Waiting and Delayed Discharge
The next item of business is a debate on motion S1M-3248, in the name of Malcolm Chisholm, on action on waiting and delayed discharge, and two amendments to the motion.
If previous patterns are anything to go by, I would stand in the chamber selecting the good waiting statistics, the Opposition parties would throw back the bad waiting statistics and nobody who is listening to the debate would be much the wiser. By contrast, I will face up to the bad as well as the good, as that is an essential part of a culture of improvement. I hope that the opposition will be equally balanced, as nothing is more demoralising for staff in the national health service than relentless, one-sided negativity.
I begin by praising staff and thanking them for their superb efforts, in particular over the winter, when so many extra procedures were carried out. That resulted in a substantial drop in the number of people on the waiting list at the end of March and, more important, a drop in the number who wait longer than six months for in-patient or day care treatment.
Nothing matters more to patients than the length of time that they have to wait for treatment. That is why we have refocused the NHS on reducing waiting times rather than waiting lists, starting with those at the end of the queue who have waited longest. That is because it is at the end of the queue for treatment that the real problems with NHS waiting lie.
The NHS in Scotland has an excellent record in dealing with those who are in urgent and serious need. Members should remember that more than half of patients in Scotland never even need to go on to a waiting list, because they are treated immediately. For those who do enter a list, about eight out of 10 are treated within three months.
The problem that we have identified applies to those at the end of the queue, whose conditions may not be quite so acute, but who are still in need—the two out of 10 who wait longer than three months and up to 12 months for in-patient and day-case treatment. We have started to tackle the long waiters, and have reduced the number of those who wait more than six months by 6 per cent in the past year.
Our existing target is for no patient with a guarantee to wait longer than nine months for in-patient or day-case treatment by 2003. That compares with a period of 12 months at present. We are 90 per cent of the way towards achieving that target. We are ambitious for the NHS and for what it can achieve. Improving that target further needs increased investment, improved co-ordination and more capacity in terms of staff and equipment.
In the first six months of this year, we have announced a near 50 per cent increase in health spending over the next five years and we have created a national waiting times unit to bring new focus to waiting times activity and to ensure better use of available capacity inside and outside the NHS. Last week, we entered into advanced negotiations to buy the Health Care International hospital for the NHS for £37.5 million and transform it into a national waiting times centre.
Will the minister give way?
I will do so in a minute. The key elements have been put in place to significantly step up NHS performance on waiting. That is why now is the right time to set still more ambitious targets, to slash the long waits and to improve the experience for those patients at the end of the queue.
I can announce today the first new national waiting targets to be set for the NHS since the Scottish health plan of December 2000. By 2005, the maximum time a patient with a guarantee waits for NHS in-patient or day-case treatment will be six months, which is half what patients can experience today and 30 per cent better than our existing target.
Hand in hand with tackling long waits, we will ensure that those waiting for treatment for priority conditions such as cancer and heart disease are treated even more quickly. Significant progress is being made in those areas. For example, away from the headlines, waiting times for radiotherapy at Glasgow's Beatson centre are half what they were a year ago.
Nationally, we can do better. By the end of this year, our existing target is for no patient waiting for a heart bypass operation to wait longer than six months. Most patients wait for a much shorter time than that, and more than four out of five patients already get treatment within a shorter time. With the additional cardiac treatment capacity that we are securing by bringing the HCI hospital into the NHS, we now expect the NHS to ensure that everyone needing a bypass or angioplasty is treated within 18 weeks by 2004. Those are ambitious targets for a service that is ready, willing and, increasingly, able to deliver improvements.
There are still deep-rooted problems and issues around NHS waiting, which we must tackle. I am very aware of and concerned by the increases in out-patient waiting times, which can often have just as significant an effect on patients' experience as their experience at other stages. Before that stage, I am also aware of issues around waiting to see a general practitioner or another member of the primary care team.
I give way to John Swinney.
It is fortuitous that the minister has given way on that point—it is the one that I wanted to ask him about. I welcome what the minister says about future reductions in waiting times, but has he given any consideration to the idea of including in the whole waiting time experience the amount of time that individuals have to wait to see consultants to have particular problems diagnosed? At present, there are no guarantees covering the length of time that people wait at that stage. Is the Government prepared to make any commitments on that point to guarantee that people wait a much shorter time for consultants' opinions following referral from GPs?
Part of the change from waiting lists to waiting times is a focus on every stage of the patient's journey. I will talk now about the stage up to seeing a member of the primary care team, and then about the stage up to seeing a consultant or someone else for an out-patient consultation. Every part of the journey matters, and we need to focus on all the stages. I know that John Swinney wants to add them all together, but most people will want to make progress on each of them. Whether or not we add them all together is not the key issue; what matters is reducing waits at every stage of the patient journey.
Will the minister give way?
I have only four more minutes in which to speak and I have a great deal to cover. I cannot give way again, and I will have to cut what I was going to say on that last point.
I turn to GPs and the primary care team more generally. By October there will be an action plan and timetable in every NHS board area for the delivery of a 48-hour maximum wait to see the right member of the primary care team. That means the right time, the right place and the right quality of care, which is the objective of NHS reform.
We have made tackling out-patient waits a major priority for the national waiting times unit. It is working with NHS boards to develop local waiting times standards that focus on tackling the longest waits for out-patient appointments and for diagnostic tests. It is also working to address the problem of DNAs—people who do not attend appointments—who account for 11 per cent of out-patient appointments. Progress on that issue would have a significant impact on waiting times.
We have also announced the establishment of a national waiting times database. The database is already in existence on a pilot basis. By the end of this year, it will be available publicly and will provide information on out-patient waiting times in all NHS board areas throughout Scotland to increase patient choice. Patients will then be able to choose to go somewhere where there is a shorter waiting time.
What about delayed discharges?
I have only three minutes left and I will have to collapse a lot of the points that I wanted to make.
You have four minutes.
Thank you very much for the extra minute.
Many out-patient clinics are now led by nurses or other health care professionals. That is pertinent to Mary Scanlon's amendment, which talks about activity. That activity—at present and historically—has never been counted: only consultant-led activity has been counted. That fact must be taken into account in considering activity levels. Work is under way to count that important activity and to develop new ways of working throughout Scotland.
The very impressive conference entitled "Good Practice in Action in the NHS", which took place earlier this month, was a tremendously encouraging demonstration of the progress that has been made in streamlining and redesigning services around the needs of the patient. I cannot go into the many examples of that, but I shall give three examples. In Fife, the waiting time for an endoscopy has fallen from 16 weeks to four weeks, because of the work of nurse endoscopists. In the Western Isles, the use of a unique teledermatology system has resulted in waiting times being cut from up to seven months to between two and four weeks. In Dumfries and Galloway, the average waiting time at the one-stop lung cancer investigation clinic has been reduced from 12 days to four days. The redesign agenda is important for waiting times.
Dennis Canavan referred to delayed discharge. Frank McAveety will speak about that in more detail. I remind members of the £20 million that is attached to the action plan to ensure that 1,000 extra people will be transferred out of hospital and into more appropriate care settings during the coming year. That is an example of partnership working. We have distributed the remaining £15 million of the £20 million that was announced last year on the basis of the action plans and we will monitor the situation closely.
In my last two minutes, I must address the amendments. Both refer to increasing in-patient waiting times. I have already said that we are right to target our efforts on those who wait longest, rather than seeking to achieve movements of a day or two at the median or middle of the list. That is where we can make the biggest impact for patients. The example that came up at First Minister's questions two weeks ago was a good one. In Lanarkshire and Tayside, the waiting times of people who waited longer than six months were reduced by 24 per cent and 18 per cent, respectively, while the median waiting time increased. I am sure that people in those areas welcomed the priority that we attached to that policy.
The SNP amendment talks about the Health Care International hospital being used
"exclusively for NHS patients in Scotland".
Like other NHS hospitals, the HCI hospital will be used overwhelmingly for NHS patients; however, there is no reason why NHS patients should be different from other patients. This year only, some existing contracts will have to be honoured as well.
The SNP amendment also refers to the abolition of deferred lists and the introduction of maximum waiting time guarantees for all. I am certainly open-minded on the issue of deferred lists, but I want to follow all the recommendations of the Audit Scotland report. It asks the information and statistics division of the Common Services Agency to review the rationale of deferred lists. Let us have that review before we make final and detailed decisions. The SNP fails to understand anything about deferred lists if it thinks that the maximum waiting time guarantee should apply to all. Some people on the waiting list may want to delay their treatment or may have to do so for clinical reasons.
Will the minister give way?
I do not have time to give way. I have time only to deal with the Tory amendment, which raises two important points.
I have referred to activity. It takes some brass neck for the Conservative party to say that activity levels have fallen when, since 1997, we have had 58,000 more in-patient and day-case episodes in spite of the fact that a lot of the activity is not counted—as I have mentioned—and in spite of the major advances on working times and the reduction in junior doctors' hours, which have been good for patient care but have obviously had an effect on activity levels.
If I do not describe the Conservative party's accusation of political interference as their having a brass neck, I do not know what words I can find to describe it. No party ever interfered more in the health service than the last Conservative Government. The Audit Scotland report makes it clear that there is no evidence of systematic or deliberate irregularities in the management of waiting lists. There has been no political interference. We know what the role of Government is. Our role is to provide funding, to set priorities and to establish national standards. We are the Government that bases its policy on empowering front-line staff.
I move,
That the Parliament applauds the outstanding commitment and work of NHS staff in delivering reductions in waiting lists and the longest waiting times; recognises that more needs to be done, particularly for those patients experiencing the longest waits; welcomes the work of the National Waiting Times Unit and the proposed use of HCI as a national waiting times centre; notes the outcome of the Audit Scotland report on the management of waiting lists and that the Health Department will be working with others to implement its recommendations, and supports vigorous action on a range of fronts to reduce waiting times and the delays experienced by patients awaiting discharge from hospital.
On the minister's point about deferred waiting lists, it is absolutely ridiculous to argue that just because some people choose to opt out of a guarantee, that is somehow a justification for withholding the guarantee from everyone. That argument is nonsense.
The member has woefully misunderstood what I said. Of course anyone who does not have a reason for wanting their treatment to be delayed or for having to have their treatment delayed should have a waiting time guarantee. I will act on that recommendation, just as I will act on all the other recommendations in the Audit Scotland report.
There are people on the deferred waiting list who do not want their treatment to be delayed and they should have a waiting time guarantee in the same way that everyone else does.
I will sound a note of consensus. I join the minister in paying tribute to the staff who work so hard in the NHS to deliver a quality service for patients. We should all acknowledge that they do so in extremely difficult circumstances. I am pleased that the minister has conceded that much still requires to be done to reduce waiting times. Although I welcome the new targets that he has set, I suspect that patients want less in the way of headline-grabbing targets for the future and more in the way of steady progress in the here and now.
Waiting times are still on an upward trend. The median waiting time, which relates to the period between a patient's initial visit to their general practitioner and the point at which they receive treatment, has increased by 20 days—nearly three weeks—since 1999 and by nine days in the most recent quarter alone. Median waiting times are not unimportant.
The Executive has made great play of the fact that it is concentrating on the patients who have waited longest. No one can argue with that. However, at the end of last month, the minister claimed that no patients in Scotland had waited more than 12 months for treatment. I will return to the inadequacy of the patient guarantee. We know from the Audit Scotland report that the minister's claim was simply untrue. That inquiry uncovered nine patients—
Will the member give way?
Not now. I have given way to the minister once already. I will do so again later, if I have time.
In orthopaedics alone, Audit Scotland's inquiry uncovered nine patients who had waited more than 12 months for treatment. It is reasonable for the public to be sceptical about the six-month target that has been set today, as patients are still waiting for treatment for longer than 12 months.
Apart from the obvious stress and inconvenience that are caused to patients, the most troubling aspect of the increase in waiting times is the fact that it cannot be attributed in any way to an increase in the number of patients who are being treated in the NHS. Since 1999, the NHS has treated fewer in-patients and day-case patients and fewer out-patients. In total, nearly 65,000 fewer patients are being treated than when the Executive took office. It is perhaps an understatement to say that more needs to be done.
I whole-heartedly support the work of the national waiting times unit. I have little doubt that the extra beds that will be available to the NHS as a result of the purchase of HCI will help, especially as 800 acute beds have been lost to the NHS since 1997. However, I was alarmed when I read at the weekend—and when I heard it confirmed by the minister—that the Government's intention is to continue to use HCI for private and overseas patients. With so many patients languishing on waiting lists for so long, surely it is vital that all available capacity at HCI is used to treat Scottish NHS patients.
Will the member give way?
Not just now.
The difference between HCI and other NHS hospitals is that HCI was bought from the private sector with taxpayers' money for the sole purpose of reducing waiting times. Will the minister give an assurance that HCI will be used exclusively for the benefit of NHS patients?
I have already explained the situation. Given the fact that there is a certain degree of exchange between hospitals in all parts of the United Kingdom, some might find it rather offensive that Nicola Sturgeon wants HCI to be used exclusively for people in Scotland. However, the fundamental point is that HCI will be like every other NHS hospital in Scotland, after we have dealt with the temporary and short-term issue of the existing contracts, which are a matter of law. As a lawyer, Nicola Sturgeon might have been thought to have some understanding of that.
HCI is not like other NHS hospitals. It has been brought into the NHS for the purpose of reducing waiting times. The hospital is to be a national clearing house for waiting times in Scotland. As such, it should be used exclusively for the benefit of Scottish patients.
Let me move on to the Audit Scotland report. It is worth mentioning in passing that the report would not even have been commissioned were it not for the persistent pressure of John Swinney and SNP members, who exposed closed, deferred and reclassified waiting lists. That is why the First Minister instructed the report to be written. In my view, the report's findings are a real cause for concern, because they uncover a number of inconsistencies and irregularities in the management of waiting lists across the country. The report contains important messages for health trusts, health boards and national Government.
Two issues are of central importance. First, the report confirmed the steady, year-on-year increase in the number of patients on deferred waiting lists. When that is coupled with the fact that Audit Scotland could find no convincing reason for the existence of deferred waiting lists, it becomes hard to shake the suspicion that some patients are being put on such lists simply to reduce the headline figure. The minister will deny that, but let me suggest that the way to ensure that such a thing does not happen is to have only one waiting list. In the absence of a good reason to keep deferred waiting lists—Audit Scotland could not find a good reason—it is time that they were abolished. I ask the minister to give that assurance.
The second issue concerns the 12-month waiting time guarantee, which the minister has today announced will be reduced to six months by 2005. The guarantee applies only to in-patients and day-case patients. The guarantee does not apply to patients who are waiting for an appointment with a consultant or for treatment as an out-patient, nor does it apply to patients who are on deferred waiting lists for in-patient treatment. In other words, the overwhelming majority of patients who are waiting at any given time have no maximum waiting time guarantee whatever.
Last quarter's figures, which are the most recent available, show that 1.3 million of the 1.5 million patients who went through the system as in-patients, day-case patients or out-patients had no waiting time guarantee. That is not good enough, especially because the longest waits are often for an appointment with a consultant or for out-patient treatment. Those parts of the patient journey are not covered by any guarantee. There is no doubt in my mind that there should be waiting time guarantees for all patients and for all parts of the patient journey. Instead of following the minister's suggestion of adding all the different stages of the patient journey together, we should ensure that the patient has a waiting time guarantee during every stage of the patient journey. That is fundamentally important if the whole patient journey and the whole experience of the patient are to be taken into account.
All parties in the chamber are agreed that tackling delayed discharge is absolutely vital. Not only is it vital for the sake of those individuals who are not receiving appropriate care, but it would liberate capacity within the national health service to speed up treatment for others. However, it is difficult to pass any up-to-date judgment on the success of the Government's action in tackling the problem, because today's debate takes place two days before the most up-to-date statistics on delayed discharge are due to be published. I am sure that we will return to the matter at a later stage, when we will perhaps be in possession of more information.
I move amendment S1M-3248.1, to leave out from "delivering" to end and insert:
"the face of increasing in-patient and out-patient waiting times; is extremely concerned at the disturbing findings of the recent Audit Scotland report, Review of the management of waiting lists in Scotland; calls for deferred waiting lists to be abolished and for all patients to be given a maximum waiting time guarantee; supports the work of the National Waiting Times Unit but calls on the Scottish Executive to give a commitment that HCI will be used exclusively for NHS patients in Scotland, and supports more vigorous action on a range of fronts to reduce waiting times and the delays experienced by patients awaiting discharge from hospital."
It is a bit rich for Malcolm Chisholm to talk about other people having a brass neck when he has shown his own brass neck today. Mr Chisholm's motion accepts the Audit Scotland report; we all accept that report. It is a welcome clarification—
I know that Mr Chisholm is excited, but I hope that he will let me get started. He has put me off my stride.
The report considers reclassifications, closed lists and deferred lists. Mr Chisholm's brass neck is evident from the first line of his motion, which refers to "reductions in waiting lists". He knows perfectly well that that is not truthful; it does not accord with Audit Scotland's report.
I welcome the minister's ambitious targets—we all welcome ambitious targets—but what really counts is how many patients are treated, how soon they are diagnosed, how soon they are assessed and how much all of that impacts on their health care. I am pleased that he accepts the recommendations of the report, because it is crucial that the debate moves forward.
Over the past few years, much has been promised and said by the Executive on the subject of waiting times and waiting lists. Scottish Conservatives very much welcome the new report. However, it is shocking that—despite the report—the minister presents us with a motion suggesting that there have been significant reductions in the last quarter whereas what has taken place is significant reclassification. Despite claims that no closed waiting lists exist in Scotland, Audit Scotland's report states:
"Where there are significant staff shortages or other constraints, it is not acceptable to close lists or leave the list to grow ever larger".
That is a clear acknowledgement that lists are closed.
On page 8 of the report, Audit Scotland confirms that, from 1999, deferred lists have increased at a rate of 8 per cent per year. More than 30 per cent of patients on waiting lists in South Glasgow University Hospitals NHS Trust, North Glasgow University Hospitals NHS Trust and West Lothian Healthcare NHS Trust are on deferred waiting lists.
The minister has fudged on the issue of reclassification, but the Audit Scotland report confirms the extent of reclassification. In a recent meeting in Highland, it was confirmed to MSPs from different parties that, had reclassifications been carried out in accordance with the minister's guidance, waiting lists of 3,000 could have been reduced by 300. That would have been a reduction of 10 per cent simply as a result of a paper exercise—but no more patients would have been treated.
Again from the Audit Scotland report, we learn that only Highland Acute NHS Trust and the Yorkhill NHS Trust did not follow the guidance on reclassification. Therefore we can assume that all other acute trusts in Scotland have reduced their waiting lists by 10 per cent because of reclassification rather than because of an increase in patient care.
I could not mention certain things in the motion because it had to be lodged before the Audit Scotland report came out. The Audit Scotland report says that reclassification reflects developing medical practice that brings benefits to patients. The report points out certain local irregularities, which we will act on. That is why I have made it clear that I will accept the recommendations of the report. What Mary Scanlon and Nicola Sturgeon fail to grasp is the central message of the report, which is that there is
"no evidence of systematic or deliberate irregularities in the management of waiting lists."
That central conclusion is rejected by both Opposition parties.
I do not think that Mr Chisholm has read the report clearly. Pages 29 and 30 illustrate the extent of specialty procedures in which there has been reclassification. In Argyll and Clyde Acute Hospitals NHS Trust, only dermatology was affected; in Grampian University Hospitals NHS Trust, it was cataract removal, vasectomies, in-growing toenails, removal of cysts, general surgery and ophthalmology. There is not even a consistent approach across Scotland. We are not simply considering day-case procedures and new procedures. The Executive's position is quite misleading.
If the minister will not agree, will Mary Scanlon agree that no one objects to the legitimate reclassification of certain procedures if it is for the right medical reasons? We object to the fact that when patients are reclassified under the current system, they lose their waiting time guarantee. That matter has still not been addressed. Some patients have a guarantee and others do not.
That is exactly the point and the Executive would gain more respect if it were a bit more honest.
Serious questions also have to be asked about performance assessment frameworks and the targets set by trusts. We need to know how much has been achieved by distortion of the figures, reclassification, deferred waiting lists and closed waiting lists, and how much has been achieved by treatment of patients. When patients move from one classification to another, that is a matter of concern, given the performance-related pay issues for some managers in the NHS.
Today we have two waiting lists: a true list and a deferred list. We also have closed lists and significant reclassifications. On top of that, the latest figure for bed blocking is 3,116, despite millions of pounds being poured in to alleviate the problem.
Direct payments would obviously help the situation and I hope that every person who has their discharge from hospital delayed will now be offered a direct payment so that they have freedom, choice and control over their care instead of having to wait for local authorities to pay.
Will the advent of free personal care on 1 July alleviate bed blocking so that more people can be treated? Yesterday I visited the Church of Scotland home in Edinburgh. Staff confirmed that two care homes across the road—Bruntsfield and Pitsligo House—had been closed in the past two years. There is an undoubted reduction in the number of residential and nursing care homes, reducing places for the elderly. It is hardly surprising that the Church of Scotland closed those homes given that it faces a £5 million loss within the next year.
Whatever the minister says, however brassy his neck is, and despite all of the fiddling, according to Audit Scotland and the information and statistics division, more than 11,000 fewer people are receiving home care since 1998, 50,000 fewer people are seen by a health visitor since 1997, and 13,000 fewer people are seen by a district nurse since 1999.
When we consider the acute sector activity by quarter we see that, since the opening of the Parliament, more than 6,000 fewer in-patients are being treated, 10,000 fewer day cases are being treated, the median wait is up by five days, the number on deferred waiting lists is up by 5,000, 64,000 fewer out-patients are being treated, 10 per cent fewer patients are being seen within nine weeks, and the median wait for out-patients is up by 12 days. Despite all the minister's efforts to distort the figures, and despite his brass neck, the figures for activity in the NHS are still against him.
I move amendment S1M-3248.2, to leave out from "in delivering" to end and insert:
"; regrets the fact that waiting times are longer than they were when the Scottish Executive took office; notes with concern a simultaneous drop in NHS activity; particularly regrets the political interference within the NHS which has led to the inconsistent and unclear record keeping within the NHS discovered by Audit Scotland; and further notes that while the Executive continues to exert political control over our health service waiting times and delayed discharges will only get worse and that the best way to deliver improvements is to put patients first by giving them real choices and devolving power to local hospitals and GPs so that decisions are taken on the basis of clinical priorities."
Reductions in waiting times and waiting lists remain a key priority for the Executive, for the Parliament and for the patients that we represent. I echo previous speakers' thanks to the staff not only for their sterling efforts to reduce waiting times, but for all the other work that they do to keep the health service functioning at a high-quality level.
Far too many Scots are waiting too long. The Minister for Health and Community Care and the First Minister have said as much. It is clear that the Executive is determined to do all it can to reduce their wait by taking action on a range of fronts. Those include the setting-up of the national waiting times unit, the purchase of HCI, the funding of the recruitment of more doctors and nurses, the expansion of one-stop clinics and measures to tackle a lack of capacity caused by delayed discharge, including funding for the care homes settlement.
We should not lose sight of the fact that more than half of the patients who are treated in our hospitals do not wait for treatment. Of those who wait, almost half are treated within one month and 80 per cent of the others are treated within three months. We are committed to our nine-month target and we welcome the minister's announcement today of a target of six months by 2005.
In certain priority areas such as heart bypass operations, waiting times have been significantly reduced and, compared with 1997, there has been significant improvement in the number of cataract operations, angioplasties and knee and hip replacements. The latest list figures, which were released in May, show that the Executive has had some success in targeting those patients who have been waiting longest. Compared with last year, there has been a 6 per cent decrease in the overall number of patients who wait longer than six months.
However, it is also clear that the number of people who are waiting is up on 1999, and people are still waiting longer. The Executive is committed to turning that round, as well as to delivering a clear picture of waiting in Scotland's health service. That is why the First Minister asked the Auditor General to undertake a review of the management of NHS waiting lists. It is crucial that patients have faith in the figures that are being quoted to them, and it is crucial that service planners in the NHS have a clear picture of where progress is being made and where efforts require to be redoubled.
The Audit Scotland review shows that there are worrying inconsistencies in the administration of lists and the application of central guidance in recording waiting list information, but its report, under the heading "Main findings", states clearly that
"Audit Scotland found no evidence of systematic or deliberate irregularities in the management of waiting lists."
Those who are trying to accuse politicians of fiddling the figures are doing so in direct defiance of the Audit Scotland report.
Will the member give way?
No, I would like to make progress.
The Executive's acceptance of the report is to be welcomed, and signals a commitment to delivering a clear and consistent waiting list system. It is critical that we pick up on the key issues that are outlined in the Audit Scotland report. The administration of lists, the reclassifying of patients' treatment and the use of the deferred list are all key areas of concern. On administration, it is clear that despite procedures being in place, day-to-day practice in adding to and updating lists differed from that procedure. Indeed, in some places delays added up to 20 days to someone's wait. It is also worrying that clinical information that is held electronically is not being handled confidentially—a point that was raised, quite rightly, by the British Medical Association.
We all know that medical practice is changing all the time. The advent of one-stop clinics and the greater use of primary care services in diagnostics mean that many patients are now dealt with in different ways. Some procedures that previously were dealt with on an in-patient basis are now undertaken in an out-patient setting.
However, although waiting time targets are set for first out-patient appointments, there are no formal waiting times or list targets for out-patient procedures. That means that those who are waiting for out-patient procedures have been taken off the list and in many cases, as we have heard, have lost their waiting time guarantees. Only Grampian NHS Board and Lothian NHS Board—I am happy to say, as a Lothian MSP—have continued to monitor existing and reclassified out-patients and have maintained their guarantees. Audit Scotland is clear that that is the fairest way to deal with those patients, but it is not how the majority are being treated throughout the country. I look to the minister to address that issue urgently.
On deferred waiting lists, the Audit Scotland report states that it cannot see the rationale for two lists. I note what the minister said about examining that matter. There has been a steady increase in the number of people on the deferred list. Indeed, in West Lothian that list accounts for 35 per cent of those who are waiting for treatment. The report flags up a lack of consistency in placing patients on and removing them from the deferred list. The fact that there is a shift in emphasis to waiting times from waiting lists surely provides an opportunity at least to reconsider the value of running two lists. We welcome the fact that the minister has indicated that that matter will be considered by the information and statistics division.
It is clear that the Executive has put in place a number of measures to tackle waiting times. The national waiting times unit was set up in January, and by the middle of May it had purchased an additional 2,100 additional procedures from spare capacity in the NHS, as well as a further 2,000 operations from spare private sector health care capacity. The unit provides much-needed co-ordination in a way that not only improves the service that is delivered to patients, but maximises the capacity of the NHS. All health boards must produce action plans for their areas, which will be in place by the end of the month. That will be backed up by £20 million of investment for action.
Scotland's patients expect results, but they also expect pragmatism from this Administration. Last week's announcement of the nationalisation of the HCI hospital at Clydebank was extremely welcome—a bargain purchase of a £220 million hospital for £37.5 million. The minister can go shopping with me any time he likes. That represents good value for the public purse. It not only represents an opportunity to increase capacity through the doubling of operations carried out there to 5,000 in the first year, but secures jobs and delivers a national waiting times centre for Scotland. That will add to the co-ordinating role that the waiting times unit already undertakes.
Finally, in making full use of the capacity of the NHS, we have also been addressing the long-term difficult issue of delayed discharge. The Executive has released an extra £20 million, the final £15 million of which is released this week, to try to free up NHS beds that are being used inappropriately.
NHS Lothian has the highest number of patients who await discharge, who use a staggering 11.6 per cent of NHS Lothian's beds. As Mary Scanlon said, Edinburgh has been badly hit by the loss of 290 nursing home places since September 1998 and the loss of 330 residential home places since 1995. NHS Lothian and the local councils, working together, have identified their key priority as growing the care home market by purchasing and commissioning 240 care home places now, which includes the development of four new care homes.
It is crucial that community alternatives to hospital are developed. I am delighted that the Executive has announced an extra £2.7 million to assist with NHS Lothian's action plan. I hope that NHS Lothian's target of a sustainable reduction of 160 delayed discharges throughout Lothian by April 2003 will be met as a result.
Finally, hospital-acquired infection is another key reason why people spend too long in our hospitals. A recent study by the University of Glasgow suggested that that might be an even bigger problem than bedblocking through delayed discharge. I welcome the fact that the Executive is dealing with that in several ways, including the convention this Friday. I am sure that we will return to that subject after the recess, as will the Health and Community Care Committee.
In conclusion, the Liberal Democrats welcome the shift from waiting lists to waiting times and would welcome any move to bring clarity to the recording of the relevant statistics. We acknowledge not only the difficulties that are faced, but the tremendous job that staff have done and the support that the Executive has given. We welcome the minister's response to Audit Scotland's report as the way forward and we will support the motion.
I counted two uses of the word "finally" and one "in conclusion" in that speech.
I was keeping you on tenterhooks.
Waiting times have been, are and will be too long for some time, but they are being tackled. The evidence is that the measures that we have adopted are having an impact.
On 31 March, just under 72,000 patients were waiting for in-patient or day treatment. That is a fall of nearly 11 per cent during the year. More than half the patients who are treated in NHS Scotland hospitals receive immediate treatment and some never join a waiting list. Of those who do, more than half are treated in one month and eight in 10 are treated in three months.
In Forth Valley, the number of patients who wait more than six months has fallen by 21 per cent. I congratulate Forth Valley staff, whose dedication has, I am sure, significantly contributed to that reduction. However, orthopaedics remains an issue in Forth Valley and I have asked the waiting times unit to examine that.
More needs to be done, especially for patients who expect the longest waits. The national waiting times unit has allowed areas in which long waiting lists have existed to use spare capacity in the NHS. Cancer and heart disease are the top priorities for national waiting list times. By 2002, the maximum waiting time for heart surgery will be 24 weeks. By 2005, the maximum wait from urgent referral to treatment for all cancers will be two months. Waiting times for heart bypass operations have more than halved since 1999. The average now is 10 weeks, compared with five months then.
Staffing improvements are planned, including the recruitment of more nurses and funding for the training of additional doctors, of whom there should be 475 by 2004. A fundamental review of medical work force planning is near completion. The Minister for Health and Community Care has called for investment and effort to be more co-ordinated, more focused and more closely linked with reform than ever before.
That co-ordination includes health bodies and local authorities getting together to tackle wasted resources from delayed discharge. It is essential that robust plans are put in place to deal with that. It is also vital that appropriate packages are adopted to put patients' plans in place before they go home, not after their release. Appropriate community care services must be planned by all the agencies together, including the voluntary sector.
Does the member share my concerns that although when we talk about delayed discharge, we often think about the elderly, many patients with mental illness are subject to delayed discharge, and that the discharge of 29 patients in Carstairs has been delayed because of the lack of a medium-secure unit in Scotland?
Clearly, there are concerns about the time that it has taken to find appropriate places for those patients.
Twenty years.
As my colleague Brian Fitzpatrick said, it has taken 20 years.
I know that the minister is examining the issue. It is clear that there is a long way to go, but I am sure that further investment and a co-operative effort will deal with waiting times. We can look forward to a reduction in waiting times in the future.
The Audit Scotland report has shown up the disgrace of the waiting time fiddle that is confusing for patients and distressing for their relatives. The minister has repeated the Audit Scotland finding that there is
"no evidence of systematic or deliberate irregularities in the management of waiting lists."
I am reminded of a passage in a book by John Pilger, in which he wrote about Robert Maxwell and the apologists for Robert Maxwell who used to say, "I am a journalist. Maxwell never told me what I had to write." Of course Maxwell did not do so. The journalists knew exactly what they had to do. The case is the same for the Labour cronies who stuff health boards and health trusts in Scotland. The minister does not have to tell them what to do about waiting lists. They just know that they have to make the list look better for the Executive.
Tricia Marwick may wish to reflect on what she said. I am sure she knows, or she ought to know, that the appointment of Audit Scotland has nothing whatsoever to do with the Scottish Executive. Audit Scotland is an independent body.
I am sure that the minister will withdraw that remark. I did not refer to Audit Scotland but to the cronies that he has stuffed on health boards and health trusts. Those people do not have to be told what to do; they know what they have to do. They have to make the Executive look good. Audit Scotland has exposed the waiting list fiddle and the minister failed to address that point today.
Tayside NHS Board has taken existing in-patients and out-patients off its waiting lists and has not recorded elective admissions. In Fife, procedures have been reclassified and patients waiting for such procedures who could have been treated as out-patients have been taken off waiting lists. New referrals are not added to the waiting list if they are already in-patients. Some patients retain their waiting-time guarantees, while others do not. The situation is confusing and distressing for patients and their relatives. Patients are left worried and unsure about which list they are on, how long the list is, what the waiting time is and what will happen to them.
On Tuesday of this week, The Courier and Advertiser highlighted the circumstances of Mrs May Cullen. For those members who did not read the article, here are the details. Mrs May Cullen from Burntisland was admitted to hospital in March and was advised to seek an appointment with a neurologist with respect to her condition. She suffers from seizures and epilepsy had already been ruled out. Mrs Cullen received a reply from Fife Acute Hospitals NHS Trust telling her that the first appointment with a consultant would be early in 2004—almost two years away.
Mary Mair, the trust's directorate manager of medicine, wrote to Mrs Cullen and admitted that the delay was
"unacceptable to yourself and to the trust."
The unacceptable delay is not helped by the fact that there is no neurosurgeon in Fife. More worryingly, Fife NHS Board has known of that situation for some time, but has refused to make resources available. The situation is intolerable.
The distress that has been caused to Mrs Cullen and patients like her the length and breadth of Scotland cannot be allowed to continue. I challenge the minister to explain to Mrs Cullen why she will have to wait so long for an out-patient appointment and what he intends to do about that. The six-month guarantee is welcome, but it will do absolutely nothing for people like Mrs Cullen.
Of course, that wait is totally unacceptable. The whole objective of our waiting policy is to target those long waits. The waiting times unit has spoken to Fife NHS Board and every other NHS board in Scotland precisely to ask them to work up action plans to deal with those unacceptable waits.
The minister misses the point. Mrs Cullen is an out-patient. She will get no waiting time guarantee.
She is an out-patient.
Exactly, but she has no guarantee of when she will be seen. It is completely unacceptable that the minister will not roll out the system to allow out-patients to be given a waiting time guarantee. Mrs Cullen will have to wait two years and then she will perhaps get a waiting time guarantee of six months for treatment. That is not helping at the moment.
It is quite clear that, while the Executive fiddles the figures, the people of Scotland are suffering. It is time that the Executive got a grip of the situation and gave waiting time guarantees to people at every single stage of the process through the system, including seeing a GP and seeing a consultant at an out-patient clinic. That is what people like Mrs Cullen are crying out for and that is what the minister should be doing.
Delayed discharge among elderly people who need residential care placements is a continuing problem in Angus, where a significant number of patients are still blocking beds in the county's hospitals. Bedblocking causes stress and worry for elderly patients and their families, and prevents beds being used for other things by other patients who need treatment. Angus Council and the Tayside health authorities should be doing more to tackle the problem. They can do that most effectively by making appropriate use of the private and voluntary residential care sector.
Rather than working closely with the private sector, the SNP-controlled Angus Council has been facing allegations of bully-boy tactics towards elderly residents in the private and independent sector during the run-up to the implementation of free personal care. It is reported that Angus Council social workers have gone round residential nursing homes attempting to coerce fee-paying residents into switching to council care—including one 93-year-old blind lady at Fordmill nursing home in Montrose.
Westminster Health Care, which runs Fordmill nursing home, has complained about that to the Scottish Executive, stating:
"The people who are residents in the home are there because they are vulnerable. They are elderly people and some of them have some degree of confusion. They shouldn't be put in a position where they are expected or coerced, while unaccompanied or advised by their loved ones or legal representatives, to make decisions in a very short period of time."
I have already written to the chief executive of Angus Council asking for an internal inquiry into that conduct. All that I have had is an instant denial from the SNP social work convener, Glennis Middleton.
Mr Allan Keir, the chairman of the Organisation of Residential Care Homes Angus, has suggested that the council has acted in an unprofessional manner, and has said that there must be
"doubts about the ability of Angus council homes to accommodate any more"
elderly people, as they
"enjoy a very high occupancy".
He has further hit out at the convener's assertion that social workers have done nothing wrong, saying:
"When the judge, jury and accused clearly have a vested interest in proving themselves innocent then natural justice is an early casualty".
Joe Campbell, the chairman of Scottish Care, claimed that the council's actions demonstrated that some Scottish local authorities are hell-bent on the destruction of the private sector. Those concerns have reinforced suspicions in Angus, held by many, that the SNP council has an ideological problem with the private and independent sectors, is biased against them and is seeking to undermine them and force people into council care.
Will the member give way?
No.
To tackle bedblocking and delayed discharge among elderly Angus residents, Angus Council must work hand in hand with the private and independent residential care homes sector. Angus Council must get its act together and start treating the private and independent sector in a fairer and more professional manner.
I am pleased that the Executive's motion survives both attempts at amendment. I am also pleased to see support from the Executive for NHS staff and recognition of the key role that they play in building a better health service for Scotland. It is entirely proper to recognise their commitment and hard work. Of course we will have knockabout in this chamber, and we will also have legitimate and principled debates about the NHS, but I hope that we can unite in reflecting on the work done by NHS staff. We should not miss any opportunity to reflect on that.
We also need to keep in mind the factors that affect waiting lists, which Cathy Peattie outlined. More than half the patients who are treated in NHS Scotland receive immediate treatment and never join a waiting list. About half the patients are treated within a month and about 80 per cent are treated within three months.
I was particularly pleased to hear the minister speak about the need for a culture of improvement. We do not suggest that not much more needs to be done before we can say that we have established the NHS that we want in Scotland. Previously, there was deliberate and damaging underinvestment in the health service, which was visited on it by those who opposed the NHS in principle and in deed. Mary Scanlon is a nice woman—
The member is talking about patients and waiting times. Perhaps he should reflect on the fact that a Conservative Government introduced the patient guarantee and the patients charter and the Labour party did not oppose many aspects of those at the time.
The Conservative party's real health spokesman, Dr Liam Fox, has said of the NHS that the Conservatives' plan is to show that it cannot work and will never work. I will reflect on that and we will continue to remind the people of Scotland about it. The Conservative party voted down the additional funds necessary to make the NHS in Scotland work. Mary Scanlon has accused Malcolm Chisholm of having a brass neck, but on the Conservatives' performance and given the commitment in the Conservative party's known agenda in respect of the future of the NHS, she deserves a baronetcy. She should be the Baroness of Brassneck.
It is interesting that the member considers Liam Fox to be the Conservative party's real health minister. Does that mean that the member thinks that Alan Milburn is the Labour party's real health minister?
There is only one Malcolm Chisholm.
There is a legitimate point to be made about ideology rather than the devolution settlement. There is an ideological argument about the future of the NHS and we have heard nothing from the Conservatives that suggests that they are in anything other than the same camp as Dr Fox. [Interruption.]
Order.
We also know that not one brown penny of extra funding for the NHS was promised by the nationalists last year.
In the minute and a half remaining to Brian Fitzpatrick, will he move on from facile political point scoring and address some of the important issues that have been raised that affect real people throughout Scotland?
I will defer to Miss Sturgeon's expertise in facile political comment.
We cannot shrink from the findings of Audit Scotland in the performance audit report and I was pleased that the minister faced up to them. We should ensure that patients' interests are protected as more cases are dealt with on an out-patient or day-case basis. Members will have seen in the performance audit the remarks of the team about endoscopies in the North Glasgow University Hospitals NHS Trust. I do not want to be like those who try to bandy around the words of the report. There was no evidence of patients' treatment being reclassified for anything other than clinical reasons.
Will the member give way?
No, I will not. [Interruption.]
Order. Let the member continue.
Like Margaret Smith, I welcome the pragmatism behind the Executive's decision on HCI. It would have been a desperate display of poor judgment to have missed out on that once-ever opportunity. Patients and their families will welcome progress in cutting waiting times, in creative thinking and in action to deliver reductions.
Before I sit down, I want to mention again to the minister the key contribution that will be made in reducing waiting times for patients by facilities such as the ambulatory care and diagnostic facility proposed at Stobhill hospital in the constituency of my colleague Paul Martin. He, other constituency MSPs and I will have lively discussions with the minister on the wider issues of the acute services review, but I assure the minister of the tremendous support that there will be for early progress on the submission for Stobhill. I hope that he will keep that proposal in mind as a key measure in reducing waiting times.
I welcome Audit Scotland's report, which is the subject of the debate. However, I have seldom attended such a depressing debate. I do not think that I have heard in so short a debate so many statistics thrown about to so little advantage by so many people. What is the purpose of those statistics? I cast doubt on the way in which all parties use statistics.
For example, I was contacted today by a constituent in Glasgow, who wanted information about tomorrow's special meeting of the Greater Glasgow NHS Board, which will decide the recommendations about the future of accident and emergency provision in Glasgow. The constituent referred me to an advertisement for the meeting in The Herald, which included a website address and a telephone number. The number was not answered and the website address was wrong. When my constituent identified the correct web address, there was no information or background material there about the special meeting. I mention that story partly as an illustration of what can happen occasionally—I am sure that it was an administrative hiccup rather than anything more sinister. However, I suggest that the statistics upon which we rely so solidly in debates can be the result of computer or human error. We should limit ourselves in the extent to which we rely on statistics.
I asked members what the purpose of the statistics was. Let us consider waiting times and the way in which the Government or the Executive supply figures to demonstrate that a situation has improved, and the way in which the Opposition supplies statistics to demonstrate how matters have got worse. Then, in emergencies, Mrs Cullen of Fife is introduced to the debate, as well as examples of individual situations that members use to support their case. At the end of the day—
Will the member give way?
No, let me make my point.
The provision of health services in Scotland can be regarded from two angles. First, we need an adequate NHS to deal with the crises, the problems, the operations and the things that have gone wrong. Secondly, we need health provision —and social provision—in Scotland that avoids the position of having to have so many operations. In debates such as this, there is sometimes a suggestion that the more heart bypass operations there are, the better. The logical end result of that would be that everyone in Scotland could have a heart bypass operation—that would be the ultimate achievement, but that is not the case. We have to balance the acute services provision against putting in place health promotion activities to improve the diet, lifestyle and health of the people of Scotland.
More and more money has been put into the health service in recent years and diligent efforts have been made by Governments of a variety of persuasions to try to get best use of those resources. There is general acceptance now that money is not the whole story. We can throw extra money at the problem, but that results only in a sideways movement. It is a bit like punching a jelly: one punches it at one side to achieve something and a bulge that one had not anticipated at the start appears at the other side.
A proper forward-looking manpower survey is required to investigate the needs of the health service. The survey should deal with the retirement of consultants, the new people coming in, the numbers of people whom we train, how long it will take to put them in place and how we can deal with the problems in the short term. We cannot snap our fingers and produce hundreds of new doctors, consultants and nurses. We all know that there is a problem in recruitment and retention.
Does the member recognise that we need those figures to be able to plan manpower in the NHS? We must recognise and acknowledge the unmet need and the demand for a service. Some form of measurement is essential. Does not the member share my concern, given that the Audit Scotland report states that the reason for the deferred list is unclear and yet over 30 per cent of patients in north and south Glasgow are on the deferred list?
Mary Scanlon has made her speech.
I will allow you a little longer to account for that intervention.
What Mary Scanlon said was exactly the point that I was trying to make. We must conduct a thorough and proper analysis with a view to identifying management decisions about where the health service is going. Some issues can be resolved now through improvements in management techniques and other actions that can be taken to make things work better. However, other improvements will take longer to put in place. Even with the best will in the world, doctors, who take six years to train, cannot be put in place immediately to sort out problems in the health service. We must consider what can be done in the short term until those doctors are available. We must also ensure that we plan to train more doctors and nurses and to have them coming on stream in time.
My final point, which is about HCI, relates to a different category from some of the other figures that we have heard about. HCI is a solid new hospital provision for the NHS. It represents a bargain offer that allows us to deal immediately with waiting list and waiting time difficulties without attacking other health service resources. We can look forward to the use of the mothballed facilities at HCI with a view to the creation of a centre of excellence, which will be of great use.
Let us not become too obsessed with statistics; let us consider what happens on the ground and the practical ways in which that can be improved. There has been an absence of suggestions about that from the Opposition.
It is the job of the Opposition to hold the Executive to account. Members should recognise that the debate is a result of pressure from the SNP. It is the job of Government to take responsibility. I do not want the Minister for Health and Community Care to abdicate his responsibility. He should consider the abolition of deferred waiting lists.
As recently as last week's First Minister's question time, Jack McConnell insisted that everything was fine in the NHS in Scotland. This week, Audit Scotland has proved him wrong. I will reprise some of the recent history of the health service in the Lothians. I remind members that the debate is not simply about statistics—it is about people.
A young constituent of mine, who had been the subject of sexual abuse, was initially denied assessment because the child mental health list in the Lothians was closed. In West Lothian, general practitioners have had to close their patient lists and people have had problems accessing their GPs. Waiting times are calculated from the time that patients are referred by a GP; if there is difficulty in seeing a GP in the first place, that adds to the wait. In West Lothian, waiting times are seven days longer than they were in June 1998. Another constituent of mine who required investigative surgery for breast cancer had her operation at St John's hospital at Howden cancelled because no sterilised instruments could be provided from Edinburgh royal infirmary.
Such problems arise not through lack of commitment on the part of NHS staff, but because the staff do not have the required policy and resources to deliver. We should pay tribute to those who have busted a gut and worked weekends to get the waiting lists to their present level. However, that is not sustainable.
We found out recently that hospital trusts in Lothian NHS Board have had to cut back their operating budgets. The 1 per cent strategic change deduction is to pay for the private finance initiative at the new Edinburgh royal infirmary, which has fewer beds than it needs and fewer beds than the old royal infirmary. Other NHS services are suffering because of the expense of the PFI project. It is no wonder that the chair of Lothian NHS Board consistently cancels the meetings that I arrange to discuss those matters.
I want to focus on some of the waiting list information. On 7 February, under SNP questioning, the First Minister admitted that waiting lists in West Lothian were being fiddled. He said that gastroenterology had been reclassified, which had helped. It has helped only because the aim of the tick-box culture is to meet targets. We cannot have public services that are led by a tick-box culture—they must be led by patient care.
Page 35 of the Audit Scotland report refers to the fiddles in West Lothian. It states:
"West Lothian Trust has incorrectly used the deferred list for patients waiting for treatments of low clinical priority".
In the quarter ending in March of this year, 29 per cent of waiting patients in West Lothian were on deferred waiting lists. That is the second highest figure in the country.
I referred to the 1 per cent cut that is happening throughout Lothian because of the new Edinburgh royal infirmary.
Will the member give way?
Sorry.
West Lothian Healthcare NHS Trust has a £5.6 million deficit. How does that relate to how we will cut waiting lists and waiting times? There is a problem in West Lothian with recruiting and retaining consultants. Staff are needed to ensure that operations can be done at their assigned time. There is also a more immediate problem. One would think that we would want to keep hospital wards open and hospital beds in operation. Why, then, did the trust management team only last week, when considering its long-term financial recovery plan to deal with its £5 million deficit, say:
"The Trust Management team will recall they previously considered the bed utilisation option appraisal and agreed, in principle, to pursue the Ward 19 closure."
Ward 19 is the ear, nose and throat ward. The trust management team went on to say:
"This action remains an integral element of the Trust long term financial recovery plan, consequently colleagues are asked to re-endorse the principle and agree that the proposal be implemented as soon as possible."
How can we close wards but keep beds open and meet the minister's targets on waiting times and waiting lists? Those targets cannot be met if wards are being closed. Why is the ENT ward in West Lothian being closed, not to meet policy resources for patient care, but to meet a long-term recovery plan for a £5 million pound deficit at the same time as we are paying for the PFI—which the Tories put in place?
I endorse what my colleague Robert Brown said about statistics. Obviously we need statistics and we should collect them, and they should be as good as possible. However, the vital thing is that we should not believe them. There should be a ten commandments for incoming members, one of which should be, "Thou shalt not believe any official statistics." That is not a party point, but a factual point. The most extreme case that I met was when I was seeking to get a pedestrian crossing on a road that I had travelled hundreds of times. The official figures for the average speed of cars referred to car speeds that were slower than any I had ever seen. The whole thing was rubbish.
Many official statistics are rubbish. I am sure that we could all give examples of individuals telling us that they are going to have their operation in 14 or 15 months' time, which is unacceptable. The Executive deserves credit for asking Audit Scotland to look into that matter. Audit Scotland did so and found various anomalies that the Executive is trying to put right. That is good, open government for which the Executive deserves due credit.
I would like to reaffirm points that have been made by colleagues about the importance of hospital-acquired infection, which is a destructive problem. According to the statistics of a commercial pressure group—which are also probably wrong—HAI causes more occupied beds than delayed discharge. I endorse the point that was made by Robert Brown about the importance of preventive and social medicine and of not just chopping off people's limbs.
The pressure within the health service tends to be on the high-technology people, the very skilled professors of this and that, who want the latest machines to do good things with. However, all the pressure goes in that direction rather than to GPs, trying to improve people's housing, sport, or whatever it might be.
Despite some good efforts by the Executive, there still seems to be a bit of a muddle over the funding of residential accommodation. There are still charitable bodies—not profit-seeking bodies—that cannot balance the books in running residential accommodation and have to close. That is unacceptable.
We could make more progress if there was a person, or a small group of people, whose job was to ensure liaison between health bodies and councils; they could go round the country beating people's heads together. There is still a problem in getting the two sides together and achieving the best result for our money. At the moment, people can blame each other.
We face a philosophical problem. On the one hand, we do not want to interfere in the day-to-day management of health activities—the professionals should get on with it and do it as well as they can. On the other hand, they are accountable to the public, as are we, and we have to have an effective way of ensuring that they show that they are delivering with the money that they are allocated. In this and other debates, many members have repeated the truism that merely throwing money at a problem is not the answer and that what matters is how the money is spent. We have to work out a system by which, without unduly interfering with the management, we can measure outputs in order to get health boards to prove that they are using the money well. I hope that the minister will develop that thinking.
We were promised that this year would be the great year of delivery, when Labour's promises would finally make an impact on the patients and the users of the NHS. That has certainly happened because, for all the billions of pounds—I stress that we are talking about billions—that have been spent, the Executive has not only failed to cut the number of people who are waiting, but has failed to raise the number of people who are being treated or to treat them in a shorter time. That is not delivery; it is more like reckless dereliction of duty.
The statistics speak for themselves, but I will not go into them as we have heard them from the Opposition speakers throughout the afternoon. The fact is that, after many years in government, the Scottish Executive's targets are merely where the Conservatives left off. That shows what a failure Malcolm Chisholm's policies are. If members do not want to take my word for it, they should take the word of Alan Milburn, who has reputedly urged the Scottish Executive to modernise as well.
Today's debate has focused on two areas, the first of which is the purchase of the HCI hospital in Glasgow. I cannot deny that £37.5 million for a new hospital is a good buy for anyone, but I must point out that the purchase is not the result of a progressive, well-planned health care policy but is a car-boot sale panic buy to accompany Mr Chisholm's many task forces and working groups. Against the background of the hundreds of priorities that Mr Chisholm's department seems to have, that is understandable. In fact, I would be grateful if Mr McAveety, when he sums up, could tell us what areas of the Scottish Executive's health policy are not priorities, as that would allow us to know who will not be disappointed.
The other half of the debate focused on the Auditor General's review of waiting lists in Scotland. The report assures us that there has been no deliberate attempt to manipulate the waiting lists, but how would the Auditor General know that, when the only people he asked were the management in the trusts? Following that logic, I am sure that we will all go and ask Ronnie Biggs whether he robbed the train.
The report talked about the growing size of the deferred waiting list. That list is beginning to resemble a list of the disappeared from some far-off country. Month after month, patients pour in with no hope of a return to Government waiting list targets. However, what is interesting in the Auditor General's report is the list of people who are excluded from the definition of deferred treatment. As well as patients who cannot make appointments because of holidays or other personal events, admissions that were cancelled for non-medical reasons such as a lack of staff, beds or facilities are excluded. That is why the Scottish Executive's reassurances do not stand up.
In March, 2,000 patients were moved under code 9 exemptions from the waiting list to the deferred waiting list. A code 9 exemption is described in the patients charter as being to do with
"Exceptional strain on the NHS such as major disaster, a major epidemic or an outbreak of infection, or service disruption by industrial action".
A code 9 exemption does not apply to patients who choose to move their treatment or who are unwell at the time of admittance. That means that we are being told that, in March, 2,000 people went from one waiting list to another not because they asked to go on holiday or were too ill to receive the treatment, but because the NHS was suffering from a major disaster, a major epidemic or a massive bout of industrial action. I cannot recall those things happening in March, but I can recall a movement in Government targets.
Of course, information on code 9 exemptions is not published, but I have got hold of some. It shows that, of those 2,000 people, 410 had been waiting for more than 12 months. We all remember the First Minister's assurances to the leader of the SNP that no one had been waiting for more than 12 months, but in the past year 1,200 people have moved, under a code 9 exemption, from the true waiting list to the deferred waiting list because they have been waiting for more than 12 months. There are people waiting who want treatment, are available for treatment and have been moved by the NHS and the Scottish Executive. That is a fiddle. It is a lie. It is letting down those who expect a better service for their billions. It is a betrayal.
Let us examine Mr Chisholm's brass-necked points, as they are important. First, it was the Conservatives who introduced the patients charter and the waiting guarantee, not Mr Chisholm and not his party. Of the eight PFI-funded hospitals that Mr Chisholm claims for himself, six were built under the Conservative party. Mr Chisholm said that nine months was a totally unacceptable waiting time for a heart bypass when the Conservatives were in power. He is not even getting close to that.
Brian Fitzpatrick's points were the usual rubbish. Mr Milburn should hang on: Mr Fitzpatrick says that it is a matter of ideology.
Will Ben Wallace give way?
No, I must sum up.
Mr Milburn has continued fund holding, continued private concordats and expanded the involvement of private foreign companies and PFI. Whose ideology is that?
We must also wait for Mr Fitzpatrick to resign. I think that, when he was a candidate for the Parliament, he pledged that he would resign if the secure unit at Stobhill went ahead. We will hold him to that.
All that the Labour Executive knows how to do is to fiddle and throw good money after bad. It has no idea how to run the NHS, least of all how to save it within 48 hours.
On a point of order, Presiding Officer. The code 9 patients were removed from the waiting lists for tonsillectomies for very good reasons on the advice of the chief medical officer.
That is not a point of order, but it is now in the Official Report.
The debate on waiting—
On a point of order, Presiding Officer. Is it not inappropriate for a senior minister to make such an inaccurate point of order? Perhaps mere back benchers can make mistakes with points of order, but for a senior minister to make such a point was inappropriate.
The minister possibly learned from you in that respect, Mr Gallie. I would like to get on with the debate, as we are running slightly behind the clock.
The debate on waiting times is well timed indeed, in the light of the shenanigans that were revealed by the Audit Scotland report, to which many members have referred. That report was produced only after the SNP—in particular, John Swinney—pursued the matter at First Minister's questions. The report was not produced, as Margaret Smith would like to think, out of the goodness of Jack McConnell's heart. We pursued it and dragged it kicking and screaming out of the Executive, as all members know.
The SNP welcomes the new waiting time targets that the minister announced today. However, the reality is that waiting times are going up. There has been an increase of 20 days in median waiting times. The minister has a long way to go—if he can be bothered to listen. Audit Scotland has revealed that many patients are waiting more than 12 months for treatment. That is a clear breach of the 12-month guarantee. Why should the public trust the Government when it announces a new six-month target wait if it cannot even meet the 12-month target? That will hardly instil public confidence.
The Audit Scotland report revealed a large number of inconsistencies and irregularities, to which many members have referred. The management of waiting lists has been found to be very inconsistent throughout Scotland. Frankly, for the Executive to claim no responsibility is unbelievable, because a culture has been created that encourages hospitals to find ways of keeping down their waiting lists no matter what. That culture has led directly to the deferred waiting list, which has been used to siphon off 25,000 patients from the true waiting lists so that they can disappear from the headline waiting list figures. To say anything other than that is unbelievable and no one believes it.
Audit Scotland could find no rationale for deferred waiting lists. What more evidence is required in order for deferred waiting lists to be abolished? We do not need another inquiry; we need deferred waiting lists to be abolished.
The difference between the SNP and the Scottish Executive is that we accept the Audit Scotland report and its detail in full. The report says that the ISD should conduct a review of the rationale of deferred waiting lists. That is precisely what we will get the ISD to do.
The difference is that the SNP believes in action rather than words—and action today. That is the difference between this party and Malcolm Chisholm's party. It is not just the SNP, but the BMA that has said that 25,000 hidden patients are included on the deferred waiting list. If those patients were included on the true waiting lists, the Government's targets would not be being met, despite the Executive's claims to the contrary.
It is time for action on a number of fronts. It is time for the deferred waiting lists to be abolished, and that should be done today, not next week or next month. It is time for patients at all stages to receive a waiting time guarantee. What is the problem with that? Why does that pose the Executive so much difficulty? It is also time for an independent health inspectorate to be established to protect patients' interests from Government interference, which has been so clearly demonstrated by the Executive.
Delayed discharge remains a huge, long-term problem, which must be addressed so that people receive the appropriate care in the appropriate setting and in order for the capacity of the NHS to be extended. I hope that the figures that are due out will show progress. However, one trust chief executive told me last week, "The system is silting up as bad as ever." I hope that it is not silting up, because that means that the 3,000 people who are trapped in inappropriate hospital wards continue to be trapped there. That is a tragedy.
The Administration is on very shaky ground when it comes to waiting times and waiting lists. It has lost the public's trust on waiting times and waiting lists. The public do not believe a word that the Executive says on waiting times. We need a health system that is free from political interference, in which the public can have full confidence. We will wait forever for that under the present Administration, and it is time that it gave way to a Government that will put the public interest before Government interference.
I thank Shona Robison for building up to such an anticlimax. What is missing from the debate is a recognition that the Executive is putting more money from its resource base than ever before into the Scottish health service. In addition, when we have been faced with challenging responsibilities, Malcolm Chisholm has intervened and taken action on a whole series of matters. In most cases, those actions were opposed in a curmudgeonly fashion by the SNP, with their development not even recognised as credible.
Since last week, when we learned of a wonderful opportunity in the form of the acquisition of a hospital, the SNP has been trying to come up with an attack, once more turning the debate into a cross-border dispute about whom we treat within a hospital facility in Scotland, rather than recognising that the centrality of our contribution has been to tackle much of what SNP members have been talking about this afternoon. The difference is that—unlike what Shona Robison said—we are delivering on many of the key issues. We are not pontificating on them from the sidelines, which the SNP will be condemned to do in the future.
After three years in the Parliament so far—
Will the minister give way?
Let me continue, so that I can enlighten Nicola Sturgeon. For three years, the Opposition—the SNP in particular—has said that we should be focusing on waiting times. The SNP has one window of opportunity on one partial aspect of waiting lists and it tries to make a major issue of it without recognising that, even according to the Auditor General for Scotland—an independent person, contrary to the systematic allusion to a crony, which appears to be what Tricia Marwick suggested he is—there is clearly no way in which there has been political interference with the waiting lists.
Will the minister give way on that point?
I am happy for Patricia to enlighten us once more as to what she was really trying to say about Bob Black.
I thank the minister for giving me my Sunday name, yet again. He knows full well that I was making no reference to Bob Black and that I never suggested that Audit Scotland is not independent. I was referring to the Labour cronies that the Executive has stuffed on health boards and NHS trusts the length and breadth of Scotland. They are the ones who know what the Executive wants to be done.
Sophistry is a wonderful word—the member should look it up.
As we are not casting aspersions on Bob Black—I thank Patricia for that clarification—let me remind members what he says on page 5 of the Audit Scotland report:
"Audit Scotland found no evidence"—
I will repeat that for the benefit of the hard of hearing—
"Audit Scotland found no evidence of systematic or deliberate irregularities in the management of waiting lists. However, we found some inconsistencies across Scotland in the administration of waiting lists and the application of central guidance on recording waiting list information".
That is exactly what Malcolm Chisholm said that he will take action on. He will wait for the review by the information and statistics division of the Common Services Agency.
In the concluding part of the report, under the heading "Conclusions", we are told again:
"Audit Scotland found no evidence of systematic or deliberate irregularities in the management of waiting lists."
I emphasise that because the SNP failed to recognise that conclusion, choosing instead to focus on minor matters in the report that the minister is willing to address.
I am offering two constructive suggestions. If the minister takes responsibility and accepts those suggestions, we can remove the suspicion of fiddling once and for all. First, we should abolish the deferred waiting list and have one waiting list. Secondly, we should give all patients a maximum waiting time guarantee. Then there would be no suspicion that, if patients were reclassified, it was only to take them out of that guarantee and to make a failing Government look slightly better.
The minister has stated what he wishes to take from the full report. The report also recommends that a review should be undertaken before we can make the decisions that Nicola Sturgeon is asking us to make. That is right and proper. If SNP members do not think that that is a right and proper way for a Government to handle the situation, that is why they will never be in government in Scotland. That is the difference between them and Malcolm Chisholm.
I have done some research on the definition of deferred waiting lists. There have been no changes at all in the definition of deferred waiting lists since they began—I hope that Nicola Sturgeon heard me properly. De facto, that means that there has been no political interference in the definition of deferred waiting lists, although that was the very—
Will the minister give way on that point?
Sorry. I have heard enough this afternoon.
That is the charge that the SNP has peddled in the newspapers for the past few weeks.
I want to address the bigger picture. Many members raised issues about the decision on deferred waiting lists. As I have said before—and Malcolm Chisholm reiterated this—some folk would prefer to stay on a deferred waiting list because that would be more convenient for them. We asked for the review, contrary to what we have heard this afternoon from what I would colloquially call the John Swinney fan club, which has tried to claim that John Swinney made that demand. The First Minister said that he was happy to undergo the scrutiny of the report. We are accepting the report in its totality and we want to make further recommendations.
I appreciate the minister's efforts to clarify the situation regarding the deferred waiting list. If the definition has not changed, why are fewer than 15 per cent of patients on the waiting list in Tayside on the deferred list, whereas more than 30 per cent of patients in the NHS trusts in the north and south of Glasgow are on the deferred list? If the definition is the same throughout Scotland, should the percentage not be the same throughout Scotland?
Mary Scanlon makes a valid point. Malcolm Chisholm wants to take part in the review to try to identify ways in which such anomalies can be addressed.
Many members have asked whether there are plans to address concerns about waiting times in the areas that they represent. Cathy Peattie identified an issue in relation to Forth Valley NHS Board. The national waiting times unit discussed that issue with the board last month and I have agreed an action plan with the board, which will address the longest waiters, not just in orthopaedics but in all specialties.
I want to spend the remainder of my speech on an issue that is of critical importance—delayed discharge. Last Friday, I was delighted to announce the release of the outstanding resources to address the action plans that have been put forward by NHS boards and local authorities during the past few months. That money will be put into the system to ensure that the system is integrated and is able to deliver a package that includes early intervention. Early intervention will mean that people do not spend too long in hospitals with the result that they cannot be found places outside hospitals that would suit their care. We injected a large additional resource of £20 million precisely to address those issues. I am glad that that injection of funding has received widespread support throughout the Parliament.
We must consider how we deliver a much more effective strategy that will tackle the charges that have been made by the main Opposition party. Unlike the SNP, I do not want there to be too many hospitals or too many beds across Scotland. I want a health service that supports a strategy of delivering much more effective health care in localities.
Much of the critique on bed numbers has focused on clinical changes rather than on the financial arrangements for the development of hospitals. Different strategies through local health services and health centre provision and the intervention at an early stage of other players within the health field are key elements of the debate about health in Scotland. That is why we should reject the SNP's narrow and nationalist sectarian perspective on the use of HCI. We must fulfil our outstanding commitments to patients. Unlike the SNP, we were delighted to welcome the acquisition of HCI for the public sector. We will take up the issue of delivering on waiting times and we will make a difference in Scotland.
In conclusion, the health team and I are happy to be judged on delivering for the people of Scotland. That is why the Scottish people put their trust in us rather than in the SNP.