Plenary, 27 Sep 2007

Meeting date: Thursday, September 27, 2007

Official Report 768KB pdf

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NHS Waiting Times

Good morning. The first item of business is a debate on motion S3M-545, in the name of Ross Finnie, on waiting times.

As Murdo Fraser was gracious enough to point out as I was entering the chamber, today is an historic day. I am grateful to Murdo Fraser for acknowledging that and for pointing out to me that after eight years and 147 days in the life of this new Scottish Parliament, this is the Liberal Democrats' first Opposition debate. Not surprisingly, as the successors to the great Liberal and author of the report that led to the creation of the national health service, William Beveridge, we have chosen health as our topic for debate.

We have heard a number of pronouncements on health from the new Government, the latest being the Cabinet Secretary for Health and Wellbeing's statement on waiting times. Like many others, I hoped that last week's pronouncements would clarify the Government's position on, for example, the precise nature of the legally binding waiting time guarantee, which services would be included in their new 18-week guarantee, and whether clinicians rather than politicians would prioritise provision of care.

Sadly, each pronouncement served only to add to the confusion, which in turn served to underline the fact that although ministerial statements can be helpful, they are no substitute for parliamentary debate. So, today we are providing a platform to explore in more detail the new Government's plans for tackling NHS waiting times. I am particularly glad that the Scottish National Party's chief whip and business manager has readily acknowledged and conceded that important point.

I welcome the cabinet secretary's announcement of the intention to accelerate the previous Executive's decision to scrap availability status codes. As the British Medical Association's recent briefing put it:

"ASCs were initially introduced to reflect that, for a small number of cases, it is not always possible to treat patients within the waiting times guarantees for either clinical or personal reasons. These ASC codes were never intended as an administrative loophole to hide patients who could not be treated within waiting times guarantees."

The BMA is right.

However, the new system that has been proposed by the cabinet secretary implies an enormous administrative burden for the NHS. The proposed individual waiting time clocks for the patient, who might be suffering from different illnesses and therefore require different treatments from different specialists, is not only complex but will result in multiple waiting time clocks. If there is to be a review of waiting time procedures, the last thing that NHS staff need is a system that will waste valuable treatment time in reviewing, recording and unravelling a mountain of waiting time data in order to offer two appointment times, which might seem to be attractive but which will inevitably halve the time that is available for appointments.

In her statement last week, the cabinet secretary confirmed that no extra money would be forthcoming from the Scottish Government to fund such an administrative extravaganza. She also assured Parliament that front-line services would not be compromised as a result of the new system.

I cannot remember whether Ross Finnie was in the chamber during my statement. In any event, he will have read the Official Report and seen that Labour members claimed that the system that I announced was their invention. If that is true, did Ross Finnie—who was a member of the previous Administration—raise any of his concerns at that time?

The cabinet secretary is absolutely right; I was not present in the chamber for her statement but I have read it with great care. Labour members were right to say that some of her proposals were the invention of the previous Executive. However, invention is different from implementation—an important distinction. Some very good ideas have been bowdlerised by people who have chosen to implement them in a cack-handed fashion, which is the case with this new waiting time guarantee.

Mr Finnie is drowning.

Not at all. The cabinet secretary gave an interesting statement and I am glad that she spotted that I would have had the time to consider the detail and spot the flaw that is inherent in its logic. The Liberal Democrats believe that NHS money should be spent on front-line services, not on trying to unravel a new and complex system.

The picture becomes even more confused when one examines the SNP Government's much-vaunted legally binding waiting time guarantee, which curiously I did not see featuring prominently in the cabinet secretary's statement, even though I read it—somewhat painfully—for a second time.

As the cabinet secretary confirmed on "Newsnight Scotland", the legally binding guarantee will be enforceable only through the courts, which will mean American-style litigation being brought into Scotland's health service, with a lawyer at every bedside. That can only result in health service staff spending more time in the courtroom than in the treatment room.

Will Mr Finnie be reassured that there is nothing to be concerned about because the disappearance of civil legal aid will mean that no one will be in any position to pursue a case?

That is a problem. Although Mr Fraser's intervention was entertaining, I hope that he shares my concern that the withdrawal of civil legal aid is serious and will merely add to the litany of the Government's failures.

In response to questions from the Liberal Democrat leader, Nicol Stephen, on 6 September 2007, the First Minister claimed that the legally binding guarantees are based not on an American model but on a Norwegian model, which he described as working "extremely well" and which he invited us to study. Well, we studied it before we asked the question at First Minister's questions, following the old legal dictum that one should not ask a question to which one does not already know the answer. The Norwegian system—which is so much admired by our First Minister—produced an increase in the number of somatic patients on waiting lists, from 210,000 in 1993 to 260,000 in 1995, after the introduction of the legally binding waiting time guarantee in 1990.

As for the Government's rejection of the notion that such a system would result in legal action, examination of the composition of the Norwegian Board of Health Supervision shows that it has 25 lawyers, but only 20 doctors. We are therefore entitled to conclude that if the preposterous idea of a legally binding guarantee is introduced, final decisions on treatment by Scotland's doctors will be more influenced by the shadow of litigation than by clinical evidence, and that Scotland's health boards will have to divert scarce resources from treatment of patients to preparation for the legal onslaught from litigious patients.

Furthermore, there is the question of priorities. In her statement last week, the cabinet secretary said:

"There will no longer be any exclusions because a hospital"

—shorthand for medical staff—

"decides that treatment is a low clinical priority or is too highly specialised." —[Official Report, 19 September 2007; c 1834.]

If we have ever read a classic example of politicians—in this case SNP Government politicians—trying to override and interfere with the clinical judgement of our doctors, that is it.

The part of my announcement that Ross Finnie cites was announced by the previous Administration in "Fair to All, Personal to Each" back in 2004. Does he think that it is right that procedures such as double hip replacements for frail elderly people were classed as being of low clinical priority and were therefore not subject to a waiting time guarantee? That is the system he is trying to defend.

Absolutely not. One does not set a priority in relation to a particular case in isolation. One sets a priority in relation to the other competing pressures on which the clinician must take a decision. [Interruption.] A double hip replacement may, of itself, be perfectly properly classed as a priority, but there is still the question of how to judge that against the other clinical priorities that have presented themselves on the day on which the judgment about whether to provide treatment has to be exercised. If there is a more pressing priority, the clinician should have the right to take that decision and should not be hidebound by rules that the cabinet secretary has set down.

Will the member give way?

No—I want to develop my point.

He is just talking tosh.

Not at all. [Interruption.] The continual sedentary interventions mean that I already know the point that Shona Robison wishes to make. Indeed, I even heard it being corrected in exchanges between her and the cabinet secretary. Not only did I hear the first draft of the intervention, I heard it in its proposed final form.

The BMA has made clear its views, which the cabinet secretary might regard as "tosh"—that is entirely a matter of judgment for her. It believes that waiting time initiatives can, if they are improperly applied, distort clinical priorities.

If they are improperly applied.

That relates to the question of an unreasonable limit, whereby the politicians, not the clinicians, set the standard.

Such improperly applied initiatives can result in patients who have less serious complaints being treated before those who have more complex medical problems. The BMA appeals to politicians

"to work in partnership with clinicians to develop targets that are meaningful, relevant and that deliver benefits to patients who are most in need of care."

Are the Liberal Democrats not in favour of any maximum waiting time? If they are in favour of one, what maximum waiting time do they favour?

I have made it absolutely clear that I am not in favour of imposing a maximum waiting time limit, which takes—[Interruption.]

We have had enough sedentary interventions.

I am grateful for your support, Presiding Officer, although I am bound to say that the sedentary interventions have been rather entertaining, if not informative. I hope that they will be caught in the Official Report, so that other members can get the benefit of them.

You should be winding up, Mr Finnie.

The important point is that we are talking about whether clinicians have the right to take the final decision and to override waiting time rules when they believe, in their professional judgment, that that is the proper course of action. The BMA is saying that it must be the patients who are most in need of care who get the benefit of that final decision. I hope that the cabinet secretary will listen to the BMA's advice before she imposes the new guarantee. [Interruption.]

Can we have one debate at a time, please?

If we are serious about tackling waiting times in accordance with clinical priorities, the NHS must have access to all available resources. That means that it must be able to access any spare capacity that might be available in the private sector from time to time. We are not talking about the provision of resources to create additional private capacity; what is necessary is a pragmatic decision to put patients first and to make use of all available facilities in patients' best interests. The SNP's dogmatic view, whereby it rules out making use of private capacity in any circumstances, is not just redolent of political dogma but, more important, is totally at odds with what is in patients' best interests.

As the motion states, the Government must

"make an early statement on how it intends to implement its maximum waiting time guarantee without impacting on those with the greatest clinical need"

and, just as important, it must,

"as a matter of urgency, publish a comprehensive assessment identifying the additional administrative and bureaucratic burdens"

that its new waiting time proposals will impose on the NHS. It must also set out how much they will cost and how they are to be funded.

I move,

That the Parliament is concerned that the Scottish Government's approach to waiting times will lead to an increase in bureaucracy, placing an administrative burden on clinicians; believes that introducing a legally binding guarantee will put further pressure on health professionals leading to a litigation culture in the NHS; regrets the decision by the SNP to put political dogma before patient need in ruling out the use of the private sector to reduce waiting times; regrets the lack of commitment from the Scottish Government to invest further in primary health care facilities; calls on the Scottish Government to continue making progress in reducing the longest waits, while prioritising shorter waiting times for the most serious conditions; calls on the Scottish Government to make an early statement on how it intends to implement its maximum waiting time guarantee without impacting on those with the greatest clinical need, and believes that the Scottish Government must, as a matter of urgency, publish a comprehensive assessment identifying the additional administrative and bureaucratic burdens that these new proposals will place on the NHS, how much they will cost and where the money will come from.

I begin by welcoming what will be, if Ross Finnie's approach to patients' rights is anything to go by, the first of many Liberal Opposition debates. At the next one, perhaps the other half of the Liberal group will turn up to hear what their spokesperson has to say.

The cabinet secretary is an important member of the Scottish Government's Cabinet and a senior member—the deputy leader—of the SNP. What percentage of her members are present?

I remind Ross Finnie that it is a Liberal Democrat debate.

I welcome the debate for another reason: it gives me the opportunity to stress this Government's absolute commitment to putting the interests of patients first at all times. Central to that commitment is our determination to drive down waiting times. For any patient, the wait for an outpatient appointment, a diagnostic test or hospital treatment causes huge anxiety. I, for one, believe that it is our obligation to mitigate that anxiety as much as we can.

Let me do something a little unusual, Presiding Officer: I want to give credit to the previous Administration for the progress that it made in reducing waiting times. Its record was far from perfect, as the hidden waiting lists and the failure to meet the cancer waiting time guarantee demonstrate, but I welcome the fact that waiting times are significantly lower today than they were a few years ago. That makes it all the more strange that Labour seems to be prepared to back a motion that calls into question the policy of maximum waiting time guarantees. I hope that I am wrong about that, but if I am right, it will set back the cross-party consensus that has long existed on the issue. It will negate everything that Andy Kerr tried to do, which is perhaps why he is not in the chamber. It contradicts Labour's manifesto and, to be frank, it renders their claim to commitment to consumer-focused public services absolutely meaningless and laughable.

I wonder whether Nicola Sturgeon was listening to Ross Finnie's speech. As the Liberal Democrats make clear in their motion, we are concerned about two things. We are concerned not about the idea of removing the hidden waiting lists, as the SNP refers to availability status codes, but about dealing with the bureaucracy that will accompany the implementation of the concept, which will impose a massive burden on the health service. That will be compounded by the introduction of legal guarantees that will remove the clinical right to make decisions. Those are the two issues that we are debating today, not the principles that you outlined at the beginning of your speech, which we support.

I remind members to refer to other members by their full names. The only "you" in this chamber is me, and I am not taking part in the debate.

Very wise, Presiding Officer.

I listened to Ross Finnie very carefully. I heard him say that he did not agree with maximum waiting times. That is what Labour will be signing up to if its members back his motion.

Let me confirm that this Government will continue to put patients first and that it will continue the process of driving down waiting times, which is why I have confirmed our intention to work with the NHS to achieve by 2011 a maximum wait of 18 weeks from general practitioner referral to treatment. I believe that that pledge has widespread support from the NHS, from members of all parties in Parliament—at least, I thought that that was the case—and, most important, from the public.

For the benefit of the new Liberal health spokesperson, let me explain that a maximum waiting time guarantee is exactly that—a maximum. It is an upper limit on the length of time for which a patient will wait. Within that maximum period, the decision on when a patient will be treated is entirely a matter of clinical judgment. Patients who need to be seen more quickly will be seen more quickly, and urgent cases will be seen straight away. For some serious conditions such as cancer, it is appropriate to set shorter maximum waiting time guarantees. However, if the Liberals are really suggesting—as their amendment and Ross Finnie's comments imply—that there should be no upper limit on how long a patient can wait for treatment, then they are seriously out of touch with public opinion and with clinical opinion.

I do not want to get into a debate on semantics, but an issue arises here. If one is prepared to accept that during the course of the guaranteed waiting time clinicians should be able to exercise discretion, then one must also accept that clinicians should be able to exercise discretion at any point along the pathway, even—although it would be regrettable—towards the end of the period. One cannot, as Nicola Sturgeon said in her statement, say that there will be no exceptions.

Ross Finnie has just confirmed that he does not think that there should be any upper limit on waiting times. To have discretion to breach the upper limit would mean that there was no upper limit. I disagree with that position, and so does this Government.

I want to make some progress.

The Liberal motion calls on us to cut the longest waiting times and to prioritise serious conditions. Let me assure the Liberals that that is exactly what we are doing—as well as ensuring a maximum guarantee, or an upper limit, for all patients. This Government recognises the importance of prioritising serious conditions, which is why we have pledged publicly to meet by the end of this year the 62-day cancer waiting time target. That is a target that the previous Administration failed completely to deliver on.

As for the longest waits, I remind Ross Finnie of my announcement last week on abolishing hidden waiting lists, which will ensure that the thousands of patients who have, until now, been excluded from waiting time guarantees and who have, in many cases, waited two years or more for treatment, will now benefit from a guarantee. Indeed, since this Government took office, thousands of patients have already been removed from hidden waiting lists. While Ross Finnie merely talks about tackling the longest waits, this Government is actually doing it.

I make no apology for wanting to reduce waiting times for all patients, appropriate to their needs. I reject absolutely—as Andy Kerr used to do—the point that is made in the motion that shorter waits will mean more bureaucracy for the national health service. That is nonsense—the opposite is true. Anyone who knows anything about the NHS knows that shorter waits mean less bureaucracy. Better information technology systems to track patients through their journey of care mean less form filling and manual record keeping for staff. Shorter waits mean fewer complaints, less need to review patients' cases and higher levels of patient satisfaction generally. In other words, there will be a virtuous circle of better services, which will lead to smoother and more efficient administration.

I turn to making waiting time guarantees legally binding. Yes—this Government will ensure that patients' rights are meaningful, because that is what patients have the right to expect. Yes—we will consult on the details and we will welcome comments from everyone who has an opinion. Frankly, the nonsense from the Liberals about lawyers at bedsides is soundbite politics at its worst: believe me—I am no novice when it comes to soundbite politics. A "red herring" was how the Patients Association described what they have said. The association—it knows what it is talking about—also said that the Government's plans are what patients have been waiting for for a very long time. The association understands, even if the Scottish Liberals do not, that the point of making guarantees legally binding is not to give patients the opportunity to sue doctors, but to ensure that the guarantees are delivered and that patients get the treatment to which they are entitled.

Will the member take an intervention?

I will just make a bit of progress on this point, in which I think Mr Rumbles will be interested.

It is worth noting that in Norway, which has had legally binding guarantees for six years, not a single case has gone to court. That is the reality. However, Ross Finnie need not just take my word for the sense of taking that approach; he should ask the Liberal Democrat shadow health spokesperson south of the border, Mr Norman Lamb MP, who has just published the health policy document that I have in my hand. Mr Lamb advocates individual patient contracts to enshrine a range of patient entitlements, including the right to a maximum waiting time guarantee. Unless the law has changed since I studied it, contracts are legally binding, so clearly Mr Lamb has more in common with the SNP than he has with Mr Finnie. Perhaps Mr Lamb had Mr Finnie in mind when he said that some say

"this sort of entitlement can distort clinical priorities".

He added that he believed that it is

"the single most effective means of driving up efficiency in hospitals."

Perhaps Mr Finnie and Mr Rumbles could learn a thing or two from their colleague from south of the border.

I would like Nicola Sturgeon to pursue the point on the legal guarantee. Could she just outline what the remedy is for a patient who has a legal guarantee that does not meet the waiting time targets?

Perhaps Mr Rumbles could read the document by his colleague from south of the border, who goes into detail. A range of remedies are available, such as the right to be treated in another health board area, the right to have a case referred to the ombudsman and—in extremis—the right to take legal action.

Ah!

I say to Mr Rumbles that the point of legally binding guarantees is to ensure that patients' rights are meaningful, that guarantees are not breached, and that patients get the treatment they deserve.

I say to members in all parts of the chamber that I am more than happy to have an extremely robust debate. I have absolutely no doubt that we have got it right on this issue and that we will be backed by patients.

Patients across Scotland today will have listened to Mr Finnie saying, in effect, that upper limits on waiting times are not appropriate. Those patients will despair because not having those limits would take us back to the bad old days of the health service when people waited for excessively long periods. This Government will not take us back to those days.

Will the cabinet secretary take an intervention?

No, Mr Finnie—I am afraid that she is almost out of time.

I regret the attempt to turn a shared commitment—to ensure shorter waiting times for the benefit of all patients—into some kind of adversarial debate. However, I give this assurance: what has happened will not deter this Government in our efforts to ensure an effective, safe, high-quality and responsive health service of which we can all be proud. That is why we will continue to build on the progress that has been made in reducing waiting times and will deliver the best deal for patients. It is called putting patients first and it is what this Government stands for.

I move amendment S3M-545.2, to leave out from "is concerned" to end and insert:

"calls on the Scottish Government to build on the progress made by the last administration in reducing waiting times by establishing a new 18-week whole journey waiting time guarantee by 2011 and consulting on a Patients' Rights Bill that will ensure a more patient-focussed NHS."

I am delighted to be speaking in the debate. It is my first proper outing under my new responsibilities; it is indeed quite a challenge.

Mary Scanlon seems to have left, and I was just about to make a point about her, just as Ross Finnie made a connection with Murdo Fraser. Oh, she is here—I did not see her. Mary and I share an inheritance of Irish stock, and I think that that contributes to the fact that we both have feisty natures. I look forward to many interesting debates. In Mary's case, debates are always conducted with good humour—I will let members draw their own conclusions about whom I leave out of the good-humoured club.

I enjoyed Ross's speech this morning. It was extremely—

Please use members' full names.

I apologise, Presiding Officer. I miss Ross Finnie's good humour from around the Cabinet table.

Health is an important issue for the Government and the Parliament. I do not need to emphasise to anyone the importance of the issue to families, individuals and communities across Scotland. I am sure that the SNP Government knows full well how interested everyone in the chamber is in the issue, and I am sure that the Government will factor the chamber's views into its considerations and deliberations—especially given the fragility of its minority status. It will be no surprise to Nicola Sturgeon that I will exercise my responsibility to hold the Government to account with considerable vigour.

I was going to say that I was pleased that the SNP acknowledged the progress that was made under the previous Executive. I am thinking about waiting times in particular but also about our broader achievements in health, which I will comment on shortly. At the outset, I want to clarify absolutely and without qualification that Labour's amendment reflects, as will our contributions today, that it is not the waiting time guarantee that is at issue but the way in which the Government will pursue it.

Will the member take an intervention?

No, Shona, let me make the point; perhaps you can then answer it directly.

The big issue that we had with Nicola Sturgeon's statement last week was that you implied, disingenuously, that we were deliberately hiding people on the availability status codes. You know that that was not the truth. Perhaps when you come in, Shona, you can tell me the name of one person who was on the lists for an illegitimate reason.

I repeat that the only "you" in this chamber is me.

The problem with availability status codes or hidden waiting lists was not, as some have alleged, that they were abused in some way, but that the rules per se were unfair to patients because they meant that many patients ended up waiting much longer than the waiting time guarantee. I hope that Margaret Curran agrees that it is welcome to see the back of them and that we can now give every patient a waiting time guarantee.

As I said last week, Nicola Sturgeon borrowed Andy Kerr's model. She implied that we were deliberately masquerading people on those lists, but that was not the case. I notice that she has not produced the name of one person who was there illegitimately.

I want to talk about our significant, broader achievements in health, which I hope we will return to many times. Those substantial achievements were the result of leadership, political direction and effective delivery, and it is vital that they are maintained. Nicola Sturgeon quoted Liberal Democrat politicians down south, and I suppose that it is appropriate for me to quote Gordon Brown, who has had a significant and important conference this week. I think that all of Britain welcomed his restatement of the commitment of Labour to public services. It is important to remind ourselves that our great achievements in health are due to the investment that resulted from his stewardship of the British economy and his commitment to public services.

In 1999, £4.7 billion was committed to the health service in Scotland. In 2007, the figure was £10 billion—that is a phenomenal increase. I will ensure that the SNP does not undermine in any way the significance of Labour's achievements. We will hold the SNP to account. We should recognise what came from those substantial investments. In addition to the smoking ban, deaths from cancer were down by 15 per cent, strokes by 40 per cent and heart disease by 45 per cent. Cataract operations were up by 38 per cent and knee replacements by nearly 80 per cent. I could go on and on about the extra doctors and nurses. We appreciate what that means for the quality of life experience for those patients, as well as the freedom from pain and the opportunities that those patients are now afforded.

The SNP has inherited a significant legacy, which it must not squander. That is recognised in the SNP's amendment, and I hope that the SNP sticks with that, although the tenor of its contribution so far does not seem to indicate that it will.

Given that the 18-week whole journey target, which is one of the elements of our amendment, was a commitment made in Labour's manifesto—a shared agenda—is it not concerning that Ross Finnie said that he had ruled out maximum waiting times, which indicates where his motion is coming from? Will Margaret Curran support our amendment in guaranteeing that 18-week whole journey target?

I was about to say that the whole journey guarantee in our manifesto is one to which we are firmly committed. We promised to deliver, just as the SNP has committed to a waiting time of 18 weeks for the whole journey by 2011. We did not make that commitment lightly. It was properly costed and we knew that we could deliver it within the timescale. It is central to the SNP's credibility, as it is to the credibility of any Administration, that it deliver on its commitment.

On that point—

I am sorry. I am desperately running out of time.

Our charge against the SNP today is to question the idea that a legally binding guarantee helps patients along that journey. That is the germ of the debate and it is the issue that Nicola Sturgeon is trying to avoid.

Will the member give way?

I am sorry. I genuinely do not have time.

If the SNP has to make guarantees legally binding, does that mean that it does not have confidence that it can deliver without them? Labour could have done it. How can the SNP have a legal guarantee without having recourse to law? How can it have recourse to law without involving lawyers? The SNP is involving lawyers when it should be involving clinicians.

Will the member give way?

I have said no three times.

As Gordon Brown has indicated, and as Andy Kerr made clear in "Fair to All, Personal to Each", the next step for Labour is to personalise care and reduce bureaucracy. That is central in Labour's amendment. I hope that the Liberal Democrats will accept that amendment, because that is what we want to emphasise, and I hope that no one will be misguided by the SNP's obfuscation. I also hope that the Parliament can support the demand in the Liberal Democrat motion that the SNP should produce a comprehensive assessment of how it will move forward on the issue. If the motion is agreed to, that will be a vital step forward for the chamber in holding the Government to account. Members must take the view that they will not risk waiting time guarantees or the service that is available to patients. We must ensure that the SNP Government is held to account for facile proposals such as the one that it has come forward with today.

I move amendment S3M-545.1, to leave out from "is concerned" to "on clinicians" and insert:

"calls on the Scottish Government to review the implementation proposals to ensure that the principles of Fair to All, Personal to Each are implemented with the least bureaucracy possible and ensure that the new waiting list system provides the highest quality support, particularly for the most vulnerable in our society".

Like Margaret Curran, I congratulate Ross Finnie on his speech. It is indeed an historic day. After eight years in government and 147 days in opposition, the new Lib Dems have all the answers on the NHS. I further congratulate Ross Finnie on his explanation of the difference between invention and implementation.

It is unfair of members who intervened on Ross Finnie, and did not give him the opportunity to finish what he was saying on the upper limit for waiting lists, to misquote him. I heard clearly what he was saying and I understood it, but there was misrepresentation from the Government benches.

Will the member give way?

I will not. I have got too much to say in a short time.

The Scottish Conservatives are delighted to speak to the motion, which

"regrets the decision by the SNP to put political dogma before patient need in ruling out the use of the private sector to reduce waiting times".

We welcome converts to the Tory cause, no matter how late and no matter what their previous convictions.

Last week, we heard of the abolition of the availability status codes—otherwise known as the hidden waiting lists—which currently total 25,000. Added to the real waiting lists, that presents a challenge within an 18-week waiting time guarantee, let alone an 18-week legally binding guarantee. As I have said previously, many patient groups fall outwith that waiting time guarantee, legally binding or not. Those groups include people with mental health problems, infertility patients, and people with drug and alcohol addiction who are waiting for detox and rehab. Some patients can wait for years, not weeks or months.

There are 28,000 people in Scotland waiting for physiotherapy. Ross Finnie's point was that there should be a clinical judgment rather than a straight 18 weeks for all conditions. Physiotherapy patients have a recommended 18-week wait. However, although the Government insists on an 18-week target, that it is not appropriate for all patients. Given that 33,000 people in Scotland are off work due to back pain, would it not be good value for money to employ more physiotherapists and gain shorter waiting times? Would it not be good for people to get back to work rather than sitting at home for 18 weeks, particularly given that a small problem can become a chronic problem if it is left for that length of time? That would help the individual, help the family and help the economy.

Instead of legally binding waiting time guarantees being introduced for certain groups of patients, we suggest to the new SNP Government that more work force planning should be done not only in physiotherapy, but in chiropody, or podiatry as it is now known. The number of podiatrists has not increased since 2003, with the result that many elderly people are forced to pay privately for podiatry care and treatment to keep themselves mobile and independent.

It is right to raise the E112 scheme, which states:

"Under the relevant rules and European Court of Justice judgments, you are entitled to go abroad for treatment … if … you face an ‘undue delay' in receiving the care you need in the UK."

Given that the Government has specified an 18-week waiting time, any lawyer could fairly assume that any patient whose wait exceeds 18 weeks could be funded by the NHS for treatment elsewhere in the European Union.

As I understand it, people can claim reimbursement of the charges for treatment up to the amount that it would cost the NHS to provide the care. As more patients find out about the scheme and we get a definition of "undue delay", more people could receive treatment abroad that is paid for by the NHS. Of course, undue delay and treatment abroad under the E112 scheme are now more likely because the Government refuses to use fully the resources and capacity of the independent sector in Scotland.

The First Minister, Mr Salmond, stated:

"The system that we have proposed and put out for … consultation is based on the system that is used in the Norwegian health service".—[Official Report, 6 September 2007; c 1497.]

He said that the system will be patient centred and will put patients first. Given his endorsement of the Norwegian system, I ask the Cabinet Secretary for Health and Wellbeing the following questions. Norwegian legislation gives patients a choice of hospitals in which to be treated and an option to change their general practitioner twice a year. What choice will the Scottish Government give patients? The Norwegian waiting time guarantee makes use of available capacity in other countries. Will the SNP send patients out of Scotland to meet the targets rather than using the staff and other resources of the independent sector in Scotland?

Will the SNP's legally binding waiting time guarantee cover care at home? Will it include all community care, as is the case in Norway? In 2004, Norwegian legislation was amended to extend the free choice of hospitals to include private hospitals that have agreements with the health authorities. Will the SNP allow patients in Scotland to choose which hospital to attend from a range of independent and NHS hospitals? In Norway, patients have the right to treatment in a private or foreign hospital if the time limit is exceeded. Will the SNP give patients in Scotland that right?

In the membership of the Norwegian Board of Health Supervision, the number of doctors, 20, is exceeded by the number of lawyers, 25. Is that really the SNP's model for health care in Scotland? The First Minister recommends the Norwegian model of health care, but even in Norway legally binding waiting time guarantees have not reduced waiting times by a single day.

Spellbound though I am, as always, by the quality of Ross Finnie's oratory, I am amazed by the defeatist attitude that is encompassed in his tawdry motion. I presume that it was cobbled together in an attempt to secure support from those with entirely different motives and aspirations. Perhaps we will have to decide after the debate, having read the Official Report, but I heard Ross Finnie recommend that we should depart from a waiting time guarantee in some circumstances. I remind him that a waiting time guarantee was included in his party's manifesto as recently as 2007. It is clear that there has been a shift away from that policy in a short period of time.

The Government policy about which Ross Finnie and his party are concerned is the introduction by the end of 2011 of a legally binding guaranteed maximum waiting time of 18 weeks for the journey between GP referral and treatment. That is not a ludicrous target. It will most likely be met in England and Wales by the end of 2007; it will seem impossibly lax to the citizens of nearly every other developed nation; and it was adopted by Labour in its 2007 manifesto.

I accept the member's argument about the target in itself and the legitimacy of the time period, but the argument today is about the target's legally binding status. That is what concerns us.

I reassure the member that I am approaching precisely that point. If she listens, she will hear me address it.

What are the objections to the target? People say that there will be increased bureaucracy, more pressure on health professionals, a greater administrative burden, and a concern for the suppliers of health care rather than consumers' interests. However, things have changed. We have a Government that puts patients' needs first.

Oh!

I say to Dr Simpson that the Scottish health service is to be run for patients. Do the Opposition parties really want to go on the record opposing that philosophy? They say that legally binding guarantees will lead to a litigation culture. If Labour supports the motion on that account, it will show that it had no confidence that it could fulfil its promise of a maximum wait of 18 weeks. No one will go to law if the promise is met.

Will the member take an intervention?

Not at the moment. I want to make some progress. I have a shortage of time, too.

The member named me.

As I named Dr Simpson, I will take an intervention.

I thank the member for his courtesy.

We entirely support the guarantee. The problem is with its legality. If it is backed by legal issues, it is a different matter. We introduced a series of guarantees whereby, if a patient was not treated in their local hospital, they went to the Golden Jubilee hospital, which we renationalised. If they did not get into the Golden Jubilee because there was a problem with particular circumstances, they could go to the private sector. The SNP Government will get rid of that approach. If it was not possible for the patient to go to the private sector, there was ultimately a right for them to go abroad. We introduced all those rights.

Not a speech, please.

There is no need for a legal guarantee.

I am sorry that I mentioned Dr Simpson's name; I did so only because I thought that he was choking on his water, but he has now made a speech in his own right. I do not have time to respond to it, but I certainly can. Ultimately, any guarantee anywhere in the world that is worth its weight is legally enforceable. Our guarantee is no different.

Will the member take an intervention?

Sit down, please. [Laughter.] Sorry. I ask the honourable member to sit down.

Labour assumes that Scotland cannot deliver health care to the standard of other nations. I say that it can. What we need to achieve that aim is a clearly articulated policy that it must happen.

Earlier this month Mr Finnie's boss, Nicol Stephen, hysterically painted a lurid picture of a lawyer beside every bed, with health service staff spending time in the courtroom rather than the treatment room, if waiting time guarantees were to be made legally binding. He must think that his party is still in government and running the health service.

How can the 18-week maximum wait be achieved? All health boards and hospitals will form their own plans, but I suggest two areas in which progress can be made. First, unnecessary follow-up appointments are still made for hospital outpatient clinics. If we reduce the number of those, more time will be freed up for earlier initial appointments. Secondly, there is still an unacceptable number of missed appointments. In one specialty in NHS Lothian last year, about one new patient in eight failed to attend their initial appointment. Simple, inexpensive measures can significantly reduce the figure, again shortening waiting times.

The motion alleges that the SNP Government rules out use of the private sector to reduce waiting times, but that is not true. Where gaps in the provision of health care have been left by the previous Labour and Lib Dem Government, we are content to allow judicious use of the private sector to ameliorate the situation. What we are against is the long-term privatisation of the health service and the private finance initiative, which take money from the health service into the private sector and provide nothing in return. [Interruption.]

The member should be winding up.

I think that it is other members who are winding up, Presiding Officer.

I ask members to read the motion, note that it contains a ragbag of loose information, and vote against it.

Members have focused on waiting times to get into hospital for treatment. I draw the Parliament's attention to a problem that some of my constituents have. They are on a hidden waiting list to get out of hospital. That brings a whole new meaning to waiting times, does it not? Will the guarantee apply to patients who are ready to be discharged?

Dr McKee said that the SNP puts patients first. In the past week, however, a number of my constituents have called my constituency office on behalf of a neighbour, relative or loved one. The problem stems from the fact that, as we speak, in another place—namely a meeting of the full Fife Council—the new SNP-led administration will agree a £600,000 package of cuts to the social work budget. It has instructed social workers in Fife to refuse care packages for Fifers who are waiting to be discharged from hospital.

I would like to consider the example of my elderly constituent, Mr McKilligan, from Rosyth—but I will give way to the minister first.

Given that the member raised the matter at the Health and Sport Committee, I looked into it. In that case, people did not get the choice of care home that they wanted, so the delay is due to choice. I have sent in a team to examine the Fife situation. I can guarantee that, like other councils, Fife Council will meet the six-week delayed discharge target next year. I hope that the member will be reassured by that commitment.

I am not reassured. My elderly constituent, Mr McKilligan, does not want to go into a care home. He wants to go home, not to any other establishment. He has given me approval in writing to raise his case in the Parliament today. He has been told that he has six months to live because he has cancer. He has been told that he cannot go home just now because the council cannot provide a care package. He is not alone—there are dozens of others like him. He has been told that he may discharge himself and pay for his own care package, which, he has been informed, will cost him upwards of £200 a week. That policy is despicable. Why does Nicola Sturgeon allow the frailest of our people to be treated in that way?

I hope that the Government will take note of that case. This week I have been informed of other cases, all stemming from the same problem, which have happened in the past 10 days. All those cases are winging their way to the cabinet secretary, to the SNP leader of Fife Council and to the chief executive of Fife NHS Board. Whenever I have a constituent's permission, I shall issue a press release about their case to highlight the outrageous new policy of Fife's SNP-led administration.

We are all intrigued by the fact that the SNP's policy development draws on the Norwegian experience. We are used to SNP members citing the Irish experience, although they seldom tell us that prescription charges in Ireland are £60 a go. In Norway, a big-picture approach was taken, rather than the fragmented approach that the SNP is taking today. Should we look forward to more reliance on Norwegian health policy? We know about the fees that people have to pay for health treatment in Norway.

Will the member give way?

I have to make progress.

As has been highlighted in a report from the Organisation for Economic Co-operation and Development, fee paying is directly linked to waiting times. When people in Norway undergo a health check or receive medical treatment, they are obliged to pay a user fee, which is paid directly to the health institution that has provided the treatment.

The OECD's report on waiting times says:

"Waiting times for elective surgery are a significant health policy concern in approximately half of all OECD countries. The main objectives of the OECD Waiting Times project were to: i) review policy initiatives to reduce waiting times in 12 OECD countries; and ii) to investigate the causes of variations in waiting times for non-emergency surgery across countries. The first objective was addressed in an earlier report".

It tells us:

"An interesting feature of OECD countries is that while some countries report significant waiting, others do not. Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom)."

Interestingly, the report highlights the fact that

"Waiting times are not recorded administratively in a second group of countries (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States) but are anecdotally (informally) reported to be low.

This paper contains a comparative analysis of these two groups of countries and addresses what factors may explain the absence of waiting times in the second group. It suggests that there is a clear negative association between waiting times and capacity, either measured in terms of number of beds or number of practising physicians. Analogously, a higher level of health spending is also systematically associated with lower waiting times, all other things equal.

Among the group of countries with waiting times, it is the availability of doctors"

that is "most significant." I hope that the minister will pay attention to that fact.

There is a report in The Herald today about Monklands hospital, where 240 new doctors will be needed. The availability of doctors is critical to waiting times. This is not simply about administration; there is an issue around the shortage of specialists—a shortage in the human resources that are needed to deal with cases.

The OECD report continues:

"Econometric estimates suggest that a marginal increase of 0.1 practising physicians and specialists … is associated respectively with a marginal reduction of mean waiting times of 8.3 and 6.4 days … and a marginal reduction of median waiting times of 7.6 and 8.9 days, across all procedures included in the study."

I must stop there, but I hope that the minister will have regard to the real patient issues. They are not being dealt with today, as is evidenced by my points about the examples in Fife.

I dispute what Helen Eadie said. For the first time, there are clear instructions to patients about their rights regarding the waiting time guarantee. They are contained in the leaflet, "Hospital appointments and waiting times explained". I will deal later with some of the issues around that.

First, however, I must compliment Ross Finnie. He is always good value. He always insults with wit and charm. However, he cannot get away from the fact that, for the past eight years, Labour and the Liberal Democrats were in power in the Parliament, and we have inherited the current situation from them. That includes the dreadful cases of people who cannot get released from hospital because there is not the money in social work departments to pay for their care at home.

Still on Ross Finnie's speech, we have heard a lot of slurs about lawyers this morning. I am no longer a practising lawyer, but I point out that, for more than a decade, the Labour-Liberal Government failed to fund civil legal aid. There were warnings that the paucity of fees for civil legal aid would mean that income from private clients would no longer subsidise such cases and that firms would stop taking them. I welcome the lighted-hearted remark from Murdo Fraser about that but, even as we speak, and as was reported in the newspapers recently, very few people now have access to civil legal aid. We have inherited that disgraceful situation from the previous Government.

I turn to the categorisation of clinical priorities. I will park the argument about having a maximum waiting time guarantee—I refer to Ross Finnie's speech. We have aired that issue enough. We should, however, make it clear that 18 weeks is a maximum waiting time. I suggest to Ross Finnie that there is room for clinical intervention. I looked carefully at the cabinet secretary's speech on the matter, and I have raised the issue in questions to her.

Will the member take an intervention?

I wish to proceed with this point first. Previously, categorising clinical priorities varied from NHS board to NHS board. For instance, people undergoing a double hip replacement in one area might be told that it is a specialist treatment, but they might not be told that in another area. In one case, they will get a maximum waiting time; in another, they will not.

In her statement, the cabinet secretary spoke about situations when the clock would have to stop:

"Another example would be the patient who has a temporary medical condition, such as raised blood pressure or a chest infection, that makes it clinically inappropriate for treatment to be undertaken. The patient will therefore be unavailable, but the hospital will keep the patient on the list and under review until the issue has been resolved. The waiting time clock will be stopped until the patient is fit again and available for treatment."—[Official Report, 19 September 2007; c 1834.]

The idea that there is no reasonable clinical discretion is simply not right.

I will give way.

To whom are you giving way?

To Mr Finnie. I am sorry—I did not see anybody else wishing to intervene.

We were not making a point about cases where patients developed further conditions, causing the clock to stop; we were making a point about choosing between two patients presenting on the same day, one of whom, in the eyes of a clinician, had a priority. I am sorry that our view is not shared by Dr McKee. He prefers his political masters now. That was our point, however.

The point that we are fairly making is that the maximum waiting time that will be given to any patient is 18 weeks. If there are clinical reasons why they cannot be treated within that time, there will obviously have to be discretion.

I want to make progress. We are not given extra time for interventions, regrettably.

Some red herrings have been raised about legal issues. I do not want to overwork the Norwegian or any other example. A bill will come before Parliament that will propose remedies. If it cannot be enforced, giving people a guarantee—whether it is for a television or for a waiting time—is a pointless waste of paper. Our proposal—which is open to consultation—is for a series of appeals that patients could go through. They could go to an NHS board—which we hope will be elected—or to an appeals committee. There will be remedies available to patients through the NHS system, and if those remedies fail, patients will have the right to go to court. That does not mean that patients will go to court in the first instance, just as people cannot in the first instance go to the Scottish Public Services Ombudsman or to the Press Complaints Commission—which I am thinking of doing—but have to go through other routes first. The guarantee, however, will be enforceable; I cannot say it any clearer than that.

The member says that patients will ultimately be able to go to court. Would it not be better to allow them ultimately to get treatment abroad or elsewhere, instead of having to go to court?

In Norway, nobody has gone to court because the mere fact that people have that right acts as a deterrent. To give the member a parallel example, the anti-smoking legislation covering public places that was pioneered by Kenneth Gibson and Stewart Maxwell and which I am glad that you picked up—

Dr Simpson, please do not look for an intervention because I named you.

That legislation has worked as a deterrent because it is enforceable; very few have breached its conditions.

I remind members that, although we are discussing waiting times today, a bill will come before committee and there will be every opportunity during evidence taking at stage 1 to express any anxieties about the system, to test its legal enforceability, to decide whether the mechanisms will overwhelm the system, and to lodge amendments to see whether it is worthy.

Let us have the debate and examine the evidence before us. With the will of the Parliament we will, I hope, end up with an 18-week maximum waiting time guarantee that is enforceable.

I welcome the opportunity to take part in the debate on health, because it is an important issue that underpins many of the topics that we discuss in the Parliament. There is an important link between health and other issues that are crucial to Scotland, ranging from the economy to sport and from housing to education.

The debate is focusing on waiting times and primary care because those are important for delivering a healthier, fairer Scotland. I am sure that members agree that we want to speed up the patient journey from the waiting room to diagnosis to treatment, and I acknowledge the work of the previous Executive in reducing waiting times from 18 months to 18 weeks—something that has contributed tremendously to tackling some of the health issues that we face.

As Margaret Curran acknowledged, that reduction is due in part to the allocation of funding from the United Kingdom Government. From 2002 to 2007, the health budget grew by 39.3 per cent to £10.25 billion, which represented 32.8 per cent of the overall budget. That shows what a priority health became for the previous Executive—as I am sure that it will become for this Executive—and that funding allowed us to tackle the major issues of heart disease, cancer and lung disease.

As part of a cross-party group of MSPs, I recently visited the excellent facility at the Beatson oncology centre and saw at first hand the positive impact of investment in health. I was interested to hear one of the professors at the Beatson centre talking about the positive impact of the smoking ban—which was, incidentally, introduced by the previous Executive. The professor also spoke about the other important issues in public health policy and the need to move forward on the issues of smoking and alcohol. There are a lot of issues that need to be tackled, and positive action on waiting times and investment in primary care would help greatly.

There was a lot of talk during yesterday's enterprise statement about decluttering. It is important that we do some decluttering in the area of health and waiting times in order to ensure positive delivery—binding agreements have the potential to introduce more bureaucracy. The SNP likes to quote the Norwegian example but, as Richard Simpson pointed out last week, that has resulted in an increase in numbers of people on the waiting list from 210,000 to 260,000.

The member has said a lot about the supposed disadvantages of a legally enforceable right to a maximum waiting time. I am sure that his view would not be shared by the 35,000 people who were on hidden waiting lists under the previous Administration. Given that he and members of his party object to the principle of a legally enforceable right to a maximum waiting time, does he also think that there should not be legally enforceable rights for workers and consumers, in case lawyers ultimately become involved?

We are specifically discussing health. My colleague Margaret Curran was quite clear about our views on the waiting time guarantee. We have some reservations about increases in bureaucracy. As the health secretary acknowledged last week, the guarantee needs to be delivered within health boards' current budgets, which means that it could undermine other delivery priorities for local health boards.

In the time remaining, I will move away from the technical aspects of the debate and cover other issues. Health is an important equality issue. In areas where there is poverty, deprivation and a high incidence of drug use, there are also health problems, which it is important that we address. We should provide economic opportunities so that people live more stable and healthier lives.

I acknowledge positive aspects of primary care in my constituency. I recently visited a general practice in Halfway and was impressed by how it had organised its operations with information technology and by the fact that it prioritised early intervention.

The work of community health partnerships links into communities well. I draw to members' attention the Rutherglen and Cambuslang community health initiative, which does a lot of work in the community to raise awareness of health issues.

This debate is important, because people want positive action as they wait for appointments. They are not interested in a Government spending £100,000 on changing signs or £500,000 on a new broadcasting commission. Let us have action on shorter waiting times and investment in primary care. The time to act is now.

No one disagrees with the aim of reducing the length of time that someone waits for treatment in the NHS when they are ill. The SNP does not have a monopoly in this area, even if it seems to believe, or suggest, that it does. The real question is what the best way is of introducing reduced waiting times into the NHS, at the same time as continuously improving patient care.

"Nothing is more dispiriting to staff than filling in endless forms that add nothing to their efforts. The mania for short-term targets, matched only by the frenzy for new schemes and crafty wheezes, fulfilled the need of some politicians to try to prove that they were doing something."—[Official Report, 12 September 2007; c 1601-2.]

That is what Christina McKelvie said in the skills debate in welcoming the abolition of targets in education. Imagine such dispiriting form filling being introduced with personal, legally binding guarantees.

However, this debate is about not just the form filling and bureaucracy, but whether introducing a waiting time guarantee is the right way forward for the NHS. We can look to the Organisation for Economic Co-operation and Development, which the SNP often quotes, for advice in this area. Its health working paper, which analysed waiting time guarantees, states:

"the introduction of an ‘unconditional maximum waiting-time guarantee' may induce the provider to give higher priority to less severe patients (who have waited longest), as long as they approach the maximum waiting time … This behaviour conflicts with clinical priority and the guarantee may in practice act as a guarantee for low-priority patients."

I say to the minister that that is from the OECD.

Does that mean that the Liberal Democrats do not support maximum waiting time guarantees?

As Mr Finnie made clear earlier, the Liberal Democrats do not support legally binding personal guarantees. The minister continues to misrepresent our position. Of course we want targets for waiting times to be reduced. The problem, as the OECD has said, lies with the Government's approach, which involves legally binding personal guarantees.

Last week, the cabinet secretary quoted Margaret Watt, the chairwoman of the Scotland Patients Association, as endorsing her plans. I wonder whether the Minister for Public Health read the issue of the Evening Times in which Mrs Watt said:

"It is hard to believe any of the politicians. How often have we heard them promise something only to say: ‘We'd love to do it but we can't afford it,' once they are voted in?"

She cannot be referring solely to the Scottish National Party; of course, it is a plague on all our houses. However, she went on to say:

"We would lean towards any party that is trying to take the politicians out of the health service."

The SNP is putting politicians at the heart of the national health service, with central strictures in the guise of patients' rights. As the cabinet secretary said last week, there is now an end to professional medical judgment about prioritising care and there will no longer be any exclusions because of low clinical priority. However, we heard from Christine Grahame that there will be clinical discretion. In Mr Finnie's example of a situation involving two patients—one with low priority care needs and one with urgent priority care needs—presenting at the same time, the treatment priority would be the low priority patient, as the OECD said.

Will the member give way?

I will let the minister in later, if I have time.

Three weeks ago, the SNP Government said that non-consultant-led services would not be part of its waiting time guarantee. However, we now understand that all services will be covered, including podiatry, physiotherapy, psychiatry and audiology. I would like clarity about whether the guarantee will be applied to psychology services. If so, I would like the Government to state how it will define the completion of that treatment.

Four months ago, the SNP Government announced a new independent scrutiny approach for the closure of NHS services. This month, there is some confusion about whether that applies to GP practices.

Last week, the SNP announced an end to availability surplus codes but failed to mention that the previous Executive had already given funding to NHS boards to remove those. Incidentally, I am sure that the Minister for Public Health was as surprised as I was to see in the annual review paper of NHS Borders, which was released on Monday, tables that clearly showed that there are no patients in the Borders with an ASC 3 or ASC 4 code, a table with an ASC code waiting for admission at 31 March broken down by specialty and a table with the maximum waiting time for those patients. We should have been surprised to see that information, as we had been led to believe that it was all hidden. It was so well hidden that it was in a report that Shona Robison welcomed on Monday and in a report that Andy Kerr commended last year. Some secret, that.

After the cabinet secretary's statement last week, I met the chair and chief executive of NHS Borders and asked whether delivering the end of availability surplus codes would pose them difficulties. The reply was interesting. I was told, "No, because we have the funding and IT systems in place." I asked about the legally binding waiting times guarantee and the chief executive said, "We will be able to implement it, but we need considerably more resources than it's been indicated that we'll get—so far."

On the 18-week target, the document that the minister commended on Monday says:

"This 18 week target will be achieved through systems mapping within all specialties"

and

"the use of private providers in urology, orthopaedics, ENT, neurology, dermatology and general surgery."

However, the SNP is ruling out private providers, which means that much more capacity in all those areas will be needed in the NHS.

Mary Scanlon is right to point out that Norway has one of the highest rates in the world of sending patients to another country to receive treatment.

The OECD says:

"There is a wide range of examples of the implementation of maximum waiting-time guarantees. However, in a number of countries they have been modified or abandoned (Denmark, Norway, and Sweden). Moreover, there seems to be no agreement on the way to formulate the guarantee."

It also says that that formulation

"has also proved to be unsuccessful as it is difficult to determine uniform criteria for need."

The minister does not have to believe Ross Finnie, Norman Lamb or me, but she should believe the OECD.

This has been a historic day. We were all entertained by the sight of Ross Finnie losing his virginity as the leader of an Opposition debate. Without being unkind, I should say that I appreciate that that is not a mental image that we want to dwell on for too long. I enjoyed Ross Finnie's speech, which was entertaining and effective.

Much of the debate has concentrated on waiting time targets. However, that is not the only issue in the health service, nor is it the only issue that is referred to in the Liberal Democrat motion. I will concentrate my remarks on primary health care, which the motion touches on, because, although waiting times for treatment are important to people, they are not always the most important thing; the interface between the patient and primary care can be more important, particularly in relation to out-of-hours cover. Anyone who has had to contact the health service in the middle of the night because they have a sick child or adult in their house knows that that can be stressful. It is essential that high quality out-of-hours care is available as part of our primary care services.

I am sure that the minister will be well aware of the recent Audit Scotland report on primary care out-of-hours services, which highlights the continuing pressure that out-of-hours services are under. The report found that many health boards are having difficulty filling GP out-of-hours rotas and that, if more GPs opt out of working out-of-hours cover, as many have already done, the future of the service will be at risk. The report says that there is a significant risk that current models of service delivery are not sustainable in the long term. That is a serious criticism and the Government urgently needs to make a serious response.

On many occasions, I have raised concerns about how NHS 24 operates, particularly in relation to rural areas, such as parts of Angus, Perthshire and Stirling in my parliamentary region. There is no doubt that the changes to the out-of-hours service have not been welcomed in many of these rural areas. It seems that the need to use NHS 24, combined with GPs opting out of providing out-of-hours cover, has resulted in a poorer health service—one in which lives could be put at risk.

I had thought that those criticisms were shared by the SNP, at least while it was in opposition. In the Sunday Herald of 23 July 2006, Shona Robison said:

"We believe there needs to be a fundamental restructuring of the service, with it devolved to health boards to provide the out-of-hours service, including the element of NHS24."

That is exactly why the cabinet secretary was pushing that point at the review of NHS 24. At every health board review, we have been talking about the need to devolve NHS 24 to a local health board area and co-locate with other out-of-hours services. Good progress is being made on that.

I am pleased to hear that good progress is being made, but that reassurance does not seem to have reached my constituents, who continue to be concerned about the operation of NHS 24 and the out-of-hours service that they receive. We need improvements to the service and a thorough review of the structure of NHS 24, so that better local health care provision can be delivered, particularly to rural areas.

Tied in with that issue is the question of ambulance cover because, clearly, the changes in out-of-hours cover have an impact on the ambulance service. As the cabinet secretary knows, I have written to her to express my concern about the fact that the number of ambulances stationed in Pitlochry has been reduced. Although the minister has set out the reasons for the reduction in ambulance cover, I believe that halving the number of ambulances in Pitlochry from two to one could have an adverse effect on response times to accident and emergency call-outs in highland Perthshire.

One ambulance now covers an area of roughly 400 square miles in highland Perthshire. That massive area includes a major section of the A9—Scotland's most dangerous road on which all too many serious accidents occur—and areas where people climb, canoe and enjoy other potentially hazardous activities. To put it into context, if the ambulance stationed in Pitlochry is occupied and another is required for an emergency call-out, the nearest available ambulance that serves highland Perthshire will have to come from Blairgowrie, Crieff, Killin or even Perth itself. The situation could arise—

The member has one more minute, and I must point out that he is beginning to stray from the terms of the motion.

As I am discussing the part of the motion that highlights the lack of investment in primary care, I would have thought that my remarks were competent. However, I will draw quickly to a close.

I am concerned that an ambulance travelling from Blairgowrie or Perth to the north-west of highland Perthshire might take an hour and a half to reach a casualty. I realise that ambulance response times in rural areas will not be the same as those expected in Dundee and Glasgow—represented by Shona Robison and Nicola Sturgeon respectively—but I think that people in those areas can reasonably expect an ambulance service that responds to the demands placed on it.

I make no apology for raising serious issues that affect the delivery of primary care and the future of out-of-hours GP services. They are key areas both of health service activity and of public concern, and ministers must be able to reassure the public that the service for which they are paying is not getting worse and is not putting their health—or, indeed, their lives—at risk.

I was hoping that the Liberal Democrats' motion would be a bit more constructive and consensual—but, alas, no. Yet again, we have negativity from the party of contradiction. If the Lib Dems do not want shorter waiting times, I am sure that they will have even fewer MSPs in four years' time.

Everyone in the chamber, apart from the Lib Dems, wants shorter waiting lists and, indeed, no waiting times at all. Taking no action has never been an option, because it will lead to an NHS that will continue to be burdened with waiting times that are totally unacceptable in this day and age. This morning, Margaret Curran referred to the extra funding given to the NHS from 1999 to 2007. Although everyone welcomes that additional money, the public wonders whether it has been wisely spent and whether the NHS is any better as a result.

Will the member give way?

Not at the moment.

I am surprised that the Lib Dems have lodged a motion that opposes improvement in the NHS. Thankfully, though, the motion also highlights their position on patient rights. I believe that patients should have rights; obviously, the Lib Dems do not. Their scaremongering about a lawyer at every bedside is utter nonsense and simply shows their contempt for the Scottish people. No one in this Parliament with any sense believes that Scotland will end up with an American-style litigation system. Those who do have no confidence in the Scottish people or the Scottish NHS and therefore have no place in this chamber.

The motion also shows the Lib Dems' desire to grasp the privatisation of the NHS. I cannot believe that a party that was in Government until only recently is able to defend or even promote the NHS's continued privatisation.

Will the member give way?

Not at the moment.

Oh!

The chamber will have to forgive me. I consider the NHS to be sacred and to be for every member of our society. The NHS in Scotland is not for sale and should not be privatised. It should be of the people, for the people and by the people.

Will the member give way?

I am sorry; I need to make some progress.

We should consider the Lib Dems' poles-apart positions on this matter. In Edinburgh, they want more privatisation whereas, in London, they do not want it at all. Only last September, after the Labour Party conference passed a motion against their Government's policy of even more privatisation, the Lib Dem MP Steve Webb said:

"The recent announcement that there is to be no limit on the involvement of the private sector in the NHS will alarm the vast majority who do not want to see the health service privatised."

The London Lib Dems are against privatisation, but their Scottish branch wishes to embrace it.

Will the member give way?

I am sorry; I need to make some progress.

Oh!

I am sure that every party in the chamber, except the Scottish branch of the Lib Dems, is able to highlight many examples of Lib Dem hypocrisy. They have this reputation for being nice, fluffy and cuddly, but as today's motion proves, they are cynical and hypocritical and, apart from allowing the people of Scotland to have a referendum on independence, will say and do anything to get into power. Unfortunately they were successful for eight years. However, this year, thankfully, the Scottish population saw through their deceit and voted accordingly.

This year's SNP manifesto pledged to reduce waiting times and introduce a patients' rights bill. We believe that by the end of 2011 no patient should wait longer than 18 weeks from GP referral to treatment; indeed, as the Labour Party's manifesto contains a similar policy, I would have thought that it would support the SNP in this matter.

As we all know, hidden waiting lists were the unspoken truth of the previous Administration. I will not labour that point, but I think that patients should have real rights and shorter waiting times. The SNP Government will introduce the same kind of patients' rights legislation that, as various members have already pointed out, has been a success in Norway. The Norwegian system gives patients rights to information, rights to individual plans, rights to medical records and special rights for children. Who in the chamber does not want such rights for themselves, their families or their constituents?

The Scottish branch of the Lib Dems wants privatisation, but the London branch does not. The Lib Dems do not believe in giving patients rights, because they think that that will lead to a "litigation culture". Moreover, they have no confidence in the Scottish people. What is the point of them? As they obviously have no confidence in Scotland, why should Scotland have any confidence in them?

Nicola Sturgeon recognised that, despite its many failings, the previous Administration made some progress in reducing waiting times. The SNP Government has been big enough to highlight that, and it simply wants to make continuous improvements to help Scotland's patients and the NHS as a whole. In that light, I urge every member to back the Government's amendment.

In her statement last week, the Cabinet Secretary for Health and Wellbeing said that she would improve patient choice by offering each patient two appointments, instead of the current one. At the moment, when allocating appointments, staff at out-patient clinics use their local knowledge of, for example, journey times to offer patients suitable appointments. Patients are then sent a letter with sufficient notice of a single appointment date and time. If the appointment is suitable, nothing more needs to be done; the patient simply turns up at the allocated time. Under the current system, all available appointments are allocated to begin with. If the time and date are unsuitable, the patient phones to reschedule the appointment, and the original appointment is then offered to the next person on the list either by card or, in the case of a late cancellation, by telephone.

Under the new system outlined by the cabinet secretary, each person will have the choice of two appointments, and they will need to phone up and select one. As a result, only half of the available appointments will be allocated in the initial trawl, because one choice will always remain unallocated. Moreover, every patient will need to phone in to select their preferred appointment. What happens to unselected appointments? Does the system have to start so far back from the appointment date to allow appointments to be allocated in twos again, or do staff have frantically to phone around those on the waiting list to fill the unselected appointments?

Will the member give way?

I will give way in a moment. I asked a question on this matter last week, and I want to set out my concerns very clearly so that the cabinet secretary can give me a clear response.

Surely, although the new system will need the same number of staff as the current one to allocate the initial appointments, many more staff will be required to deal with the calls either to confirm or to reallocate appointments.

I have listened very carefully to the member's speech. She will understand that our aim is for the system to be underpinned by better IT in order to reduce bureaucracy and lift the burden on staff.

As for the choice of patient appointments, I hope that the member is aware that, these days, many hospitals—and we are seeking to increase the number—allocate appointments through a modern telephone booking system. Indeed, appointments will increasingly be made in that modern way, because it is in the patients' interests to do so. After all, choice can be given without the kind of bureaucracy that Rhoda Grant has envisaged. We should be aiming for a much more streamlined system for the benefit of all patients.

To be honest, I was going to suggest a system of the kind that the cabinet secretary is talking about. However, that is not the kind of system that she outlined in her statement. It is important that, if appointments are to be offered on that basis, the person is written to and told that they should phone to book an appointment. That is not giving someone a choice of two appointments; it is giving them a choice of the whole range of appointments that are available at that time. That would be an excellent system, but it would need more staff.

Under the proposed system, what will happen if someone does not phone? Staff will need to monitor the lists constantly to see who needs to be chased up. Will they then have to phone that person? Will they reallocate the two appointments that the person has been offered? What will happen if the original person turns up for an appointment that has been reallocated? Will two patients need to be seen at the same time?

Moving on, what will happen if neither of the allocated appointments suits a patient? My reading of the cabinet secretary's statement is that, if the first appointment does not suit the patient and they are allocated a second appointment that still does not suit them, they will go back to the end of the queue.

If neither of the two appointments suits the patient, at the discretion of the health board the patient may be referred back to their GP. There may be a reason why the person is not willing to accept an appointment.

What is proposed is an infinitely better system than the system that we have just now. Currently, if a patient cannot make an appointment for any reason, they do not go back to the end of the queue; they lose their waiting time guarantee for all time. They never get it back again and end up waiting for perhaps two years or more. Whatever reservations the member may have about our proposed system in practice—and we will certainly be held to account for its implementation—does she concede that it is a far better system than the one that the previous Administration put in place?

No, I cannot concede that. The cabinet secretary misrepresents what happens just now. At the moment, if someone is offered an appointment that they cannot accept, they phone up to make another appointment. The health service is not so bureaucratic that it does not offer the person another appointment.

The cabinet secretary says that the new system will offer a patient two separate appointments. However, if they are on holiday at the time of the first appointment and have a work commitment to fulfil at the time of the second appointment, under the new system they will lose their waiting time guarantee. The cabinet secretary needs to make the new system more flexible. She must also take into account the fact that the new system will need more staff. A system such as she described in her intervention, in which people phone up and choose an appointment time, would be much more preferable to the appointment system that she outlined in her statement.

There are many other points that I would like to make, but I have taken interventions and I do not want to prevent other members from speaking by taking any more time. I would appreciate it if cabinet secretary would address the points that I have raised. The system that she set out in her statement is not the system that she has talked about in interventions, which would certainly be much better.

We are running short of time. I will allow the next two members—Hugh O'Donnell and Jamie Hepburn—six minutes. I will then call Karen Gillon, Bill Kidd and John Lamont, who will get four minutes each.

I am happy to be involved in another important health debate that is substantially on the issue of waiting times but which also relates to primary care services. It is on the latter that I would like to focus, particularly in relation to the region that I represent.

From the various pronouncements of the cabinet secretary and the minister, I get a sense that we are developing our health service in a piecemeal way. A fundamentally opportunist political decision was made to retain services at Monklands hospital and the hospitals in Ayrshire.

Will the member give way?

Let me make some progress, first. I will take an intervention in a moment.

It is almost inevitable that one of the rebuttals that I will receive when I raise the issue of Monklands hospital is the fact that I supported a motion to retain services there. The fact is that the motion also referred more widely to primary care services and the threat that was posed to them by the approach that was being taken to Monklands hospital by the Administration.

I would like to focus on primary care services. Even the remotest possibility that a politically motivated decision relating to Monklands hospital will impact on minor injuries clinics in Cumbernauld, the new health centre in Kilsyth and any improvements to the overstretched GP facilities at Craigmarloch comes remarkably close to criminal negligence.

I recently had the pleasure of attending a briefing by NHS Lanarkshire. Mr O'Donnell was unable to attend the briefing, so he sent a member of staff along. Clearly, they were unable to convey to him what we were told at the briefing. We were told by one of the officials there that the decision to keep the A and E unit open could not be linked to any impacts on other services.

That is interesting. That information was conveyed to me. However, it was also conveyed to me that the Government has shelved £253 million worth of development and £100 million of investment in primary care services, which are now under threat as a direct result of the politically motivated decision to keep the A and E unit at the hospital open without any additional funding. That is the reality.

Cumbernauld is the largest town in North Lanarkshire. In the 35 years for which I have lived there, various Administrations and Governments have promised a hospital and improvements to the primary care services in the town. The closest that our town has come to that, however, was the minor injuries unit that was promised and planned as part of the picture of health initiative.

Yes, I and other members supported the retention of the A and E unit, but not at the expense of vital primary care services. For the cabinet secretary to claim that the unit can be retained within existing resources is either completely naive or completely cynical—I am not sure which. It is also completely unrealistic to expect the health board to reorganise and staff a new set of politically driven proposals on waiting times within the same budget. I am sorry, but that just does not add up.

Time will tell which of us is right on the issue of primary and community care. I am determined to save A and E and have decent community care, which was not provided under the previous Administration. For clarity, can Hugh O'Donnell confirm that there are circumstances in which he would back the closure of the A and E unit at Monklands hospital?

No, that is clearly not what I am saying. I said that the A and E unit should not be saved at the expense of primary care services. Is the cabinet secretary saying that she will provide the funding for the original picture of health primary care services in addition to the funding that was promised for A and E at Monklands hospital? Clearly not.

Colleagues have highlighted the shortcomings of the plans for waiting time guarantees. The cabinet secretary has assured us that her proposals are achievable within the current budgets. Although that assurance is not credible under any circumstances, at the moment we cannot even question it because we do not know the cost implications of either decision. It is time for the Government to come clean about what it will pay, how it will pay and what it will cut in order to achieve those politically motivated goals.

This is the beginning of autumn. The fig leaf of the comprehensive spending review cannot continue to cover the shortcomings of the Administration. Autumn brings the falling of the leaves, and I think that those shortcomings will be severely exposed when we get the comprehensive spending review.

I am somewhat disappointed that the Liberal Democrats persist in attempting to mislead the public about the policies that are being pursued for our national health service by the SNP Government. Indeed, as Stuart McMillan said, the Liberals are not only trying to mislead people; they are positively trying to scaremonger on the issue.

Ross Finnie's motion is disappointing, although altogether unsurprising, and wrong on many levels. First, it falls down by describing the Government's proposed changes as

"leading to a litigation culture in the NHS".

That suggestion reflects much of the rhetoric that Nicol Stephen manfully—indeed, painfully—pursued at a recent First Minister's question time. Mr Stephen's more outrageous claims included the suggestion that

"The SNP's proposal will mean American-style litigation in Scotland's health service … it will result in health service staff spending time in the courtroom rather than the treatment room."

However, his most outrageous fit of hyperbole was the claim that the proposals will mean

"a lawyer by every bedside"—[Official Report, 6 September 2007; c 1497.]

Clearly, Ross Finnie has not paid attention to his leader's exchanges with Alex Salmond—although who could blame him for not doing so?—because, if he had listened, he would have heard that the SNP proposals are largely based on a Norwegian model. That point has been well made today.

Can the member explain why the OECD is so wrong to say that the Norwegian experience should not be followed? Can he also explain why the College of Family Physicians of Canada research into the Norwegian experience gives the lessons learned as "Introduce private providers" and, as Mary Scanlon suggested, encourage more patients to go abroad? Why are the OECD and the Canadian physicians so wrong?

I suppose that the OECD and the Canadian physicians will need to explain that themselves.

My point relates to the waiting time guarantee—[Interruption.] I ask members to let me continue. On how many occasions have Norwegian patients taken legal action because they have a system of guaranteed waiting times? As Nicola Sturgeon spelled out earlier, the answer is none—not one single occasion. The claim that the changes will lead to masses of litigation and

"a lawyer by every bedside"

is simply hyperbole and scaremongering. Therefore, it is nothing short of the stuff of fairy tales—not as entertaining, of course, as Wendy Alexander's very hungry caterpillar tale—for Ross Finnie to claim, as he does in the motion, that the changes will lead to a

"litigation culture in the NHS."

The Liberal Democrats are scaremongering and they do the debate a disservice by perpetuating the fantasy of lawyers "by every bedside".

Given the cabinet secretary's absolute statement that the only way in which the guarantee could be pursued is through the courts—as she admitted on "Newsnight Scotland"—is it not entirely reasonable to assume that the only way in which the matter can be pursued is through the courts?

Again, Mr Finnie has not been listening. Going through the courts is not the only recourse, although that will of course be the ultimate recourse for a legally binding guarantee. The question that the Liberal Democrats must answer is why they are so scared of legally binding guarantees. Their position highlights the fact that their manifesto commitment was hollow. The Liberal Democrats' hostility to the waiting time guarantee is particularly peculiar in light of their manifesto. Given their attitude today, we now see that that pledge was not worth the paper that it was written on.

As has already been pointed out, the Liberal Democrats' shadow health secretary in England, Norman Lamb MP, has called for a patient's contract. Presumably, that would be legally binding. He has said that such a contract would include maximum waiting times. I also note in passing—

Will the member take an intervention?

No. I have taken enough interventions.

Norman Lamb has also called for elections to health boards. That is more common ground with the SNP. What a pity it is that his progressive views are not shared by his party colleagues in Scotland.

It is also a pity that the Liberal motion suggests that, under our proposals, doctors will somehow become encumbered by the weight of bureaucracy. The Liberals have not presented any evidence for that suggestion.

In what little time remains to me, I will deal with the part of the motion that talks about the role of the private sector in NHS health care delivery. Although other members have focused on private health care, the wording of the motion is unclear as to whether it refers to private health care or to the private finance initiative. That being the case, I am concerned that the motion, if agreed to, would further entrench the idea of involving private finance in the NHS. Suffice it to say that we are not being dogmatic in opposing that idea. I certainly concede—I make no apologies for this—that ideology plays a part, although I understand that the Liberal Democrats would not know ideology if it bit them. Certainly, principle plays a part, although I understand that the idea of principle is also a stranger among Liberal ranks. However, the SNP position is directed above all by practical considerations. Allyson Pollock has stated that the use of private finance in the NHS involves

"diverting revenue from clinical services, staff, and supplies."

The private sector is driven by private profit. I make no criticism of the private sector for that, but private profit has no place on the front line of our NHS.

In closing, I reject the Liberal motion in its entirety. The SNP Government is delivering on health, from the continuation of the Monklands and Ayr A and E departments to the abolition of hidden waiting lists and the introduction of an 18-week waiting time guarantee. The Liberal motion serves as a useless distraction from those good efforts, so I hope that members will reject it tonight.

I call Karen Gillon to be followed by Bill Kidd. I remind them that they have four-minute speeches.

I welcome the opportunity to participate in this morning's debate and I add my support to the amendment in the name of my colleague, Margaret Curran.

Regarding Stuart McMillan's comments, I appreciate that many on the SNP benches were not members during the previous parliamentary session, but "constructive" and "consensual" are not the words that spring to mind to describe the SNP's contributions in Opposition debates in the previous session. The Opposition's role is to oppose and to offer constructive criticism when the Executive makes the wrong decisions. That is what the Liberal motion and the Labour amendment do. It is essential that we build on the previous Executive's success in cutting waiting times. We all want to make further progress in reducing the maximum wait for all patients.

My remarks will focus on investment in primary care, which I believe is essential. In May 2005, I had the opportunity to spend a week in Monklands hospital as a result of an acute asthma attack. I can only commend the staff in the ward for the care that I received, but the week was without doubt enlightening. I spent much of the time in the emergency care ward. Almost everyone in that ward—including myself—had been admitted with a long-term chronic condition, the proper management of which had broken down. They had conditions such as asthma, diabetes, heart disease, bronchitis or emphysema. Such conditions can be debilitating but, with appropriate primary care and thought-through treatment plans, they can be mitigated. The lives of patients with such diseases can be made easier—and, indeed, normalised—by the provision of appropriate primary care. Such conditions are exacerbated by poverty, poor housing and lack of education.

Investment in primary care does not come cheap. If we are serious about health care, we need to move towards a situation in which such patients are not in acute hospital beds—because they have received the appropriate primary care and support to manage their condition. A person with diabetes should know that the labelling on the back of food packets contains helpful information. People in the ward that I was on did not even have that basic information. We need to move towards that situation by investing heavily in primary care. That is why I want the emphasis and funding of the health service to shift, as much as possible, from acute to primary health care so that we avoid such admissions in the first place.

Hugh O'Donnell raised the much-vexed issue of NHS Lanarkshire. I supported the proposal in "A Picture of Health" that would have moved resources from acute to primary care. Others on the Labour benches argued for a different configuration of A and E services, but none of us argued for the retention of three A and E services in Lanarkshire because that would have meant that resources could not be shifted from acute to primary care.

Jamie Hepburn said that, at the briefing that he attended, he was told that the A and E decision had no consequences for, and no knock-on effect on, primary care. However, in a letter to me about the construction of primary care facilities in my constituency, the chief executive of NHS Lanarkshire mentions

"the knock-on impact of the various options under the review of Accident and Emergency Services on the remainder of the Health Board's development programme."

A minor injuries unit in my constituency—which should be under construction at the moment and which would have been accessible to the people of Clydesdale—is no longer under construction as a direct result of the cabinet secretary's decision.

If the SNP wants three A and E facilities in Lanarkshire, that is all well and good. However, it must back that up with resources so that other people in Lanarkshire are not put at a disadvantage. SNP members cannot have it both ways. They must either put their money where their mouth is or allow NHS Lanarkshire to provide for the patients in the way that it thinks best.

I am surprised that we are revisiting this issue again so quickly, but not surprised that the Lib Dems have had to cobble together so many apparent concerns and regrets, as listed in their motion. There will be no jokes from me about Lib Dem cobbles.

Having worked on the clerical and admin side of health care in some of the biggest hospitals in Glasgow—[Interruption.] I am being interrupted by members from my own side. I am aware of the excessively long waiting lists and waiting times that patients have had to thole, frequently in pain and often in frustration and despair, and I am proud to be part of the new Government, which took on the previous Administration's hidden waiting lists with the intention of making hospital treatment more responsive to patient needs.

I am confused when I compare the 2007 SNP manifesto, which says that waiting times should be shorter with a new national waiting time guarantee, with the 2007 Lib Dem manifesto, which says that waiting times should be shorter with a "new waiting time guarantee". If that was deemed to be the solution by both parties prior to the elections five months ago, should not the Lib Dems just accept that if their policy stance is the same as the Government's, they should be happy to see it being put into practice and stop indulging in embarrassing backtracking?

I have four minutes and am nearly finished; I ask the member to take a seat.

After all, did the Lib Dems not think through their policy on waiting time guarantees before including it in their manifesto, or were they so confident of losing the election that they did not bother to investigate and cost their promises? To argue that there will be increased bureaucracy is fatuous, unless they can present evidence to corroborate that assertion. Do they not know that experienced NHS administrative staff are already in place to operate the present system and that they would rather operate a waiting list that is shorter rather than longer? I ask the Lib Dems to show us why a new IT programme should result in an increase in the difficulty of tracking patient records or waiting times—or had they not thought of that before now, just as they did not think of it when they compiled their manifesto?

Will the member give way?

The member has spoken more than anybody else in the chamber; I ask him to hold on please.

To suggest that increased litigation will result from the new Government's measures is scaremongering and suggests that clinicians are incapable of judging an appropriate waiting time to set within accepted national standards. Why should Scots be more litigious than people in any other European nation? Perhaps the Lib Dems are confusing the citizens of this country with those of the United States of America, where private health care, which the Lib Dems promote in their motion, is commonplace, if not rife, and where ambulance chasing is a mainstay of the legal profession. As Sean Connery says, "That is not the Scottish way."

To suggest, as the Lib Dem motion does, that the Scottish Government should abandon its manifesto commitment and deliver some variation on a new national waiting time, which the Liberals and Labour wanted and which the Tories also promoted in the lead-up to the election, is tantamount to betraying the trust of the Scottish people.

Do not get me started on dogma. The radical Lib Dems in England state that they oppose the privatisation pursued by Gordon Brown's new new Labour Party, while in the chamber, Scotland's Lib Dems call for the private sector to be used to reduce waiting times. I would ask them not to hold their breath, but, as well-meant advice, that would be as disingenuous as their motion.

The debate is about health; it is about ensuring that the people of Scotland get the health care that they deserve; and it is about ensuring that they get health care as quickly as possible.

Although I acknowledge that the debate is perhaps more to do with the quality and speed of service and treatment, there is a comment in the motion about investment in primary health care facilities. Therefore, I want to speak briefly about the provision of health services, particularly in rural areas such as the Scottish Borders. The issue is not so much about the quality of service as the withdrawal, centralisation and downgrading of primary health care services. There is no point debating waiting times if patients who live in rural Scotland have limited access to many services.

For many patients, the lack of a service will have a detrimental impact on the quality of treatment in the first place. Thanks to the failed health policies of the previous Lib-Lab Administration, Scotland lost 45 cottage and community hospitals during the past eight years. In my constituency, we lost our cottage hospitals at Coldstream and Jedburgh. Both hospitals provided excellent, long-standing service to both communities. Despite overwhelming local support from residents in both towns and more widely throughout the region, the former Labour Minister for Health and Community Care under the Lib-Lab pact ratified the decision to close the hospitals.

Therefore, what a surprise I had when I read the Lib Dem health motion, which calls for more investment in primary health care facilities. The Lib Dems were in power during the past eight years—the previous Government's failings are their failings and they must take responsibility for them.

Will the member give way?

I apologise to Mr Purvis—I have only four minutes.

There is a new threat in the Borders—rural surgeries might be closed or downgraded. That threat has come to light in my constituency only in the past 10 days with the news that the Kelso medical practice proposes to close its surgeries in the villages of Yetholm and Morebattle in Roxburghshire. Those two neighbouring villages, although undoubtedly rural in nature, have a population of more than 1,000. With the main town of Kelso more than 7 miles away, and with extremely limited bus and other public transport options, the residents are completely dependent on services provided in the villages. Those services include local shops that struggle to keep open, the post office, which is fighting to survive the Labour Government's post office closure programme, and the local GP surgeries, which we now know could close on 21 December.

Our rural communities, and our rural health services in particular, are under attack. What quality of service will an 84-year-old Yetholm resident who cannot drive receive when her local GP surgery is closed? I ask the Cabinet Secretary for Health and Wellbeing whether the proposed patients' rights bill will be extended to include not only patients waiting for hospital treatment, but patients in rural Scotland who do not have access to a GP.

The local NHS board will make the ultimate decision about whether the Yetholm and Morebattle surgeries are to survive. However, the Kelso practice has made it clear to me that it will need additional financial support from the health board if it decides that the surgeries are to remain open. I therefore welcome the reference in the motion to investment in primary health care. Every member will know about the severe financial constraints under which health boards operate.

I urge the new Administration to take action to save rural GP surgeries throughout Scotland by providing health boards that operate in the rural parts of our country with the necessary additional funding to save those surgeries. Rural services took a hammering under the previous Administration; I ask the new Government not to make the same mistake.

This has been an entertaining and lively debate on a Liberal Democrat motion. As several people observed, the motion is pretty breathtaking in its audacity. Ross Finnie asked us to believe that all the things that were bright and beautiful about the previous Government were contributed by the Liberal Democrats and all that was nasty and crabbit and which led to its defeat was the responsibility of the Labour Party.

This week, Wendy Alexander apologised for the shortcomings of that Government. We are entitled to ask whether the Liberal Democrats associate themselves with that apology.

Will the member give way?

In a moment.

If they do, why has the Liberal Democrat leader not been sacked too? What is so special about the present leader of the Scottish Liberal Democrats that he is the first leader of a governing party in 37 years to retain his job after marching his troops from government into opposition?

Labour must look askance at its former partners—a bathful of fair-weather friends. Labour often says to us that we do not tip our hats often enough in tribute to the previous Executive, so let me pay tribute to its perseverance in indulging so many feather-brained Liberal Democrat notions for eight years.

I congratulate Ross Finnie on this historic first of many Liberal Democrat Opposition debates—it was a tour de force; it was the speech of a potential leader. Not dwelling on the abominations that they visited on Scotland and their slavish support in government for the bowdlerisation of accident and emergency services visited on the people of Glasgow, the Liberal Democrats contort themselves to find sufficient nuance in five months of SNP administration to frame today's motion.

Much to my chagrin, Ross Finnie has indeed teased out statements and expressed intentions of the new Government that are deserving of question. We, too, are concerned about the practical realities that will engulf the proposed patients' rights bill. It was the cabinet secretary herself who, in a Kafkaesque image of an enormous room full of clocks, conjured up last week the vision of an administrative burden that would be both costly and difficult not only to put in place but to manage. After conjuring up that vision, it is ridiculous for her to expect us to believe that no cost is associated with it.

Given that the member has made equal attacks on both parties, can he clarify whether the Conservatives will vote for our motion today or for the Scottish National Party amendment?

The member will have to wait and see.

Does the irony escape the cabinet secretary that, despite her aversion to the private sector, if her patients' rights bill is enacted, the public sector NHS will subsidise the private legal sector and, when cases are successful, that will bleed the NHS of even more front-line cash?

I nearly fell off my seat when Christine Grahame referred to the independent deterrent. That is the first time that I have heard the SNP deploying the nuclear weapons argument in favour of its patients' rights bill. Jamie Hepburn said that there had been no legal intervention yet as a result of the patients' rights bill in Norway, but that is because patients in Norway have the choice of treatment in an independent hospital or abroad. If the SNP is to rule that option out and prevent the private sector from making any contribution, it is entirely predictable and correct to say that more lawyers will be involved and that they will be parading down the corridors of the NHS.

Helen Eadie reminded us that the SNP is now contributing to government not only in the chamber but in minority run councils throughout Scotland. As I have said before, the record that it is laying down is the record on which it will be judged in due course.

Nicola Sturgeon said that patients have been waiting for a very long time. I do not think that they have been waiting for the patients' rights bill; they have been waiting for more effective treatment. Had she visited the Vale of Leven demonstration a couple of weeks ago, she would have seen health campaigners bring before the meeting dozens of reports from previous health secretaries, all of whom have said that they will put patients first. How can patients be put first if we rule out options that would treat them faster? The SNP makes "private" sound peevish and sinister. Stuart McMillan went on at great length about a great conspiracy to privatise the NHS. With the exception of the SNP, all the other parties, which have a far greater tradition either for or against the traditional private sector, accept that there is a role for the independent sector in bringing about more effective treatment of patients. I implore the cabinet secretary, not because I love her—who could love this Administration more than it loves itself?—but because I want the Administration to succeed in its objective of reducing hospital waiting times, to reconsider her approach. I do not see how the Administration can achieve that objective if it is determined to deny itself one of the key ways in which the result could be achieved.

With a heavy heart and with due deference to the derision that I think should choke the Liberal Democrats, we believe that the questions asked in the motion deserve to be answered. We will listen with interest over the next few minutes as the following speeches guide us towards our voting intention at decision time.

I call Dr Simpson, who has six minutes.

Did you say six minutes?

Yes.

In that case, I will have to cut my speech.

I am pleased to sum up in support of the Labour amendment to the Liberal motion. I refer members to my written declaration of interests, including membership of various colleges and associations and my current consultancy work for the Edinburgh drug action team.

Certainly when I was a member in the first session, the Parliament was in agreement that we needed to improve the patient journey and I do not think that any member is against that now. Despite the attempts by some SNP back benchers to divide us, there is general agreement on that principle.

I welcome the cabinet secretary's acknowledgement of the progress that has been made; the Labour Party accepts that there is always further progress to be made. I reiterate our commitment to the 18-week guarantee. It was in our manifesto and we will support the Government in taking it forward.

Will the member give way?

I will complete my point first.

It is clear that the Liberal Democrats are not against the 18-week guarantee. What they are against and the reason why we support their motion is the bureaucracy involved in that guarantee.

I will deal with the debate in four sections.

I will pass over the fact that I have always struggled to understand what Labour meant by a "guarantee" if it did not mean it to be binding. I will instead ask Richard Simpson to clarify an important point. Ross Finnie said that there are circumstances, if a clinician were to say so, in which patients should not be treated within the maximum waiting time guarantee period. Does Richard Simpson agree?

I will explain carefully to Nicola Sturgeon what Ross Finnie was saying. If one patient is given an appointment in the last week of their guarantee and another patient with a critical condition comes in and prevents the doctor from proceeding with that appointment, we go beyond the legal guarantee. I will come back to the matter again later. That is the explanation to which Ross Finnie and Jeremy Purvis referred.

I will pass fairly quickly over our record, but I will reiterate points made by my fellow Labour members. In 1997, 26,000 patients were waiting for more than 26 weeks—36 are doing so today. In any terms, that is a significant achievement, which was achieved by removing many of the blockages. It was due not only to the doubling of spending, which Margaret Curran mentioned, from £900 a head to more than £2,000 a head, but to the improvement of the NHS system.

James Kelly, Karen Gillon, Murdo Fraser and others said that the primary care sector has been developed. It has not been developed enough and more progress has to be made, but nevertheless it has relieved hospital admissions. For example, a report noted that chronic obstructive pulmonary disease services in Tayside have reduced the number of hospital admissions there.

Helen Eadie referred graphically to the reduction in bed blockages. There were nearly 4,000 blocked beds when we took power in 1999. The figure is now down to just over 1,000 and there is further downward pressure. The removal of such blockages has been very important.

Today's debate is not about a desire to change the patient journey or to remove the guarantees; it is about how we implement them. In 2004, we committed in "Fair to All, Personal to Each" to improve the patient journey and to remove the availability status code waiting lists. In order to do that, there must be a comprehensive set of services. That includes, as Conservative colleagues and others have said, a pragmatic approach to the use of the independent sector. There are 4,000 patients being treated, under contract, in the private sector. Will the SNP now eliminate the use of the independent sector? The 1,000 patients in Tayside who benefit from ear, nose and throat services, the 1,000 in Glasgow who benefit from orthopaedics and the 300 in Alex Salmond's area, Grampian, who benefit from heart procedures will not welcome the SNP's refusal to act in a pragmatic way.

There is a fourth element to add to the first three. It is necessary to improve the structure, have a waiting list support system in the Golden Jubilee hospital, which we renationalised, and to use the private sector pragmatically. A final guarantee is that, if all else fails, the patient can go abroad. Those are the guarantees. We do not need a legal guarantee on top of that. I will return to the matter if I have time.

I turn specifically to the point of the amendment. We seriously invite the minister to reconsider the implementation proposals.

Will the member give way?

I cannot take an intervention, as I am in my last minute.

Let me introduce members to the 82-page new ways project document. Its highly bureaucratic approach will result in many patients being removed from waiting lists altogether. That is the SNP's solution to the waiting list problem. Members will read of new codes such as WT 10/10, WT 10/30, WT 19/10 and WT 26/90, which are only a few of the codes that will be recorded on the removal of patients from the list for non-response; deciding that the offer that they have been made is not reasonable; and failing to attend twice—Ian McKee referred to that in relation to the poorest communities. The figure for non-attendance across the NHS in Scotland is currently 12 per cent. If a patient does not attend, they get taken off the list. If someone cancels twice, even for good reason—for example, because they are looking after a terminally ill relative—they get removed from the list. The hospital makes the decision; it is nothing to do with the GP, who is merely informed and not consulted.

I urge the minister to reconsider the system for the sake of the vulnerable patients to whom Mary Scanlon and others referred: those who are homeless; those who are illiterate; those who have no phones—there are still some in that position; and those who are confused. Many groups will be seriously affected by the bureaucratic interpretation of a good proposal.

The Lib Dem motion and many of the Lib Dem speeches send out strange messages to the Scottish public today. The first message is that the Lib Dems do not want robust waiting time guarantees. The second message is that they do not believe in strengthening patients' rights, which is in marked contrast to the view of the Lib Dems' health spokesperson at Westminster, Norman Lamb. The third message is that they want to see investment in the private sector at the expense of the NHS. I suggest to the Lib Dems that that is not much of a vote winner.

I know that the minister does not yet have the Official Report in front of her but, using her good memory, can she point to one phrase in any speech by a Liberal Democrat that said that we would invest more in the private sector? We said that the private sector should be accessed only when that was the right and pragmatic thing to do.

It stands to reason that the investment in the private sector that Mr Finnie wants must come from somewhere and the only place from which it can come is the NHS. I will come back to that point in a minute.

Let us be clear that good progress has been made on waiting times and we recognise the previous Administration's efforts in that area. However, there is more to be done. That is why we have set a target of an 18-week whole journey for patients. Labour supported that target, but there has been some confusion over that today. Richard Simpson said that there are circumstances in which a breach is okay, which is a marked departure from the position of the previous Minister for Health and Community Care, Andy Kerr, who did not accept any breaches in the waiting time guarantee.

I make it categorically clear that Labour is committed to patients having an 18-week whole journey by 2011. We believed that, under Labour, we would have the resources, the political leadership and the ability to deliver that target without needing a legally binding waiting time guarantee. The SNP cannot deliver the target without such a guarantee, but we could have.

That is not what Ms Curran's deputy said. He said that there would be circumstances in which the guarantee would be breached. This Government will not allow breaches to happen—we will deliver on the 18-week guarantee.

On the motion's reference to the shortest waiting times, we are saying that the 62-day target for waiting times, including for cancer patients, will be met by the end of this year. We recognise that that is an important target.

The motion criticises us for a supposed lack of commitment to investing in primary care facilities—nothing could be further from the truth. I have looked at the annual reviews of each health board, which have robust and commendable plans in place for primary care facilities investment. Many of those plans would be put at risk if the part of the Lib Dems' motion that wants investment in the private sector came to fruition. Such investment can be done only at the expense of building capacity in the NHS.

Will the minister give way?

In a minute.

We have never said, either in opposition or in government, that it is wrong for health boards to use the private sector to address short-term capacity issues—we have no problem with health boards doing that. That has been, and will remain, our position. However, that position is different from that in the Lib Dems' motion, which proposes investing in the private sector as part of capacity building to tackle waiting times. We want to invest in the NHS and build capacity in it to reduce waiting times—that is where we differ from the Lib Dems.

One of the annual reviews to which the minister referred and which she warmly commended is that of NHS Borders. She will have seen that, on waiting times, the review states:

"This 18 week target will be achieved through … the use of private providers in urology, orthopaedics, ENT, neurology, dermatology and general surgery."

Can the minister make it clear to NHS Borders whether she will permit it to use more private providers over the next four years, or whether it will have to use fewer?

NHS Borders did not ask us for permission to use more private sector capacity. What it is doing is fine; it can continue to use the independent sector—there is no problem with that. What the Lib Dems are saying is that, as part of their health strategy, they actively want to divert resources from the NHS to the private sector—we are saying no to that. We are happy for the independent sector to be used at the margins of the NHS. That practice has always been the case and it is not a problem. However, we do not want to sacrifice building NHS capacity for the sake of the private sector, which is what the terms of the motion propose.

Will the minister take an intervention?

No, thank you.

I move on to patients' rights and the different approach of Norman Lamb, the Lib Dems' health spokesperson down south. He has a forward-looking vision of building up patients' rights and putting the patient at the centre of the health service. How different that approach is from what we have from the Liberal Democrats here today, which is a cobbled-together motion that desperately tries to seek agreement from the other Opposition parties, rather than outline any positive vision for the health service. The Liberal Democrats have nothing positive to say on health.

Contrast that with our position: we want to ensure that patients' rights are at the centre of what we do in the NHS.

If patients' rights are at the centre of the NHS, and given that the minister bases her model on the Norwegian one, will she give patients the right to choose between a private hospital and an NHS hospital, which is the case in Norway?

Patients already have that right, but we want to ensure that we have the capacity in the NHS to ensure that they can be treated here instead of having to travel abroad for treatment, which Mary Scanlon highlighted in her speech earlier. The NHS will have the capacity to deliver for patients, who will not have to go abroad or to the private sector. The Government will deliver that capacity.

Will the minister tell me exactly where in Fife or elsewhere in Scotland any patient has the right to choose which private sector hospital they can go to?

In Fife, as elsewhere in Scotland, we want to ensure that the NHS has sufficient capacity. Helen Eadie raised very serious issues about some of her constituents, which I have asked officials to look into. We will get back to her on that. I am concerned to hear about any issues concerning delayed discharge and people not getting the right to go home or to go into a care home, whether in Fife or anywhere else. I will write to Helen Eadie about that.

Let us be clear, however, that the debate has clearly exposed Labour's feeble words. The party's leader, Wendy Alexander, talks about a patient-focused NHS. However, when it comes to putting patients' rights at the centre of the NHS, Labour votes against it.

Will the minister give way?

I cannot. I am in my last minute.

Labour's actions show how different the rhetoric is from the reality with the Labour Party. The Government wants to ensure that patients' rights are central to what we do in the NHS. That is what patients want and what the Government wants—we will deliver on it.

We have had a long and interesting debate, in which my colleague Ross Finnie outlined our great concern about the SNP Government's proposals on waiting times. To say that what it proposes will create an administrative nightmare is very apt. I know that because I used to work in ISD Scotland—the information services division—which collects health statistics on behalf of the NHS in Scotland, the Government and the Parliament.

When I worked in ISD, it was a high-pressure administrative organisation, which would be swamped if the Government's proposals were enacted. The Government may think that its ticking clock is fine—it may be, in theory—but the reality is that either more people would have to be employed to administer what the Government proposes, or there would be a significant reduction in the numbers of clinical staff, who would be replaced by administrative staff. That seems the more likely outcome, given that the Government insists that the huge increase in red tape will be dealt with from existing budgets. I am sure that SNP grass-roots campaigners would love their party for doing that.

In her opening speech, the cabinet secretary gave credit to the previous Administration on the progress that it had made on waiting times. However, she fails to realise that, in some cases, putting a so-called legal guarantee on a patient's maximum waiting time will simply be unworkable. It will put in jeopardy the continued progress on the previous Administration's work that is now being made for patients throughout Scotland.

Surely, if a guarantee is not binding, it is not a guarantee. If it is not binding, will patients not find it meaningless?

As other members have pointed out, we accept the guarantee. It is the legally binding nature of what is proposed that will cause the problems.

Alasdair Allan claimed that the crucial issue is the legal stance that will be taken, but he, too, fails to understand the repercussions. A legal link to maximum waiting times will cause concern for our doctors and nurses and take their minds away from their current absolute focus on health care—after all, they are only human.

For the Labour Party, Margaret Curran said that the actions of the previous Labour-Lib Dem Government resulted in extra doctors and nurses and much speedier treatment for patients. She said that the next step for Labour would be to personalise care. However, as Helen Eadie well outlined, that has not always happened. We welcome Margaret Curran's amendment, which seeks to cut the massive amount of red tape and refocus on patient care. That is the right focus for the people of Scotland.

I welcome Mary Scanlon's mature and well thought out speech. She rightly highlighted a number of areas in which treatment will take longer than the SNP Government's proposed maximum 18-week waiting time. Patients seeking treatment in areas such as mental health and infertility are likely to have on-going treatment well beyond 18 months. The Government fails to recognise that in its plans to make the 18-week limit legally binding.

Mary Scanlon and my colleague Ross Finnie highlighted the fact that in the Norwegian model that the SNP Government plans to follow, the Board of Health Supervision has 25 lawyers but only 20 doctors. Those figures are a clear indication that adopting the Norwegian model would result in the loss of clinical services and the promotion of legal services. That is not what patients in Scotland want to see.

What we have not put on the record thus far is that Norway's first attempt to give a guaranteed waiting time resulted not only in an increase in the waiting list but a doubling in the number of violations or breaches of the guarantee, from 5,000 to 10,000, and therefore a doubling of the potential for litigation.

I appreciate that information.

I am not saying that the Government's proposals are entirely without merit. We welcome its plans to give patients some degree of flexibility in making appointments. However, the way in which the Government plans to introduce the measure means that it will not be of practical help to patients. Also, if the measure is to become anything close to operational, it will undoubtedly place a huge burden on the taxpayer.

What rubbish.

Thank you.

One of our greatest concerns with the Government's proposals relates neither to clinical nor administrative issues but to the fact that they will lead to a system in which we are likely to see a lawyer at every bedside. Scotland has a number of things for which to be grateful to the United States of America, but fostering a climate of litigation is not one of them—it is a major concern. If anyone doubts that that climate could be fostered, I ask them to reflect on the huge number of lawyers who, as local authorities move towards single status, have been touting for cases on a so-called no win, no fee basis. With such law suits hanging over them, authorities find it difficult to reach a collective settlement with the unions and almost impossible to predict accurately the likely cost, whether or not single status has been achieved.

If the Government thinks that it is unlikely that its proposals will result in litigation, it should think again. If it really believes that no legal case will result from medical treatment in Scotland, why does it insist on having a legal guarantee? The Government cannot have it both ways.