Meeting of the Parliament

Meeting date: Wednesday, November 2, 2016

Official Report 1146KB pdf

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National Health Service

The next item of business is a debate on motion S5M-02232, in the name of Donald Cameron, on the national health service in Scotland.

16:21  

The subject of the debate is, of course, Audit Scotland’s report “NHS in Scotland 2016”. The report is now a week old. The picture that it paints of the NHS in Scotland is, however, much older. That is the true tragedy. As I will discuss later, the problems that are described are the problems that Audit Scotland described 10 years ago. That is 10 lost years, 10 years of inaction and 10 years of delay.

I will remind Parliament of some key points: only one of the eight key performance targets has been met, the number of out-patients waiting for an appointment went up by more than 20,000 in a year, and there is a recruitment crisis with skills gaps across the NHS. Those are just some of the damning statements in the report.

I have always said that we will welcome successes when they arise, and there are small glimmers of light in the report, so it would be churlish not to acknowledge them. Audit Scotland states that NHS Scotland met its drug and alcohol treatment standard, which we welcome, and the cancer target of 31 days between a decision to treat and first treatment was missed by a very marginal 0.1 per cent. There is also recognition that there has been a reduction in bed days lost to delayed discharge.

However, although there are morsels of good news, in any balanced view the report remains a stark indictment of the SNP’s handling of the NHS. Why do we keep hearing that? The SNP Government refuses to acknowledge that after nearly 10 years in its hands the NHS in Scotland is in critical condition. The longer the Government buries its head in the sand, blames other people and talks about a good record, the worse that will get.

Unlike the Government, we want to analyse the problems that are facing our NHS and, more important, talk about the solutions that will make it work not only for patients, but for the front-line staff who care for them. Those staff are one of the many reasons why people have such huge good will—for the moment—towards the NHS. That affection for the NHS does not mean that there are not fundamental problems with the way it is being run here in Scotland. In the report, charge after charge is levelled and proved. It is a forensic critique of a public service that is on its knees, so it would be incredible if the Scottish Government and the Cabinet Secretary for Health and Sport were to describe the report as anything other than deeply alarming.

A politician uses rhetoric at his or her own risk because its currency is devalued by overuse, but the position that we are in is more than “challenging” and “difficult”. It is truly a crisis. If we take targets as one aspect, all but one were missed, as I said, and performance on some is going backwards. Performance on the 18-week referral-to-treatment target is down by 1 per cent on last year, performance on the 12-week treatment time guarantee is down by 2 per cent on last year, and performance on referral to out-patient appointments is down by 3.4 per cent on last year. Those are not mere numbers: they represent real people across Scotland who are relying on our NHS but are being let down—each missed percentage point a person, and each fraction a family.

As I said earlier, and as Ruth Davidson pointed out last week, for the past 10 years Audit Scotland reports have been warning the Scottish Government about the lack of a clear plan to deliver a better NHS. Crucially, they have been warning about the failure to shift the balance of care. When the SNP took office in 2007, Audit Scotland published a report that said that there was

“no evidence that resources are shifting”

from traditional means of delivering services to community-based services.

I thank Donald Cameron for giving way. Does he accept that shifting of services out of acute hospitals into the community might make targets harder to reach—in the short term, at least?

As I was saying, in 2008, Audit Scotland said that despite the Government’s policy of shifting the balance of care closer to home, there was

“no evidence available to show changes in the balance of expenditure”

had occurred. In its 2009 report, it said the same thing—that

“significant changes in the balance of care from acute to more community-based services have yet to become evident”.

In 2014, the same thing was said. Last year, in its 2015 report, Audit Scotland was scathing about the Government when it said:

“the Scottish Government has not made sufficient progress towards achieving its 2020 Vision of changing the balance of care to more homely and community-based settings”.

We know what the 2016 report says: exactly the same thing—no progress, no shift in the balance of healthcare, and much more action required.

Year after year, the warnings have been ignored and we are now at breaking point. Despite the long wait, I welcome some of points that were made in the cabinet secretary’s statement earlier. I welcome the fact that the Government intends to accelerate the shift from acute care to primary, community and social care. I welcome the fact that the Government is committing to shifting 50 per cent of front-line NHS funding to outwith the acute hospital sector. However, the fact remains that that should have happened years ago, when Audit Scotland first raised the issue.

That said, as I read the cabinet secretary’s amendment I was encouraged. I thought, “At last—a genuine attempt to set out a list of actions, some of which we could support.” I should have known better. The final line of the amendment refers to UK Government welfare policy. How depressing that, at the last, the cabinet secretary chose to include a partisan red herring at the end of her amendment to try to shift the blame on to someone else. As far as I have been able to see, the Audit Scotland report makes no mention whatever of the effects of welfare policy. Reverting to type is an attribute of the Government.

Let us rise above that. It is clear that a fundamental change in direction is required. To carp from the sidelines is futile and, as a strong Opposition, we do not intend to do that. I have said it before and I say it again—blanket opposition to change in the NHS is irresponsible. The NHS can never be static and we accept that tough decisions have to be taken. The current political debate is failing the NHS because saving the health service now and for the future is more important than the politics of anyone in Parliament.

We want to contribute positively to that endeavour, which is why the Scottish Conservatives are setting out 15 things that we say can be done now and over the next few years to take our NHS through this difficult period, thereby showing that there is a middle course between underaction and overemotion. We are setting out several proposals that we feel can help our NHS to grow, to meet the challenges ahead and, crucially, to ensure that many of the recommendations that Audit Scotland has routinely made can be met.

For example, we are calling on the Government to consider the following: to give immediate clarity on which services will change and which will not; in the next six months, to evaluate the impact of splitting elective and acute care; to expand mental health services into primary, emergency and community settings; and to publish a national workforce plan and commit to six-monthly updates to this Parliament. Those are just a few examples; they are just sensible, straightforward and pragmatic suggestions that should be being implemented but are not. They should be being implemented because in order to solve the problems that exist, new ideas are required.

To sum up, if the SNP truly cares about the future of our health service and wants to provide better government for Scotland instead of endless constitutional navel-gazing, it must deliver an NHS that is fit for not just the next five years, but for the next 25 years and beyond.

I hope that the Audit Scotland report goes down in Scottish political history as a seminal moment in the story of our health service. I hope that the report really does mark a turning point, because we are truly at the stage of make or break.

I move,

That the Parliament welcomes the publication of the Audit Scotland report, NHS in Scotland 2016; believes that the report paints a picture of a health service in crisis; notes that the NHS in Scotland has failed to meet seven of its eight key targets, that NHS boards are facing unprecedented levels of savings and that the health service as a whole is experiencing widespread problems in recruiting and retaining staff; believes that, after almost 10 years in power, the SNP administration must take responsibility for the clear and significant failures in the NHS, and, as a matter of urgency, calls on the Scottish Government to set out its response to all of the recommendations made in the Audit Scotland report.

16:29  

Audit Scotland has provided a balanced overview of the NHS and has made several recommendations, which we accept in full.

As we consider the report, we have to recognise the challenges in our health services, but we must also acknowledge the many achievements. First and foremost, with patient satisfaction levels up to 90 per cent, I begin my speech by commending highly the commitment of all our staff across the NHS in Scotland. It is our staff—our nurses, our midwives, our doctors, our paramedics—whose dedication allows us to meet the challenges that we face and to implement new initiatives to ensure that we continue to deliver a health service that we can rightly be proud of.

I am proud of the national health service, I am proud of the record level of investment of close to £13 billion that has been committed by this Government, I am proud of the highest ever levels of staffing, and I am proud of our improvements in health, patient safety and survival rates. All those investments were acknowledged in the Audit Scotland report, but this Government wants to go further to ensure that the NHS receives the resources that it needs to equip it for the future. For example, having increased front-line health spending by 8.2 per cent since 2010-11, we will go on to increase the NHS revenue budget by almost £2 billion by the end of this parliamentary session, which is the highest commitment by any party in Parliament.

However, we need to do more than just give the NHS extra money. As I said earlier this afternoon, the NHS cannot stand still—we need to reform. We all recognise the nature and scale of the challenges that our whole system of health and social care faces. That is why we will continue to drive forward our significant programme of transformational change.

Will the cabinet secretary take an intervention?

I will, in a second.

The strategy is founded in our twin approaches of investment and driving reform. It underpins our 2020 vision, and will be delivered through the key programmes of work.

We will continue to deliver integration of health and social care. We will implement our national clinical strategy with its recognition of the need for new investment, for new ways of delivering medical services more effectively to communities, and for new approaches to practice. We will accelerate reform of primary care and of our comprehensive approach to public health improvement. To support those programmes, we will develop a national workforce plan.

On transformational reform, are you aware that at Ayr hospital between April and September this year there were a total of 7,594 missed appointments, which represent 9 per cent of the total number of appointments? I presume that that figure is replicated elsewhere in Scotland. Do you agree that, if that problem could be addressed that would go a long way towards reducing pressures on our overburdened NHS?

I ask members to speak through the chair.

I agree with John Scott that missed appointments are a challenge that we need to address. Boards are looking at ways of addressing that challenge through text messages, through follow-up and through reminders. I do not think that the answer is to charge people for missed appointments—which is what the Tories are proposing—because that would just compound health inequalities in our society.

I hope that I have managed to lay out the intense level of activity that we are undertaking to meet our aspirations on the 2020 vision. We have to move at pace, so for that reason, by the end of this year and as recommended by Audit Scotland, I will present a transformational change delivery plan to deliver that vision, which will bring the various elements together in a single framework.

The Audit Scotland report confirms that our strategy is the right one. We need to work together across Parliament and with our colleagues in health boards, local government and the workforce to progress it, to ensure public confidence in it, and to make it happen at pace on the ground. It is the right plan, and no one and no party in Parliament has come forward with a different plan. I have looked at the Tory plan—it is mainly our plan with a few small additions. I suppose that imitation is the best form of flattery, so I thank them. I hope that we will get the backing of Parliament for the plan’s implementation.

We know that simply doing more of the same things yet faster will not deliver the standards of care to which people in Scotland should have access. We also need to ensure that the mechanisms that we use to measure performance keep pace with our wider reforms and our commitment to improvement. To do that, we have put in place a review of targets and indicators for health and social care. The review will ensure that targets and performance indicators lead to the best outcomes for people who are being cared for—whether that is in hospital, primary care, community care or social care services. I am delighted that Sir Harry Burns has agreed to bring his expertise to the role of independent chair of the review. I am sure that members will offer support for Sir Harry in the review, along with support from the different sectors and professional bodies that provide care.

The Government is serious about ensuring that people are supported to maintain their independence as long as possible in their own homes and communities, and about ensuring that fewer people need to go to hospital to receive care. Where hospital care is necessary and appropriate, people should spend less time there and should return home more quickly. I am pleased that delayed discharge has reduced under this Government, and I remain committed to eradicating it by continuing to invest in preventative and rehabilitative services. We know what works. If all partnerships were delivering the reductions in delay that have been achieved by the top 25 per cent, we would immediately halve all delays. We will work with partnerships to help them to deliver change to reduce delays.

In her manifesto, the First Minister outlined the SNP’s continued commitment to the six essential actions for accident and emergency, which were launched a year and a half ago and have led to significant improvement in unscheduled care. The actions comprise a home-grown programme to improve whole-system emergency care, based on clinical feedback. The programme was produced jointly with Academy of Royal Colleges and the Royal College of Emergency Medicine. It is no coincidence that Scotland’s core A and E departments have been the best performing in the United Kingdom for the past 18 months. That is a credit to all involved. However, despite those improvements, we absolutely recognise the challenges and are facing up to them. We accept that although we have a huge amount of work still to do, there is a general consensus nationally, locally and among representative bodies about enhancing the patient experience and ensuring optimal care, and there is enthusiasm in that regard.

Audit Scotland recognises the need to make a real shift from relying on treating people in hospital to providing care in the community and in primary settings, as well as in the home. We agree, which is why we are increasing the share of the NHS budget that is dedicated to mental health and to primary, community and social care. The First Minister has announced an additional £500 million to be invested in primary care, which will help to further shift the balance of care. That means that, for the first time ever, at least half of front-line NHS spending is being invested outwith acute hospitals.

Can you wind up, please?

As I bring my remarks to a close—

You will have to stop. I am sorry—we are very tight for time.

I move amendment S5M-02232.3, to leave out from first “believes” to end and insert:

“recognises that health and care services face increasing demand pressures and that the NHS must evolve to deliver more care in community and primary settings, as well as in the home; notes that the Scottish Government has welcomed the report’s recommendations, and, by the end of the year, will set out a cohesive framework for the delivery the integration of health and social care, the National Clinical Strategy, public health strategy, Realistic Medicine, workforce recruitment, supporting population health, and meeting the 2020 Vision; believes that the shift from acute to primary, community and social care must be accelerated; supports plans that, by the end of this parliamentary session, at least 50% of frontline NHS funding will be outwith the acute hospital sector, and condemns that the UK Government’s welfare cuts have harmed the physical and mental health of some of the most vulnerable people in society and have further increased demands being placed on health and care services.”

16:36  

I welcome the cabinet secretary to the chamber. It is nice to see her twice in one day, with nobody to hide behind.

Last week, Audit Scotland published its annual state of the NHS report. It is the worst report on the NHS since devolution—a damning indictment of 10 years of SNP mismanagement of our NHS that lays bare the failings of the cabinet secretary and her Government. No amount of Government spin or warm words from the cabinet secretary can hide the fact that Audit Scotland—an authoritative, expert and, crucially, independent body—has painted a picture of an NHS in crisis. Only one out of eight patient standards has been met. That is not just a statistic—behind it are thousands of patients and families who have been let down.

However, this is not just one bad report. It identifies a trend under this Government and this cabinet secretary. In 2013, only four out of eight standards were met; in 2014, only three out of eight standards were met; in 2015, only two out of eight standards were met; and now, in 2016, only one standard in eight has been met. What will it take before the cabinet secretary recognises that the NHS is in crisis? Does the level of standards that are met have to hit zero before there is any admission of the failures of this Government?

At its heart, the report reveals one key failing: workforce planning. It reveals a Government that is letting down our hardworking and dedicated staff—the doctors, nurses, midwives, healthcare assistants, porters, physiotherapists, radiographers and many more. There are too few staff working too many hours and dealing with too many patients, but without the support or resources that they say they need to do the job properly.

I have heard members of the Government party say that exposing the failures of the Government on the NHS somehow lets down our hardworking staff. However, we should be in no doubt that betrayal of our staff comes not from those who are exposing the Government’s failures but from those who wilfully underresource, undervalue and overwork them.

I use this moment to thank all our staff who have dedicated their lives to caring for others and to say, “It’s you and your patients we are fighting for today.”

We have heard from nursing leaders that their workforce is reporting inability to cope with their workload and that the situation is only getting worse. It is unacceptable that we now have more than 2,500 nursing and midwifery vacancies. As a direct consequence of that, we have seen spending on private nursing agencies skyrocket.

The Audit Scotland report found that the cost to the NHS of a whole-time equivalent private nurse is in excess of £80,000 a year, but an NHS nurse costs only £32,000. Locum consultants earn as much as £400,000 per annum, which is enough to pay for four NHS consultants. At the same time as the Government is cutting budgets, £173 million is being spent on private agencies.

On budgets, the independent Auditor General confirms what Labour has been saying for months: this year there will be almost £500 million of cuts, on top of £300 million last year. Those cuts are having a direct impact on staff, on patients and on services. They are deliberate, conscious and calculated decisions to force cuts on health board after health board. Those decisions have consequences. The health secretary let the cat out of the bag when she said on “Good Morning Scotland”, on the morning of the publication of the Audit Scotland report, that Labour should stop—I quote—

“putting blocks in the way to any changes to services in Parliament.”

The services changes we are trying to stop—closures at the Vale of Leven hospital, the Royal Alexandra hospital, Inverclyde royal hospital and Lightburn hospital—are to services that we were promised were all safe by the cabinet secretary.

There is an alternative. We could use the powers of the Parliament to invest in social care and to invest in front-line services. To conclude, as the Royal College of Nursing said:

“How many more reports will be published by Audit Scotland before action is taken? Patients, staff and families deserve a decisive response from the health secretary.”

Well, cabinet secretary—what is it to be?

I move amendment S5M-02232.1, after “unprecedented levels of savings”, to insert:

“, which will mean cuts to local services; notes the vote in the Parliament on 28 September 2016 on motion S5M-01677 and reiterates its call for the Cabinet Secretary for Health and Sport to call-in service changes for ministerial decision; notes”.

We move to the open debate. It is a tight four minutes for speakers; I will try to give time for interventions, but please make them short.

16:42  

Our NHS workforce does an amazing job. What is clear is that none of the criticism of the performance of NHS Scotland is aimed at the work that staff do to deliver health services to communities across our country.

The Audit Scotland report set out clearly the major key challenges facing the health service in Scotland perhaps, as Anas Sarwar suggested, specifically on recruitment and retention of staff within the service.

It is increasingly clear that this Government has failed to deliver a sustainable workforce in Scotland. The impact of that is affecting the delivery of key services and the meeting of the Government’s health targets. How have we reached this position? It is worth reflecting that student nurse numbers were cut by the Government by around a quarter between 2007 and 2013—particularly between 2011 and 2013 when the current First Minister was health secretary. That has clearly impacted on our health services and, as the Royal College of Nursing briefing for today’s debate states:

“our health services are now reaping the consequences of decisions taken by Government at that time.”

The financial position of our health service is also of great concern, as outlined in the Audit Scotland report. As a Lothian MSP, I am acutely aware of the financial challenges facing my local health board and how that is impacting on the delivery of health services to the people I represent in Parliament.

Behind those statistics, as Donald Cameron has mentioned, let us not forget that we are talking about people—our family, friends and neighbours. As has already been said in the debate, health boards have failed to meet seven out of eight key national targets, reporting lengthy waits for emergency treatment, in-patient and out-patient appointments, cancer treatment and mental healthcare for children.

Given the concerns being expressed by alcohol and drug partnerships across the country about their funding arrangements, I too question whether we will see them maintain the service they provide and meet the treatment targets that they have set for the future.

The Scottish Government has a waiting target for orthopaedic appointments of 12 weeks from the date of receiving a general practitioner referral. However, NHS Lothian admitted to me in a letter only last week that such is the increasing number of patients referred to orthopaedics in the Lothian region that they are finding it impossible to meet the target. I have a number of elderly constituents who are in desperate need of hip replacements and who are in severe pain every day but who face waits that they have been told could be up to seven months just for an initial consultation with an orthopaedic consultant. That is clearly unacceptable and it is happening on the SNP Government’s watch.

In fact, the Audit Scotland report outlines that the number of people waiting is increasing, with over 275,500 out-patients waiting just for an appointment.

All organisations and political parties agree that we need a shift in the balance of how care is provided away from the acute setting. We agree. However, the question that is being asked again and again is whether the Government is providing the leadership that is needed to actually achieve that.

Will the member give way?

The member is in his last minute, I am afraid, so unless it is very short—

I will give way if it is very quick.

Very short.

Does Miles Briggs recognise the £200 million investment in the elective centres, the aim of which is absolutely to address the future requirement of his constituents for work on hips, knees and eyes?

I recognise that, but the issue is the impact on healthcare in Lothian. As I said, constituents are coming to see me who have been told that they have to wait seven months before they can have a consultation—yet we are told that they have 12 weeks to wait.

Sometimes in politics, reports are published that should act as a wake-up call for the Government of the day. I have no doubt that Audit Scotland’s publication of its report last week is one such occasion. I began by paying tribute to those who work in our health service. I am sorry to say that, increasingly, it seems that they are lions led by SNP donkeys.

16:46  

There are significant challenges facing our beloved NHS. Some of them are very serious and will require new ways of working, some will require creativity and all will need serious levels of funding to solve them. However, they are in no way unique to Scotland. We are facing budget challenges, an ageing population and huge price hikes for essential life-extending medicines, but those same challenges face many countries such as ours right now; indeed the same challenges currently face the rest of the United Kingdom. That has led the Auditor General for Scotland, Caroline Gardner, to comment:

“We know that many of the pressures that we are seeing in Scotland apply across the UK and elsewhere. Scotland’s performance stands up well against that of the rest of the UK.”

This year, the NHS budget is £12.2 billion, which amounts to 40 per cent of the Scottish Government’s budget. That is a serious commitment by the Government to the NHS. By the end of this session of Parliament, health funding will be at least £500 million more than it would be with inflation-only increases, and that was a manifesto commitment that only the SNP had.

That level of financial commitment has allowed overall staff levels to be at their highest ever, with over 138,400 whole-time-equivalent staff as of March this year, which is an increase of 11,000 since the SNP came to power. There are more staff across the board, from nurses and midwives to general practitioners, paramedics and oncologists. That level of financial commitment is made all the more remarkable when set against the fact that the money that is available to the Scottish Government has been rapidly dwindling.

Does the member acknowledge that, since 2010, the UK Conservative Government has provided £1.46 billion in Barnett consequential funding for our health service in Scotland?

That money has been passed on, but would the member want the Scottish Government to follow the example of the Conservative Government in England, which has led to striking doctors, low morale, an accident and emergency crisis and chronic levels of underfunding?

The UK Government has reduced Scotland’s fiscal departmental expenditure limit budget by 10.6 per cent in real terms between 2010-11 and 2019-20.

The rising cost of drugs is another major pressure. In 2014-15, the NHS spent £150 million more on drugs than in the year before, even after adjusting for inflation, which is an increase of more than 10 per cent in one year.

NHS boards in Scotland have successfully increased the prescribing of unbranded rather than branded medicines to generate efficiencies and Scotland now has one of the highest generic prescribing rates in the world. However, there is a trend for even unbranded drugs to be subject to massive price hikes. Prescriptions of one drug for irritable bowel syndrome fell by a third when the overall cost to the NHS rose by 300 per cent because of a 500 per cent price increase. Westminster is taking action on the issue and a bill that seeks to limit unbranded drug price rises is expected to be passed next year, which will be a welcome development.

No one wants their loved ones to miss out on new and potentially life-saving drugs, so the Scottish Government has provided more money through the new medicines fund, which has gone up from £21.5 million in 2015 to £85 million in 2016. We must do more with less while striving hard to provide high levels of service to patients. The Scottish Government places a high priority on resourcing the NHS and on developing it to tackle head-on the issues that our society is facing.

16:50  

I declare an interest as my wife and daughter both work in the NHS.

No member in the chamber should be under any illusion that the publication of the Audit Scotland report last week was a watershed for the NHS in Scotland. For years, patients, staff, families, elected representatives and trade unions have known about the mounting pressures that the NHS is facing, and every one of us has been lobbied by people who want to raise their personal concerns. Many of those concerns have been dismissed by ministers who respond with robotic statements in which they reel off numbers and percentages from their ministerial briefing folder, all of which are unrecognisable to the patients, the staff and the dogs on the street who all know full well the impact of those pressures on their loved ones.

Audit Scotland has confirmed once and for all that none of those concerns are attempts to scaremonger, talk down staff or undermine our greatest public service. They simply reflect the material reality that NHS patients and staff experience every day. I hope that the Government starts to listen and take responsibility. We want no more diversionary tactics, no blaming of someone else and no wishing away the array of problems that the report exposes.

Early on, the report gets to the heart of the issue when it states:

“NHS funding is not keeping pace with increasing demand and the needs of an ageing population.”

The First Minister and the cabinet secretary claim that record funding is going into the NHS. In that case, is not the Audit Scotland report a damning indictment of the mismanagement and ineffectiveness of that funding? A football club owner or manager can put record funding into a team, but if the results continue to be poor, those who pay their wages rightly call for their head.

The truth is that health inflation is at 6 per cent and demand is rising, yet boards have received just over 1 per cent. Only one standard of eight has been met; agency spend is up; vacancy rates are soaring; there is a GP crisis; and social care is on the brink. In the real world, that means that more people are finding themselves in the same situation as my constituent James Neilson—mentioned at First Minister’s questions last week—who is unable to walk because of a blocked artery and has been told that he must wait for more than 30 weeks just to be assessed. More people are stuck in hospital when they should be at home; mental health patients are going through crisis with no support; and more and more people are unable to get a GP appointment.

The tragedy is that there are thousands more James Neilsons out there. NHS Lothian has already warned us that it will fail to meet most of its treatment time guarantees as result of the so-called efficiencies that it has to make. When will we stop hearing ministers and civil servants misleading the public? If they cannot meet legally binding treatment time guarantees, they should—for heaven’s sake—stop taking the people for fools by calling those cuts “efficiencies”.

It is people who suffer when targets are not met, it is people who suffer when the workforce is under pressure, and it is people who suffer when they cannot get an appointment with their GP.

I direct my final comments to the Tory party. That the Tories should come to this chamber to lecture anyone about the national health service—the greatest piece of social legislation ever introduced—is beyond satire. They would privatise the NHS, outsource it, sell it off and break it up in a heartbeat.

We must invest in our public services. We must use our resources effectively. The Audit Scotland report suggests that the Government is failing miserably on both counts.

16:55  

I thank Audit Scotland for its far-reaching and detailed report and for the crucial recommendations that it has made.

The report rightly criticises the Government for the lack of detail that it has provided on major service reforms. David Hogg, a GP based on Arran, told the Health and Sport Committee yesterday that we cannot talk about realistic medicine without presenting realistic plans for service delivery. I am glad that the Government’s amendment establishes a timeframe for delivering the cohesive framework that Audit Scotland has asked for, and I want the framework to be delivered by the end of the year, as promised. Audit Scotland’s call for three-year financial frameworks for health boards is a sensible one, and I hope that that sensible move forward will be included in the Government’s plans.

At this point, it is worth asking what recommendations Audit Scotland would have made to this Parliament. I do not think that it would have advised us to keep retreading the same debate that we seem to be continually having.

The report makes it perfectly clear that even with real-terms increases to the overall health budget, spending is not matching increased public demand. Shortcomings in funding and service delivery are not acceptable, but we need to pair criticism with proposals for action. Once again, a wholly critical motion has been presented by a party that consistently resists any move towards more progressive taxation and refuses to take a realistic approach to funding high-quality public services. I do not know how the Conservative Party thinks that we are going to develop more sustainable health services without fairer public spending and taxation.

I do not accept the charge that we have not produced proposals. We produced a 15-point plan, which contains a number of ideas, and we have tried to create a positive prospect for the NHS. Will the Green Party echo that?

It is fair to say that the NHS is having to deal with the impact that Tory austerity has had on many of our most vulnerable citizens, and that this Parliament has had to spend money to mitigate the impact of many damaging cuts. It would have been nice to see some of those constructive proposals in Donald Cameron’s motion.

It is absolutely right to criticise the Government for doing too little to shift the balance of care. The Royal College of Nursing has called the pace of change painfully slow. However—although it does not feel comfortable for any of us to say this—we need to think carefully about our approach to service redesign. Audit Scotland says that NHS boards face significant

“political resistance to proposed changes to local services.”

I accept that there have been issues with public consultations on some of the service changes that health boards have proposed. Part of the problem, as Audit Scotland has pointed out, is that neither the Government nor individual health boards have done enough to open up meaningful public conversations about the long-term direction of service delivery. However, the Parliament has an incredibly important role to play in that regard. We must debate the issues broadly, openly and collaboratively, wherever possible.

The British Medical Association put a very blunt statement to us when it said:

“there needs to be a significant increase in the investment to close the funding gap. If there cannot be a commitment to more resources then a range of realistic future health service models using current planned resources must be set out.”

The truth is that we need both. We need sustainable investment in our health services and we need to think about future health service models that meet people’s complex needs.

Audit Scotland has asked the Government to model the cost of implementing the national clinical strategy. I want that modelling to consider the contribution that health services make to local communities and local economies, because such consideration has been lacking so far. We cannot have a fully informed debate about the impact of service changes without understanding the economic and social role that health services play in different parts of Scotland.

We need to ensure that there is equitable access to primary healthcare. I point out that yesterday’s report—

I am afraid that you cannot point out anything—

Even though I took an intervention?

You must conclude. Sorry.

Thank you, Presiding Officer.

16:59  

The SNP is

“able to win elections but it is seemingly unsure what to do thereafter. The danger is that”

Nicola’s

“Government end up simply managing, not leading”—

I ask the member to use full names in the chamber.

I am actually quoting somebody here—I will come to that.

“The danger is that”

Nicola’s

“Government end up”—

Well, you did not say “I quote.” Slow down.

Can I have the time back?

Make it clear that you are quoting, or I will misunderstand you—heaven forfend. I do not want to do that, Mr Cole-Hamilton.

May I have some time added on at the end?

I will decide whether you get the time back, and the answer is yes.

Thank you.

In the sage words of your friend and mine, Kenny MacAskill, the SNP is

“able to win elections but seemingly unsure what to do thereafter ... The danger is that her”—

Nicola Sturgeon’s—

“Government end up simply managing, not leading, the political agenda; much indeed, as Labour did in years before devolution. Mitigating austerity but managing decline.”

Those words are now being stencilled on lunch boxes across the unionist movement.

If a measure of a civilised society is how we care for our sick and infirm, by any stretch of the imagination the SNP Government is failing on many of its tasks. In any other profession, if the senior management team of an organisation that had 10 years to fix the problems and meet the key performance indicators that were before it had spent so much money on so doing, it would be on its final warning. As report cards go, that published by Audit Scotland was excoriating. It reads like a horror show.

By any stretch, it is a target-rich environment for Opposition spokespeople. However, in the ministerial statement that we had this afternoon, which was well padded out with sycophantic questions from members on the Government benches, we heard not one admission of failure. The first step to fixing a problem is admitting that one has it in the first place.

Nearly two years ago, the cabinet secretary said:

“I want, over the course of this year, to eradicate delayed discharge out of the system and I’m absolutely determined to do that.”

However, in its report Audit Scotland cited glacial progress in that area at best.

This is the question that I would have asked after the ministerial statement. On Monday, a family came to my surgery: four siblings whose 83-year-old father is a resident in Corstorphine by the name of George Ballantyne. George had a fall in March and was taken to Liberton hospital. After treatment and a mild infection, he was declared fit to go home in June. Following extensive renovations and adaptations to his house, he was told on three separate occasions to prepare to go home the next day. However, this evening he will spend his 150th night at Liberton hospital since he was told that he was fit to go home. Given that she comprehensively failed to address delayed discharge in her statement, will the cabinet secretary or her ministers explain to Mr Ballantyne in their summation why he is still in hospital tonight?

The fact is that the integration of health and social care, which promised so much, has been underfunded, has not been properly orchestrated and is failing patients across the country.

Right across Audit Scotland’s reports we see failures, but Donald Cameron is right to point out successes. I accept that meeting the three-week waiting time for treatment for drug and alcohol problems is to be supported, but what the Scottish Government gives with one hand it takes away with the other. You can bet your bottom dollar that the 22 per cent cut to alcohol and drug partnerships in our communities will see that progress eradicated. Put simply, as I said yesterday, in Edinburgh alone that equates to £1.3 million in service cuts year on year. That is a fire sale and the cost will be measured in human lives.

On this most solemn, most important duty the SNP has been found wanting. When the SNP asks Opposition members what they would have done differently, it is often offered alternatives, yet its members ram fingers in their ears and bury their heads in the sand. The eyes of the nation are on the Government to discharge its duties in this area. Who can blame them if they now wish to turn away in disgust?

17:04  

Anyone watching the debate at home will no doubt feel a sense of déjà vu, as this Parliament discusses another Audit Scotland report that yet again highlights serious strain on our NHS—on services, on staff and on patient care.

Just last week, the First Minister played to her nationalist back benchers, who were no doubt impressed by her warm words on the state of our NHS. However, the public are less than impressed, and I assure the First Minister that the residents that I represent in the north-east of Scotland are less than impressed by the fact that the latest Audit Scotland report highlights the still-unresolved challenges of a severe skills shortage and the struggles that we face in recruiting and retaining medical staff.

In 2015-16, staff turnover in NHS Grampian was 8.9 per cent, which was considerably higher than the national average of 6.4 per cent. Figures from June showed that emergency medicine consultancy had a vacancy rate of 26.3 per cent in NHS Grampian compared with a vacancy rate of 9.7 per cent in Scotland as a whole—it was almost three times that level. Further, the most recent primary care workforce survey showed that, in NHS Grampian, over two thirds of shifts were unfilled 48 hours before work days, weekends and public holidays.

In the midst of this recruitment crisis, the Scottish Government continues to impose caps on the number of Scottish-domiciled students who attend our universities and, in particular, those who wish to study the very subjects that could help us to resolve this catastrophe. When the residents whom I represent are experiencing a decline in the quality of service, and when they tell me that NHS Grampian is reaching breaking point, it beggars belief that our universities are forced to turn away talented Scots due to bad Government policy.

Will the member give way?

I have got only 4 minutes.

The current capping policy is simply making the situation worse. Just over 1,030 Scottish-domiciled students applied for medicine courses starting in 2017—reflecting an 11 per cent drop over the past five years—and the situation is so poor that the leadership of NHS Grampian has expressed deep concern. Speaking in evidence to the Health and Sport Committee, Gerry Lawrie, the deputy director of workforce, stated that she was extremely disappointed by the dramatic fall in the number of local trainee doctors. She said that, when she started her career in the NHS, 95 per cent of the junior doctors were trained locally. However, she went on to say:

“Twenty years down the line, I am lucky if the figure is 50 per cent ... I am disappointed that the University of Aberdeen has reduced the number of places, because we are struggling to recruit not just in primary care, but in other areas.”—[Official Report, Health and Sport Committee, 27 September 2016; c 21.]

In response to such a damning criticism, the health secretary denied that there was any crisis in GP recruitment. Clearly, the trappings of high office are preventing ministers from seeing what is happening on the ground, or perhaps they are blatantly denying the existence of the problems because that is more convenient.

Will the member give way?

The member is in his last minute.

Audit Scotland reported on NHS Grampian’s financial settlement, and there in black and white we can see that the region is 1.4 per cent below its NRAC allocation six years after the funding allocation formula for health boards was introduced. That is an astonishing £12.2 million that NHS Grampian should get but does not get. Despite all that, NHS Grampian is still being asked to make efficiency savings of 3 per cent this year. That is yet more evidence that—as in all other public services—the SNP is short-changing the north-east of Scotland.

The Parliament has the full powers to deliver an NHS that is fit for the future. However, since May, the priority of this Government has been to posture on Brexit and consult on another divisive and destructive referendum. The SNP has given up on governing for Scotland, and it is clear that its obsession with separation transcends its concern for the quality of patient care.

17:08  

The Audit Scotland report demonstrates that there is still work to be done. However, as my colleague Ash Denham said, there is nothing unique about the challenges that are faced by the health service in Scotland. Those challenges are faced by other Administrations throughout the UK and, indeed, many other countries worldwide, and the Scottish Government is focused on meeting those challenges.

Unlike the crafters of the Conservative motion, Audit Scotland acknowledges some of what has been achieved by the Scottish Government. The report states:

“Over the last decade, there have been improvements in the way health services are delivered and reductions in the time that patients need to wait for hospital inpatient treatment. There have also been improvements in overall health, life expectancy, patient safety and survival rates for a number of conditions, such as heart disease.”

Audit Scotland also acknowledges that the demands on health and social care services have been increasing because of demographic changes and because people are living longer with multiple long-term health conditions and increasingly complex needs.

As a nurse and a trade union official in the NHS, I knew only too well the challenges that staff and management faced over the years I was employed in the service. I also have first-hand experience of the hard work, diligence and compassion of nurses and midwives, medics and allied health professionals throughout the NHS, who are supported by lab staff, administrators and facilities staff. Those are the qualities that all those staff bring to their workplace every day as they seek to help and care for their patients.

That dedication and hard work is acknowledged in the recently published high patient satisfaction rates, with more than 90 per cent saying that their overall care was good or excellent. However, I would not want members on the Conservative seats to let an accurate health statistic get in the way of them scoring cheap political points and undermining the good work of our NHS staff.

It is right to acknowledge the challenges facing the health service, and this SNP Government is doing that. Indeed, it is not only acknowledging the challenges, but tackling them. It is addressing them through reform in areas such as health and social care integration, and by moving the focus of care from hospital to community settings.

NHS staffing numbers are at record levels—they are up more than 11,000 under the current Government—but, looking forward, the service faces challenges in recruitment, and the Scottish Government has been working with partners to address those challenges. However, the task is not being made any easier by the UK Tory Government’s recent actions, particularly following changes to UK immigration rules on post-study work visas, and its dismissive attitude following the Brexit vote to the fate of thousands of EU nationals on whom the health service and social care providers rely.

Will the member take an intervention?

The member does not have the time.

At yesterday’s Health and Sport Committee, we heard a stark example of how our rural services rely on overseas-born staff. Of the 13 consultants employed in the Western Isles, only one is Scots born. The Western Isles has been actively recruiting in Spain for other vacancies, but uncertainty about EU nationals’ status post-Brexit may hamper efforts. Given that this is a consequence of a situation wholly attributable to the UK Conservative Party, the irony of the Conservatives in this chamber crowing about the recruitment challenges facing the Scottish NHS will not be lost on my constituents.

As we watch with concern the mismanagement of the English health service under Tories in Westminster, including increasing privatisation and a record number of trusts in special measures—including another one yesterday—for either quality or financial reasons, I for one am thankful that we have a devolved health and social care service and a Government with a strategy for ensuring that it evolves to meet our people’s needs.

I am sorry, but I have to tell Mr Mason that he has only three minutes for his speech. We will try to make it up to you on another day. Thank you.

17:12  

I might hold you to that, Presiding Officer. Because of that, I will not take any interventions.

I start with some of the key messages and the wording that appears in Audit Scotland’s report. Under the summary, the key messages start by saying:

“Over the last decade, there have been improvements in the way health services are delivered and reductions in the time that patients need to wait”.

That is certainly a very positive start, despite what some Opposition members have said.

Point 3 of the key messages says:

“However, boards are struggling to meet the majority of key national standards and the balance of care, in terms of spending, is still not changing.”

If I want to concentrate on one point this afternoon, it is this: are we serious about community and preventative care or are we serious only about targets that are easy to measure? Are we willing to sacrifice some hospital targets in the short term in order to invest more in primary care and prevent hospitals being needed so much in the longer term?

Part 1 of the report deals with financial and service performance. Key message 3 says:

“NHS boards need to look at reorganising acute services to free up more resources for investing in community-based facilities”.

Why is that not happening? The report goes on to explain—Alison Johnstone has cited this already—that the health boards

“are often faced with considerable public and political resistance to proposed changes to local services.”

The British Medical Association and the RCN make that point, too. The RCN says that health boards are

“caught in the crossfire of political and public opinion.”

The BMA says:

“politicians ... are quick to criticise planned service changes”.

I think that virtually all of us agree that we should emphasise the community, but it is too easy for the Opposition to say that it is all a crisis, that someone had to wait too long for a hospital appointment and that someone else did not get the expensive drug that they wanted. Perhaps we as politicians all need to take more collective responsibility. The NHS can never provide all that people want, and we need to switch resources to the preventive and to the primary site.

The report says that we need to manage expectations. Do Opposition members agree with that part of the report? Will they commit to helping to manage expectations?

After those key messages, we have the heading:

“Although health spending has increased it is not keeping up with growing demand and the needs of an ageing population”.

The suggestion seems to be that demand and needs are the same thing, but surely they are not. I will not expand on that point, as I do not have time.

We are all proud of our health service and we all want the best for it, but all of us need to be a bit more honest and realistic with the public.

Thank you very much for taking just three minutes.

17:15  

For the record, I declare an interest in relation to the debate. When I was elected in May, I was employed by Parkinson’s UK, although that employment ceased in May. I am also a councillor on Dumfries and Galloway Council.

Today’s debate has given members an opportunity to reflect on Audit Scotland’s assessment of nearly 10 years of SNP control of our NHS. Had it not been for Opposition time and Opposition pressure, there would have been no debate and no last-minute statement from the cabinet secretary.

We can see why the SNP did not want to talk about the report. It is a damning verdict on nearly a decade of SNP mismanagement of the NHS, which is in crisis. Seven out of eight key patient standards have been missed, health boards face unprecedented financial cuts, there is a soaring drugs bill, and a recruitment and retention crisis is being experienced across nursing, GPs, consultants and social care.

The crisis was entirely predicted. When we read the Audit Scotland report, it is like groundhog day—we have been here before. Audit Scotland, the BMA, the RCN and others warned six years ago that the crisis was going to happen and their warnings were ignored by the Government. Even today, the SNP amendment talks about the need for change but then says that we will have to wait until the end of the year for a change plan. It is a case of more dithering and delay from the cabinet secretary. Maybe we would have had a plan by now—if only the SNP had been in power for the past 10 years.

As the Auditor General says in the report, no one disputes the need for change and the need to shift the balance of care from hospitals to the community but, despite that being the Government’s policy aim for a decade, it has little to show for it. It is on funding of the NHS and social care that the report really exposes how utterly divorced the Scottish Government’s rhetoric is from reality. Day after day, we are subjected to sycophantic press releases from the Government that tell us that money is pouring into the NHS, if only staff were not so inefficient in how they used it.

It is true that there are inefficiencies. The spending of £7.5 million more on agency nursing costs, which was caused by an utter failure in workforce planning by the Scottish Government, is one of those inefficiencies but, as the report says, the simple truth is that

“NHS funding is not keeping pace with increasing demand and the needs of an ageing population.”

The Government needs to start being honest with the public and to admit that health boards, rather than just having to make efficiency savings, are being forced to make cuts to services that they do not want to make, which have nothing to do with change and which are just to balance the books.

When will the Government start to accept that, for all its rhetoric about increased investment and moving the balance of care to the community, its nasty and vindictive attacks on local government budgets are having entirely the opposite effect? Does the Government seriously think that it is possible to savage council budgets by 25 per cent and expect that not to impact on social care or the many council initiatives that are crucial in supporting our communities’ health needs?

It is time that we had an open and frank discussion about what we want from health and social care and how we plan to pay for it. I agree entirely with Alison Johnstone that it is time to admit to the public that, if we want to properly fund social care when we face a massive rise in demand, we will need to use the Parliament’s tax powers and ask those with the broadest shoulders to pay a little more, but that is not the position that is set out in the SNP’s amendment.

It is time that we had a coherent, joined-up change programme that is built on genuine consensus with staff and the public rather than the arrogance that the Government displays as it pats staff and the public on the back but dismisses with a we-know-best attitude their genuine concerns about service cuts. It is time that the SNP and the cabinet secretary took responsibility for the failings that are set out in what is unquestionably the worst Audit Scotland report since devolution, which has been published on the Government’s watch.

17:19  

The only point that I will make to Colin Smyth is that at the previous election, the SNP stood on a platform of making the biggest investment in the NHS of any of the parties, and we were elected on that manifesto.

Will the cabinet secretary give way?

Labour was roundly trounced and came third on its manifesto commitments.

Will the member give way?

Sit down.

The people have judged who they believe would provide better stewardship of the NHS, and that is SNP members, not Labour ones.

On the promises that were made in the election, the cabinet secretary promised my community that services at the Vale of Leven hospital would be protected. I would like nothing better than for her to keep that promise.

We have saved the Vale of Leven from the cuts that the then Labour Government put in place to undermine that hospital. Our commitment to the vision for the Vale of Leven remains and, as I set out in my statement, a consultation process is under way for any changes that are proposed. Jackie Baillie knows that fine well.

Will the cabinet secretary give way?

Please sit down, Mr Findlay.

I will come on to Mr Findlay’s comments, if he will give me a minute.

Donald Cameron said that he welcomed the commitments that I made in my statement, and I welcome his welcome. However, he then criticised us for mentioning the UK Government’s welfare changes in our amendment. It is remiss of the Tories not to understand the impact of welfare changes on health inequalities. If they do not think that welfare changes are having an impact on health inequalities, they are living on a different planet from the rest of us. Of course the changes are having an impact, and it is right and proper for that to be recognised in the debate.

Miles Briggs mentioned orthopaedic appointment waits in NHS Lothian. I absolutely understand the issue, which we are working with NHS Lothian to overcome. I will soon have more to say about out-patient appointments and helping boards to tackle out-patient waits. In my intervention on Mr Briggs, I pointed out that we have a plan for elective centres, two of which will be on the east coast and will therefore have a direct impact on the demand for services for hips, knees and eyes not only now but from our ageing population in the future.

A number of members—including, I think, Miles Briggs—talked about UK Government funding. In the past week, the UK Parliament’s Health Select Committee has forensically dismantled the UK Government’s claims about £10 billion of funding, which that committee has called incorrect and misleading. It really does the Tories no good to start lauding what the UK Government claims to be spending on health when the Health Select Committee has only this week driven a coach and horses through those claims. The Conservatives need to reflect on their own UK Government’s performance on financial support to the NHS.

Ash Denham made important points. She reminded us of the Auditor General’s comment that Scotland’s NHS performance stands up well against the performance of the rest of the UK. I am not claiming that we do not have challenges—indeed, I set out in my statement our response to those challenges—but, compared with performance in the rest of the UK, Scotland’s NHS stands up to scrutiny, and we should be proud of its achievements. There are now 11,000 more staff than there were when we came to power, but there are vacancies that need to be addressed.

Neil Findlay talked about what patients think. Ninety per cent of in-patients have rated their treatment as good or excellent. That is not to say that there are no challenges—of course there are—but our NHS still has high satisfaction rates, which we should welcome. I wrote to Mr Findlay in response to his concerns about Mr Neilson; he should get that response today, and I hope that he and Mr Neilson will welcome that letter.

Will the cabinet secretary give way?

Okay, but I am short of time.

Very briefly, Mr Findlay.

Does this not get to the crux of the problem? Constituency cases should not have to be raised at First Minister’s question time to get results for constituents who are sitting in pain at home.

I agree, which is why we are working with NHS Lothian to improve out-patient performance. As I said, I will have more to say about that shortly.

Alison Johnstone made important points about the debates that we have in this place. She talked about not retreading the same debates and the need to look at sustainable funding and models, and she said that we perhaps all need to face up to difficult issues. I agree and I hope that we can have a more mature debate on some of those difficult matters.

I am sorry, cabinet secretary, but I have to stop you there. The point about having a mature debate seems a good place to stop.

I will write to members—in particular Alex Cole-Hamilton—to respond to issues that they raised.

Thank you very much.

17:25  

Presiding Officer,

“Given the extraordinary health pressures that we face from a rapidly ageing population, dwindling birth rate ... changes in working patterns, evolving technology and an ever expanding health gap between rich and poor, it should be obvious to all that the status quo definitely cannot be an option.”

Those words are from the Kerr report, which a past Scottish Government commissioned in 2005. Since then, the report’s recommendations have done little more than gather dust on a shelf. We sit here approaching the end of 2016 and precisely none of the issues that Professor David Kerr mentioned is any less prevalent.

The cabinet secretary stated that the Scottish Government is spending more money on the NHS but, as many in the real world outside the chamber understand, what is key is not the amount of money that is spent but what it is spent on. In other words, effective budgeting and planning are required.

Prevention is often mentioned in health debates in the chamber. In reality, there is scant evidence of any move by the Government towards that kind of innovative approach. The explosion in type 2 diabetes cases now accounts for some 12 per cent of the Scottish health budget. According to the Scottish Association for Mental Health, the rise in poor mental health is costing the economy some £3.6 billion a year. Musculoskeletal issues are costing in excess of £350 million a year. Along with the likes of cardiovascular disease and strokes, those conditions are not just costing NHS Scotland money but shortening life expectancy and reducing the quality of lives.

All those things are fundamentally affected by inactivity or obesity, or both. The obvious answer is to set up a long-term strategy to tackle those mounting issues, which are putting more unnecessary strain on our NHS.

Actions speak louder than words, so let us look beyond the words of ministers in the chamber and look at the Scottish Government’s actions. Jogscotland, which has 40,000 weekly active members—80 per cent of them are women—and gives the opportunity for organised exercise in a safe environment, is having its funding cancelled. That £100,000 equates to £2.50 per person per year to positively impact on their health and wellbeing now and in the future, not to mention the likely related health and wellbeing impacts on their families.

Swimming lessons are not compulsory in Scottish primary schools, but they are in England.

There are a wee bit too many conversations going on. Give the member the privilege and politeness of listening to what he has to say.

The Scottish Government has pulled the £1.72 million of top-up funding to support school swimming lessons. The result is that 40 per cent of children—around 15,000 each year—are heading to high school as non-swimmers, according to Scottish Swimming, and a higher percentage of them live in socially deprived areas.

There is much talk of health inequality, inequality of opportunity and closing the attainment gap. However, all the evidence points to the fact that exactly the opposite is happening. Expert advice from agencies is falling on deaf SNP ears. In the words of Tolstoy,

“The most difficult subjects can be explained to the most slow-witted person if they have not formed any idea of them already; but the simplest thing cannot be made clear to the most intelligent person if they are firmly persuaded that they know already”.

In my short time so far in this building, that has typified the Government’s approach—it thinks that it knows better than everybody else.

None of us in the chamber should be surprised that the first bill that the Government put out to consultation was about independence. We should be disappointed, but not surprised. However, with the damning Audit Scotland report, we see the consequences of a Scottish Government that has forgotten that it is responsible for more than satisfying its own constitutional obsession. The SNP spent years, millions of pounds and countless hours of resource on a 650-page plan for independence. Is there any possibility of its devoting even a fraction of the energy that it put into that to a long-term, sustainable plan for the Scottish NHS?

The Scottish Conservatives were voted into the Parliament to be a strong Opposition and to hold the Government to account. People should rest assured that we accept that role, and we will do it to the best of our ability every day of the parliamentary session. However, sometimes issues arise that transcend party politics, and we believe that this is one of those issues.

With the publishing of the Audit Scotland report, it is now possible for all to see that our most precious of services—the NHS—is under increasingly intolerable pressures. It must therefore be the duty of all Opposition parties to ensure that the Government’s lack of initiative and focus and the Government’s continued attempts to duck its responsibilities are called to account.

The SNP’s cunning plan to avoid criticism of its NHS plan by having no plan at all cannot be allowed to go unchallenged. Our NHS deserves better and the Scottish public will demand better. The SNP Government needs to be shaken out of its constitutional daydreaming and I therefore commend the motion to Parliament.