Waiting Times
The next item of business is a debate on motion S3M-6393, in the name of Nicola Sturgeon, on progress towards the 18-week referral to treatment target. I reiterate what I said earlier: we have absolutely no spare time and I will need to stop members when they reach their time limit.
15:24
I welcome Murdo Fraser to his first debate as the Tory health spokesperson. I am sure that colleagues on all sides of the chamber will agree that the parliamentary health community is a select and elite bunch of people to which it is not easy to gain access. Any body that has Ross Finnie as a member must be select and elite.
I welcome this opportunity to debate a topic that we all know is really important to all our constituents. Two weeks ago, we debated the new national health service quality strategy. I said then that patients want more from the NHS than speedy treatment; they want treatment of the highest quality in all its aspects, which is why the quality strategy is so important. I will say more about that later.
The focus on quality in its widest sense should not and will not reduce our commitment to ensuring the quickest possible access to treatment for patients. Waiting for a diagnosis when you are worried that you might be ill and waiting for treatment when you know that you are ill are undoubtedly among the most anxious and stressful experiences of people’s lives, and it is right that we continue to do everything possible to reduce that stress and anxiety.
The good news is that, over the past few years, the NHS has made considerable progress in reducing waiting times. Some of us will remember, in the early days of this Parliament, getting letters from people who had been waiting a year or even 18 months for treatment. We can all be grateful that that is a thing of the past. As I said in the debate on the quality strategy, both the present and the previous Administrations can take credit for the progress that has been made. The fact that a sharp focus on reducing waiting times, backed by considerable resources, has been a priority for both Administrations is welcome.
However, when we took office three years ago, although progress had been made, waiting times were still too long—people faced a wait of six months for a first out-patient appointment and for in-patient treatment. That is not intended to be a party-political point. The commitments that were made in the Scottish National Party and Labour manifestos in the 2007 election—they are referred to in the Labour amendment, which we are happy to support—suggest that we both recognised that. It is encouraging that we have seen a real acceleration of progress over the past three years. Under this Government, the maximum waiting time standard for out-patient consultations and in-patient and day-case treatment is now 12 weeks.
The waiting time figures that were published on Tuesday of this week show that, as of the end of March this year, the NHS is not just meeting but in some respects exceeding those targets. Patients are having their first out-patient consultation within 12 weeks of referral. That is all the more impressive when we consider that the guarantee now includes referrals from other sources, such as consultant-to-consultant referrals, not just referrals from a general practitioner or a dentist. As a result of that change, about 93,500 more patients are benefiting from quicker access. In addition, 99.8 per cent of patients are waiting four weeks or less for the eight key diagnostic tests—a level of performance that is two weeks better than the six-week standard—and 99.5 per cent of patients are waiting less than nine weeks for in-patient and day-case treatment, which is three weeks better than the current standard of 12 weeks. Those are the shortest waiting times that have ever been delivered by the NHS in Scotland.
Against that background, it is no exaggeration to say that the transformation that has been achieved in recent years has been remarkable. Not that long ago, the level of performance that is now being achieved would have been inconceivable, and I am sure that all members will want to pass on our thanks to all those front-line staff in the health service, and all those who support them behind the scenes, for their hard work in tackling the issue with such success.
The progress that I have described is all the more impressive when we consider that the so-called hidden waiting lists were abolished at the start of 2008. That was one of our early commitments and within a year, 30,000 patients were removed from those lists. We now have a situation in which patients who were previously excluded from waiting time standards now have the shortest waiting times that the country has ever experienced for access to health care. I hope that members from across the Parliament welcome that fact. Audit Scotland certainly acknowledged it in its “Managing NHS waiting lists” report, in which it stated that waiting times had
“come down considerably in recent years”
and that
“People who would previously have had an ASC are now waiting for a shorter period of time”.
That highlights the progress that has been made.
Another of our early commitments was to improve the performance of the NHS against the 62-day cancer treatment target. That target should have been met in 2005, but when we took office performance was still 10 per cent short of meeting it, so in 2007 we made a clear commitment that the target of a maximum wait of two months from urgent referral to treatment for all cancers would be delivered by this Administration. I am pleased to report that sustained delivery of that target has now been achieved for more than a year. The most recently published data reported 96.5 per cent compliance, which represents an increase of 12 per cent since the beginning of 2007.
That progress is welcomed but, as I am sure we all agree and we will hear in today’s debate, we can and should do more, particularly for the patients who face the trauma, uncertainty and life-changing experiences that cancer brings. That is why NHS boards are working to deliver the new 31-day treatment target for all cancer patients by the end of next year. That will provide a fairer and more equitable service for all cancer patients after they are diagnosed, whatever the route of referral to diagnosis.
There is no doubt in my mind that timely access to health care is an important aspect of its quality. The benefits of shorter waits for patients and their families are clear: earlier diagnosis and quicker decisions on treatment lead to better outcomes. There is less unnecessary worry for patients and less postcode variation, which is also important.
That is why we have set an even more ambitious target. From the end of next year, patients can expect to be seen and treated within 18 weeks from referral by their general practitioner. Based on the performance that we have seen so far and which I have narrated this afternoon, we can have a great deal of confidence that Scotland is well on track to deliver the challenging target.
Having said that, I do not underestimate for a second the enormous task that the NHS faces in delivering that ambitious vision. We have made a good start, but it will require innovation, modernisation and service redesign to meet the target by the end of next year. It will also require prudent management of resources in what are very tight budgetary situations. That is why we are working with the NHS to provide the support and resources to meet the challenge, and in that regard I am happy to accept the Tory amendment, making it clear that continued progress on waiting times must remain a priority notwithstanding pressure on resources.
Unfortunately, I am not able to accept the Liberal amendment, although I have every faith that genuine sentiments lie behind it. It is of course the case that decisions about treatment are, and always should be, taken by clinicians, and it is also hugely important to ensure timely access to follow-up appointments—I certainly agree with that part of the Liberal Democrat amendment. However, it is important that we have in place national maximum waiting time guarantees. Maximum waiting times are just that—maximums—and they should never fetter a clinician’s discretion to decide that a patient needs earlier treatment. It is important that there is a clear framework of maximum waiting times to give patients certainty about the maximum period of time that they will expect to wait.
I am confident that the significant progress on tackling waiting times that we have already seen will continue thanks above all else to the dedication and determination of NHS staff to deliver the best possible service for patients.
As I said at the outset, although patients understandably want speedy treatment and quick access to care, they want much more than that from the NHS. They want a health service that is compassionate and which treats them with dignity; they want to see partnership between clinicians and patients; they want services to be provided in clean and safe care environments; they want hospital food to be good; they want continuity through their journey of care; and of course they want to have confidence in the quality and effectiveness of any treatment.
Achieving all that, for every patient, every time they use the NHS, is what the new quality strategy is all about, and I am happy that the Parliament had the opportunity to debate it just two weeks ago. As we move forward, we want access to care to be as swift as possible—and we will continue to ensure that—but we also want a health service that puts patients and the quality of patient care at its absolute heart. I am happy to move the motion in my name.
I move,
That the Parliament welcomes the progress that has been made in reducing waiting times for patients; applauds the commitment, dedication and hard work of all NHS staff who have contributed to delivering significant improvements for the people of Scotland, and acknowledges that NHSScotland is on track to deliver the Scottish Government’s challenging whole-journey waiting time target of 18 weeks by the end 2011.
15:34
I am sure that members will indulge me if I start by paying tribute to Mary Scanlon. I will not embarrass her with a long and glowing testimony, given that such a testimony from the Labour benches would undoubtedly not go down too well among her colleagues. Suffice it to say that her contribution to health was always well informed and, although there were many occasions on which we did not necessarily agree, I always found that she cared passionately about the NHS. I am pleased that she will continue to contribute, as part of the Tories’ health team, and I look forward to debating with her—robustly, of course—in the months to come.
I welcome Murdo Fraser to the health brief. He can be in no doubt that we face a challenging agenda, with tightening budgets and increasing numbers of people who require NHS treatment. I look forward to the insights that he will bring to our debates. Given his previous form, I am sure that those insights will be sharp, to the point and sometimes painful. I recommend that he continues to monitor my website, as he did in relation to minimum unit pricing, because he might then agree with me on a wider range of issues—who knows?
Today’s debate is about the success that has been achieved by our hard-working staff in the NHS—doctors, nurses and administrators. It is right that we should recognise their efforts and applaud their commitment to driving down waiting times. Much has been said in recent times and during the election campaign about protecting front-line services and having fewer pen-pushers and administrators—we have all been guilty of making such comments, to varying degrees. Although we need to review and prioritise what we do, I praise the administrators and managers who have worked hard alongside clinicians to give effect to the policy of driving down waiting times. What they have achieved is phenomenal.
The scale of the task was enormous. In the years of the previous Conservative Administration, there was an 18-month waiting time target. I say that not to make a political point but in recognition of the distance that the NHS has travelled since then. The Labour-Liberal Democrat Scottish Executive set out a new approach to waiting times in “Fair to All, Personal to Each: The next steps for NHSScotland”, in which waiting times were considered in terms of the overall patient journey. The approach was welcomed, as was the achievement a year ahead of schedule of the target to treat in-patients within 18 weeks.
I acknowledge and welcome the manifesto commitments from Labour and the Scottish National Party to move to an 18-week whole-journey treatment time and I welcome the progress that has been made. I support the cabinet secretary’s approach, which is to bear down further on waiting times and set new and more challenging standards.
I have a little sympathy for Ross Finnie’s argument. However, targets have been essential in driving down waiting times. We would not have made the genuine year-on-year progress on reducing waiting times that has been achieved if we had not set out our clear expectations of the NHS and if the cabinet secretary had not backed up those expectations with resources. It is about not political targets, but targets that are agreed in partnership with the NHS, so that they are realistic and achievable. I acknowledge the desire for flexibility, but it would not be right to take our foot off the pedal at this time.
I pay tribute to Malcolm Chisholm, who when he was Minister for Health and Community Care had the foresight to take the Golden Jubilee national hospital, formerly the HCI hospital, into NHS control. The hospital has worked successfully as a national waiting times centre, and the additional capacity that was created directly contributed to health boards’ ability to manage their waiting lists and achieve the targets that were set.
We started with a waiting time guarantee of 18 weeks from GP appointment to being seen by a consultant. That was reduced to 15 weeks from 31 March last year and to 12 weeks from 31 March 2010. Of course, the overwhelming majority of patients are seen within nine weeks for in-patient and day-case treatment, and the gap is narrowing for out-patients. I have no hesitation in commending the cabinet secretary for that reduction in waiting time.
There is no doubt that someone who is ill, perhaps seriously, will be extremely worried while they wait for a diagnosis and treatment. There is an impact on the health and wellbeing of not just the individual but their family and friends. We are fearful of the unknown and we often imagine the worst, so it is critical that we get the best treatment as quickly as possible. We have all heard heartbreaking stories about people who waited months if not years for treatment and about the impact of that wait on their lives. It is right that such stories are consigned to the dustbin of history.
In that context, I ask the cabinet secretary to consider whether it is possible to go further. As members know, there are different waiting time guarantees for cancer, which the cabinet secretary set out. The national waiting time target for cancer treatment that Labour first set in 2005 was 62 days. The SNP then halved that in setting a target of 31 days, which is to be achieved by December 2011. Given that cancer continues to cast a dark shadow over Scotland, the Scottish Labour Party manifesto for the recent general election committed to a new target that would have reduced the waiting time from one month to two weeks for seeing a cancer specialist and getting results. We all know—and experts confirm—that early detection and treatment of cancer means better rates of survival. Therefore, I urge the cabinet secretary to look again at the waiting time for cancer treatment. If she can reduce that time further, that would receive unanimous support from members not just on the Labour benches, but across the chamber.
In the spirit of consensus, let me say that we will continue to look at how much further we can drive down cancer waiting times. I hope that Jackie Baillie will agree with me, which I invite her to do, that we must ensure that such targets are sustainable. The 62-day target was not set in 2005 but was meant to be met by that time, yet it took some time after that for that to be achieved. We have now set a target of 31 days as the next step in the journey. It is right that we should make that sustainable, but I am sure that we would all agree that we should seek to go further as and when we can.
I am happy to agree that any target that we set should be sustainable, should be backed up by resources and should be capable of delivery.
I ask the cabinet secretary to consider waiting time targets in further areas, which I know other colleagues will expand on. In particular, I ask her to consider waiting time targets in the following three areas: in vitro fertilisation treatment; bariatric surgery; and adult mental health treatment.
With regard to the third of those, I particularly welcome the new waiting time guarantee on child and adolescent mental health services, which followed a Health and Sport Committee inquiry into the issue. I remember fondly my brief sojourn on the committee in the course of that inquiry. I know that considerable challenges arise in the provision of adult mental health services, but no one could fail to be moved by the recent plight of the young woman who lived in a car park outside a Lanarkshire hospital, desperate for help and struggling to cope with her mental health. Access to services when they are needed is of course desirable, but we all understand that ensuring that supply matches demand takes time. Therefore, access to services after a reasonable waiting time is widely understood. Will the cabinet secretary look again at including a waiting time target for adult mental health services?
Secondly, my colleague Richard Simpson has previously highlighted issues about the availability of bariatric services. The cabinet secretary’s recent announcement on new provision at the Golden Jubilee hospital is particularly welcome. When that service has bedded in, will she consider whether it would be appropriate to provide a waiting time for that?
Nicola Sturgeon rose—
If I was not about to run out of time, I would happily give way.
Thirdly, will the Minister for Public Health and Sport, who I think has responsibility for this, do more to tackle the postcode lottery for IVF treatment? I recognise, as I think does the ministerial team, that the picture across the country is inconsistent. In the west, one health board has a waiting time of six months for treatment while another health board that operates from the same treatment centre has a waiting time of two years. In the east, the waiting time is three years. There are also inconsistent criteria. I had a constituent who would have had to wait two years, but when she was invited by the consultant to be treated privately was suddenly treated in a matter of months. We need to look at doing things differently. Many of the couples who seek such provision cannot wait any longer. I know that work is being undertaken, but its pace is quite slow so I wonder whether it could be hurried up.
Our health debates are usually robust, but often we join together to praise the work of the NHS. On this occasion, I think that the Parliament is most definitely proud of what the staff have achieved and will congratulate the Government on progress.
I move amendment S3M-6393.3, to insert at end:
“; welcomes the progress made by the previous Labour/ Liberal Democrat administration in setting a new approach in Fair to All Personal to Each whereby waiting is considered in terms of the overall patient journey and further welcomes the commitment to treat inpatients within 18 weeks being achieved a year ahead of schedule, paving the way for Labour and SNP 2007 manifesto commitments of an 18-week referral to treatment target, and notes that this compares with a waiting time target of 18 months set by the last Conservative administration.”
15:43
This is my first speech in my new role as Conservative shadow cabinet secretary for health and wellbeing, so I thank Nicola Sturgeon and Jackie Baillie for their warm welcome. I am very conscious of the fact that I am breaking into what has until now been—with apologies to Mr Finnie—very much a woman’s world. I am sure that Mr Finnie will welcome the fact that I bring some gender balance to the front benches for health debates.
At the outset, I pay tribute to my predecessor, Mary Scanlon, for all her excellent work on the health brief in the previous three years and, indeed, in previous parliamentary sessions. Of course, Mary Scanlon remains a very important member of the Conservative health team and will continue to sit on the Health and Sport Committee, where I know her contributions are valued. I also pay tribute to Jackson Carlaw, who is moving on to pastures new from his work as shadow minister for public health and sport. I welcome back to the health brief Dr Nanette Milne, who brings a huge wealth of experience both in the field and, indeed, in the Parliament.
The Government’s motion welcomes the progress that has been made in reducing waiting times for patients. It would be churlish to do other than join in that welcome. If we expected Jackie Baillie to be churlish this afternoon, we were disappointed.
However, I strike a note of caution. In the past, the Conservatives have voiced scepticism about an overemphasis on target setting within the NHS. Waiting times should not be considered the most important indicator of performance, because overall patient outcomes and a range of other measures are more important. For that reason, we have sympathy with the terms of the Liberal Democrat amendment in Mr Finnie’s name and, in the spirit of the new Conservative and Liberal Democrat relationship, we will support the Liberal Democrat amendment. [Interruption.] I see that Mr Finnie is thrilled by the support that he has from the Conservative benches.
Nevertheless, we should accept that waiting times are important to individuals and we have undoubtedly seen real progress in recent years in bringing waiting times down. Like Nicola Sturgeon, I remember that waiting lists and waiting times were a regular feature of parliamentary debate and tussles at First Minister’s question time in previous parliamentary sessions. The fact that we rarely hear those issues discussed in the Parliament and rarely hear individual cases being raised at question time speaks for itself about the welcome progress that has been made and the hard work and dedication of individuals in the NHS. In the past decade, substantial extra sums have gone into the NHS. Although we might question whether we have had value for money from all that additional investment, the reduction in waiting times is one area in which we can see that the money has had an impact.
It is to the vexed issue of funding that I must now turn, in referring to the amendment in my name. The Conservative party believes strongly in the NHS and we believe that NHS funding must be protected at a time of severe downward pressure on the public finances. I and my family use the NHS, like all other members of the Conservative team, and we want to ensure that we have a strong, well-funded public health system. That is why we are pleased to welcome the Westminster coalition Government’s commitment to guarantee real-terms increases in health spending in each year of the Parliament. That does not mean that there will be a standstill in front-line NHS funding, because it is complemented by a commitment to cut the cost of NHS administration by a third and transfer resources to support nurses and doctors on the front line.
I believe that the lead that Westminster has set should be followed by the Scottish Government. That is why my amendment asks that the Scottish Government makes a similar commitment to that of the UK Government to protect health spending.
I am happy to say to Murdo Fraser what I said to Jackson Carlaw—who has joined us in the chamber—in our previous health debate. As the Government protected the health budget this year, we made it clear that we will continue to do that. If the coalition Government follows through on its welcome commitment to secure real-terms increases for the NHS, all the Barnett consequentials from that will be applied to the health service. That is a sign of the great commitment that we all have to the national health service.
I welcome that response from the cabinet secretary. I did not think that my first run out as health spokesperson for the Conservatives would turn out to be such a love-in, but there we are.
Protecting the overall health budget does not mean that we will not still have challenges. Demographic changes, the fact that people are living longer and increases in the cost of treatment and drugs will mean that there is additional demand for money within the NHS. Demand is always likely to exceed supply, which means that there will be a need to reconfigure services from time to time.
As we heard earlier this afternoon at question time, we should not get hung up on protecting either individual establishments or levels of employment in the NHS, which seems to obsess the Labour Party. What matters is not inputs but outputs, and in particular the level of patient care. We have as much of a duty to drive through efficiency savings in the NHS—to free up more money for front-line services—as we have to find efficiency savings in other parts of the public sector. We should never forget that the pressure on the public finances comes as part of Labour’s legacy or that, had Labour’s job tax gone through, it would have removed £40 million from the Scottish NHS budget.
I welcome what has been done on waiting times for patients, I join others in applauding the hard-working NHS staff who have helped to achieve that, and I welcome the Scottish Government’s commitment to protecting NHS spending.
I have pleasure in moving amendment S3M-6393.1, to insert at end:
“, and urges the Scottish Government to ensure that such progress is not compromised by either reductions in its budget or by efficiency savings within NHS boards.”
15:49
I am in a rather different position from the cabinet secretary and the Labour health spokesperson in so far as they were prepared to lavish praise on the new Conservative spokesperson before they had heard his contribution, whereas I am in the position of deciding whether I should do so after having heard his remarks. I am pleased to advise Mr Fraser that, despite all that he has said, I am still pleased to welcome him in his new capacity.
I do, however, have concerns about his arithmetic. He was at pains to point out the apparent female domination of health spokespeople in the chamber. Perhaps I have lost my sense of arithmetic, but as far as I am aware, the cabinet secretary, the very able health minister, the spokesperson for the Labour Party and of course Mary Scanlon, who occupied the position of Conservative health spokesperson, comes to four. By my arithmetic, I am one and Jamie Stone, who I think is discussing crofting as we speak, makes two. Dr Richard Simpson, as I understand it, is a member of the male fraternity, as is Jackson Carlaw. That comes to four each. If that is female domination—we will not go there.
I hate to embarrass Mr Finnie, but I am female, and I am part of the health team in the Conservative party. That makes it five-four.
I did not wish to insult Dr Nanette Milne; I was merely confining myself to two spokespeople per party. If she wishes to expand the numbers in each party, we could go on all afternoon; in the interests of time, we will not.
This is an important debate. Liberal Democrats are happy to welcome the significant progress that has been made in reducing waiting times throughout Scotland and, in some cases, in reducing the variations across boards. Not only did we have very long waiting times; we also had some serious postcode lotteries. Unfortunately, that persists in some areas—I will return to that in a moment. However, the general principle of what has been achieved should not in any way be understated and the Government deserves credit for it. As the cabinet secretary pointed out, all those who work in the health service and have delivered on this important improvement in patient care deserve every praise for what has been achieved.
The debate now has to move on. It is not about taking feet off accelerators or suggesting that the targets that have been set are not important in themselves, but in recognising the improvement that has been made and the mindset that has been changed in the health service, it is also timely that we should look to see exactly where we are and what we are trying to achieve.
The initial target was enormous and therefore it was very much about simply bringing down numbers, but the health secretary recognises that it is not just a numbers game. There are qualitative aspects that cannot and must not be ignored.
Initially, it was easier to concentrate on certain elective procedures, as the British Medical Association has pointed out. That is fine and it set benchmarks that were able to be achieved, but some of them represent only a very small percentage of the total number of procedures for which patients seek improvements in waiting times. Bariatric surgery and IVF treatment were mentioned. There are other areas in which we must be clear that equality of access to treatment must be part of what we are seeking to do.
My amendment is about improving on where we are. It is not intended to suggest that we need to take our foot off the accelerator or change the line of progress; it is to suggest that, having made that improvement, we now have to reflect on whether we can improve the quality of delivery. We have to accept that, across the range of conditions that are subject to guarantees, and some that ought to be subject to guarantees, the clinical need of the patient should always take precedence over fulfilling any other dogmatic target that is set. As I said a moment ago, this is not just a numbers game. That is important.
As this policy and its delivery have been developed, we have come to a point at which we can introduce—as the cabinet secretary has done, in many areas—a degree of improvement in the standards that are to be applied. That is critical in this delivery process.
As the waiting time debate moves on, there are elements that can be added. Earlier, that would not have been possible, due to the size and quantum of the task. Now, however, having made this incredible achievement, we should not lose sight of the fact that we are not simply driving forward numbers, we are driving forward patient care. That, and the clinical excellence that is needed, should be part and parcel of what we do.
It is in that spirit that I move the amendment in my name. I am, of course, delighted to have the support of the Conservative party, but that is Conservative party support only—it goes no further than that.
I move amendment S3M-6393.2, to insert at end:
“, believes that the achievement of the 18-week Referral to Treatment standard must not be at the expense of patients waiting to access services not covered by the guarantee or patients waiting for follow-up appointments; recognises that clinical need and patient care should always take precedence over fulfilling political targets, and therefore considers that the achievement of maximum waiting times should ultimately be at the discretion of clinicians.”
15:56
I, too, welcome Murdo Fraser to his new position. There have been so many welcomes in this debate that I think that I shall go to the Official Report tomorrow and hit control-F to see how many there were in total.
I say to Murdo Fraser that the gender balance on the Health and Sport Committee is equal: we have four men and four women. He can rest assured that he is not a lone male soul wandering about in the health portfolio.
I do not want to reprise everything that has been said about waiting times. Of course, we all congratulate everyone—including administrative staff, cleaners and so on—who has increased the efficiency and the tender loving care in our NHS. I note what Jackie Baillie said about cancer treatment times improving—we are so consensual today; it is lovely, is it not? That has made a huge difference, because, when people hear the C word, they think that their life is ending, and that feeling can get worse as they make themselves ill waiting to be treated.
I turn my attention to the Patient Rights (Scotland) Bill. Ross Finnie is right to say that we must not get hung up on waiting times at the expense of care. I know that that is not the cabinet secretary’s position. The issues belong together. I am interested in the fact that the Patient Rights (Scotland) Bill will introduce a further provision around the treatment time guarantee that will, in certain cases, guarantee a period of 12 weeks from referral to treatment, although that is not an absolute.
Ross Finnie expressed concern that certain patients might be parked somewhere, just so that the NHS can meet its time guarantees, but I take solace from section 8 of the bill, which says that if there is a breach of the treatment time guarantee,
“The Health Board must ... make such arrangements as are necessary to ensure that the agreed treatment starts at the next available opportunity”.
It also says that, in making those arrangements, the health board
“must not give priority to the start of any treatment where such prioritisation would, in the Health Board’s opinion, be detrimental to another patient with a greater clinical need for treatment”.
There, in black and white, it is stated that, at the end of the day, clinical need must take priority. Further, section 8(3)(c) says that the health board
“must have regard to other relevant factors”,
which is a catch-all provision that will deal with, for example, circumstances in which it would not be clinically appropriate for someone to be treated in that timescale, perhaps because of some other condition that they have.
The point that the member is making is excellent, but I want to point out that, quite correctly, under their duty of care, health professionals would be acting unethically if they did not treat someone who required that treatment, irrespective of whatever targets were set by us.
Indeed, but it is important to set national targets so that we have accountability and something that we can measure. We can at last stop the postcode lottery that I know exists in some areas. The work is incremental, but great progress is being made.
I am glad that we have acknowledged what the previous Administrations and my own Government have done, because we all want to achieve the same end, and it cannot all be fixed in a oner. This Parliament, through its very existence and its concentration on health issues, can move things forward. There is a fairly consensual view among members from all parties on many issues—although not on others, I say to Jackie Baillie.
To focus only on the issue of waiting times, as if that is somehow the antithesis of high standards of care, is the wrong way to view the issue. It involves a balance; waiting times can be measured, and they give people a sense of where they ought to be. They can be used as a benchmark, but they will never work against the clinical treatment of a person. If treatment is not required at a certain time or is not suitable to be carried out within the guarantee, it will not be done, and someone else will not be left to perish untreated elsewhere.
16:01
I welcome the opportunity to speak in the debate, and I draw members’ attention to my entry in the register of interests.
It is evident to all that the Parliament can rightly be proud of the waiting time reductions during the past 11 years. Under Labour there was a dramatic improvement, which Jackie Baillie outlined, and we welcome the progress that has continued under the current Administration.
Those improvements are achieved not by members in the chamber, but through the commitment and dedication of all NHS staff to the patients that they serve. In many situations they have exceeded the targets that we have set, and I join other members in thanking them.
I welcome the commitment in the Patient Rights (Scotland) Bill that was introduced in March to reduce the waiting time guarantee to 12 weeks. It is vital that good service provision and efficiency remain a high priority, and that such positive targets are not put under threat from recently emerging front-line staff cuts.
Progress has been made in many specialisms, and much of the focus has been on meeting the waiting time guarantees for those with a physical illness. Members will be aware of my long-standing interest in mental health. I represent a very rural constituency, and I am aware that the challenges that are faced by people with a mental illness can be compounded in rural settings. I am concerned that there is still a significant gap in waiting time guarantees for adults requiring mental health treatment: there is no timeframe for such treatment, or even a requirement for adults who need mental health treatment to be treated quickly. Mental health has historically been excluded from service provision targets, which undermines access to good patient referral, care and treatment. That is hugely detrimental to the one in four people in Scotland who will experience a mental health problem during their lives. We must counter it by ensuring that fair health service provision and targets are extended to meet the needs of all in our communities.
Health, as members are all too keenly aware, is a matter of not only physical fitness but mental wellbeing. Considering health needs in such a holistic manner is vital in order to meet the very real health concerns that Scotland faces. It seems to make little sense that the 18-week referral to treatment commitment provides exclusively for physical health and does not include mental health. The evaluation of NHS Scotland’s performance against health improvement, efficiency, access and treatment—HEAT—targets includes a commitment that, by March 2013, children and adolescents will have to wait no more than 26 weeks from referral to treatment. I welcome that, but there is still no such commitment for adults. The commitment to a 26-week journey for children and young people with mental health issues, when compared with the 18-week target for physical health issues, suggests a disparity in prioritising physical health over the mental health of the young in our communities.
The HEAT targets state that new psychological therapies are to be agreed by November this year, but it is not clear what the maximum waiting time for access to such treatments will be. The Patient Rights (Scotland) Bill—disappointingly for those who work and advocate in the mental health profession, and for those who are personally dealing with such complex illnesses—fails to include mental health treatment in its 12-week treatment guarantee. There is an opportunity to improve mental health service provision through targeted referral to treatment guarantees in that area.
According to the Public Audit Committee report on mental health services that was published last week, there is, across the board, a general lack of outcome measures for mental health treatment. What does that say about our concern for the high proportion of Scots—including our own family and friends—for whom mental health is a constant struggle? Are we offering the best support so that the national health service can respond well to the needs of the one in four Scots—children, adolescents and adults—who face mental ill health?
Our health service needs to be viewed much more holistically, with both physical and mental illnesses given the same commitment. That requires the input of not only primary health care providers but community groups in a multidisciplinary approach. One initial way of signalling a commitment to a broader notion of health care would be to equalise the time of referral for both physical and mental ill health, ensuring that provision is fair for all.
I am sure that the cabinet secretary and the minister understand and appreciate the concerns of those suffering from mental ill health, the impact of which can be just as traumatic and severe as that of many physical conditions. I therefore urge the cabinet secretary and her team to look again at the issue and to see in what ways people who require treatment for mental ill health can be given a timeframe within which they should reasonably receive treatment. Furthermore, I ask whether any workforce planning has been done to look at what can be achieved and where the gaps are in the field of mental health, because that is a key issue in being able to move matters forward. I also ask, finally, whether the cabinet secretary is confident that the provisions under the Patient Rights (Scotland) Bill are not discriminating against people suffering from mental ill health.
Nicola Sturgeon rose—
The Minister for Public Health and Sport (Shona Robison) rose—
I am in my last 30 seconds; I have to finish.
This is an important issue. Across the parties, we can move forward on it. I understand the complexities that are involved, but for too long people with mental ill health have been ignored or have been left on the sidelines. We have the opportunity to put them right up front and give them the service that they require.
16:07
I thank Jackie Baillie and Murdo Fraser for their generous comments. Equally, I pay tribute to my colleague Jackson Carlaw for his commitment, passion and humour, which made it a pleasure to work with him on the health brief.
In supporting Murdo Fraser’s amendment, I will highlight some consequences—unintended or not—that occur as a result of the tick-box culture to meet waiting time targets in the NHS. We can all agree on the drive for patients to receive the best-quality treatment, but that has to be at the time that they need it. That is the first problem with the target. As 99 per cent of doctors who took part in the BMA survey confirmed,
“Patient waiting times should be based on the individual patient’s clinical needs—not political targets.”
I will give an example. A constituent in the Highlands was referred by his GP for a hip replacement some years ago, but that did not happen. He received cortisone injections, so he received treatment, although it may not have been the appropriate treatment, but a box was ticked and success was marked. Now, after three injections, he has only recently got on to the waiting list for surgery. He is in serious pain, he has had to give up work and he cannot walk. Would it not have been better to have given him the hip replacement when he needed it, based on his individual, unique clinical need? Instead, despite his immobility and his serious pain, he is likely to wait another 18 weeks to keep the NHS within its targets. How can that be in any way helpful to his recovery and, I hope, his return to work?
The second point, which has been raised by other members, including Christine Grahame, is that waiting times are not the only or indeed the best indicator of health performance. Could patient outcomes, which Murdo Fraser mentioned, readmission rates and the millions of pounds paid out in clinical negligence not all be considered?
That brings me to the many conditions that, as other members have mentioned, become subject to Cinderella services because they are not included in waiting time targets.
I am with Karen Gillon on the issue of mental health. For far too long—for months, years or decades—people have been parked on anti-depressants because of the long waits for psychological and psychiatric support. I know that many GPs do not bother referring patients with stress, anxiety and mild depression in the knowledge that there are long waits. The lack of early diagnosis and early intervention results in a mild condition becoming a chronic and enduring mental health problem.
Jackie Baillie mentioned infertility. There is not only an age bar with respect to infertility; there are long waiting lists. That forces many people to find their own private treatment. Many people I know in the Highlands have remortgaged their homes to pay for treatment. Many people who can ill afford to do so are being forced to go private.
I will give another example. I am being extremely consensual. Yesterday, Andy Kerr and I, as, respectively, the convener and the vice convener of the cross-party group on ME and chronic fatigue syndrome, listened to patients and clinicians who are working towards a Scottish good patient practice statement on ME, which Professor Lewis Ritchie described as
“bringing the condition out of the shadows”.
The patients and clinicians talked about their aim of getting an accurate diagnosis, recognition of the condition by GPs, consistency of treatment and referral to specialists. That is taken for granted for pretty well all conditions in Scotland, but with ME, there are so few specialists that referrals do not even take place.
I welcome the additional bariatric surgery at the Golden Jubilee national hospital, but, if my figures are correct, I understand that there are more than 2,000 people on the waiting list. With the number of operations that it is intended will take place each year, I think that we will find that it will be many years before the existing waiting list is got through, let alone any additions to it.
Finally, the pursuit of targets means that health boards have little time for innovations, such as telehealth and other e-health opportunities, whose implementation can be much more in patients’ interests. I am talking about modern, innovative, high-quality care. Like other members of the Health and Sport Committee, I have been shocked by the ease with which health boards can make efficiency savings. I think that it was asked in the previous debate why such savings have not been being made for years if making them is so easy. However, I hope that the greater emphasis on value for money, a quality strategy and better treatment will encourage much-needed innovation and help to put patients’ needs back at the heart of the NHS.
16:12
I will begin by telling members about someone I know who lives in the city of Edinburgh. Around 15 years ago, his doctor referred him for a hospital out-patient appointment. My friend is an obsessional timekeeper at the best of times, so he was mortified when extra-heavy traffic delayed his journey to the hospital and made him a little late for his appointment. He apologised to the receptionist. He said, “I’m very sorry I’m late. Will the doctor still see me?” The receptionist studied her paperwork intently. “Don’t worry, Mr Williams,” she said brightly after a moment, “I’ve found your name now. In fact, you’re not at all late. You see, your appointment isn’t for another year.” He had made the not uncommon mistake of taking note of the time, day and month, but he simply assumed that he was to be seen in three months rather than in 15 months, which was the waiting time for that out-patient department in those days.
It is true that his condition was not life threatening, but even minor conditions can cause a great deal of stress if they are not attended to reasonably promptly. Minor-sounding, vague symptoms can be the early harbingers of more serious diseases, and early treatment of them can be imperative. At one stage, waiting times were such a concern to me as a doctor that I—a passionate believer in a national health service that is free at the point of need—in desperation sometimes advised those who could afford to pay for a private consultation to do so. The specialist opinion often reassured the patient that nothing was serious, and those who needed treatment, although they still had to wait in a queue to use the national health service, found that the total referral-to-treatment time was drastically reduced. I hated doing that, but decided after a great deal of thought that the welfare of the individual patient was more important than my rather abstract principles.
How things have changed. The figures that ISD Scotland published last Monday show that, as of 31 March, 99.9 per cent of patients were waiting for less than 12 weeks for new out-patient appointments, and 99.5 per cent of those referred for in-patient and day-case treatment were waiting for less than nine weeks. That is an all-time low. The national health service is well on the way to meeting our demanding target of a whole-journey waiting time of 18 weeks by the end of 2011.
As members know, I am essentially a consensual sort of person, so it gives me a little pain to have to point out that NHS waiting times lengthened enormously under the Conservatives’ watch, although I know that that was so long ago that it is impossible to blame personally those who grace the Conservative benches today. Again in the spirit of consensus, and not wishing to cause offence to Jackie Baillie, I freely admit that some of the groundwork for the dramatic improvements that we salute today was laid down in those otherwise dark days when Labour held sway in this land. However, I must report with some sadness that sometimes Labour resorted, in my area at least, to reducing waiting list times by the innovative expedient of closing lists altogether. I say to Jackie Baillie, how good it is that we can have a common cause from time to time and how much better it would be if we extended that co-operation in other fields, such as the minimum unit pricing of alcohol.
In that spirit of consensus, will the member consider backing our proposed amendments at stage 2 of the Alcohol etc (Scotland) Bill on alcohol treatment and testing orders and caffeinated alcohol?
I will happily discuss those issues with Jackie Baillie when this debate is over.
Above all, credit must go to that legion of doctors, nurses and other health workers—including, dare I say it, administrators and managers—who have worked their socks off to make the changes happen. I add my voice to those that have already been raised to praise them.
Where do we go from here? I suppose that we will aim for even shorter waiting times. However, I want to add some words of caution. I have sympathy with the tenor of the Lib Dem amendment, if not every point in it or its language. There is no doubt that setting a target such as the one that we are discussing sharpens minds and produces results that would have been difficult to achieve without such a focus. However, targets are not always guaranteed to be entirely beneficial. Like the medicines that are dispensed in the health service, they can sometimes have unpleasant side effects. I have known target regimes, admittedly south of the border, in which operations or other treatments for less important conditions have taken precedence over those for more serious conditions, because otherwise a target time would be breached. That is especially relevant in the field of cancer, a diagnosis of which strikes fear in the minds of most of us, but which can describe a range of conditions, from the relatively minor to the truly life threatening. On occasion, incentive-driven managers have been tempted into pushing clinicians into making decisions regarding treatment priorities that otherwise would have been made differently.
I have been reassured by the statements made by the cabinet secretary, Christine Grahame and Richard Simpson. I am also reassured by the comments that the Patient Rights (Scotland) Bill will allow clinical judgment to be exercised so that patients do not suffer from the sort of regimes that I have described. For that reason, I give my whole-hearted support to the motion and commend it to members.
16:18
Much of the language has been about these times of consensus and coalition. Ian McKee, in a previous speech in the Parliament on the same topic, gave fulsome praise, probably quite understandably, to the cabinet secretary. Today, wonderfully, he gave fulsome praise to Jackie Baillie and Murdo Fraser. I do not know whether either of them will have benefited from the experience, but I understand the spirit of co-operation and consensus.
Ian McKee began with a story of someone with personal experience of the previous situation, in which there were long waiting times for treatment. Stories are important. The story that we have heard this afternoon and that has united all members is one of progress. There has been progress from what many will remember of the experience in the 1980s. The young Murdo Fraser might have been a member of the Federation of Conservative Students, potentially an acolyte of Michael Forsyth and maybe part of that radical Thatcherite experience in the 1980s. Times have changed. I welcome Murdo Fraser to the front bench in his role as health spokesperson for the Conservatives.
The territory of the debate has changed. On waiting times, we are moving on. We are moving on even on investment in the health service. All the way through the general election campaign, excessive efforts to reassure the public were made by all parties, and especially by Mr Cameron, who gave an absolute commitment on funding the health service. I welcome that. A quiet victory of Labour in government is that it moved the Conservatives’ position. I hope but remain to be convinced that the Conservatives’ commitment to the health service will be proven in the next few years.
I welcome the fact that a Conservative spokesperson has said that he will use the national health service. I would hate to think that that is because—unlike UK Cabinet members—Murdo Fraser is not quite a millionaire yet, but we can always endeavour to arrive at that arrangement.
Remarkable progress has been made on waiting times. That has not been easy; we have had to challenge established interests in the health service. An interesting story is that, all the way through since 1999, all the documents that have been produced have been remarkably similar. When I taught English in secondary schools in Glasgow and the west of Scotland, I always said to young people that all stories were by and large similar, whether they were classical stories or modernist writing. The concept is that a story can be told only in certain ways.
Through “Our National Health” in 2000, “Fair to All, Personal to Each” in 2004, “Delivering for Health” in 2005 and “Better Health, Better Care”, we have had remarkable consistency. All those titles did not cost much to produce; whoever does them for the health service might help Skills Development Scotland with titles. What underpins each of those documents, with nuances on each side, is the idea of restructuring and redesigning the service and recognising the experience of the patient journey. I mention stories because the journey of a story is, in a sense, the same as the journey that a patient must take. What matters is how patients tell their stories.
We have dramatically shifted the health service debate in Scotland. All health ministers have contributed to that, and I hope that that will continue in the turbulent period that lies ahead for all of us in the spending pattern for public services. The challenges are pretty clear: we have heard them from all members this afternoon.
One challenge is how we drive down further people’s treatment times, particularly for conditions that are life threatening and are not easily sorted in the long run. I had the privilege of dealing with the petition to the Public Petitions Committee on access to cancer treatment drugs, and I commend the cabinet secretary for her commitment to that petition. The compelling message that was repeatedly put to the committee was that people did not have time. That is why I welcome the commitment to drive down further waiting times to see cancer specialists and I hope that we can achieve it.
I would like further amplification from the cabinet secretary on the challenge of keeping in line with the commitment to increase spending on the health service that has been made elsewhere in the United Kingdom. That is a testing issue for her because of what lies ahead for all of us in Scotland and elsewhere in the UK, but that commitment is welcome.
I will raise an important matter on which collaboration is required. I am concerned that, if we have the arbitrary policy that is emerging from behind-the-scenes negotiation in the coalition Government of a cap on non-European Union immigration, that will have an impact on the quality of potential recruits into our health service. I would like further deliberations on that. The cabinet secretary might not always deal with that issue, because it will depend on whatever emerges in the next few years from the UK Parliament, but we must be cognisant of it.
We have made progress, but the story is not concluded. We must use today’s debate to ensure that we deliver a health service to which all parties are committed. More important, the public must feel that there is a story worth telling about the quality of their experience in the health service.
We move to winding-up speeches.
16:24
Quite properly, the opening speakers in the debate, whose speeches were largely consensual, recognised the enormous progress that has been made and the contribution that those in the health service make. They also recognised that achieving the waiting times target has brought much-needed benefits for patients.
The debate has been interesting, and shortened though it has been, more attention has been paid to how we can build on this excellent progress. The opening speakers—indeed, the cabinet secretary herself—highlighted the need to extend the range of areas where attention is given to ensure that patients experience a more level playing field no matter their condition. Karen Gillon spoke, quite properly and at some length, on the real difficulties facing people with mental health problems. Mary Scanlon has developed the expertise on that subject in the chamber. One of the disappointments of her new role is that she will no longer speak ahead of Karen Gillon in health debates—even from where I am sitting, I sensed her disappointment at that. As she always does, Mary Scanlon added to the debate, and added ME to the issues.
The theme of my opening remarks was the range of conditions. We need to develop, build, improve and extend to ensure that the target is about more than waiting times; it must also be about the quality of care that is provided.
Ian McKee got close to supporting my amendment, but withdrew from doing so at the last, critical point in his speech. What a disappointment that was to me. I say to him that the issue is how we extend the target to include quality of care so that it does not become just a numbers game. That is where I differ from colleagues in my views on the Patient Rights (Scotland) Bill. As the convener of the Health and Sport Committee, who other than Christine Grahame would be familiar with sections 8(3)(a) to 8(3)(c) of the bill? Those of us who have the health portfolio are intimately knowledgeable about that. Indeed, even given the newness of his brief, Murdo Fraser nodded when Christine Grahame spoke; he knows exactly what sections 8(3)(a) to 8(3)(c) are all about.
My point is this: while the entitlements that are set out in the rubric of the bill are highly laudable and correct, I am not persuaded that simply transposing them into a legal undertaking is necessary or desirable. Apart from anything else, the bill contains no back-up—patients have no right of enforcement, so I am not sure what the purpose is.
With reference to sections 8(3)(a) to 8(3)(c), and notwithstanding his reservations about provisions being put into statute, does the member accept that clinicians will have discretion? I am sympathetic to the Liberal Democrat amendment, but I cannot support it, because there is always discretion for clinicians.
That might be, and it certainly is within sections 8(3)(a) to 8(3)(c). My point is that that does not need to be put in a bill. Indeed, the waiting time improvements did not require legislation. The issue has been to create a framework. I accept that such frameworks can always be improved, and that some of the wording in sections 8(3)(a) to 8(3)(c) could be different, but the danger of including the provisions in a legal framework is that, instead of concentrating on the aspects of care that are more difficult to define, we concentrate on the numbers game, because that is easier and enables us to say, “That is the legal right that I want to prosecute.” That would not be helpful in achieving agreement around the chamber on how to develop further our ability to deliver on patient care, particularly in the context of shorter and reducing waiting times. That is the main thrust of where we are trying to go.
Ian McKee was right: where are we going now? We should be looking forward. He was among many members who said that shorter waiting times are not the only objective. That is why the Liberal Democrats part company with the SNP on the issue. I do not believe that the Patient Rights (Scotland) Bill will add, qualitatively, to the aims and objectives of improving care. It will focus attention on the wrong aims and objectives, and it will narrow the field instead of broadening it, as everyone in the chamber hopes to do.
I stick to the amendment in my name, and I hope that those who teeter on the brink of giving me support might, in the final analysis, vote for it.
16:30
This has been an enjoyable and interesting debate, with a degree of consensus that I was not quite expecting.
Like Murdo Fraser, I well remember the dominance of waiting lists and waiting times issues in debates on the NHS during the previous session, and the many times when, as Conservative health spokesman, I berated the Labour-Lib Dem Executive for its top-down, target-driven approach to running the health service. There is a certain irony that, as I pick up the health brief again, just as the new Conservative-Lib Dem coalition takes the reins at Westminster, the first debate to come my way should be about the achievement of Government-set waiting times targets.
That is not to decry the very welcome progress that has been made on shortening the time that patients have to wait between referral and treatment, which is clearly of great importance for patients at a time when many of them will be fearful of what lies ahead. There is no denying that spectacular progress has been made towards the 18-week referral-to-treatment target. To have reduced waiting times to the unprecedented levels that the cabinet secretary quoted at the start of the debate is a tremendous achievement, which could not have been possible without the co-operation at every level of a committed, very hard-working and dedicated NHS workforce, which has rightly received plaudits from all sides of the chamber today.
I note the cabinet secretary’s caveat in connection with cancer waiting times—that they must be sustainable. That is indeed important.
Waiting times are not the only indicator of performance in the NHS, nor are they the most important, as members have said. Improving patient outcomes must be the focus for the NHS, as well as the quality of care that patients receive. The cabinet secretary is well aware of that, but it is always worth reiterating it. As Mary Scanlon pointed out in her speech, in a target-driven system there is too often a temptation to make decisions that tick boxes and meet paper deadlines rather than clinical need. If that is pushed too far, it eventually frustrates professionals and demoralises the workforce to the detriment of patients’ welfare, and it erodes trust in the ability of the NHS to deliver the outcomes that we all want to see. Ross Finnie’s amendment makes some important points in that regard, and we are happy to support it.
There will always be competition for resource in the NHS, as demographics change, as biomedical science and technology advance and as pharmaceutical research makes available new drugs that can prolong life and improve its quality for patients who previously would have had no hope of survival. For example, there has been real progress in recent months on the availability of cancer drugs for terminally ill patients, following the determined campaign by the late Mike Gray and his wife Tina McGeever. The cabinet secretary is to be commended for her response to their petition to the Parliament.
It is so important to protect funding for the NHS at this time of severe pressure on public sector finance, as Murdo Fraser said. That is why our amendment looks to the SNP Government to commit to protecting health service spending, just as the UK coalition Government has pledged to guarantee real-terms health spending increases year on year. We are delighted to have the cabinet secretary’s reassurance about that commitment.
Much can be done in the NHS by the people who work within it looking critically at current practice and suggesting changes and innovations that will impact on its efficiency in achieving the best outcomes for patients. There have already been a number of successful innovations in the Scottish NHS as a result of staff input, and there must be many more possibilities.
The example that comes most readily to my mind is the dramatic reduction in waiting times for patients in Tayside who require physiotherapy, which was brought about after physiotherapists there took a long, hard look at why patients were waiting 18 weeks to be seen—18 weeks during which many readily treatable acute conditions could progress to a chronic state, resulting in easily preventable time off work and the inevitable impact of that on the benefits system and the local economy. Having considered the detail of the referral-to-treatment process, streamlined it and cut out the duplication, those physiotherapists were able to reduce the waiting time to four days—a dramatic reduction by any standards. Not only did that achieve the best outcome for patients, it resulted in staff ownership of the patient journey and a greatly increased level of professional satisfaction.
Such great ideas often come out of stressful situations, and I reckon that if clinicians and others working in the NHS were allowed to focus just a bit more on patient outcomes rather than centrally set targets, we would see some real efficiency improvements in the service, such as better use of available resources, better outcomes for patients and more satisfaction for staff, who are the bedrock of our NHS.
We all know that significant challenges lie ahead. The legacy of the recently defeated Labour Government’s mismanagement of our public services will take some sorting, but with the Scottish Government’s commitment to protect NHS funding, and the continuing dedication of our hard-working NHS staff, whom we rightly applaud today, we can look forward to improving outcomes for patients and an NHS that is fit to cope with the increased demands that will be placed upon it by an aging population and the availability of new treatments that are made possible as a result of scientific and technological innovation.
We are happy to acknowledge the progress that has been made so far in improving NHS access times for patients. We welcome the Government’s commitment to ensuring that such progress is not compromised by the issues that Murdo Fraser dealt with during his speech. I am very happy to support the amendment in his name.
16:36
I draw members’ attention to my declaration in the register of members’ interests, particularly with regard to psychiatry and membership of the Scottish Association for Mental Health.
The debate has probably been one of the most consensual that we have participated in during the current session of Parliament, and that is understandable because the progress that the health service has made since 1997, with the support of successive Governments, has been quite phenomenal. There has been a truly substantial change that has benefited all patients, and it has continued under successive Governments, including the SNP Government. I pay tribute to the SNP Government for the amount of funding that it has put into the NHS and for the direction that it has given.
Frank McAveety, Ross Finnie and Nanette Milne all indicated that the targets are not always comfortable, but that is as it should be. Targets need to be challenging and should not be tick box. If waiting time targets become tick box and managers begin to play administrative games to meet them, that is inappropriate. The targets should be and are set in partnership with the NHS staff.
The HEAT targets that were generated during the past decade have been excellent in driving us forward. We have achieved times of 12 weeks and nine weeks for in-patient and day surgery. Cancer waiting times are down to two months, and progress is being made towards a single month. Cardiac targets were met ahead of those in England. Ambulance targets, which have not been mentioned, have made a phenomenal achievement of 75 per cent of category A calls being answered in less than eight minutes.
Accident and emergency departments have met their four-hour target. Those of us who are old enough to remember the 1990s will remember people waiting on trolleys for hours and sometimes days to get in. That is an interesting area, because it has been one of the most uncomfortable targets. There has been the use of what are called various names, although clinical decision units is probably the most common one. If they are used simply to remove a patient so that a target is met, that is inappropriate. On the other hand, if they are used so that a patient can get all the results they need before they go home, rather than having to go home and come back, that is appropriate.
We have to be more sophisticated in how we do this, and that was the thrust of Ross Finnie’s amendment and his quite persuasive arguments. Unfortunately, we, too, cannot teeter quite far enough to support it. A message should go out from here that targets have to remain.
Against the standard of patients waiting no more than six weeks for the eight key diagnostic tests, 90 per cent are now waiting less than four weeks, which is another superb achievement that I hope will be continued. However, as we wrap those into a single 18-week whole-journey waiting time target—with a shorter period for cancer—the issue is whether we obliterate the sub-targets within that. It is important that people wait only a very short time for tests so that they get their results quickly and do not mind then waiting a bit longer for treatment within the 18-week period. If the 18-week totality does not contain those sub-sections, it could be problematic. I hope that the cabinet secretary will indicate whether we are going to retain the sub-targets.
General practice has not been mentioned, although it is a great achievement that well over 90 per cent of patients are now being seen by a member of the primary care staff within the 48-hour target. That was a sensible target, unlike the target in England, which stipulated that they had to be seen by a general practitioner rather than any member of the primary care staff. However, less than 60 per cent of GPs are offering advance bookings, which is, frankly, unacceptable. The figure has improved, but it must be driven up. It is wrong that someone with a chronic condition cannot make an advance booking for a time that suits them. If self-management and partnership are what it is all about, we absolutely need to drive up that figure.
Several members, including Karen Gillon and Mary Scanlon, referred to exclusions from service provision targets. Mental health is the biggest of those and is the most important, in the sense that I think the Patient Rights (Scotland) Bill will make that exclusion discriminatory. I question whether, under equalities legislation, that would be practical or possible without clear mental health targets beyond the two existing HEAT targets.
I do not deny that Karen Gillon made an important point. However, for clarity and information, I point out that the Patient Rights (Scotland) Bill does not exclude in-patient mental health treatment from its provisions.
I welcome that intervention. We have HEAT targets for psychologists and for the reduction of antidepressant prescribing. We also have a very welcome child and adolescent mental health services target, although it is still a waiting time of 26 weeks between referral and treatment—but that is more to do with workforce development and so on. We need to look at some of the early measures that we talked about the other week, the nurse-family partnership being very important. Beyond that, I have been working hard to get the Place2Be into primary schools. It is a tier 2 service that is developing. I am glad to say that several health boards and local authorities are responding positively to that charity, which has a big effect.
Assisted conception is another area that needs to be developed.
We are going to get drugs targets shortly, and it is important that we also have an alcohol target.
There are challenges beyond all the targets that we are setting, which are to do with new treatments that are being introduced. The treatment for heart attacks and the stroke thrombolysis treatment will require us to look carefully at what is happening there and at the standards that are being set by NHS Quality Improvement Scotland, which are another form of target. I know that the cabinet secretary and her department will work hard to ensure that the target of 80 per cent of those for whom it is appropriate receiving the one-hour door-to-needle service for stroke thrombolysis treatment is met.
Where for the future? We are moving steadily towards the 18-week total journey time target, and I welcome the fact that the cancer targets—which Labour announced in the general election campaign—have received support from the cabinet secretary with the proviso that whatever we do must be sustainable. It is crucial that people get the diagnosis, the tests and the initial contact with a specialist, and setting a sub-target by which that must be achieved within the month target might be a way forward.
Bariatric surgery has been mentioned, and I welcome the Golden Jubilee national hospital’s announcement. However, Fife has no bariatric surgery at all; hopefully, people in Fife will be able to get to the Golden Jubilee national hospital. Furthermore, NHS Forth Valley does not have an osteoporosis service, and a lot of members mentioned postcode issues. That is another area on which we now need to concentrate.
I finish by referring to the new ways system of defining and measuring waiting times, on which Audit Scotland has reported, which has clearly been a success. It is a fairly bureaucratic system with a big electronic data warehousing section in the middle, but that is appropriate in the management of waiting times and it has definitely been an improvement. Nevertheless, I reiterate a concern that was not totally removed by the audit, which is about those who are illiterate, those who have learning difficulties, those who have early-onset dementia, those who are homeless, prisoners, travelling people, asylum seekers, refugees and immigrants with language difficulties. I wonder whether we are monitoring closely enough whether those people are among the 100,000 patients who have been taken off the waiting lists for various reasons. I also raise the question of the 300 complex needs patients we now have, which needs further analysis.
We must continue to address the balance of quality and speed, but let us today celebrate the NHS’s achievement and welcome the continued challenges that we are setting it to improve its services to patients.
16:45
I am grateful to members for their speeches in what has been an interesting and, I believe, worthwhile and consensual debate. In addition, I recognise the contribution that Mary Scanlon and Jackson Carlaw have made to previous health debates.
As we have heard, patient waiting times are a topic that retains a high level of interest among members across the Parliament and one that demonstrates how vital health care services are to all of us in Scotland. I was interested to hear that there appears to be general cross-party support on a number of areas, such as building on the current waiting time standards by giving patients a clear indication of the maximum time that they will have to wait from referral to treatment.
I take on board some of the comments that have been made about clinical judgment and want to respond, in particular, to the Liberal Democrat amendment. It has emerged from the debate that it is extremely important that we work with our clinical colleagues to ensure that any system has the relevant tolerance to allow it to recognise and support the targets. As I have said on a number of occasions, patients who have to be treated more quickly because of their clinical need should receive that treatment as soon as possible. That is not only common sense; it is the very essence of a clinically driven system, and we will always support and defend that principle. Ross Finnie’s point about quality being paramount was well made. I hope that he has been reassured during the debate that that remains the case.
I know from speaking to patients and their families across Scotland that access to swift and safe treatment remains a key issue for them, as it has been and will continue to be for the Government. The recently introduced Patient Rights (Scotland) Bill, which a number of members mentioned, will provide a waiting time guarantee that will be easily understood by patients and their families. It will remove any possibility of a return to long waiting times following diagnosis and will provide a firm and guaranteed end point for treatment. I hope that all members will support that step change in the patient experience.
Christine Grahame and Ian McKee were among those who commented on the Patient Rights (Scotland) Bill. Christine Grahame pointed out that it includes the safeguard that clinical need will always take priority. The fact that that is in the bill is extremely important.
The issue of long waiting times for categories of patients who are currently not covered by waiting time standards has been raised. For the avoidance of doubt, let me make it clear that the Government is committed to ensuring that all patients have swift and safe access to the full range of services that they need from the NHS. As the cabinet secretary mentioned, expanding the range of patients who will be covered by the 18-week whole-journey target is an issue that is already being addressed. The cabinet secretary also indicated—and other members echoed the point—that cancer waiting times have undergone a remarkable transformation, but more can be done, which is why the new cancer targets that are to be delivered at the end of 2011 have been extended to include patients who are identified through screening programmes.
A number of issues have been raised around the treatment of mental health patients. We should remember that, for the first time, we have set a target that covers mental health services. As has been mentioned, by 2013 no one will wait longer than 26 weeks from referral to treatment for specialist child and adolescent mental health services. We want to go further than that but, as Richard Simpson rightly acknowledged, there are workforce challenges. It is not possible just to set a target, flick a switch and expect it to be met. Measures have to be put in place, not least of which is the need for specialist workforces to be developed and trained. The fact that we will develop a new psychological therapies target during 2010-11 is another important milestone.
In her intervention on Richard Simpson, Nicola Sturgeon made the important point that rights in relation to waiting times for in-patient mental health treatment will not be excluded from the provisions of the Patient Rights (Scotland) Bill. That is an important step forward. Karen Gillon made a number of important points about the subject. Of course we want to go further with adult mental health services, but we will be able to go only as fast as is possible and sustainable. That is an important point, which a number of members made.
Jackie Baillie raised the issue of waiting times for infertility treatment. They have been a problem for a significant number of years, with a wide variation in waiting times across the country. There was a time when a waiting time of three years was commonplace in a number of health board areas. That was totally unacceptable, and progress has been made. We want to do more, which is why we have funded Infertility Network Scotland to work with boards to address the inadequacy of access to the service. That will ensure a consistent approach across the country and offer patients direct influence on the future direction of the service.
However, we want to go further. That is why we have set up an expert group on infertility, which last met on 28 April. A priority for the group is to consider an achievable, fair and acceptable waiting time target for infertility treatment. The group will report by the end of this year.
The debate has focused on waiting time performance, but sustained delivery of this level of performance also depends on having a workforce to deliver the highest level of care to the people of Scotland. We have invested more money in the NHS than ever before, with increased spending on health in Scotland at record levels. A couple of members spoke about what the future holds in that regard. The cabinet secretary made the commitment that the Scottish Government will continue to protect the NHS in these difficult times. She said to Murdo Fraser—and I can reassure Frank McAveety on this point—that any consequentials from NHS funding south of the border will go to the NHS in Scotland. We have made that commitment and we will deliver on it.
An example of how boards have been working together to build capacity was the announcement last week on bariatric surgery, looking at innovative ways of making services more accessible to people. Next month, the Golden Jubilee national hospital will start—[Interruption.]
One moment, minister. If the Lib Dems’ meeting needs to take place, will they take it outside, please?
Thank you, Presiding Officer.
Next month, the Golden Jubilee national hospital will start treating patients from three NHS boards for gastric banding. If the service had not been created at the Golden Jubilee, those patients would have been sent to the independent health care sector. Jackie Baillie was right to praise Malcolm Chisholm’s decision to bring the Golden Jubilee national hospital into the NHS because it has provided a range of innovative ways of ensuring that patients have swift access to good-quality treatment and it is a real resource for the NHS more generally.
It is fair to say, as others have done—we recognise and appreciate that—that we have seen a remarkable transformation in the delivery of health services in Scotland under this Government. Our priority has been to get the best quality of care possible for patients. Although we have made significant steps forward, there is always more that remains to be done, and the Government is committed to achieving even greater success in the health sector. We want a service that puts patients at the heart of everything that it does. Great progress has been made towards that goal, but there is always more to be done, and the Government is committed to ensuring that it is indeed done.