“NHS in Scotland 2015”
To ask the Scottish Government what its response is to the Audit Scotland report, “NHS in Scotland 2015”. (S4T-01144)
Audit Scotland’s report mirrors our own assessment on the need for our national health service to evolve to meet the changing needs of Scotland’s people. The report recognises that we have increased health resource spending in real terms, and we will continue to increase the front-line NHS budget at least in real terms for the next session, too, should we be re-elected.
The NHS has made substantial progress under this Government, and Audit Scotland’s report highlights a record high workforce that provides a variety of high-quality services, support and advice, which have contributed to people living longer, along with continued advances in diagnosis, treatment and care.
In accident and emergency, the statistics for the last two full months show that Scotland is performing at above 95 per cent. That is not matched in any other part of the United Kingdom.
Hospital waiting times have been transformed and are at historically low levels under this Government. The median wait for hip replacements has reduced by 87 days; the median wait for knee replacements has reduced by 93 days; and the median wait for cataract operations has reduced by 44 days.
On patient safety, Clostridium difficile infections among patients aged 65 and over have reduced by 84 per cent, and MRSA has reduced by 88 per cent.
The Government has a clear vision for the future of our NHS and will take the right action to ensure that we continue to have an NHS that Scotland can be proud of now and in the future.
I thank the cabinet secretary for an interesting reply. I think that most people were shocked to learn from Audit Scotland that the Scottish National Party has cut health spending in real terms since 2008, even though health spending in the rest of the UK has risen. That is a regressive agenda and is the exact opposite of what the Scottish Government has been telling us and still tells us. In trying to fix the back-door austerity from the SNP, will the Scottish Government address why nine of the 14 health boards are still below their funding and why some are forced to request loans to meet their commitments?
If Jim Hume had read the Audit Scotland report, he would have seen on page 10 that
“Between 2008/09 and 2014/15, the revenue DEL budget increased by 2.2 per cent”.
What Jim Hume referred to, of course, was the total with the capital budget included. His party was part of the UK Government that cut the Scottish Government’s capital budget by nearly 25 per cent. Of course that was going to have a consequence for health capital. However, the front-line spend for our hospitals, doctors and nurses has increased in real terms.
Audit Scotland clearly lays out challenges for us. As I said in response to the report when it was published, we recognise that we need to increase the pace of change, particularly in implementing the 2020 vision. I have made that clear. However, I hope that some Opposition politicians might be able to bring themselves to recognise that the Audit Scotland report says that the resource spend has increased in real terms. Will Jim Hume do that?
The cabinet secretary does not recognise that spending has grown in the rest of the UK but fallen in Scotland, and she has not answered fully the question about funding for nine out of the 14 health boards. NHS Grampian remains at nearly £17 million short of its funding share.
The news is worse for mental health. In any month, half the boards do not meet the target. Mental ill health affects many people and deserves to be taken more seriously. Why has the mental health budget share fallen in each of the past five years?
Jim Hume will be aware that Jamie Hepburn announced additional resource of £100 million for mental health.
Jim Hume mentioned Grampian. NHS Grampian received the highest level of increase of any mainland board. Perhaps if Labour and the Liberal Democrats had fixed the allocation formula for boards when they were in power, NHS Grampian might not have had the big distance to make up that it has had. We have made a commitment that all boards will be within 1 per cent of parity and we will keep it.
Jim Hume touched on the health resource consequentials from the UK Government. In every single year since 2010, every penny of that health consequential resource has been passed on. Indeed, in 2015-16, we added an additional £54 million. I accept that there are challenges in our NHS, but I will not accept any inference that this Government has not given every penny of resource consequentials to health. We have protected the health budget; we have made sure that boards have had uplifts to enable them to take forward the improvements in patient care and safety that they need to make.
I am very conscious of time, which is extremely tight for the whole afternoon. To get in as many members as I can, I ask that members please keep to one brief question.
How has the health resource budget changed since the previous election? What has been the change to the Scottish Government’s resource budget from Westminster over the same period?
I made it clear in my previous answer that every penny of health resource consequentials has been passed on, along with an additional £54 million. The capital budget to this Government was reduced by 25 per cent and it is absolutely clear that that would have an impact on our capital spend. As I said, every penny of resource spend has been passed on. I also add that health’s percentage share of the Scottish Government’s budget has increased every single year and is far higher now than it was under the previous Administration.
We are all having difficulty with the figures, so it would be good to have them clarified. In the last two years of the previous Labour Government, there were increases in health spend of 6.2 and 5.2 per cent. To hear that there has been a reduction of 0.7 per cent, albeit that that includes a significant capital reduction, is extremely worrying. We need to have the matter clarified by an independent source.
One third of the NHS estate is not fit for purpose. The Government targets for the elimination of the high-risk maintenance backlog have not been reached. That is very worrying indeed, because the backlog covers significant elements of the estate. Will the cabinet secretary agree to place in the Scottish Parliament information centre a detailed interim report, before the next report in March 2016, from each health board on the progress that is being made on the backlog?
I assure Dr Simpson that we keep a very close eye on the high-risk maintenance backlog. Of course, he and others must recognise that a 25 per cent cut to the capital budget has implications for all the capital spend across the Scottish Government, including on health. Surely he must recognise that page 10 of the Audit Scotland’s report says in black and white that the resource spending for the NHS has increased in real terms? In 2015-16 prices, the increase will be 5.8 per cent up to 2015-16.
I accept that the capital budget has been challenging. Of course, each year the capital budget in health fluctuates, as do other capital budgets. I hope that Dr Simpson will take my assurance, because the figures are in black and white on page 10 of the Audit Scotland report.
The cabinet secretary knows that we all support an integrated health and social care system. However, the Royal College of General Practitioners says that general practice funding has fallen from 9.8 per cent of NHS spending in 2005-06 to 7.6 per cent in 2013-14, and that budget freezes this year have meant an inflationary loss of 1.2 per cent for general medical services. Audit Scotland and the RCGP highlight that more needs to be done to make an integrated health and social care system possible. What long-term action is the Government taking to reverse those trends and prevent the predicted repercussions in order to ensure that we achieve an integrated health and social care system?
Nanette Milne makes a not unreasonable point. The reforms of primary care that we need to make in order to modernise require us to resource primary care appropriately. We have made a good start on that. We will invest £60 million over the next three years to kick-start the reform. We have announced that there will be a new contract based around a different set of principles that will move us away from the quality and outcomes framework from 2017. In the transitional year, we will dismantle large parts of the QOF to reduce bureaucracy. In addition, the First Minister has announced a substantial increase in the number of general practitioner training places.
All that should indicate to Nanette Milne and other members that we absolutely recognise the need to do more in primary care if we are to be able to keep people out of our hospitals and treat them safely in their own homes.
The children’s ward at St John’s hospital is under review and is struggling to recruit staff. Why is there a recruitment freeze at NHS Lothian, and will the cabinet secretary do anything about that? Will she also explain why there is a 53 per cent increase in the use of agency nurses?
I am closely involved with NHS Lothian on St John’s. As the member knows, the review is looking at a pan-Lothian approach, because of the difficulty in recruiting to paediatric specialties, not just at St John’s but across many parts of Scotland. Neil Findlay can be assured that I am keeping a close eye on the situation.
It is interesting that the member mentioned agency spend. I do not know whether he is aware that agency spend in the final three years of the previous Administration was greater than agency spend in the whole of our time in administration. In three years, the previous Administration spent more than this Government has spent in eight years. Indeed, in its final year in office, the previous Administration spent £2.5 million more than the amount that Jackie Baillie, in her press release, has attacked me for spending. Labour members ought to look at their history before they start throwing brickbats at our NHS.
Clutha Vaults Helicopter Crash
To ask the Scottish Government, in light of the air accidents investigation branch report into the helicopter crash at the Clutha Vaults, what steps it can take to bring closure for the families involved. (S4T-01142)
Our thoughts continue to be with the families and friends of those who lost their lives in the Clutha tragedy, and the Scottish Government again offers its deepest condolences to them. I share the families’ disappointment that the AAIB report does not provide the closure that they sought and that, after two years of investigation, the AAIB did not reach a clearer conclusion. The report raises more questions than it answers.
The Crown Office confirmed last week that, as the incident involved deaths in the course of employment, a fatal accident inquiry is mandatory. The FAI will be held as soon as possible and will allow for wider reflection on some of the other issues that could have impacted on the events that evening.
What is clear, however, is that because there was no flight data recorder in the helicopter—something that was not required by regulation given the size of the helicopter—it will be very difficult to establish all the answers. The issue of helicopter safety is reserved to Westminster, so the Cabinet Secretary for Infrastructure, Investment and Cities and I have contacted the Secretary of State for Transport to seek reassurance from the United Kingdom Government that it will ensure that the report’s recommendations are taken forward swiftly.
I welcome the announcement that a fatal accident inquiry will be undertaken. I hope that the inquiry provides the answers that the families deserve to have.
Previous AAIB reports, which stretch back over 10 years, have recommended that flight data recording equipment be fitted to all aircraft, but the recommendations have never been implemented. I take on board what the cabinet secretary said about speaking to his Westminster counterparts, but is there something else that the Scottish Government can do to help the people who are suffering and who have no answers yet?
I am aware of the reports to which the member referred. She will be aware that there are two aspects to regulation in the area that we are talking about. There is regulation through legislation from the European Aviation Safety Agency, which is responsible for the pan-European approach to aircraft safety. There is also the domestic regulator, which is the Civil Aviation Authority.
We want the recommendations in the AAIB report, which fall to both the CAA and the EASA, to be taken forward swiftly. We want to ensure that all action that can be taken is taken forward as swiftly as possible, and that is why we are engaged with our counterparts at UK Government level to ensure that the regulators and also the European agency are considering these matters timeously and that they act on the recommendations quickly.
I thank the cabinet secretary for his support for the recommendations to be implemented and action to be taken. However, he will know that the manufacturers had been aware that operators were periodically returning defective EC135 fuel sensors and, after the tragic accident, have begun a series of modifications to the EC135 fuel system. Does he share my concerns that this potentially defective system could be apparent in other helicopters of the same design? Will he support calls for all similar helicopters to be examined for any such defects?
Yes, I share the member’s concern on these matters. Public safety is of paramount importance, and I would expect all actions to be taken to address any issues, such as those that have been highlighted, that may prove to be defective around the operating systems within this and any other type of aircraft.
As the member will recognise, it is the regulators’ responsibility to ensure that manufacturers and operators are adhering appropriately and taking action timeously to deal with any issues that may arise from modifications that are required.
Clearly, some of these issues can be explored further in the fatal accident inquiry once it has been constituted. I want to ensure that there is an opportunity for all these issues to be explored in that environment. Public safety is of absolute importance in these matters, and I would expect that all those who are stakeholders in safety are taking forward appropriate measures to address any issues that are highlighted.
I call Drew Smith. Briefly, please.
I thank the cabinet secretary for the answers that he has given. Is there any reason why operators of helicopters could not look to install recorders in advance of the regulation that he spoke about being brought into force?
Part of the distinction here is the nature of the regulation of different flights. For example, emergency medical flights are regulated by the legislation that is set by the European Aviation Safety Agency, whereas police helicopter flights are classed as state flights and are regulated by the CAA, so there are slight differences with the different regulators and their roles.
I assure the member that, as a Government, we are looking at every avenue that is open to us and at what further measures need to be taken in relation to those who operate in Scottish contracts to ensure that the recommendations that have been set by the AAIB are implemented swiftly.
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