National Health Service (Work Force)
The next item of business is a debate on motion S2M-944, in the name of Malcolm Chisholm, on building and supporting the national health service work force, and three amendments to the motion.
The theme of this afternoon is simple: health care staff matter because they make the difference in delivering dedicated care to the people of Scotland day in, day out. I start by thanking all of them and pledging my determination to value, to empower and to support them to an ever-increasing extent.
Yesterday, the latest figures for the health care work force in Scotland showed a net growth in whole-time equivalent staff of 4,310 in the past year, with increases in every NHS board in Scotland. That growth includes 1,003 more qualified nursing and midwifery staff, 428 more allied health professionals and 246 more medical staff. As I said, all those staff are whole-time equivalents.
I thank the minister for giving way so soon. How many of the 1,003 nurses and midwives that he mentioned are midwives?
I accept Carolyn Leckie's point: the vast majority of those 1,003 are nurses. However, we plan to increase the number of midwives. Their number has to some extent been declining because of the declining birth rate.
I want to make a more general point about the figure for nurses and midwives. Although I am never complacent, I have to say that I checked annual increases over the past 20 years and found that last year's increase was the largest during that period. Indeed, it might well be the largest increase since the period before 1984. We should acknowledge that.
Growth will improve further by building on the 27 per cent rise in student nursing numbers since 1999, and through all the initiatives that have been spearheaded by the facing the future nursing and midwifery recruitment and retention group, which I chair as a matter of priority. As part of that approach, opportunities are also being offered to health care support workers to become fully qualified nurses. For example, on Monday, I will meet some health care support workers from Glasgow who have, while still in employment, successfully completed the higher national certificate in health care at Cardonald College, and have now entered the second year of pre-registration nursing at the University of Paisley. That flexible route to registration, in which those people are front runners, has since commenced all over Scotland.
Planning the work force is crucial. We need to deliver the right people with the right skills in the right place at the right time. That means planning the size and shape of Scotland's largest work force for five or 10 and more years hence. We do not have a good track record on work force planning; indeed, it seems to me that it never happened at all in the 1980s and 1990s. As a result, last year we established the national work force committee, supported by a newly established national work force unit in the Health Department, to bring coherence and leadership to work force planning for NHS Scotland. We have also been building work force planning capacity at local and regional levels, appointing regional work force champions and investing in regional work force networks.
I thank the minister for giving way. I certainly agree with what he said about delivering the right people to the right places. However, nearly half of the new posts for the health service are administration posts. Does the minister believe that that is delivering the right people to the right places?
That is nonsense. Is Shona Robison really attacking medical secretaries who support clinical staff, people who look after medical records—who are vital for patient care—and people who service and staff ambulance control rooms, who are certainly vital for patient care? I notice that both the Scottish National Party and the Conservative party are going down that route. I assure members that the number of senior managers in the health service has declined by hundreds since the days of the Conservative Government, when the bureaucracy of the internal market was at its height.
By the end of March, we will have developed our first national work force plan to coincide with the establishment of the new boards throughout Scotland. The plan will provide a comprehensive position statement and scenarios for the future. The new boards, the regional service and the work force planning networks will be able to draw on the national picture—the first national plan—to inform their planning processes in the longer term and, in turn, they will inform further development of the national plan. In addition, we at the centre will be better able to ensure that the supply of staff matches the service's demand for them.
We are also starting to do our work force planning on an integrated care-group basis. The report of the expert group on acute maternity services highlighted the importance of work force planning in the delivery of a high-quality maternity service. To achieve that, a national maternity service work force planning group has been established. The group—chaired by Professor Andrew Calder—will, in line with the expert group's report, oversee the development of a strategic approach to integrated work force planning and service development for maternity services in the NHS in Scotland. I look forward to following the group's progress.
Planning is important, but delivery matters even more.
Will the minister give way?
I will do so in a moment, but I am behind just now.
There is an immediate recruitment and retention challenge for NHS Scotland and we have already made progress in partnership with NHS employers. For example, we have done so under the banner of our facing the future programme for nurses and midwives and, with the input of the NHS centre for change and innovation, we have given new prominence to flexible working. Examples of that include: self-rostering teams in Forth Valley NHS Board; job-share extension of maternity leave in West Lothian; annualised hours in Ayrshire and Arran NHS Board; weekend-only working in Argyll and Clyde NHS Board; and career-break opportunities in Lothian NHS Board. In an increasingly competitive labour market, it is important that NHS employers are at the leading edge in terms of offering flexibility.
Will the minister give way?
The next in line is Jamie Stone, but he will also have to wait.
NHS employers also need to treat staff well. Our staff governance standard, which was launched two years ago, demonstrated our clear commitment that the NHS in Scotland should be an exemplar employer. The standard is unambiguous and reflects our fundamental belief that staff should be well informed, appropriately trained, treated fairly and consistently, involved in decisions that affect them and provided with an improved and safe working environment. Our programme to tackle violence and aggression towards staff is just one tangible expression of the standard. We have funded a range of practical projects, including personal-attack call systems, electronic lock-down areas and barriers in accident and emergency departments. We will not accept violent or aggressive behaviour and are working actively to make NHS Scotland a zero-tolerance zone for such behaviour.
The standard is already a key element of our formal performance assessment of all NHS organisations. We should never forget how significant is the contribution that that assessment makes to putting NHS Scotland employers at the leading edge of human resource practice, which adds practical value to recruitment and retention of staff. However, we do not believe that that is enough. We want to go further by giving staff governance the kind of legal underpinning that is enjoyed by financial and clinical governance. That is why we are including the standard's principles in legislation that will be brought before Parliament. It will be the first legislation of its kind and it will embed staff governance principles as the right way of doing things throughout NHS Scotland.
I thank the minister for the courtesy of putting me first in his queue.
The name Andrew Calder sparked me to get to me feet. I cannot gainsay Professor Calder's professionalism or his commitment to his job. Indeed, he has been very courteous. However, I am interested to know how the minister sees his own powers in terms of intervening in, reviewing and, if necessary, overturning recommendations that are made by the good professor. The minister knows that the issue is close to my heart.
Professor Calder is doing a risk assessment in relation to maternity services in Wick. He will present his report to Highland NHS Board within the next two or three weeks and NHS Highland will come to a view on it. Ministers will make a ruling if proposals for change are brought before us. That is all that I can say about that at present.
As I have mentioned, there is much that we can build on, but the challenges in the future are formidable. The improvements that we are bringing about in work force planning, recruitment and retention, and in making NHS Scotland an exemplar employer, are not in themselves enough. Everyone recognizes that things need to change in order to achieve higher standards of patient care, delivered by the right staff working reasonable hours.
Alongside the initiatives that I have already mentioned, the new contracts for consultants and general practices, together with the pay modernisation proposals under the agenda for change, will be key to enabling the service change that is required. They will provide a platform for new working arrangements, career development and the forging of new roles for all staff groups that work in NHS Scotland, and among independent medical contractors.
We need to change what is done and how it is done: we have relied for too long on overworked doctors in training to deliver care round the clock. Instead, we must look to provide consistently high-quality care through teams of trained staff throughout the day and night. We have to change the relationships between professions as we look more and more to clinical teams and networks of skill to meet the needs of patients safely for 24 hours a day.
Is the minister aware of the staff shortages in Ayrshire and Arran NHS Board, which threaten the future of the two paediatric units in Ayrshire? Will he intervene personally if the board decides—supposedly in the name of delivering a better service for Ayrshire—to close one of the units?
I made clear the general position of ministers with reference to service change in responding to Jamie Stone, but I have followed the development of the situation to which John Scott refers. The main issues that are being flagged up in Ayrshire are to do with clinical safety and the quality of care. I will talk about those matters in the last part of my speech.
The impression is sometimes created that change in the health service is being driven by work force legislation rather than by a fundamental commitment to improving services. I want to put the record straight today by stressing that that cannot be right. I want change to be seen and understood by staff and patients in terms of better services for the future, because that is how I see it. I want to make it clear that, in my book, service reform means ensuring maximum local access to services that is consistent with clinical safety and high-quality care.
Will the minister give way?
I do not have time. I am in my last minute and I must move to my conclusion.
The Executive supports and pays tribute to the staff of NHS Scotland, who make such a difference to the people of Scotland 24 hours a day, 365 days a year. Health care staff matter, and money spent wisely on health care staff is money wisely invested in Scotland's future. No one is pretending that the journey will not be challenging as we move into that future, but I believe firmly that we can, through the policies that we are delivering, meet and overcome those challenges to deliver great benefits for NHS staff and for the people that they serve.
I move,
That the Parliament appreciates the vital contribution of a high quality healthcare system to the lives of everyone in Scotland and to our economy; acknowledges the fundamental importance of the 150,000 staff who help care for patients and pays tribute to their dedication and professionalism; welcomes the recent significant increases in staff numbers across the NHS in Scotland and the action taken to promote more flexible ways of working, create safer workplaces and protect frontline staff, support continuing professional development, and develop new roles and teamworking, but recognises the challenges facing the Scottish Executive in achieving a sustainable healthcare workforce in the long term through local, regional and national service and workforce planning and redesign, against the background of wider demographic and labour market challenges.
It is right that we take the opportunity in such debates to praise the work of the staff in the NHS. I join the Minister for Health and Community Care in doing that: those staff work in difficult circumstances to deliver the best service that they can within the resources that are made available to them.
It would be churlish of me not to welcome the increase in the number of staff in the NHS in Scotland, so I do so unreservedly. However, it is also important that we use such debates as an opportunity for a bit of honesty about the state of the NHS. It is strange that when there is a good news story about the NHS, ministers are always willing to appear in the media and claim credit for it, but when there is bad news either no one is available for comment or—if they are—they blame the health boards for the problem. A little more honesty and a little less spin would be welcome.
Although the minister welcomed the increase in the number of staff in a flurry of excitement, he failed to mention that half the posts are administration jobs. Although I accept that some—perhaps a good many—may be required and desirable, is it not interesting that not one word in the minister's press release is about the fact that some of the posts are for administrative staff? The press release is all about staff on the front line. If it is something to be applauded and welcomed, perhaps he should have mentioned it in his press release.
Shona Robison will have received, as we all have, the MSPs' update from the Scottish NHS Confederation, which makes the good argument that good management techniques are necessary to reduce bureaucracy. The update also says that good managers need to be in place to make the necessary changes. Does Shona Robison agree with the confederation?
I like good management, but I do not think that we necessarily require more managers to have good management. The Minister for Health and Community Care accepted that.
The minister failed to mention the fact that although staff numbers are up, which we welcome, numbers of vacancies are also up. Consultant, nurse and allied health professional vacancies are at an all all-time high and vacant posts are left unfilled for increasingly long periods. Consultant vacancies have increased by 82 per cent since 1999, and 52 per cent of vacancies remain unfilled for more than six months.
The simple reason why that is the case is that the numbers that we and the trusts have decided to employ have increased considerably. The significant fact is that the overall numbers are increasing.
Yes, but we still have vacancies that are causing the contraction of services the length and breadth of Scotland. Before I discuss that further, I want to put the issues in context. The most important point to consider is the impact on patient care. I suspect that we will hear this afternoon what it means for patient care when there are vacancies and their consequent effect on waiting times.
On a number of occasions in the chamber, I have acknowledged the increases in the health budget. The figures are up by 43 per cent since 1999. That is indisputable and it is absolutely right that we should welcome that. However, it is frustrating that, for every £1 million of increase in the health budget since 1999, only five additional staff have been employed in the NHS. No one is going to tell me that each of those people is receiving £200,000 as a salary, so the question has to be this: why is not more of that money reaching the front line? Only the minister can answer that.
Work force problems are, without doubt, the most fundamental issue in the NHS. Shortages are having a profound effect. More staff are required to compensate for the increased pressures on working times. The NHS in Scotland is, for a variety of reasons, failing to attract enough new consultants, nurses or allied health professionals. The pressures are the driving force behind many of the service changes that we see in Scotland. The pattern is familiar: issues relating to clinical governance and safety arise in a locality, often because consultants are not seeing enough patients to keep up their competence and skill levels. Once a question mark hangs over a service, there tends to be a knock-on effect and more staff are lost from the service. Reviews then undermine the stability of the existing work force, which leads to a catch-22 situation in many parts of Scotland.
That was the situation in the Belford hospital in Fort William, where only the force of public opinion—3,000 people turning up for a meeting on a dreich night—led to a pulling back from the proposal to downgrade the hospital. There are also concerns about the possible withdrawal of consultant-led maternity services from the Caithness general hospital in Wick. I know that that issue is dear to the heart of Jamie Stone. Real issues are affecting people throughout Scotland. We have to address those issues.
Not for a minute would I try to play down the importance of clinical governance and safety, nor would I say that services should never change or relocate, because sometimes they should. However, we have to acknowledge the geography of Scotland. If we want to attract people to come and live and work in Scotland, we have to have health services for those people in all our localities. We want people to move to localities such as Wick and Thurso, but people will not do that if they cannot access health services. We have to develop more flexible ways of delivering specialist services. Surely, in this day and age, with modern technology and perhaps with good will, we should use the opportunity that is provided by the new consultant contract to link consultants with others in larger hospitals. Technology can help people to maintain their skills and competence.
It should not always be the case that lack of patient numbers within a particular locality leads automatically to withdrawal of services, but at the moment that is what is happening. That is why the substance of my amendment is that there should be a pause for reflection that would allow us to consider the national picture that we want in Scotland. If one was to start with a blank piece of paper, one would not end up with what we are going to end up with—a fragmented service. We need to take national control of the situation to ensure that we have a truly national health service, regardless of where in Scotland a person happens to live.
I move amendment S2M-944.2, to leave out from "recognises" to end and insert:
"is concerned that consultant, nurse and allied health professional vacancies are at an all-time high and that these healthcare workforce shortages are resulting in the ad-hoc and arbitrary centralisation of services across Scotland without adequate public consultation and often to the detriment of patient care, and therefore urges the Scottish Executive to carry out a national review of service planning and redesign in order to ensure equality of access to acute and primary care services in all parts of Scotland."
Today's debate is very important for the future of our health service. I join the minister in commending all the people who work in the health service for their integrity and hard work. My amendment notes the increases in staffing in the NHS that the minister has talked about, but many of the figures that are used are simply head-count figures and some are not linked to full-time equivalents. If that were done, it would make the picture a bit more realistic. At some stage, the minister might be able to give us some of the statistics in full-time equivalent terms.
If David Davidson had listened to my speech, he would know that every figure that I gave in my speech was a full-time equivalent figure.
I thank the minister for that, although such figures were not in his release yesterday.
That said, I agree strongly with some of the points about work force planning that are made regularly in Parliament; we must have work force planning. It should be mentioned that, in Conservative Government days, work force planning was done locally rather than nationally—a point to which I will return later.
We want all front-line staff in the NHS—not just emergency staff—to work in a safe environment. The minister will have to pay some attention to the security aspects of many of the buildings in which such staff work and in which patients are treated.
Money is not the sole cause of the problem. The issue is about having enough bodies on the ground and putting patients at the centre of the NHS: the essence is that services should be focused on them. To do that, we need capacity but, to be quite frank, we simply do not have the bodies. The minister is right to say that posts are being created; I hope that they are being not only funded but filled. We need to look in that direction. It is frightening to contemplate the fact that more and more staff, including nurses, will want to retire in the next 20 years.
This week, comments have been made about medical equipment not being up to scratch—those were the Auditor General's comments, not mine. The people on the ground want to know that they are working in an environment that gives them full professional freedom and ensures the safety of the people whom they treat.
Will the member give way?
In a moment. The general medical services contract and out-of-hours services were debated fully in yesterday's members' business debate, which Alasdair Morgan secured. As I said then, the issue is not just money; it is about getting the right people to go to the right places. The minister and I agree on that.
The minister may recall that on the Health Committee's away day we discussed the fact that flexibility in the work force was not simply a question of who should do something, but who could do something. If members could agree on that, much greater flexibility in the work force could be achieved, but that will have to be backed up by better access to continuing professional development during working hours, not just in people's own time, which will be an expensive drain on people's ability to deliver services.
I am afraid that the European working time directive seemed to catch the Executive unawares, even though we have known about it for eight years. It has not been correctly allowed for and, if we are to do anything to resolve the shortage of doctors in Scotland, we must produce more of them. The issue of whether we need another medical school is worthy of debate. We would have to staff such a school and, if the additional top-up fees come into play in England, that will have a detrimental effect on our ability to attract people to teach young doctors in Scotland. A shortage of consultants would mean that many would-be consultants would have no one to train them. That is another problem.
We must free up the hospital system and move it away from central management control so that hospitals can set their own conditions and go into the marketplace to attract people from the rest of the United Kingdom or encourage new graduates to stay and work here in Scotland. That is one of our major problems.
Over the past few weeks, the minister has talked about other professionals working in the health service in ways that they have not previously. I assumed that the pharmacy contract would have been in place before we dealt with the National Health Service Reform (Scotland) Bill because it contains an aspect of care.
We are not talking only about doctors and nurses. What about the physiotherapists and the other professionals whom people need to be able to access? The truth is that we are going to have a work force problem in pharmacy. If we are to take on some of the roles that the profession would like to take on, there will be a need for another pharmacy school to replace the one that was closed at Heriot-Watt University. I suspect that such a school would come to Edinburgh because of the existing excellent schools in Glasgow and Aberdeen.
No one seems able to get access to dentists. I am pleased that we are moving ahead with the outreach centre in Aberdeen, but it remains to be seen how good that will be; the problem is in attracting people by providing the right environment for them to work in.
Many administration staff seem to be involved in central bureaucracy rather than working at local level. If we could reduce much of the centralisation in the health service and allow hospitals to opt for trust and foundation status, it would give them time to get on with their local work. I do not dispute the fact that they would need high-quality managers, but we do not need more paperwork shoved down into the system from the centre. We have to ensure that we are trying to deliver the best possible and widest range of care that is accessible to everybody in Scotland.
I move amendment S2M-944.3, to leave out from "welcomes" to end and insert:
"notes the recent increases in staff numbers across the NHS in Scotland and the need to promote more flexible ways of working, create safer workplaces and give greater protection for all frontline staff; seeks improvement in support for continuing professional development and in developing new roles and teamworking, but recognises the challenges facing the Scottish Executive in achieving a sustainable healthcare workforce in the long-term through local, regional and national service and workforce planning and redesign, against the background of wider demographic and labour market challenges, while recognising that over-centralisation of services and critical GP and consultant shortages in some board areas is leading to reduced patient access to health care."
I place on record my absolute and undying admiration for NHS staff and the work that they do above and beyond the call of duty. Working as a midwife in the NHS was and still is the hardest job that I have ever done. I welcome the SNP and Tory amendments that deal with issues of centralisation and the impact of the reduced hours of consultants and doctors on services and care. The horrendous ratio of general practitioners to patients that is proposed for out-of-hours care in Lanarkshire—where one GP will cover home visits for 115,000 people—illustrates that point ably.
I am sorry that David Davidson did not take my intervention. I was going to ask him whether he agreed with the British Medical Association, which puts the blame for the structural staff shortages that we have today fairly and squarely on the fact that trusts took decisions to employ far fewer staff than were needed because of the financial pressures on them. It is a bit rich to suggest that we go back to the dark days when trusts were introduced and given local autonomy on staffing levels. The gap between the number of NHS staff in place and the number needed widened during the Tory years and that led directly to the structural staffing problems that we face today.
However, since Labour came to power, despite starting to address work force planning, it has failed to plan resources effectively to cope with the impact of the European working time directive and demographic change in the population and work force. The convergence of reforms and changes to contracts, the working time directive, an increase in specialisms and the crisis in recruitment and retention all at the same time, leave the NHS poorly equipped to meet the health needs of the Scottish population, never mind reduce the need for health care of that population.
I will concentrate on specific points that are referred to in our amendment. The money diverted to profits via private finance initiatives and public-private partnerships would be better spent in support of the development and expansion of the NHS work force. That would also ensure that all NHS staff would be entitled to the same pensions and benefits.
The situation in maternity care and midwifery illustrates the abominable lack of appropriate planning of staffing according to care needs and changes to practice. In one year there has been a 16 per cent reduction in the number of registered midwives and a reduction in the number of student midwives. As I have already communicated to the minister, there are massive differences in staffing levels across the country depending on where birth rate plus, a staffing tool, has been introduced. In one area, where birth rate plus has been introduced, there are five midwives to 20 patients. In other areas, given all the historical problems that we have had, there are only two midwives to 20 patients.
That gives me an opportunity to say that, as part of the facing the future work, we have undertaken a very big work-load project. The report on that, which will come out soon, commends birth rate plus. We are very keen to address the disparities between different staffing levels.
I am very glad to hear that. That clearly has implications for the resources that will be needed to meet the extra vacancies that will arise as a result of birth rate plus being rolled out.
Work load is a serious issue, as has been highlighted by the Royal College of Midwives and the Royal College of Nursing. If the Executive seriously wants to put commitment behind aspirational policies and health promotions supporting breastfeeding and so on, I would point out that we are even shorter of midwives than the number of authorised vacancies would suggest. With little time, midwives naturally prioritise according to clinical need, putting that above psychological or social care. That is the picture across the whole NHS where such prioritisation has to occur. The current statistics only scratch the surface. A quantification of the reduction in work loads and the increase in the number of staff required is urgently needed. I support the RCN and RCM in their aims in this area.
I make no apology for turning to the question of pay. Agenda for change is not the panacea that it has been claimed to be. While consultant pay has risen by between 25 per cent and 30 per cent, up to 30 per cent of staff could lose money under agenda for change, according to Unison. Some could lose a dramatic amount of money, going down from £40,000 to £22,000 a year, with only one year of protection. That is a massive erosion of the current protection arrangements.
Shift working will attract fewer enhancements and, with family-friendly policies having no real meat across the board, shift work will be even less attractive than before. The minister himself earns 10 times more than hospital cleaners or catering workers, the majority of whom are women. Eighty per cent of administrative and clerical staff earn less than £260 a week, and 85 per cent of them are women. Incidentally, receptionists, medical secretaries and ward clerks would be insulted to hear that they are not front-line NHS staff. Chefs—mostly women—earn £5.34 an hour, while plumbers earn £8.83. Out of 360 cooks, 254 are women. There are 139 plumbers in Scotland. Guess what—none of them are women. As for closing the gap, we have not even seen a shortening of it. Agenda for change was meant to reduce historical pay inequality among health workers but, under current job profiles, it fails miserably. The Executive could address the shortcomings of agenda for change by establishing Scottish bargaining machinery.
As I said earlier, the hardest work that I have ever done in my life was in the NHS. It is time to stop making mugs of NHS workers. We need to end the shame of poverty pay in the NHS. We need to stop the private finance initiative and public-private partnerships. We need to reduce the work load and radically increase investment in pay and careers. We need real as opposed to token family-friendly policies. That is the only investment that will work.
I move amendment S2M-944.3, to leave out from "recent" to end and insert:
"moderate increases in staff numbers in some staff and professional groups but regrets the lack of resources and effective planning devoted to the NHS workforce by successive governments, in particular the failure to plan effectively to ensure that enough NHS professionals were trained and employed to meet the needs and changing demography of the Scottish population, the requirements of the working time directive, the New Deal for Junior Doctors, the new consultant and GP contracts or the increasing demands for staff in specialisms; further regrets the continuance of the two tier workforce through PFI/PPP and the unacceptably wide gaps in pay and pay settlements between NHS workers; believes that our health service in Scotland will only be able to properly meet the needs and aspirations of the people of Scotland by stopping all PFI/PPP projects, making substantially greater investment in training, professional development, recruitment and retention, eradicating poverty pay and gender discrimination in pay, rewarding all NHS staff equally, proportionately and appropriately and by reducing the unacceptably high workload pressures on NHS staff."
I am delighted to support the motion this afternoon. I echo the statements that members have already made on the excellent work that our hard-working NHS staff carry out. Through dealings with constituents, I know that the general public appreciate the service that NHS staff provide, and the motion pays tribute to that. The Scottish Executive has a duty to ensure that the right conditions are in place not only to allow that good work to be continued but to attract new or returning staff to the NHS.
There are a huge number of different elements to the NHS work force. It will probably not come as a surprise to many members that I will concentrate my comments on one particular field: the NHS dental work force. I make no apologies for that. The recent stampede to register at a new NHS dental surgery in Stonehaven was well publicised, and it came as little surprise when it was revealed that Aberdeenshire has the lowest number of dentists per head of population in the country, with just 24 for every 100,000 people, compared with the Scottish average of 40.
Dentistry is certainly one area in which NHS workers do not feel greatly valued and, as a result, many dentists no longer carry out NHS work. That has made it impossible for many people to access an NHS dentist, particularly in rural Scotland. The general shortage of NHS and private dentists and dental staff is a factor and there can be little doubt that too few dentists have been trained since the Conservative Government closed the Edinburgh dental school.
Does the member agree that, of the 14 objectives for health in the Executive's draft budget document, none relates to dental services or dental health?
I am surprised by Stewart Stevenson's intervention. I thought that he would at least recognise the tremendous work that is being done by the Executive to change the situation. I will come to what is being done in a moment.
The commitment in the partnership agreement to establishing a dental outreach training centre in Aberdeen is currently being taken forward by NHS Grampian and there is also a commitment for the Executive to consult on the need for a full dental school. I am delighted that even the Conservatives have recognised the error of their ways on the issue.
Mary Scanlon said in the chamber in September 2002 that a new dental school
"simply would not be possible".—[Official Report, 5 September 2002; c 13517.]
However, I was pleased that David Davidson was quoted in the press just two weeks ago as saying:
"Scotland definitely needs a new dental school."
I remind Mike Rumbles that I said what I did in the context of advice from a professor at the faculty of dentistry in Dundee, who simply said that there are not enough dental specialists to start another dental school in Scotland. I also remind Mike Rumbles that an outreach centre is not a dental school.
I notice that Mary Scanlon has not refuted anything that I said up to that point. There has been a conversion in the Conservative party. I welcome the fact that the Conservatives realise that, as they say, there is more joy in heaven—however, I will not continue that line of thought.
Go on.
No—it is too tempting.
There is evidence that dentists are more likely to practise where they study. Recent figures that show that Aberdeenshire has the lowest number of dentists seem to confirm that. Glasgow and Dundee—which are the locations of Scotland's two dental schools—have two of the highest numbers of dentists per head of population.
We must ensure not only that new dentists are trained but that those who are currently working in the NHS are looked after.
Will the member taken an intervention?
I am afraid that I do not have enough time.
The current consultation on modernising NHS dentistry is a once-in-a-lifetime opportunity to get the issue right and to ensure that dentists are properly remunerated and encouraged to stay in—and indeed return to—the NHS. I am convinced that Tom McCabe, who is the minister with responsibility for the dental service, is personally committed to such real and radical change to ensure that everyone in Scotland has access to an NHS dentist.
The commitment in the partnership agreement to deliver free dental checks for all is part of an overall move to preventive medicine, which the Liberal Democrats feel strongly about. With Executive ministers taking a proactive rather than a reactive approach to health care, I hope that we can ensure that, instead of a national sickness service, we can truly claim to have a national health service. Building and supporting our work force is the key factor in achieving that objective, as the work force is the most important resource that we have. I urge members to support the motion.
I welcome today's debate and congratulate the Executive on bringing it to the chamber.
Staff are the cornerstone of the NHS. By far the biggest part of the NHS budget goes on staff. Without the 150,000 people who care for patients 24 hours a day, 365 days a year, the health service could not exist. We must therefore be serious about supporting those who deliver care.
I would like to focus on a couple of ways in which we can improve the support that is currently offered to staff. First, we must tackle problems of recruitment and retention of all health care staff. We can ensure that the NHS is seen as a desirable place to work only by providing health care staff with quality working environments and working conditions.
To be fair, I think that progress has been made. There have been eight new hospital developments since 1999, which have greatly improved the facilities in which staff are expected to work. Anyone who has worked in some of the dilapidated Victorian hospitals in Scotland, as I have, will tell you what a difference the new facilities make.
The minister highlighted the importance of staffing issues by indicating his intention to amend the National Health Service Reform (Scotland) Bill to include staff governance, in a move that unions and other staff representatives welcomed.
The figures are positive. This week, we heard that the latest figures show a net growth in the health care work force in Scotland of 5,059 in the past year. However, the simple fact remains that some NHS trusts face the prospect of 60 per cent of their staff retiring within the next 15 years.
We need to make the NHS more appealing and family friendly. Historically, people who worked for the NHS—nurses in particular but also other health care staff—worked night shifts or day shifts, but the more modern approach has been a system of internal rotation, so that everyone works their share of nights and days. Although that approach has many benefits, not least for work force planning and career development, it does not always represent a family-friendly policy that suits everyone's circumstances. Twelve-hour shifts can be beneficial for many reasons, but they are not necessarily suitable for everyone. We must ensure that trusts look imaginatively and reasonably at the needs of individuals when working practices are considered.
In line with the First Minister's statement yesterday, we should encourage fresh talent from abroad to work in the NHS. However, it is imperative that such workers should be treated in the same way as other staff. It is important that we ensure that concerns about the possible exploitation of international staff are seriously addressed.
We must also address the shortage of doctors. Some 90 per cent of pre-registration house officers who graduated in Scotland work in Scotland, but the figure falls to 45 per cent in the case of specialist registrars. We need to make the health service in Scotland an attractive proposition for all staff and encourage those who graduate in Scotland to stay here. In that context, I am pleased to hear that the current system whereby students from the University of St Andrews spend their pre-registration year in English hospitals will soon end. History suggests that students who start work in Scotland are much more likely to remain here and it is important that we do everything that we can to help that happen.
On nursing shortages, I have advocated in the chamber in the past—and I will continue to advocate—a non-academic route into nursing. By offering only an academic route, we completely disfranchise a significant number of people who would make excellent nurses but who are unable or unwilling to pursue the solely academic route. Again, I urge the minister to consider offering a more vocational approach, to encourage more people into the profession.
We must also consider regional planning. The Executive motion mentions the challenges that are faced in
"local, regional and national service and workforce planning and redesign".
It is crucial that we rise to those challenges. I am sure that all members are aware of the recent experiences in Greater Glasgow and Argyll and Clyde NHS boards in relation to maternity services planning. The lack of strategic regional planning has meant that individual health boards have developed their own maternity services strategies. There needs to be greater integration between health boards. Although the boards say that they have regular discussions with neighbouring boards, I believe that that should happen on a much more formal basis and that significantly greater emphasis should be placed on regional planning. The minister must take that on board as he considers the guidelines for consultation.
The current uncertainty about the future of maternity services and acute services is worrying for staff. I have spoken about this before, but it is desperately difficult to attract staff to hospitals that are earmarked for closure. The uncertainty can only add to recruitment and retention problems.
Before I close, I raise the issue of agenda for change, as Carolyn Leckie did. The minister is no doubt aware of Unison's concern that the programme could lead to a reduction in salaries for up to 30 per cent of staff. I hope that the minister will address that in his closing speech. The reduction of remuneration is clearly no way to tackle recruitment and retention problems in Scotland.
The Executive is to be commended for its work in building and supporting the NHS work force. This week's statistics are a testament to that good work. Despite the fact that work remains to be done, I support the motion.
Although, because the figures state that it is the case, all of us must acknowledge that there has been an increase in staffing, the increase is simply inadequate. I refer to a parliamentary answer that I was given some time ago on the subject of consultant radiologists in which I was told that in September 2002 there were 25 consultant radiologist vacancies. Given that it takes 12 years to become a radiologist and that radiologists are at the front line of the detection of terminal illnesses and severe diseases, the impact on waiting times for individual patients is crucial and can often be fatal.
Further to that, when I was thinking about what I would say in the debate today, I decided that I would not look at statistics, which we do all the time. Knowing that all our filing cabinets are full of our case loads, I decided that I would refer to some of the problems that the Executive's national health service causes to individuals.
The first case is based on a parliamentary question. I asked
"what the waiting times have been from detection of cancerous cells by smear test to colposcopy in each year since 1999-2000, broken down by NHS health board area."
Of course, the minister's answer was that the information is "not collected centrally".
I was also told that NHS Quality Improvement Scotland, which reports on cervical screening, has a minimum criterion that
"90% of all referrals for an abnormal smear should be given an appointment within 40 working days and 90% of referrals with a moderate or severe abnormal smear within 20 working days".—[Official Report, Written Answers, 16 December 2003; S2W-4707]
That ain't happening out there in the field. A letter that I received said:
"I would like to draw to your attention the fact that despite me having cancer detected on my smear I had to wait 4 months for colposcopy at the hospital. I was originally told two weeks by my GP but this turned into one month, then two months then 4 months. Various excuses were made from staff shortages to holidays to consultants going on conferences … The wait for the clinic knowing that the cancer was growing was horrible and I don't know how I would have survived without the support of my husband and friends."
That case is not special to my filing cabinet; all of us have cases like that.
If the member has information of that sort, I suggest that the most appropriate way to deal with it is to forward it to ministers so that we can examine the circumstances. That would allow us to return an adequate response to the member.
I did so: I wrote to the minister and submitted supplementary questions, but am left with the information in the parliamentary answer.
The second case is that of a gentleman, Mr L, who suffers from a trapped nerve in his back that has escalated in severity. Mr L is registered blind. His consultant referred him to the Western general hospital with the recommendation that he be treated as a priority, but Mr L was told that he would have to wait for 65 weeks. Mr L's dog has been taken from him as he is no longer ambulatory. He is on a major cocktail of drugs, which he was supposed to be on for six weeks only but, as he cannot see a consultant, he will have to continue to take.
The list goes on. I have a case of a gentleman who was suffering from severe depression. Although he was suicidal, people cannot see a psychologist on an emergency basis in Scotland; they have to see a psychiatrist. The gentleman's psychologist had to engineer a case meeting with the psychiatrist so that the case could be treated as an emergency. The gentleman in question did not want drugs; he wanted to work his way through the problem.
It is all very well to give us the figures, but those are the issues out there for real people in Scotland. Every member in the chamber has cases like those. Although individuals should not have to come to MSPs to get pushed up the queue, it works. If we send out a letter with the Scottish Parliament heading on it, people will get moved up the queue. What about all the other people out there who are not moved up our lengthening queues?
I am glad that the Health Committee is to look into the subject. We decided to hold our own inquiry into the recruitment and retention of staff in the NHS. There is a crisis out there and all of us know that it simply will not do to paper over the cracks. The committee will hold a civic participation event after which we will inform our inquiry and then take a year to carry it out. If the Executive cannot do that, I hope that the committee can.
Sometimes I feel a bit sorry for Scottish Executive ministers, given the frequency with which I get to my feet and go on about maternity services in Caithness.
It was no accident that I pushed the First Minister to encourage new talent to come to Scotland yesterday. I see that as being one of the possible solutions. I would like to talk about the package that supports those people. I know that that is something that very much interests Mary Scanlon, although she is not with us at the moment. When we had a vacancy for a GP in Helmsdale in east Sutherland in my constituency, it became evident that what was on offer in terms of living in a beautiful part of the Highlands was not flagged up in the advertisement for the vacancy, as I am sure Eleanor Scott will recall. I think that we have probably learned from that.
During the past few days, I have learned of the resignation of the third consultant form the Caithness general hospital maternity service in Wick. The reason, in as much as one can trust what the newspapers say, is that the support, the working conditions and the back-up were not good enough. That is why that person has gone. Now we are down to locums. Tom McCabe and Malcolm Chisholm have heard me make this point before, and I am sorry to be boring about it by going on and on, but we need to think outside the box, so in the time available to me, which is not much, I would like to make a few points.
The Belford hospital in Fort William has a consultant called David Sedgewick, who was at the University of St Andrews with me. He has made the interesting point to me that his work is not just about delivering babies and that he does other work in the hospital, such as small ops or getting rid of a lump. He rejoices in that and says that it is a great strength and a great advantage, which actually makes the work better. He is multiskilling and there is something that we can learn from that. It is interesting that what is being said in Fort William about the Belford is that that is a positive approach.
The point about rotation is also important. It may or may not be the case—I speak with parliamentary privilege, but I must be careful nevertheless—that the third consultant left Caithness general hospital because of a feeling of isolation. In other words, contact with Raigmore and other parts of the NHS was perhaps not as good as it could have been. We should think about rotating consultants, so that they work for a few weeks or a few months in one place. Behind that, there should always be peer support and communication.
The minister will be aware of an example about which I was exercised about a year ago. The proposal for accident and emergency services in Thurso was that GPs should come out and that the service would go. In fact, a constructive solution emerged, and I salute NHS Highland for that. It is based on the Aberdeen royal infirmary model. A new service was put together using information and videoconferencing that involves peer support and a GP in Thurso being able to link up on screen with a professional in Aberdeen. In some ways, we could build on that for the future of maternity services and also when it comes to doctors and dentists.
It is an old point, but we cannot take away the distance or the remoteness. It is not really a case of me saying one thing and Mr Rumbles's good friend Tom McCabe saying something different. In fact, I think that there is a way in which we can solve the problem by being imaginative. I wait with interest to see what will come out of—
Will Mr Stone accept an intervention?
I am in the final seconds of my speech. This is not Stewart Stevenson's starter for 10, although it will be shortly.
For heaven's sake, let us think outside the box on this matter. That is my one plea.
The good will of NHS staff in every aspect of the service has cemented the NHS together and in that respect the situation is no different today from what it was when I started out 35 years or so ago. We can talk about work loads and wages, but the most important thing in the health service is probably morale, which is currently at its lowest ebb. What boosts morale is the fact that one can do one's job, having been trained to a high standard as a doctor, a nurse or even a typist. If people cannot do their job within the service, they almost feel like giving up. I have seen typists almost in tears with the amount of work that they have had to cope with, but there was never any chance of getting another typist. Good will is important.
Uncertainty pulls down morale. There have never been as many changes in the health service as there have been in the past 10 to 15 years and I think that everyone in the chamber agrees that the changes that are about to happen are the biggest since 1948. In some areas, such as Glasgow, many major changes are about to take place. Management is important in that respect, although I notice that the NHS Confederation in Scotland seemed to imply that good management is obvious because the lack of it—in accident and emergency services in some areas, for example—hits the headlines.
I cannot understand why we cannot get things right. People are still waiting for four to eight hours in casualty for treatment. We cannot knock down hospitals. People are not out there fighting for bricks and mortar. They want a better service. They appreciate the work that NHS staff do for them, but it is not fair for NHS staff to have to treat people on trolleys—we need to find beds. If it is the case, as I fear it might be, that there is an accelerated closure of Stobhill hospital and perhaps the Victoria in Glasgow, we will be down by 400 beds and we have not yet built the new bed unit. Good management can make an important contribution to improving morale.
Members have mentioned flexibility. We need to have flexibility and we need to get rid of the agency nurses, given all the money that they are paid. It is a shame that nurses have to work for an agency to get a higher salary, but who can blame them? Who blames the people who go to work for NHS 24? The service is well run and I commend it—I have been back to have another look at it and I hope that it succeeds, because now that it is here to stay, it must work. NHS 24 cares for its staff; it is sad to hear a person who has worked in the NHS for 21 years say that they have never been valued before but that they feel valued in NHS 24.
I would like a bit more transparency. Nurses tell their line managers that there are not enough nurses. They should not have to cobble things together and plead for more staff—there should be more staff. It is not safe for the nurses if there are too few of them and it is not safe for patients in wards if there are not enough nurses to supervise.
The BMA and the Royal College of Nursing made an important point about retaining the services of staff who are about to retire. We are reaching the stage where we do not have enough staff despite the increases. It is exceedingly important for us to retain the services of people who work in the NHS and to give them a little more time. Please let us have more transparency. We have a big problem and we should work together across parties to help to solve it.
It is always a delight to speak in a debate with Mike Rumbles. Every time I hear him, I thank the Lord that I am a Highlands and Islands MSP and can work happily with Jamie Stone and John Farquhar Munro. Mike Rumbles's inability to listen makes him a prime candidate for being the person who can cause a rammy in an empty house. I agree with Carolyn Leckie: the hardest work that I, too, ever did was in a maternity unit. I think that that would apply to many women throughout Scotland.
For many years, we have seen the expansion and upgrading of hospitals, mainly in the acute sector, as Labour followed through the Tory plans. We have also seen growth in health staff numbers, more training opportunities and greater accessibility to health care provision. The hospice movement has expanded, as has the provision of voluntary sector care, community psychiatric nurses and family doctors, who are undoubtedly the backbone of our health service, with 90 per cent of patient contact. I name those as some of the growth factors in health care only to set the scene for the recent decline.
As a Highlands and Islands MSP and Health and Community Care Committee member for four years, I know that acute hospitals are now struggling to overcome financial deficits by cutting back where possible and that there are queues when a dentist mentions the NHS. Orkney NHS Board is cutting the number of patients being sent to Aberdeen for treatment; Western Isles NHS Board faces a £600,000 overspend and is cutting its services; Caithness general hospital in Wick is cutting its maternity service; and Oban and Fort William hospitals face downgrading or merging. Bedblocking is rife because councils say that they have no money for residential and home care—I accept Tom McCabe's point about that. Low-priority chiropody patients' treatment has been cut drastically. I have a huge case load about that. That cut has made some people housebound. Others have had the offer of having their toenails removed so that the waiting list can be cut. Those are only some factual examples of the crisis that faces the NHS in Highland. When they are put together with the report of people in Wick pulling out their own teeth, we can hardly honestly commend the Liberal-Labour coalition for its support for and management of our health service.
Against that background, I remind the minister of his statement that
"If it can be done in primary care, it should be done in primary care."—[Official Report, 25 April 2002; c 11239.]
I ask him to consider the health care model in Nairn, which Dr Alastair Noble has pioneered. I believe that the example is well known to him. Under that model, local services, including the council social work department, work together. That has reduced the number of hospital admissions enormously, particularly for mental health care. We always say that best practice is out there but that it is not rolled out. That model is a good example of that.
I assure Mary Scanlon that we are promoting that model of care through community health partnerships, which we will discuss in relation to the National Health Service Reform (Scotland) Bill next week.
I would be delighted if the minister could tell me where else the Nairn model exists. Moreover, will he take account of the potential of our community hospitals in rural areas for the new out-of-hours service and for local health care?
Too often, we talk about the health service as if it involved only doctors and nurses. I commend the BMA and the RCN for the job that they do in representing their members, but some of the most critical shortages—Shona Robison mentioned them—are of chiropodists, radiographers, physiotherapists, speech therapists, dieticians and others. The input of the professions that are allied to medicine can add much to quality health care. I hope that the minister will examine seriously with his Westminster counterparts the pay scales and conditions for those professions in relation to those of other health care staff. It should not always be those who shout loudest who have the most attention. The professions that I have mentioned are a bit of a cinderella service.
I hope that a mechanism and time can be found in the Parliament—through the committees or otherwise—to undertake post-legislative scrutiny regularly and to monitor the implementation of, for example, the Community Care and Health (Scotland) Act 2002 and, in time, the Mental Health (Care and Treatment) (Scotland) Act 2003. That is crucial, as we are passing legislation in the knowledge that staff shortages exist and that we will create greater staff shortages. When the Parliament discussed the Mental Health (Care and Treatment) (Scotland) Bill, it was stated that Scotland had 29 vacancies for psychiatrists. The bill required an additional 28 psychiatrists. I do not suggest that the bill should not have been passed, but I ask the minister where the 57 psychiatrists are to come from.
A high-quality health care system depends greatly on staff, but we also need premises such as day centres, respite care establishments, drug and alcohol detox and rehabilitation facilities, medium-secure units and supported housing.
We must engage more fully with the complementary medicine sector. In 1996, the Conservatives produced a paper that set out a protocol for fundholding GPs to refer patients to that sector. I would like the Executive to make a similar commitment on alternative medicine.
I am grateful for the opportunity to speak in the debate; I thought at lunch time that I had lost my chance. I support the motion in Malcolm Chisholm's name, as it recognises the challenge that faces the Executive and the national health service and the need for more flexible ways of working. The minister is right that staffing issues—how professionals are recruited, trained and retrained and how they deliver their services—are at the heart of the major issues in today's NHS. Indeed, they are the key to cracking perhaps the biggest challenge—the relentless march towards centralisation.
As we know, throughout the country staffing problems are causing or being used as an excuse for the centralisation of acute services, sparking outrage in local communities. With the agreement on junior doctors' hours, which is now legally enforceable, the implementation later this year of the European working time directive, the impending fallout from the new GP contract and the new, expensive consultant contract, things may get worse before they can get better.
Following the summer of centralisation, the Health Committee agreed to hold a major inquiry into NHS staffing and training, the details of which are being drawn up. I am glad that the Executive now realises that the issue is sufficiently important to warrant a debate in the chamber. However, I am concerned that the talk of building and supporting the NHS work force is code for trying to deliver patient-centred services by giving professional staff whatever they want—in other words, acceding to professionals' demands at the expense of the community's expectations.
No right-thinking person would want to be treated by a tired, badly trained doctor, but that is not the same as saying that the interests of professionals and the interests of patients are always one and the same. Some might go so far as to say that on occasion they are mutually exclusive. For example, our communities want accessible health services in which they feel they have a stake. Our consultants want to work in massive teaching hospitals that reflect their specialist interests and they want to reduce their weekend working. Our communities think that they elect us to run the health service. The royal colleges, with their grip on work force planning, know that they run it. Of course, the issue of who runs the NHS is not a new one. Bevan famously said that he had to stuff the consultants' mouths with gold to get them into the NHS in the first place.
That takes us neatly to the issue of the new consultant contract. We increased top consultants' pay from £70,000 to £80,000 a year in return for greater flexibility. Under the terms of the GP contract, which was debated in the chamber last night, we will again hand over money up front without guarantees of reform. Questions remain. How much has it cost and will it cost? What benefits are guaranteed for patients and when will they be delivered? I hope that we have not paid for a pig in a poke.
We must ensure that we get value for the public purse in courage, innovation and change and that we challenge the vested interests that would prevent change. Until we tackle the reform issue, debates such as this about raw numbers will be fairly academic. It does not matter how much more money we stuff in or how many more people we employ—if we employ them in the same way, there will not be much change. If professionals do not work flexibly and we do not consider upskilling nurses or improving training, we will not reap any benefits. The vast majority of NHS staff want to deliver a first-class service for patients, to maximise their skills and to develop their careers. However, vested interests are putting barriers in their way. If we want to maximise the potential of NHS staff and to deliver the consequential improvements in patient care, those barriers must be brought down wherever they are found.
As I have only two or three minutes to speak, I want to introduce one or two fresh angles to the debate. We all support attempts to build and support the NHS work force, because if the system is better for staff and the NHS it will be better for patients. However, we must give NHS staff the right tools to use in our hospitals, the right skills and the right working conditions.
I reiterate a point that I have made in the chamber on numerous occasions since 2000. We must bring the medical equipment in our hospitals up to standard. I was not at all surprised when today Audit Scotland released a report, which was publicised yesterday, indicating that 25 per cent of equipment in our hospitals is beyond its standard life and 37 per cent has no value in hospitals' accounts because it is so old and out of date.
I have lodged written questions and asked oral questions on the matter and I have raised the issue in several debates about health. More than three and a half years ago, I lodged a motion, which received support from many of the parties in the chamber. At that time, ministers told me that they had not considered the issue, that they did not have any information on it and, specifically, that they had not investigated the impact on patient care of using old and outmoded medical equipment in our hospitals. I ask the minister to address that extremely important issue today.
We have to make sure that our NHS staff are properly trained in the use of that—preferably more up-to-date and modern—medical equipment. One of the difficulties facing our staff, particularly nurses, is that, although there are more demands on their skills, their skills are not necessarily being upgraded so that they can do their jobs properly. The new GP contracts that allow GPs to opt out of out-of-hours cover mean that nurses in the hospitals will have to pick up more of the work. We have to make sure that they get the training that they need to do that work, which will put new demands on them.
An example of that was brought to my attention this morning by people working in the NHS. Syringe drivers, or infusion devices, are syringes that inject drugs into a patient over a period of time. They are not standardised between hospitals; indeed, sometimes they are not standardised between wards in the same hospital. Nurses and other staff get no training in how to use the different bits of equipment. A nurse could change ward and suddenly find different dials, or whatever, on medical equipment that they have not been trained to use properly. If we do not give the staff the right training or the right equipment, mistakes will be made in the health service.
In 2000, the Department of Health in England published a profound document—"An organisation with a memory". Unfortunately, there is no Scottish equivalent. The document states:
"the best research-based estimates we have reveal enough to suggest that in NHS hospitals alone adverse events in which harm is caused to patients … occur in around 10% of admissions".
That is a phenomenal figure. The situation is not the fault of the staff, who do an excellent job under difficult circumstances. It arises because the Government is not ensuring that equipment is up to date and that staff are trained in how to use it. The consequences are devastating for the patients who are the victims of such mistakes and for the staff, who have to deal with those situations and the blame culture that exists in Scotland and elsewhere. We have to tackle that blame culture so that staff can come forward and tell us transparently where improvements can be made in the NHS. According to the document published in England, that could save up to £2 billion for the NHS. We could save lives and money and we could ensure that our staff worked in much better conditions, because they would be better trained and could use better equipment.
I ask the minister to address that issue. We are five years into the Scottish Parliament and it has not yet been addressed, despite the fact that it is being addressed in England. We do not have an equivalent of "An organisation with a memory", which is now deemed to be a world-class report. Scotland has to have an equivalent look at how we can help our staff and patients.
My regrets to Eleanor Scott who wanted to speak, but I have to go to closing speeches.
I open by supporting Malcolm Chisholm, who is the most open of ministers and less defensive than some in relation to his portfolio. I support his comments on administration staff. The SNP and the Tories have shown a bit of ignorance about the fact that the majority of administrative staff are low-paid workers who are on the front line. I suggest that those parties get to grips with the facts. They have done those people a great disservice today by undervaluing the role that they play in the NHS.
References have been made to violence and aggression. The biggest measure that should be taken to address that problem is an increase in staffing levels. Every member of NHS staff will say that.
The minister referred to changes in service leading to service provision that is local but consistent with safety and high-quality care. We should define that. When does the level of care become unsafe? Does the minister agree that having one GP per 115,000 patients for home visits is unsafe? I hope that he will tell me that when he sums up.
I agree with Duncan McNeil—which does not happen very often—that there is an estrangement between the public and the NHS boards about their needs for the service and a total democratic deficit that needs to be addressed urgently. I support health boards having direct accountability, but we must remember that they work in a political context and deal with the policies and resources that are made available by the Executive.
I agree with a lot of what Janis Hughes said. The debate is so complex and wide ranging that we could not possibly cover everything. New working patterns and 12-hour shifts are a complicated issue, and it is difficult to balance the needs of the service with the needs of individuals and family-friendly policies; nevertheless, a means of introducing the working patterns with the consent of staff must be established. As a branch secretary of Unison, I had long experience of having to defend workers who were being compelled to work 12-hour shifts because the majority of staff in their departments had wanted them, although they did not. It is not family friendly to compel a single parent with two children to adopt a 12-hour shift pattern that is completely unsuited to their needs.
I fully support the call to address the exploitation of international staff. It is a disgrace that the nurses to whom Unison refers have been employed on C grade. I hope that the Executive is looking into the specific contractual arrangements that have been put in place regarding those nurses, in relation to property rents and so on.
I agree that it is not appropriate that the academic route should be the only route into nurse training. We could increase nursing numbers by being a bit more flexible about that.
My concerns about strategic regional planning are well documented and consistent, and I concur fully with Unison's remarks on that as well. I have experienced closures and have seen the threat of a closure become a self-fulfilling prophecy as staff have left in droves, some of them not remaining in the NHS. There is no doubt that centralisations and closures have exacerbated recruitment and retention problems.
I had the pleasure of visiting the maternity unit in Wick, which, contrary to popular conception, is not underskilled. In fact, the opposite is true—because of the low birth rate there, the midwives whom I met have to practise the full range of midwifery skills to a high level. That is not the case in big maternity hospitals, where midwives tend to specialise more in paediatrics, labour, or whatever. All the midwives whom I met, bar one, have undertaken advanced life-support training in both adult nursing and paediatrics. Again, that is not the case in big, city-centre hospitals such as those in Glasgow, where midwives find it difficult to get the time off or the funding to enable them to undertake advanced life-support courses. There must be recognition of that, as well as of the fact that consultants in Wick operate out of Raigmore hospital at least one day a week. There are alternatives to closures.
I agree with much of what Mary Scanlon said, but I fail to see how her concerns would be addressed by the Tory amendment. Mary Scanlon often confuses me, because although I agree with a lot of what she says, I believe that the Tories' proposals regarding passports would do nothing to make things better but would make things far worse.
We cannot go on centralising. When would it stop? When there was one big super-hospital for the whole of Scotland? We need a national debate and proper consultation involving all health boards, not just a chat on the phone between health boards. We need proper consultation of the whole public, especially in relation to maternity services. The need is so urgent that there should be a moratorium on maternity unit closures until that happens.
We should avoid any perception that the majority of the poorer-paid NHS work force are funding an increase in consultant pay. It is time for equality of value to be placed on the contributions of all NHS staff and for proportionate pay and remuneration.
I call Mike Rumbles to close for the Liberal Democrats.
Thank you very much, Presiding Officer.
Dentists!
No, not dentists, but if Mary Scanlon had been in the chamber, I would have said that this was a double dose of medicine. It is a shame that she is not here.
I want to focus on half a dozen speeches that were made in this interesting debate. Janis Hughes made a very useful speech, especially in relation to vocational training for nursing staff. We must develop that kind of approach. Christine Grahame claimed, among other things, that sending a letter on Scottish Parliament-headed paper to a health board would magically move people up the waiting list. I do not think that it is appropriate to send out the message that people can jump the queue if they contact their MSP. I would not do that, and I hope that the convener of the Health Committee would not do it either.
My point was that it is not appropriate that such an approach should work. However, if constituents come to us because they are desperate, we have to try to do something for them. My point is that it should not be necessary for an MSP to do that sort of thing.
My point is that Christine Grahame said that she did it. I do not think that that is an appropriate message to send out.
Idiot.
Thank you for that, Christine.
Jamie Stone identified problems of isolation in the very north of his constituency. Jean Turner was absolutely right to mention the good will of our NHS staff cementing the service; that is certainly the one theme that emerges from the huge amount of letters about the NHS that I receive from my constituents.
As for Mary Scanlon's speech, what can I say? It is a pity that she is not in the chamber. I obviously hit a raw nerve with her. However, I had given her notice about what I was going to say. I thought that it was appropriate for me to do so; after all, I was only pointing out what she as Tory spokesman for health said about the need for a new dental school in a debate in 2002. My comments should not have come as a surprise to her.
I also want to focus on David Davidson's speech on behalf of the Tories. The Tories have some nerve to speak in debates such as this. The comments in David Davidson's speech were not like the comments that he is reported to have made in an article in The Press and Journal this morning. At a time when numbers of administrative staff have increased by 2,000 to more than 34,000, the number of GPs is up to almost 4,000 and the numbers of nurses and midwives have increased by 1,000 to more than 54,000, headlines in that great Aberdeen newspaper The Press and Journal read, "Executive is criticised for ‘top-heavy' Scottish NHS".
The story, which also carries a very good picture of David Davidson, quotes that member as saying:
"Surely there is something wrong with a system where the rate of increase of bureaucrats so vastly outweighs that of health professionals. How long will it take for the Scottish Parliament to realise this?"
The Executive is damned if the figures are up and damned if they are down. I would like to have seen the story in The Press and Journal this morning if the figures had been down. Will David Davidson enlighten us on that matter?
I thank the member for being so generous with my publicity. Does he want to be my agent?
Either Mike Rumbles is not reading the story very accurately or I have been misreported. I was simply highlighting the rate of increase in administrative staff in relation to the almost zero increase in the number of GPs over the previous reported period. Indeed, that is what we are talking about today.
It is always a good trick for members to claim that they have been misquoted. It is interesting that the Tories call the extra staff "bureaucrats" and condemn the increase in support staff such as receptionists, medical secretaries and everyone else involved in the NHS.
It is ironic that, as Malcolm Chisholm pointed out in his opening speech, the Tories introduced the levels of senior management that we had in the NHS. Those numbers have now been reduced by hundreds. As a result, it is really rich that such a headline and story should appear in The Press and Journal this morning. My goodness, I hope that David Davidson will contact the newspaper to get it to rescind its bad reporting. What I am trying to say is that the article, in fact, bore no relation to the Conservatives' response in the debate, which is the most important thing. I will close at that point.
Please continue.
If the member wants to me to stay on, I can do so just for her. However, I think that it is appropriate that I close on that final point.
The debate has been interesting. However, it is a pity that the Opposition parties cannot recognise progress when they see it. I accept that Shona Robison made constructive comments, but the Opposition parties in general cannot accept that we are going in the right direction, which must benefit the people of Scotland.
In my opinion, the debate is probably one of the most important since May last year. The state of the health service work force is the key factor for the success of the health service. Every party in the chamber is right to record its gratitude for the commitment, dedication and professionalism of all those who work flat out to maintain a caring service for their patients.
I support the Executive's efforts to protect NHS staff from abuse in the line of duty and I acknowledge that the Executive's intention is to achieve a long-term, sustainable NHS work force. There is no disagreement about the fact that unprecedented sums of money are going into the service, albeit not equitably across the country—at least as far as Grampian is concerned. However, that is a matter for another debate.
It is several years since I worked in the health service, but pressures were beginning to be felt by the work force even then. There were consultant shortages in some specialties, although not as many as there are today; dentists were becoming unhappy with their NHS work loads; and primary care was beginning to find it difficult to recruit and retain new doctors. What is worrying is that today, despite all the extra money, things are really no better, as Jean Turner pointed out. Patients are still waiting far too long for treatment and staff morale is low at all levels of employment within the service.
Since entering the Parliament, I have been shocked at what I hear of the amount of unmet need in the service. As members know, there are many health lobbying groups and every one has the same story: there is a lack of consultants, trained and specialist nurses and associated health professionals for multiple sclerosis, Parkinson's disease, asthma, kidney disease, diabetes and children with special needs. The list seems to go on and on. Speech therapists are like hen's teeth. Radiologists, orthotists and occupational therapists are struggling to cope with the demand on their services. NHS dentistry is hard to come by and we have heard today of the crisis in chiropody services in the Highlands. Chiropody is a vital service to old and infirm people; as Mary Scanlon said, without adequate attention to their feet, such people often become housebound. Like Mary Scanlon, I was pleased to hear the minister say that he is considering using the Highlands model for CHPs under the proposed new NHS legislation. However, I share Mary Scanlon's concerns that the demands that will be created by new legislation must be met.
The new primary care and consultant contracts will undoubtedly make life more pleasant for practitioners and will, I hope, encourage recruitment into general practice and the specialties. However, as members know, the nature of the service will change radically, particularly in primary care, and there will be far greater reliance on nurses and associated health professionals to keep the service running. It is easy to say that out-of-hours facilities will increasingly be nurse led and that nurses and associated health professionals will relieve GPs of a significant part of their current work load. However, that must be set against a serious shortage of trained personnel and a volume of recruitment that is well short of meeting even current demand, let alone the demands that will arise from the new contract.
The training of more doctors, nurses, dentists and AHPs is clearly needed urgently. Once trained, they need to be attracted to remain in their professions and within the health service in Scotland. I share Janis Hughes's views about practical training for nurses being better than a more academic approach. I remember the days when nurses did their apprenticeship in the wards and good, caring, professional and extremely competent nurses were the outcome. I accept that junior doctors used to work hours that were far too long, but they got much invaluable practical experience in the wards and in the operating theatres. There is a risk that their training could become less than adequate when the working time directive is fully in place. Much of the work that junior doctors did previously—mostly under supervision—will fall to qualified consultants in the absence of the junior doctors, who benefited greatly from senior doctors' experience in the old days.
Jamie Stone's proposals for rotational posts for consultants in remote areas sound interesting. I am sure that the minister will consider them.
I am pleased that the videoconferencing techniques that were pioneered in Aberdeen are paying dividends in remote communities. However, there are serious shortages of front-line staff. Like David Davidson, I was appalled yesterday to learn that in the past year the number of administrative staff in the NHS in Scotland has increased by another 5.6 per cent, while the number of GPs increased by a mere 0.5 per cent and the number of nurses by 1.7 per cent. That comes on top of a 13 per cent increase in the number of administrators in the previous three years, compared with a 0.8 per cent rise in the number of GPs and a 3.5 per cent rise in the number of nurses and midwives. Those figures indicate that the service is top-heavy with administrators who are chasing Government targets, organising and carrying out consultations and dealing with initiative after initiative from the Executive.
For goodness' sake minister, please release the health service from bureaucracy and put money where it is needed—towards front-line staff who could deliver patient care far better if they were freed from the Government's apron strings and allowed to get on with the job for which they thought they were trained. That way, the health service will once again become an attractive prospect for health professionals across the board.
I put on record the fact that my colleagues in the SNP and I fully appreciate everyone who works in the NHS: kitchen porters; administrators; consultants; nurses; and all the others. The list is so long that I cannot possibly go through all of them, but we certainly appreciate the very good work that they carry out, sometimes in difficult conditions. I am speaking in particular of nurses and others who happen to work in accident and emergency departments at the weekend who, unfortunately, are not given proper protection. We debated the issue several weeks ago and I am sure that the Parliament could have passed something that would have given all public service workers the protection that I believe they deserve.
I give a big thanks to Irene Yardley and the others at Glasgow royal infirmary who have worked tirelessly to get proper protection for nurses, who are, after all, going about their duty and should not be subjected to attacks by drunk and violent patients. I hope that the minister will consider the matter again and perhaps monitor the situation and give us a report on what is happening in accident and emergency departments at the weekends when, unfortunately, people are drunk and violent. I look forward to getting such a report.
I listened to the minister's speech and I appreciate the sentiments that he expressed about the challenges that are being faced in achieving and sustaining a viable and professional work force within the NHS. However, as Shona Robison and other members have mentioned, vacancies within the NHS have risen considerably since 1999 under the Lib-Lab coalition Government, regardless of what Mike Rumbles says. For example, consultant vacancies in Glasgow have risen by a massive 156 per cent and the number of nursing vacancies has risen from 282 to 784.
I acknowledge the minister's comments about recruitment, but it is five years since the Lib-Lab coalition Government took over, so the question is why, after all that time, we are having this debate all of a sudden. Is the Lib-Lab coalition Government only now recognising that we are so short of consultants and nurses? The Government seems to be paying lip service to the problem, but it is a bit late and it is acting once the horse has bolted.
The situation is of serious concern, particularly when it is coupled with the report published by Audit Scotland the other day. The report states that a quarter of all machines, including X-ray machines, in the health service in Scotland are obsolete—some of them are 15 years over their lifespan. That must give us all cause for concern. As I said, the Government has been in power for five years yet we are reading that kind of report. I congratulate Audit Scotland on its honesty, because I assure members that if it was up to the trust—particularly the one in Glasgow—we would never have found out any of the information.
Clinicians and staff must have access to proper equipment. In some hospitals, they have the equipment but they do not have the manual on how to work it and the person who used to work it has retired. That is a ridiculous situation.
I want to pick up on what the minister said about maternity services and the falling birth rate, which he suggested was the reason for having fewer midwives. I have spoken to midwives and they tell me that lots of midwives go into training but head down south once they have finished, because the conditions there are much better. If the minister speaks to midwives, he will hear the same thing.
The minister says that we can centralise maternity services, but there is a direct contradiction with the First Minister's statement the other day. The First Minister is calling for people to come to Scotland; I think that he wanted 8,000 immigrants to come each year. It is dangerous to assume that we can close hospitals—particularly maternity hospitals—and centralise services when we are actively encouraging population growth. We must consider a moratorium on such closures.
Janis Hughes is right about nursing. People do not have to go into academia to do nursing. Des McNulty and I were at a meeting on Saturday and this was one of the topics that came up. Among the people there were ex-nurses and they asked why people's life experience could not be considered. They asked why people could not become nurses without going to university. I hope that the minister takes up Janis's suggestion.
Mary Scanlon put the fear of death into me when she talked about people pulling out their own teeth. My grandfather used to pull out his own teeth, but it surely should not be a self-inflicted cure. Mary represents the Highlands and Islands and if people there have to listen to Mike Rumbles, perhaps they do feel like pulling out their own teeth. I will leave that to Mary's discretion.
Duncan McNeil mentioned the European working time directive and doctors' hours. He is right to say that services are being impinged upon. However, we have known about the directive for nine years. It was never going to go away; it was always going to happen. Instead of blaming consultants and others, Duncan should perhaps blame his own Labour Government.
Sorry, but I am into my last minute. We knew about the problem nine years ago but the Labour Government has done nothing about it.
Jean Turner said that we have to create high morale in hospitals and the NHS. The only way to do that is to have better working conditions and wages and more inclusiveness within hospital services. I agree with Jean. In Wick and Inverness, in the Queen Mother's hospital in Yorkhill and the Southern general hospital in Glasgow and elsewhere, insecurity does no good to staff morale and does not attract new staff. We should consider that seriously before we allow health boards and trusts to tell people that they are going to shut down hospitals. Such talk causes people to move away and to try to find secure employment elsewhere.
In conclusion, Presiding Officer—
Hooray!
Mike Rumbles is saying "Hooray." We said that when he stopped speaking. I do not need to pull out any teeth at all regarding that.
I appeal to the minister and deputy minister to consider the centralisation issue and to consider our amendment very closely. We should have a review of all hospital services, not only maternity services. We will be making a big mistake if we do not consider things holistically and just consider them regionally.
This has been a welcome debate on an important subject. Members from all sides have rightly recognised the invaluable contribution that health care staff make to the quality of life in modern Scotland.
Not for the first time, I will disappoint Ms Leckie. I will defend our health portfolio and the service here in Scotland. The Executive is proud of our health care staff. We are proud of the support that we have given them and we pledge that that support will continue, now and in the future.
As Malcolm Chisholm said earlier, health matters, so health care staff matter and money spent wisely on health care staff is money spent wisely and invested well in Scotland's future. The Executive wants all public services in Scotland to be delivered to the highest standards. None is more important than the health service, which is the very mark of a civilised society.
We have heard about the pressures faced by the NHS and other parts of the health care system. Almost every day—and certainly in the course of this debate—we have heard doom and gloom about shortages and one crisis or another. It is easy to criticise, but more difficult, and far more important, to make real improvements. The Executive has a positive agenda for improving health and health services.
I refer specifically to Mary Scanlon's point on allied health professionals. She is right. That is why we are committed to creating 1,500 additional allied health professionals by 2007; it is also why there was a 5.5 per cent increase in the number of allied health professionals last year.
I appreciate that. Will the minister also accede to the request to talk to his Westminster counterparts about pay and conditions for the professionals allied to medicine, which seem to be falling out of step with those for nurses and doctors?
That is included in the agenda for change.
We have provided extra resources to allow more staff to be recruited. There will be more nurses, more doctors and more health professionals across the board in the NHS.
David Davidson raised concerns about the supply of doctors. The fact that the projected figures for graduates are 750 in 2004 and 894 in 2005 shows that the supply is not the problem; the challenge is retaining the people who graduate.
A large number of those graduates are sent here by other countries so that they can go back and work in their own health service. Our problem is getting enough of the people who are educated here to stay on here.
I am glad to hear Mr Davidson echoing the First Minister's words. It is encouraging that there is Conservative buy-in to the policies that the First Minister is promoting.
Will the minister give way?
No, I must move on.
We are investing on an unprecedented scale in work force reforms—reforms that put the patient at the centre and that put improved, safe patient care at the top of the list.
Of course the way in which people enter the nursing profession is important, as Janis Hughes said. Routes into the profession are a matter of great concern to members of the profession. On the need for flexibility within the nursing profession, we are all obliged to take account of the pressures—demographic or otherwise—that we face in our society. I hear Janis Hughes's point.
Although there is much more to do, real progress has been made and I will provide some positive examples. We have already heard about our integrated work force planning for maternity services, but work is under way in other clinical priority areas, too. Back in October 2002, the need to develop the capacity and capability of the mental health work force was acknowledged and mental health was selected as a pathfinder for work force planning and development activities.
In June 2003, we announced our commitment to establishing a national mental health work force group. The group was formed to lead on work force planning and development activities for mental health services in Scotland on a national level. It is chaired by David Bolger, who is head of the Scottish Executive's new mental health division.
The minister mentioned patient safety. In 2000, a profound and world-renowned report, "An organisation with a memory", was published south of the border to learn from past mistakes and the National Patient Safety Agency was subsequently established. Will the minister outline what will be done in Scotland to emulate that report so that we can learn from past mistakes in the Scottish NHS, increase patient safety and help our staff with appropriate skills and resources?
Patient safety is at the forefront of our mind and is taken into account in everything that we do in the NHS. Of course we will take on board best practice, not only from this country but from around the world.
The membership of the national mental health work force group reflects the partnership approach that is being taken to developing the agenda in question. The group is made up of representatives from NHS Scotland, local authorities, NHS Education for Scotland, trade unions and professional organisations, as well as from across the Scottish Executive's Health Department.
On skills development, we are supporting the development of our staff because we know that it is of the utmost importance. The health care work force is already highly skilled, but we want to see further advances. One success story involves supporting health care staff who want to develop through the completion of Scottish vocational qualification courses. [Interruption.]
Order. There are about five minutes left of the minister's speech. The volume of conversation is rising to levels that are extremely unco-operative and unsympathetic and some very animated conversations are being held. I invite those members who have something that they desperately want to say to take advantage of those five minutes to say it outside the chamber so that the minister can continue to respond to the debate. [Applause.]
As I said, we want to support those health care staff. Our support has resulted in an increase of 40 per cent in the uptake of the SVQ in care in the acute health care sector and it has trebled the uptake of SVQs in clinical and non-clinical roles throughout NHS Scotland—better skills for better care.
Malcolm Chisholm mentioned staff governance. The staff governance standard is already a key element of our formal performance assessment of all NHS organisations. We should never forget how significant a contribution that makes to putting NHS Scotland employers at the leading edge of human resource practice. That adds practical value to the recruitment and retention of staff.
Janis Hughes also mentioned the agenda for change. It is worth reminding colleagues that the agenda for change was compiled through negotiation with a series of trades unions. It is being tested through pilots in Scotland and south of the border. It is easy for anyone to cherry pick, but the agreement must be seen in its totality and it will take time to assess it properly. I make a plea now for that time to be given.
The Executive supports the national health service. The dark days of the 1980s are gone and there will be no run-down and neglect of staff. That said, the status quo is not an option either. We do not want to preserve the service in aspic.
Does the minister agree that the call from various parties for a moratar, a moraturi—
Moratorium!
A moratorium on maternity services—that is difficult to say at this time of the day. Does the minister agree that that call is just a cop-out and that it would have made no difference to maternity services in Dumbarton or Inverclyde, where the clinicians decided to shut the services down? Does he agree that there is no role for health board managers or politicians in overriding the wishes of clinicians when they believe that an unsafe service is being provided?
I certainly agree with the sentiments expressed by Duncan McNeil. As I said before he spoke, the status quo is simply not an option and changes must be made. The argument for those changes has to be won. I respectfully suggest that it is the responsibility not only of the Executive to make the argument for those changes; it is the responsibility of every member who has decided to play a part in public life in Scotland.
Although we are prepared to make such changes, to take the hard decisions and to ensure that the argument is won, I also want to ensure that we provide an assurance that we will not forget about the importance of supporting staff as we pursue reform.
Health care staff matter and money spent wisely on health care staff is money wisely invested in the future of Scotland. Supporting front-line staff and encouraging innovation are the essence of reform. That is what makes a difference to patients and what will make a modern, responsive health service. I encourage every member here to support the motion and to reject the amendments lodged by the SNP, the Conservatives and the Scottish Socialist Party.