be dealt with. Imagine her shock and horror when she was again told that there were no beds. On the third occasion, she was admitted, but she tells me that three or four other people who had operations scheduled for that day were not.
Audrey Doig's experience inspired me to ask the Minister for Health and Community Care how many operations had been cancelled at a day's or a week's notice in Scotland in the past 12 months. In his answer, the minister indicated that, unfortunately,
"Information on the number of operations cancelled by NHSScotland is not available."
That is an interesting piece of information. He continued:
"However, data is collected centrally on the number of planned admissions to hospital for in-patient/day case treatment".—[Official Report, Written Answers, 18 February 2003; p 3015.]
Up to March last year, more than 16,000 admissions were cancelled. In the Argyll and Clyde NHS Board area, 791 admissions to the Royal Alexandra hospital in Paisley, 121 admissions to the Vale of Leven district general hospital and 173 admissions to Inverclyde royal hospital were cancelled. The problem is a lack of beds. In the case of the Victoria hospital, where Audrey Doig was treated, out-patients were being kept out by emergencies, which must have priority. Every day the hospital deals with an average of nine emergencies. Why is there no provision for that? There are insufficient beds and staff.
The median waiting time for out-patients in the Argyll and Clyde NHS Board area is 45 days. That is five days more than the median out-patient waiting time in the area when the Executive was established in June 1999. The median waiting time for in-patients is 34 days, which is two days more than in 1999. Altogether, the median waiting time for a patient living in the Argyll and Clyde NHS Board area is 79 days, which is seven days more than the median waiting time when the Executive was established in 1999. There are problems with waiting times, which I know the Executive wants to address.
Two of the 10 national vacancies in paediatrics are in the Argyll and Clyde NHS Board area. A work force shortage prompted the closure of maternity services at the Vale of Leven district general hospital in the Argyll and Clyde NHS Board area. That measure was very contentious, because maternity provision is being reviewed in the whole health board area, and it probably caused a great deal of anxiety.
There are currently 100.3 whole-time equivalent nurse vacancies that have been vacant for more than three months in the Argyll and Clyde NHS Board area. In 1999, there were 78.5 such vacancies. In 1997 there were only 33.3 vacancies that had been vacant for more than three months. The number of such vacancies has increased by 67 per cent since the Labour party came to power in the UK. Last year, Argyll and Clyde NHS Board spent £2.5 million on the whole-time equivalent of 101.5 nurses—presumably agency nurses—which is slightly more than the figure for nurse vacancies. That money would have been far better spent on filling the NHS vacancies.
The problem is one of beds and people. Much of the NHS is excellent. Emergency and acute services are excellent. However, until we solve the bed and staffing problem, there will be unnecessary, uncalled-for and unwanted criticism of the NHS. For the benefit of Conservative members, who think that we are naive, the SNP would increase nurses' pay by 11 per cent.
I welcome the debate. Everyone seems to accept that more money than ever is available to the NHS. In particular, I welcome Malcolm Chisholm's pragmatic approach to bringing down unacceptable waiting times in Scotland.
The Tories cannot pretend that more resources are needed for health but at the same time advocate tax cuts. Clearly, that is a dishonest approach. The Tories are completely out of step with the people of Scotland on the NHS.
In the short time that is available to me, I would like to move from the general to the specific. I welcome the pragmatic approach that Malcolm Chisholm and Mary Mulligan have taken to addressing the major problems of the NHS. However, in the past four years I have pursued two specific issues.
Arbuthnott.
I am not talking about the Arbuthnott formula. I had a go at the Arbuthnott formula in the previous health debate.
The first issue is audiology. I have with me a letter from Susan Deacon dated 28 April 2000. In it, she stated:
"Digital hearing aids are already available on the NHS in Scotland and we have just widened the choice available to patients by introducing further types of aid as from 1 April this year ... England and Wales ... are taking a rather different approach and have decided to pilot the use of digital aids in certain areas before deciding how to roll out their provision."
I thought that that was interesting. The minister continued:
"we are taking a very pro-active approach to the provision of this kind of equipment for patients in Scotland".
I will also quote from a letter from the chief executive of the Grampian University Hospitals NHS Trust. He states:
"I regret that currently we are not able to fund digital hearing aids ... we in this Health Board area cannot provide the digital aids despite them being available on NHS contract."
That letter was written nearly three years ago, but the situation has not improved, to the extent that patients are still not being given the digital hearing aids that they should be entitled to receive. I accept the points that Mary Mulligan has made in correspondence with me and that the Executive has allocated money for that purpose. After £8 million for digital hearing aids was announced recently, I asked Grampian NHS Board when patients in its area would be able to access the digital hearing technology to which they should be entitled. I have still received no response. I need an answer from the minister; I need to know what the minister will do to ensure that my constituents get the treatment and the facilities that they need and deserve.
In the 60 seconds that I have left, I will flag up the other specific health issue that needs to be examined—access to NHS dentistry. That is a major issue. The situation in the north-east of Scotland is worse than it is almost anywhere else.
What about Highland?
I said "almost anywhere else".
Many of my constituents cannot get access to NHS dentistry. I know that many initiatives have been launched to make money available for improving NHS dental services. There is disagreement about the fundamental problem, which is that, since the closure of the dental school in Edinburgh, not enough dentists are being trained in Scotland. We need a new dental school.
In September, I was the first person in the Parliament to call for a new dental school to be established in the north-east—in Aberdeen, for example. That would attract trained dentists to provide training in the north-east. Those dentists would be able to establish businesses and practices in that area. That is one of the only effective ways of ensuring that we make progress on the issue.
Although the Executive has produced money and initiatives, there are simply not enough dentists. Training 120 a year is not sufficient. As I am running out of time, I will close on that point. I hope that Mr McAveety will address those two issues in his wind-up.
Malcolm Chisholm accused the Conservatives of a one-sided approach to health care. We are guilty of such an approach—we put the patients first.
There has been a great amnesia over the past six years, not least from members such as Janis Hughes. Time after time, statistics that the NHS and the minister produce demonstrate that life is now worse under Labour. According to the SNP's statistics, life has got even worse since Labour was joined by the Liberal Democrats. We can rest our case. I thank Colin Campbell for his statistics. They were most helpful.
Lots of extra money—£2 billion—has gone into the health service. That is welcome. However, the opportunity has been wasted. Improvement without reform is not possible. There is no point in throwing money at systems that the staff do not like.
Staff morale is low. I spent Monday evening at a state registered nurse hustings. The SRNs told us how it was. The plain fact of life is that it is impossible to recruit and retain anyone in the health service. There is a shortage of GPs and dentists in the north-east. Why cannot they be attracted? The answer is that they are not given good conditions to work under and they are not given control over the health service. Devolution does not go beyond Executive ministers. Devolution does not exist outside the Executive offices.
If we want to set the system free to serve the patients, we should give the health boards responsibility. They should be accountable. They should design the services that are best suited to their areas. They should flag up where their priorities lie. It is impossible to legislate through targets on this, that and the next thing.
We should look at the health service rationally. We should ask, "Who has the skill? How can we best use that? How will that improve patient care?" Surely it is better to employ an expert nurse in asthma in a doctor's surgery, where she can deal with asthma in the community. Primary care is where the effort has to go. We must also deal with bedblocking. The use of the independent voluntary sector is a good way of doing that.
We would not have poured money into buying the building at HCI; we would have spent the money on commissioning care from the NHS services there. The health service can be a commissioning service. It does not have to own everything and it does not have to be nationalised, as the SNP would have us believe. It is a case of putting the patient first and saying simply, "We have this resource. We want people to be able to access health care wherever they are, according to their need." Let us face it—the most important patient is the patient who next presents. It is nothing to do with who has cancer and who has toothache. Everyone has a right to appropriate treatment in a reasonable time.
The Labour party has had four years in the Executive, plus the two preceding years at Westminster, to get a grip. It has failed to design the right system and to get the people who work in the health service on side. Those people must be consulted, they must be given a career path and they must have access to continuing professional development. In the north-east, for example, there are no facilities for giving dentists their practical training once they have done their degree. There is no money to bring in European Union dentists to give them that training. Such a fund does not exist. Although a new dental school in Aberdeen might be a solution in the long term, we are short of dentists now.
Why are we not playing at golden hellos, as the health authorities in England are? If we cannot get radiographers in Highland or in Aberdeen, why do we not find an efficient way of attracting them? Why do we not break down national pay bargaining and allow the health boards to set the levels of pay that they consider necessary to attract and retain people?
The health service must become accessible throughout Scotland. Access must not be determined by postcode and it most certainly should not be twisted by the Arbuthnott formula. If Glasgow has a problem, the minister should fix it, but he should not take money from the north-east of Scotland to do so.
I suppose that the law of averages dictates that, in such a long motion, Mary Scanlon was bound to make a good point sooner or later. She is right that we need to get the record amounts of money that we are spending on health to the front line as quickly as possible. She is right that a modern NHS must, in the words of the motion, respond to
"the real needs of patients"
and, like many of my colleagues and me, she is right not to be convinced that the centralisation of services will deliver that. However, it is beyond me how a Tory could speak to those points with a straight face. The Tories have been unable to keep a straight face this morning.
I wonder whether any other members choked on their cornflakes when they read in yesterday's business bulletin a Tory motion extolling the virtues of
"the NHS's fundamental values of high-quality healthcare available to all, irrespective of their ability to pay".
Although I could go on at length about 18 years of Tory neglect—and would be justified in doing so—attacking the Tories' record on the NHS is like shooting fish in a barrel, as my colleagues Malcolm Chisholm and Janis Hughes showed.
The motion deals with impacts on service delivery. That is a fundamental issue, whether the Tories realise it or not. There are many answers to the question, but I will focus on what affects service delivery in my area.
We have guidelines from the royal colleges, European working time directives and a reduction in junior doctors' hours. The working time directives and the reduction in junior doctors' hours mean that, in the Argyll and Clyde NHS Board area alone, we need to recruit 25 consultants and even more junior doctors.
Will the member take an intervention?
The member has had a full morning's debate and I have limited time.
That level of recruitment is necessary not to extend the service, but simply to maintain it. Those major challenges must be addressed.
The guidelines focus on certain disciplines and address risk in very small areas. Striving to reduce such risk means that we constantly chase the impact on the other services, which pushes us towards more centralisation.
In practice, that has meant that, in Argyll and Clyde, we have witnessed the closure of the maternity unit at the Vale of Leven hospital, for the want of paediatric cover. That closure, which took place without consultation with the local community, has forced mothers and young babies to travel further for care. That has happened in spite of the massive investment that we are injecting.
Like many hospitals outside the cities, the Rankin maternity unit in my constituency has found it difficult to recruit appropriate staff numbers. It has to compete with university-led services in the cities. That is another example of the push towards centralisation that we must resist. Despite the fact that the number of consultants at the Rankin maternity unit has increased, there is once again a shortage of paediatric cover, which has threatened the unit and put it only days away from closure during the past year.
Finally, I want to mention health board boundaries. Lines on a map are not recognised by my constituents or by many others. We do not see a sufficient amount of working together among the health boards. I contend that only by using common sense and by applying flexibility will we ensure that the massive investment that we are putting into the health service improves and is seen to improve patient care.
I do not often agree with Duncan McNeil, but I agree with his analysis of the situation. Large parts of the additional funding are having to be taken up to address matters that are beyond the control of the NHS, and may even be beyond the control of the Executive. That highlights the fact that we cannot expect miracles overnight. Anyone who suggests otherwise is deceiving themselves, let alone the public. A big part of the additional finance will need to go on problems such as those that Duncan McNeil detailed concerning consultant staff and junior medical staff. We will not be able to pour all the additional resources into addressing the problems of patients, because we need to deal with the long-standing problems such as the number of hours that people work.
Mike Rumbles has already highlighted the problems with digital hearing aids and dentists in my local area. David Davidson acknowledged those problems and highlighted the problems associated with the Arbuthnott formula. I want to highlight the fact that waiting times in Grampian, like those for the area that Colin Campbell represents, have increased. The median waiting time for out-patients in Grampian is now 69 days, which is 10 days longer than the national average. Before the Parliament came into existence, our waiting time was below the national average. That change reflects the shift in resources away from Grampian. We used to have services that were among the best in Scotland, but our services are now amongst the poorest in Scotland.
The out-patient waiting time is 18 days longer than it was when the Executive took power in June 1999. The in-patient median waiting time is now 34 days, which is six days longer than was the case in June 1999. The median wait in total for a patient waiting in Grampian is now 103 days. That is nine days higher than the national average and 24 days longer than patients in Grampian waited when the Executive took over in 1999. There has been a significant deterioration in service over the past four years in spite of the additional resource, which is clearly not being spent on addressing patient needs.
In the last quarter, the number of out-patients seen was 82,022. That is the lowest number in any quarter since December 1998. That is also 6,727 fewer patients than were seen when the Executive took over in 1999. Not as many out-patients are being seen. In the last quarter, the number of day cases was 4,811, which is the lowest number since December 1998 and 1,803 fewer than when the Executive took over in June 1999.
Clearly, there are capacity issues in the health service. Yes, the HCI hospital has been bought over, but we are still using sticking-plaster solutions because of the deliberate policy of reducing capacity within the NHS acute sector. Some of that is clearly driven by the Executive's perceived need to deliver all health service improvements through the private finance initiative and public-private partnerships. Capacity reduction is a direct consequence of the PFI/PPP approach to improvements in the quality of bricks and mortar within the NHS.
We have significant nursing vacancies in the north-east. At present, the north-east has 258.1 whole-time equivalent vacancies for nurses, which is an all-time high since 1996. In 1999, Grampian had only 178.6 whole-time equivalent vacancies for nurses. The increase in vacancies has been greater than 30 per cent during that period. Indeed, the problem is not simply that turnover of nurses is being used in the short term as a way of managing an NHS overspend, because 55 nursing posts—a fifth of the vacancies—have been vacant for more than three months. Either Grampian is simply unable to recruit more nurses or the vacancies are being used to manage finances.
There are serious problems that are not being addressed. However, the Tory motion's approach, which says that the private sector is the answer, is not the answer at all. There simply is not the capacity and we need to be realistic about what we can do in the near future.
The Tory motion admits that spending on the NHS has progressively increased since 1999, but it goes on to regret that the extra spending has been brought about by an increase in the tax burden imposed on everyone. The first point to be made is that any increase in the direct tax burden on Scots is certainly not the responsibility of this Parliament or Executive. For the past four years, the Parliament has refused to use the tax-varying power that the voters gave it in the 1991 referendum.
In any case, there are only two ways of increasing spending on the NHS or on any other public service. The first way is through growth in Government revenues that is brought about by rapid economic growth, falling unemployment, increased tax yields, reduced social security benefits and so on. That is the classic trickle-down theory, which President Reagan, Margaret Thatcher and John Major preached for so many years. I know from direct experience of living through that period that that approach has not worked, does not work and will not work.
The only other way of increasing spending on the NHS is through increased taxation. Unlike the Tories, who complain about that at the UK level, my complaint is that we have not sufficiently increased taxation on the rich. We should take more off the rich and spend more on public services. That is the way in which we will get improved public services in this country.
Will the member take an intervention?
Sorry, I do not have time, but I will debate with Brian Monteith outside at any time.
My belief is that we do not have enough resources. The yardstick should not be how much we spend on the national health service now as compared with the pre-devolution period—
Sorry, but I do not have time.
The yardstick should not even be how much we spend now compared to what was spent by the previous Tory Government in those dark days of long ago. The yardstick should be how much we spend compared with what is actually needed to provide patient care at the level that the people of Scotland desire.
For example, the Executive's short-life action group on ME recently produced its report, which makes recommendations. ME is not a new illness. As the "Report of the Short Life Working Group on CFS/ME" diplomatically puts it,
"This burden of illness is not well recognised at present".
In other words, the illness has been ignored for years. There is an appalling lack of provision for ME sufferers in this country.
The SLAG report makes a number of useful recommendations. It calls for needs assessment programmes and for each health board to develop plans for ME sufferers in their area. The report also calls for a tiered approach, so that we have primary care and specialist services and a regional or national service above that. The Executive working group makes some excellent recommendations, but they are just that. The responsibility for delivering the changes in the way that we deal with this illness, which is not new but has at long last been recognised, will be left with the health boards. However, the money that the health boards receive is already fully committed, so the money for implementing the report's recommendations will need to be found by taking it away from other services that are currently being funded.
No Government in a long time has ever spent enough on public services. We need to tell the people of this country the truth. The basic truth is that we do not spend enough on public services because we do not tax people in this country enough. Any party that goes into the election saying that enough money can be spent on public services to meet public demand while at the same time keeping taxes low is being dishonest. The real test of the forthcoming election is the question where we will get the revenues from to increase the spending on public services. The only real place that we can get it from is taxes. I hope that that is taxes on the rich rather than taxes on the ordinary workers.
We now come to wind-up speeches.
I will start by referring briefly to the main speakers for the four parties.
Quite correctly, Mary Scanlon referred to Arbuthnott. I am gratified that she agreed with me that, despite the best intentions of the Scottish Executive, delivery out there is somewhat patchy. As I mentioned in my intervention, in the Highlands despite the money that is going into the front end, what comes out at the other end varies depending on which part of the Highlands one is in.
Malcolm Chisholm made a robust speech and at one point Nicola Sturgeon said that she was thinking about holding the jackets. He rebutted the accusation that the Scottish Executive is taking a centralising approach and that is amply demonstrated by my own experience. If the Executive were taking a centralising approach, the minister would have been able to do more to help me with my problems with general practitioners packing up in the far north of Scotland.
The minister also made a point about the redesign of services. That has also been demonstrated in my constituency by the approach that has recently been taken to the accident and emergency service that is currently delivered from Thurso. That will lead me on to a point that I want to make at the conclusion of my speech.
The Thurso accident and emergency service has been reinstated. It is GP led, but the important point is that there is a telelink between Thurso and Aberdeen royal infirmary. The link is the first of its type in the Highlands and it means that the far north of Scotland can connect directly with the best consultancy services in places as far away as Aberdeen. That poses a question about structures and the way in which we do things in the future. It is an interesting and profound question, and one to which I will return.
Nicola Sturgeon rightly pointed out that the Conservative idea of partnership is the fig leaf that disguises an obsession with privatisation. Ultimately, that will always be the Achilles' heel of my good friend Mary Scanlon's argument. I am afraid that it will be pointed out more and more. Privatisation is deeply unpopular with the public and the idea will not sell very well.
Margaret "Matron" Smith was characteristically robust in her attitude. I apologise to Ben Wallace for her rather sharp put-down, but she is obviously on good form this morning. She made two points with which I associate myself: first, that the Conservatives acknowledge that more money is going into the NHS; and, secondly, that health promotion—heading off health problems at the pass—is extremely important.
I will turn to my part of the world in the time that I have left. I have talked about the accident and emergency situation being resolved and that is a good-news story. However, my constituency is still left with the GP problem. I cannot think how many times I have outlined that problem to ministers; the minister is only too well aware of it.
Despite what the British Medical Association announced last week, I had GPs leap at me in Thurso and tell me that I do not understand. Things are great for the central belt or for areas of high population, but the delivery of out-of-hours GP cover in the north is questionable. I do not have the detail on that at the moment, but I shall return to the ministers with the issue.
Yesterday, at the Health and Community Care Committee, we heard about the problem with the Office of Fair Trading report and recommendations on pharmacists. If we are not careful, the proposals coming from down south could wreck community pharmacies. Those points have been made to Frank McAveety and I know that he has taken them on board.
However, that leaves me with questions in my mind. Why is it that, despite the best endeavours of the Scottish Executive, we sometimes see problems out in the real world? Sometimes ministers must feel helpless when they compare what they are trying to do with the outcomes.
Although I support the Executive amendment, and in no way question the minister's commitment to improving the health service, I await the publication of the white paper with great interest. I have flagged up some problems with delivery mechanisms and structures. We all wait with great interest to see what emerges tomorrow.
Today we have had the usual story from the Tories. Everything was okay under them and market forces will deliver for the NHS. Of course, no one believes that, particularly not the public. I wonder whether some Tory members really believe it. Will they ever learn? The answer that we have had today is that it does not look like it.
Alex Johnstone made a rather peculiar speech that highlighted the fact that he needs to take the wax out of his ears and do a little more homework before engaging in debates on health. Clearly, he did not hear what Nicola Sturgeon was saying so, for his benefit, I will say it a second time.
The SNP is the only party that is committed to addressing the core problem in the NHS, which is the lack of capacity. That is why we are going to tackle bed and staff shortages by assessing the real level of acute beds that we require. At the moment, we do not know what that is. Clearly, we do not have enough or we would not have the thousands of cancelled operations that we do. We need to know the right level of acute beds for Scotland.
We then need the staff to ensure that those beds can operate. The only way we can do that is by ensuring that nurses and doctors want to come and work in Scotland. The only way we can do that is by giving the Scottish health service a competitive edge. That is why we are committed to an 11 per cent pay rise for nurses. Only then will we be able to tackle the core problems in the NHS.
If we need any evidence of those problems, we should note that we are falling further behind the English health service. Scotland has over 1,400 people waiting more than 15 months for in-patient treatment, whereas England has only 105. Given the difference in population, that is quite a stark figure.
We agree with the member's point about expanding the capacity of the work force, which is precisely what we are doing, including significant increases in nurses' pay under "Agenda for Change".
On the member's second point—and there will be more about that tomorrow—she knows fine well that no one with a guarantee is waiting longer than guaranteed, and she has to accept that sometimes there are very good reasons why someone has a guarantee exception. The tonsillectomies that had to be postponed earlier in the year for medical reasons is a good example. If that is the line that she is going to take on waiting times tomorrow, I thank her for the advance notice of the nonsense that she is going to speak.
We look forward to hearing what the minister has to say tomorrow.
The problem is that it is always jam tomorrow, but the facts speak for themselves. The Executive has failed to address the issue of waiting times over the past four years and it cannot get away from that.
Will the member give way?
No, the member is in her final minute.
It is all very well for the Executive to say that it is trying its best and admitting that there is a problem, but that is not good enough. The Executive has failed. Moving on to the other party of failure, I say that the Liberal Democrats cannot have their cake and eat it. That annoys their coalition partners greatly, as we saw at the weekend. It annoys me greatly as well because, if we were to listen to the Liberal Democrats, we would think that it has nothing to do with them. Mike Rumbles was complaining about the situation in Grampian. Yes, it is terrible that people have to wait for digital hearing aids and dental treatment, but the Liberal Democrats' Executive is running the health service and they are as guilty as their Labour coalition partners.
Will the member take an intervention?
I am in my last minute.
Colin Campbell gave an eloquent example of how the problems that we are talking about today impact on patient care, which is most important. He gave one example out of thousands of someone who has had their operation cancelled time and again. That is the reality of bed and staff shortages.
I will conclude by being magnanimous enough to say that many of the Executive's health policies are well intentioned. However, that is not good enough. Labour's stewardship of the NHS has been a failure and it has failed to use the resources available wisely and effectively. It is time for change. It is time for a new team to lead the NHS and we look forward to starting that on 2 May.
I thank the member for her contribution. If it needs a definition, I would say that it was magnanimity qualified. Perhaps the member should have listened to her colleague Brian Adam when he said that there is no overnight cure for the problems in the NHS. Maybe the SNP members require a briefing session.
The Conservatives have been brave enough—if not a bit foolhardy—to submit that they have a solution to NHS problems. That solution was clearly set out during their 18-year custodianship when they did not deliver on many of the issues highlighted in their motion. The Scottish Executive is trying to pursue many of the issues that the Conservatives have highlighted because we want to put patients first—to use David Davidson's words. If the Tories ever did that, it would be the first time.
I say to Mary Scanlon that the voters will not forget. In the words of Santayana,
"Those who cannot remember the past are condemned to repeat it."
All that Mary Scanlon offers is a future with a return to the key issues that exemplified the Tories' approach to the Scottish health service.
In his opening comments, Malcolm Chisholm was being open and transparent with the Parliament about the challenges that we face.
If we go underneath many of the comments that members have made today, we can see that they recognise that there is a capacity issue in the NHS. That applies to the acute sector, but also concerns how we can improve quality and capacity in the primary care sector. I have listened carefully. Many members from other parts of Scotland recognise that many of the issues are about how to build community capacity within the primary care sector to support the work that is done in hospitals. We recognise that, which is why we have identified a whole series of strategies to increase the number of staff in the NHS. We are increasing the number of doctors and nurses who are in training. We have increased the number of accident and emergency consultants. Over the next five years, we will be putting in £3.2 billion of investment.
There is nothing in the Tory motion, and we heard nothing in their speeches, about exactly what they would spend on the NHS. That glaring omission strikes to the heart of the dishonesty in Mary Scanlon's speech. Nye Bevan once said that the importance of the NHS was that it provided security, but also serenity, for the people of the UK that their health needs will be met. How does that match up with Mary Scanlon's comment that people should repent?
Another biblical phrase is, "You shall know them by what they say." Liam Fox was quoted as saying to a private audience of the Conservative Medical Society in April 2002:
"We've got a problem in this country where the NHS and health care have been synonymous. We're here to break that."
That is the Tories' real intention for the health service. Nothing that Mary Scanlon has said today addresses those points.
As I said, there are more nurses and doctors in the Scottish health service than there were in 1999, and £3.2 billion will be going in over the next five years. We recognise the issue of nurse recruitment, which was touched on by colleagues across the chamber, the SNP and other parties. We want to increase the number of nurses who are training. However, as many members behind me have said, the health service is more than just doctors and nurses, because non-medical staff are an integral part of the health team. That is why we are delighted that the agenda that we are moving forward across the UK, which the trade unions have accepted as part of "Agenda for Change", is about improving pay for staff across the NHS. In some cases, that means a 16 per cent hourly rate increase for ancillary staff.
People have asked what we have been doing. Nothing was mentioned in the Conservative motion about the commitment to partnership. It does not recognise that we brought into public ownership the Golden Jubilee hospital, which will result in 3,000 patients being given support. However, that is only one part of the picture. A selective picture was presented by Mary Scanlon and the Tories, because they want people to have a selective memory of what happened in the past. They hope that as each year advances, people will forget the central problem.
I say to Mary Scanlon that people remember the important issue, from which she has not distanced her party. Will her party reintroduce a two-tier internal market? We have not heard anything on that. I ask her to address the fact that her party does not want to invest in primary care modernisation, to which we have committed. There were other commitments that she did not mention. We have committed to addressing cancer and coronary heart disease deaths in Scotland. Those are central commitments of the Executive.
When the Parliament was set up, the commitment to GP fundholding, financing and incentives was taken away. The Executive promised a joint investment fund, which never existed. GPs never had any access to that fund, so in fact it was the Executive that starved GPs and primary care.
Before the minister replies, I say that I should not have allowed that intervention, because the minister is over time. Please wind up.
The Executive recognises that there are many challenges, but in terms of staff, investment and partnership, we have the right approach. We recognise that there is an issue with bed capacity, which is why we are committed to the delayed discharge strategy, which is resulting in a substantial reduction in the number of blocked beds in our hospitals.
I conclude on this key point: health in isolation is worthy of debate, but health is connected to the many other strategies that the Executive has developed, which include investment in housing, improvements in education, and opportunities into employment. If we get those three right and match them to our health commitments, Scotland will be a better place. The Executive is committed to that.
It is right and proper that, in the closing days of the session, the Scottish Conservatives should choose to debate the health outcomes of the Executive. Over the six years since Labour came to power, and the four years of the Lib Dem pact, not only have we seen billions of pounds of extra money pumped into the system, but we have seen the abandonment of a Conservative ideology on health care in favour of a pre-Thatcherite NHS system.
That has meant not only that the Executive's and new Labour's manifesto rhetoric has been put to the test, but that the public has seen a failure of the service that they were promised. Nothing speaks louder than the endless list of pledges that the Executive has failed to meet, all the way back to 1997. For example, it is now six years since the pledge to abolish mixed-sex wards was made, but it has yet to be honoured. What about the pledge in 1997 to end waiting for cancer surgery? That has not been done. What about the idea of reducing waiting times from 12 to nine months? That has still not been done.
In fact, the Executive's own secret polling during this session found that the public thought that the NHS under the Executive was worse than or the same as it was under us, so the idea that people out there do not believe the Conservatives is wrong. All members have to do is spend time at a hospital to realise that people say, "Well, I can't remember it being as bad as this." Outcomes and patients are what matter.
Will the member give way?
No, I have to sum up.
What do we get for all the billions of pounds? That is important. John McAllion made a point about investment and the need for more money. There is no point in putting money into systems that do not produce results. I will put more money into any health system that produces tangible results. The head of Tony Blair's own delivery unit, Michael Barber, recognised that the NHS is consistently failing to spend the money in the right places.
Janis Hughes made a point about a two-tier health service. Well, we have one and, in fact, it has expanded under the Executive. Postcode prescribing has increased. Let us remember digital hearing aids. More and more people are opting to go private under the Executive's custodianship of the NHS than they ever did under us. There is already a two-tier NHS caused by the Executive's policies.
Nicola Sturgeon attacked the partnership approach. We want partnership to increase capacity. Interestingly enough, she attacks partnership, but it is partnerships with not-for-profit, profit-making, independent and public sector providers that have created better health services across Europe, where they do not have shortages and waiting time problems. The partnership approach should not just be attacked and thrown away.
Nicola Sturgeon's deputy, Shona Robison, went on to talk about how the SNP was the only party that tackled capacity. We talked about partnerships. She went on to say that we are falling behind the English NHS. The English NHS has embraced the partnership approach, which is why its capacity has been increasing.
Frank McAveety used a quote and made the point that Liam Fox wants to destroy the NHS. In fact, Liam Fox was saying that the NHS should not have and does not have a monopoly on providing health care. I stand by that belief, because the Executive's health care monopoly does not work.
Malcolm Chisholm's amendment shows his misunderstanding of the differences in ideology. We believe that the debate is about ideology, because the Griffiths reforms of the 1980s were about that. Those reforms were the only way to drive forward improvements in health care, by empowering the patient, the GP and the primary care staff, not only with choice, but with funds. We will return to that. Only when patients are able to demand services based on information, assisted choice and need will the NHS become as responsive as any other system in Europe. We do not match Germany and France, which we now top in health care funding. In fact, for years—since way before Labour appeared to rewrite history—Scotland's average health spending has been above that in Europe, yet we have worse outcomes. That should not be justification to carry on writing blank cheques.
In Europe, they learn. They treat public, not-for-profit and independent providers of health care the same, and hold them in high esteem, because the issue is where the patient wants to go. Here, such providers are not utilised because of some old socialist dogma that says, "No, you can't go there, because we don't believe that these people should be able to provide."
In fact, Scotland does not have many profit-making hospitals. I inform those who are ignorant that BUPA is a not-for-profit organisation. Perhaps people should remember that when they attack such health care providers.
The minister's amendment reflects such a misunderstanding clearly. His view is that the patient should be directed to the centre, from where the Executive will dictate the services that will be planned for the patient but will not allow the patient to be the centre of service direction, funds and availability. That is a bit like the difference between a planned economy and a market economy. The planned economies collapsed with the Soviet Union, but the market economies are still here.
In the Conservative manifesto, we will propose ideas for empowering the patient. They might solve some of the previous problems of fundholding, which were by-products of fundholding and not problems of the system itself. We will also ensure that funds are used better and are moved round the system to take advantage of more capacity and more partnerships, so that, in the end, the patient directs services. Under the Executive, patients feel excluded and worried that no one listens to them and that they have no power.
What Duncan McNeil said about health board boundaries is true. Fundholding and other matters meant that health board boundaries did not have to be respected, because the patient and the GP could go where they wanted to buy the services that they needed if they were waiting too long. Under the Executive, such people are being prevented from doing that. That is important.
Notwithstanding some initial problems with the waiting times database, Ben Wallace has described the reason for the database. Patients, with the help of their GPs, will have choice—more choice than they had in the internal market, when block contracts did not allow patients such a degree of individual choice.
We should examine that. The Executive arrived, vandalised then abandoned the internal market and told patients to go to services only in their areas and to take the choice that was on offer. After a good few years, the Executive realised that that was not working and that patients felt confused, so it produced another firefighting initiative. Instead, it should have considered how to improve fundholding and get rid of some of the bureaucracy. That is what Labour did in England under Alan Milburn, after the disastrous efforts of Mr Dobson. Labour said, "Okay, sometimes practices are too small to fundhold. Let's empower local health care co-operatives or primary care groups to open and commission more services." However, the Executive spent its billions on vandalising an old system under which outcomes and results were better.
Whatever the Executive says, its figures speak for themselves. People vote for shorter waiting times, shorter waiting lists and the treatment of more people. Six years down the line, after more tax has been collected and more billions have been spent, Labour is still not getting it right. The Executive can pretend that the Tories destroyed the health service in 18 years, but the Tories did not. The fact is that the Executive is not imaginative about health care.
Margaret Smith asked who I am. I am a person who does not believe the spin. I listen to patients. Perhaps she should answer this question: what is the difference between the Liberal Democrats' health policy and the Scottish Executive's health policy? Perhaps the answer would show why the Liberal Democrats did not lodge an amendment of their own.
That concludes the health debate. [Interruption.] Order. I said that the health debate was concluded. Those who want to continue it should do so outside.