Meeting date: Wednesday, May 2, 2018
Meeting of the Parliament 02 May 2018
Agenda: Automated Teller Machines, Portfolio Question Time, National Health Service (Financial Accountability), Business Motion, Parliamentary Bureau Motions, Decision Time, Nuclear Weapon Transport (Civil Contingency)
- Automated Teller Machines
- Portfolio Question Time
- National Health Service (Financial Accountability)
- Business Motion
- Parliamentary Bureau Motions
- Decision Time
- Nuclear Weapon Transport (Civil Contingency)
National Health Service (Financial Accountability)
The next item of business is a debate on motion S5M-11984, in the name of Miles Briggs, on national health service financial accountability. I urge members who wish to speak in the debate to press their request-to-speak buttons—whenever they wish, or as soon as possible.
For members’ interest, I note that the Scottish Conservative Party has asked to use the new flexibility in debate management to increase its number of speakers from three to four. That means that Conservative speakers will have one minute less: they will have five-minute rather than six-minute speeches. However, we have quite a lot of time available over the afternoon, so I encourage all members to take interventions.14:42
Our Scottish national health service faces many challenges. I believe that it is the job of all of us in this Parliament to work to create a sustainable and financially secure NHS for Scotland.
Recent weeks have demonstrated the level of financial mismanagement in our NHS that the Scottish National Party Government has presided over. Perhaps the most obvious example has been the scandal in NHS Tayside, which brought the issue to the public’s attention in the most shocking of ways, when it was revealed that NHS Tayside had taken more than £2 million from its charitable endowment fund. Donations from the public or from bequests in wills were being used simply to help to cover the day-to-day running costs of that health board.
The current financial situation in NHS Tayside is one that Audit Scotland has, over a number of years, highlighted as “high risk”. According to Audit Scotland, NHS Tayside must make more than £205 million of savings over the next five years, and it has overspent in areas such as workforce costs, prescribing and clinical supplies.
The situation in Tayside is shocking, but that board is far from on its own. Last week, my health board of NHS Lothian revealed to the Parliament’s Health and Sport Committee that it will require £31 million just to stand still at 2017 levels. NHS boards are queuing up at the door of the Cabinet Secretary for Health and Sport to beg for financial brokerage just to be able to keep delivering the health and social care services that people across Scotland rely on.
It is worth reflecting that, when the SNP Government entered office in 2007, Audit Scotland noted that the Scottish NHS had a budget surplus of £50 million. Today it is predicted that our Scottish NHS could be overspent by more than £400 million, and it is struggling to find the cuts that it needs to bridge the current gaps. All that comes despite the Scottish Government receiving additional Barnett consequential funding from the UK Government of more than £2.45 billion.
Presiding Officer, for every MSP in this Parliament, it must often seem that every warning light is lit on NHS Scotland’s dashboard. NHS Scotland has failed to meet seven out of 10 key waiting time targets. More than a quarter of children who are waiting for mental health services are waiting too long—some for up to a year. More than one in eight cancer patients is waiting more than 62 days for urgent treatment. One in four general practices in Scotland has a vacancy. A number of GP practices have been taken over by health boards because of staff shortages. Nearly one in 10 GP surgeries in Scotland is turning away new patients. There are more than 400 vacant consultant posts and more than 2,500 vacant nursing and midwifery posts.
What impact will Brexit have on NHS staffing?
That is a very interesting point, because, 11 years into the SNP Government, Brexit is the excuse. The First Minister has cut training places. Any vacancies in our Scottish NHS are the result of decisions by the SNP Government—no one should forget that.
Care homes across Scotland, which provide care, are closing at a rate of one per month. Just yesterday, figures were published that showed that instances of delayed discharge of patients have increased by 11 per cent from February. Delayed discharge has a huge impact on people’s lives when they are stuck in hospital and unable to get home, or when the appropriate care package cannot be put in place.
Will the member take an intervention?
I would like to make progress, but I will come back to the member later.
The Cabinet Secretary for Health and Sport will be acutely aware of the cases—I have raised them with her a number of times—of my constituents in Lothian who are stuck in hospital, sometimes for hundreds of days, and are unable to get in place the care package that they need. The increasing level of delayed discharge is a significant indicator of a crisis in our health and social care services, and the crisis is increasing in many communities.
Does the member agree that it is absolutely appalling that 33,000 bed days have been lost in NHS Ayrshire and Arran in the past year? Can he tell me the overall number of bed days that have been lost due to delayed discharge across the health service in Scotland? [Interruption.]
SNP members do not like to hear the truth for some reason.
Such stories are a shocking indictment of the SNP Government’s record in charge of our health and social care services.
Will the member take an intervention?
No. I want to make some progress.
The issue is not just about numbers on a spreadsheet; it is about people’s lives—the lives of our fellow Scots and loved ones. The cabinet secretary and the SNP Government must get a grip of the situation.
That is why the Scottish Conservatives have called for specific action and for the strengthening of the Parliament’s oversight and scrutiny of our NHS finances. That is why we have called in our motion for the cabinet secretary to publish the full details of the current financial position of every NHS board and integration joint board, which is information that I believe we should all have. The Scottish Government should commit to provide Parliament with monthly updates.
I welcome the email that the cabinet secretary sent to me at half past 12 today, which accepted those very points and outlined how she will take forward enhanced reporting of NHS finances, which will begin in June. I have other asks that I will be making beyond that.
Perhaps the most concerning issue that we should be highlighting today is that the financial crisis in our NHS that is being faced by the 31 integration joint boards has yet to be revealed.
Among other things, the Conservative motion talks about IJB finances and being held to account. Will Miles Briggs join me in condemning the actions of Angus Council, which has failed to pass on to the local IJB more than £1 million of an additional £1.56 million that was provided by the Scottish Government to support health and social care activities? Does he agree that the ruling coalition in Angus Council, which includes Conservative councillors, should be held to account for depriving the IJB and my constituents of much-needed funding?
That is why we are debating the issue today. The member needs to understand the problems that are faced by the health and social care sector in Scotland. We all agree that the integration of health and social care is the right direction of travel to ensure that people receive the vital care that they need at the right time and in the right place, with a focus on community-based and preventative care models.
However, the cabinet secretary and Graeme Dey need to be clear that the SNP reform is not delivering and that there are growing concerns, which the member has outlined, from those who sit on IJBs and take the decisions. That includes many SNP councillors across Scotland, some of whom have contacted me about the role, the remit and the effectiveness of the decisions that are being taken—even SNP councillors have given up on the Government.
The integration joint boards are now responsible for almost £8.73 billion of taxpayers’ spending on our health and social care services, yet the financial accountability and reporting within IJBs is inconsistent and erratic at best.
Will the member take an intervention?
No. I want to make some progress.
Increasingly, the budget pressures that IJBs face are directly influencing their decision making in relation to proposals such as cutting mental health beds and services.
Audit Scotland has called on the Scottish Government to make fundamental decisions about how services are provided. I welcome the Government’s acceptance that we need greater financial accountability in relation to IJBs, but I believe that we need to take time now to make sure that they are truly fit for purpose. This is a major reform that the Parliament passed in the previous session, and we need to ensure that it is fit for purpose for our communities in this session. Scottish Conservatives, therefore, have also asked in our motion for the cabinet secretary to commit to a review of the integration joint boards in order that we can not only fully understand their current financial position but look to how effective they have been and what future reforms are needed. We cannot and will not just stand on the sidelines and watch a crisis in social care in Scotland build ever greater.
I did not want to make this debate personal. I believe that the future of our NHS and its financial sustainability are too important for that. [Interruption.] As I have said, in recent weeks—perhaps SNP members should start to listen—when Labour and the Liberal Democrats have called for the cabinet secretary to be sacked, I have not gone down that road. The truth is that I do not think that there is anyone on the SNP benches who could step up to the challenge. We have had a look around the cabinet secretary. Fergus Ewing—is he in today?—has presided over the farm payments fiasco. Our once world-class education system has declined under Angela Constance and John Swinney. Further, where do we start with regard to Michael Matheson and the problems and issues that are facing Police Scotland and the SNP’s centralising agenda?
The question is, who on the SNP benches thinks that they can do any better? I ask them to put up their hand if they think that they can. Anybody?
Christina McKelvie (Hamilton, Larkhall and Stonehouse) (SNP) rose—
I did not have her in mind, but—
On a point of order, Presiding Officer. I am interested to hear what the Conservatives say in the debate, but personal attacks, personal slights on members of this Parliament and bringing down the reputation of this chamber are not what we should be hearing from the Tories today. I would like Mr Briggs to speak to his motion instead of impugning the reputations of members in this chamber.
I am alert to any personal attacks that take place. However, there is some room for robust exchanges and, on this occasion, I think that the remarks were within those bounds. Nevertheless, I encourage all members to keep to the substance of the debate and not to personalities.
I will be clear to the cabinet secretary. The mismanagement and financial chaos that are facing our NHS cannot continue. They are impacting the morale of our health service staff. That is exactly why the Scottish Conservatives are putting the SNP Government on notice over its handling of the financial crisis that faces Scotland’s health boards. There is a need for action to prevent the next major financial crisis in the integration joint boards from happening.
The two critical issues that face our Scottish NHS have developed on the SNP’s watch over the past 11 years, and we now need a Government that will get a grip of the dire situation that has been created. That is why I believe that the Parliament needs to seek the urgent action that we propose. We must return our NHS to a secure and sustainable financial footing.
That the Parliament notes the financial problems in NHS Ayrshire, Tayside and Lothian; understands that these issues are being faced across Scotland; notes the ongoing lack of transparency on the state of board and integration joint board finances; calls for the immediate publication of the current financial position for all NHS bodies and for a progress review of integration joint boards, and believes that, failing sustained and immediate action, the Cabinet Secretary for Health and Sport should be held accountable for the ongoing problems.14:53
I will start by saying that I am immensely proud of our NHS. Our staff do an excellent job day in and day out. They often go the extra mile, as witnessed during the severe winter weather, when heroic efforts were made to get to work to keep patients safe. Further, with our world-leading patient safety programme, we have one of the safest systems in the world, with international interest in how that has been achieved. The vast majority of patients get a fantastic and timely service, and the fact that patient satisfaction levels are higher than ever—with 90 per cent of Scottish in-patients saying that their hospital care and treatment was good or excellent—suggests that that is the case.
I have no problem being held accountable for our NHS. That is my job. Is it a perfect system? No, it is not. Sometimes, in a system that is the size and scale of the NHS, things go wrong, and I am sure that we will hear examples of that today. However, in each of those cases, what is important is that there is an openness to reflect and learn from them, which the new duty of candour encourages.
On the point about patient safety, members may be aware that news is emerging of a breast screening error that affects 450,000 women in England. Jeremy Hunt has just made a statement to the House of Commons on the matter. Given the significant public interest in it, I reassure members and the public that the issue does not affect the NHS in Scotland. Patients should be reassured that there are no problems with our breast screening programme records or information technology systems. As usual, all women should continue to be aware of changes to their breasts and, if they have any concerns, should see their general practitioners. Scottish Government officials will work with Public Health England to identify any women affected in England who have subsequently moved to Scotland.
Like every health system in these islands and beyond, our NHS sometimes struggles to cope with rising demand. Despite record high NHS staffing—it is up by more than 13,000—our performance on key targets is not what I would want it to be. Although Scotland’s core accident and emergency services have been the best performing in the UK for more than three years and are 10 per cent better than they were three years ago, some sites still struggle and need to improve. Although there is now a downward trend in delayed discharge, with a reduction of 7 per cent in total bed days lost compared to the previous year, there is still much work to be done, especially in areas such as Lothian. That is why we are driving forward investment in, and reform of, our NHS to meet the rising demand and challenges now and into the future.
In 2014, the cabinet secretary stood where she is and said that she would achieve zero delayed discharges in our hospitals. When will that target be met?
Miles Briggs is absolutely right. I want to eradicate delayed discharge, but it is a difficult thing to do. He alluded to some of the challenges earlier on. Integration joint boards work hard, but there is huge variation in performance on the matter. For example, delay has almost been eradicated in Glasgow, whereas in areas such as Edinburgh it has not. A new chief officer is in place who will do a fantastic job in that domain. I do not underestimate the scale of the problem, and good ideas are always welcome, wherever in the chamber they come from.
On investment in the NHS and care services, I turn to the financial issues in the motion. I am more than happy to address them. Ensuring that there are sufficient resources in the NHS is something that I do every day. The Scottish Government’s budget for 2018-19, supported by the Greens, delivered additional investment in health of more than £400 million. That takes the resource budget to £13.1 billion. The Government remains on track to deliver its commitment to increase health resource spending by £2 billion by the end of this parliamentary session.
It is clear that that level of investment has been made possible without impacting on other public services only through the progressive tax policies that we have implemented. Health spending has been £360 million more than inflation since 2016-17. Had we not taken the budget decisions that we have done, the resources that are available to our health and care services would have been considerably less.
The cabinet secretary will be aware that, as I have pointed out before, over the past 10 years, NHS Grampian has been short-changed by £165 million from her target figures. That difference is being reduced now, but will NHS Grampian ever get that money back?
As I have said to Mike Rumbles on a number of occasions, NHS Grampian is one of the biggest gainers from the NHS Scotland resource allocation committee formula and it gains again this year.
I turn to the Tory motion. If the Tories are suggesting that the health and care budget is inadequate, which I think that Miles Briggs suggested in his speech, they have a responsibility to set out what level of funding they propose and how it would be funded, particularly in the light of their opposition to the progressive use of taxation. Under the Tory tax plans, there would have been £500 million less available for public finances, including the NHS. Therefore, Miles Briggs has a responsibility to address that. Perhaps in the Tories’ closing speech, we will hear about the level of resources that they think the NHS should have and where they would come from.
Many of the areas that Miles Briggs raises in his motion are areas on which I have been engaging with the Health and Sport Committee for some time. In response to the financial issues raised and the asks made in the Tory motion, I have today written to the committee, providing information on the first round of consolidated financial reports for integration authorities, an update on NHS boards’ financial performance, and the development of a medium-term financial framework for health and social care. I have agreed to review the progress of the integration authorities, and I believe that that is best done through the ministerial strategic group. I am happy to share with the Health and Sport Committee the outputs and any further actions that arise from that.
I have also set out my proposal to provide monthly information on NHS boards’ financial performance for 2018-19. Data for boards’ first formal reporting period for the financial year will be available in June, and we will report monthly thereafter to the Health and Sport Committee. I hope that Miles Briggs and others agree that what has been set out is a reasonable proposal to address the concerns raised in the motion and to provide greater transparency and accountability to this Parliament.
In responding to the recommendation from the Auditor General for Scotland, I have committed to publish a medium-term financial framework, which will take account of key programme for government commitments, along with an understanding of the financial environment and the approach required to ensure financial sustainability. That framework will be published in the coming weeks and will set out clearly the environment in which we are operating. In particular, it will set out longer-term funding needs. I am confident that the publication of the framework will play an important part in giving greater clarity to NHS boards and integration authorities as they develop plans for the coming years, and it supports the principle asked for by the Greens.
As I said in my speech, I welcome the fact that the Government has accepted the reforms and has accepted the terms of our motion. Can the cabinet secretary tell Parliament what NHS Scotland’s level of overspend actually stands at today? Does she have that figure?
We will get financial data for the first two months of 2018-19 at the end of June. I am sure that, like me, Miles Briggs wants accurate, robust information, so I say that the health finance reporting cycle has data for the first two months of the financial year published in June. That is how it happens every year. That will be made available to the Health and Sport Committee and then there will be monthly reporting thereafter.
Will the minister also publish data on past years’ situations? It is important that the Parliament see the direction of travel as well.
I am happy to provide that information. The 2017-18 position has already been made available to the Health and Sport Committee, but if there is any more information that I can provide I will be happy to do that. I want to meet the needs of the Parliament in terms of the budget scrutiny process.
The Auditor General has previously called for greater financial certainty for NHS boards, so I will say at this point that a UK multiyear funding settlement—as has been proposed by the Prime Minister, no less—along with this Government’s commitment to pass on all health consequentials, will go a long way to providing our health and social care partners with the greater certainty of funding that they need.
I welcome the opportunity to discuss with members the steps that we are taking at a local level in response to governance and accountability issues. I have given a detailed statement in Parliament setting out my response to the issues at NHS Tayside, and the details on the investigations will be scrutinised by the Public Audit and Post-legislative Scrutiny Committee in the coming months. It will be important that all parties take stock following those reviews, and that we all learn lessons from the situation in Tayside and make improvements for the future.
I set out in my statement that we would be receiving returns from all boards by 30 April. I can, however, confirm that all boards that hold endowment funds have now responded to a letter from the director general for health and social care about their approach to, and use of, endowment funds. Those responses have been passed to the Office of the Scottish Charity Regulator to review, but I can confirm today that there was nothing in the responses that is a cause for concern and that no boards are showing retrospective use of endowment funds in order to improve their financial position, as happened in Tayside. The returns have now been passed to OSCR for external scrutiny and review. I will ensure that any recommendations from OSCR in relation to the future governance arrangements of endowment funds are fully supported.
In my time as Scotland’s health secretary, spending on health has seen the largest increase of any country in the UK, and Scotland has had the largest increase per head on health spending in the UK. I will always fight for the best interests of our NHS. Reform of the NHS is equally as important as investment in it. I have set in train a huge range of actions to make the improvements that we need to see, both now and into the future, including the new primary care workforce plan, published on Monday, which will sit alongside the previous two workforce plans.
There is much in our NHS and care services to be proud of, but I am not complacent. That is why I have set out the range of actions that are already under way. I have listened to calls for greater transparency around finances and I have agreed to the actions to deliver that. That is why this Government will continue its approach of meeting the challenges that we face, delivering sustained improvement and serving the people of Scotland, now and for the years and generations ahead.
I move amendment S5M-11984.4, to insert at end:
“; supports calls for the implementation of any recommendations from the Office of the Scottish Charity Regulator (OSCR) on the future governance arrangements for NHS board endowment funds; notes the Scottish Government’s commitment to publish a financial framework for health and social care, in line with the recommendations of the Auditor General, following publication of the Scottish Government’s forthcoming medium-term financial outlook; believes that the Health and Sport Committee should have the opportunity to consider the framework to give further parliamentary oversight to the finances of boards and integration authorities; recognises that progressive financial and fiscal planning is necessary to ensure investment in Scotland's health, care and wider public services, and believes that the UK Government should set out its long-term plans for health and care funding in advance of the 2019 UK Spending Review, and that all health resource consequentials from this should be passed on in full in Scotland.”15:05
Another week, and more appalling figures on the performance of the Cabinet Secretary for Health and Sport. This is not a one-off; it is the latest in a series of failures by this cabinet secretary. Although the Tory motion and the Government amendment focus on the financial impact, which is an important issue, both ignore the human consequences: the consequences for NHS staff, who continue to go above and beyond, and for NHS patients, who are being let down by the failings of this Government.
Every time that there is a failure, we get the same old warm words and tired excuses from this health secretary when, year on year, her performance is declining. The declining performance on workforce includes more than 3,000 nursing vacancies; one in three GP practices reporting a vacancy, with GP practices closing lists and some closing down; hundreds of consultant vacancies; and a doubling in the rate of early retirement on the health secretary’s watch.
Shona Robison is right to thank the staff, but her thanks are not enough. We cannot continue to overwork, underresource and undervalue staff without there being human consequences. We heard last week from the British Medical Association and the Royal College of Paediatrics and Child Health that, such is the pressure on staff, there are now real fears over patient safety. Members should not forget that it was the cabinet secretary’s best friend, Nicola Sturgeon, who as health secretary cut the number of nurse and midwife training places. We are now living with the dangerous consequences: our NHS is in the midst of a workforce crisis, for which Shona Robison must take responsibility.
I turn to the failure over delayed discharge. In February 2015, Shona Robison promised:
“I want over the course of this year to eradicate delayed discharge ... and I am absolutely determined to do that.”
However, since that promise, more than 1.6 million bed days have been lost to delayed discharge and that has cost the NHS £380 million. Worse than the financial cost has been the human cost. More than 1,000 patients have died while trapped in hospital as a delayed discharge—another failure of this health secretary.
Cancer is a national priority. In the past year, more than 1,700 people who were suspected of having cancer had to wait longer than the expected treatment standard. Even after being referred for treatment by doctors, more than 1,200 people with cancer had to wait longer than the expected treatment standard. Those are shocking figures that expose the failure of this health secretary. Today, unbelievably, the health secretary has sneaked out the report that I am holding up, which shows that, rather than improving its performance, the Government’s plan is to scrap the waiting time standard for cancer. That is shameful behaviour from a shameless health secretary. [Interruption.] I am holding the report here, and the cabinet secretary wrote the foreword. There was no press release alongside it—it was snuck out today.
So far in 2018, in our A and E departments, more than 52,000 people have waited longer than four hours. More than 7,000 have waited longer than eight hours. Unbelievably, almost 2,000 have waited for more than 12 hours. That figure is the same as the figure for the whole of 2017—another failure of this cabinet secretary.
To date, more than 3,000 operations have been cancelled in 2018 due to capacity or non-clinical reasons because hospitals could not cope. That is the consequence of the health secretary’s workforce crisis. On the ambulance service, last week, Richard Leonard shared the terrible story of Margaret Goodman, but we know that that is not an isolated case. In 2017, more than 16,000 people waited more than an hour for an emergency ambulance. That is 16,000 emergency patients failed by Shona Robison.
On budgets, health boards are having to make more than £1 billion-worth of cuts over the next four years. In the health secretary’s own backyard, NHS Tayside is having to make £200 million-worth of cuts over the next five years. The result is the health secretary’s own health board taking money from charitable donations to support an IT system because of budget cuts imposed on it by the health secretary.
So many people have been failed—3,000 on operations, 16,000 ambulance patients, 52,000 in A and E, 1,200 on cancer waiting times and 1,700 who have been suspected of having cancer. Some 1.6 million bed days have been lost to delayed discharge. She owes not just one apology but thousands of apologies to patients across the country, yet there is no shame, no accountability and no responsibility from Shona Robison.
The uncomfortable truth is that it is not just Opposition parties, NHS staff and patients who have lost confidence in her. Even SNP back benchers are now briefing the media and calling on Shona Robison to go. We have the bring back Alex Neil campaign, led by Alex Neil, and we even have Jeane Freeman telling the media about how brilliant Jeane Freeman would be as the health secretary. In fact, it appears there are only two people in the chamber who do not think that Shona Robison should go: Nicola Sturgeon and Miles Briggs. Although I understand why the Tories would not want to talk about failing Government ministers resigning, who would have thought that it would be they who provided a fig leaf for the failings of Shona Robison?
Will the member take an intervention?
I am in my last 30 seconds, so I will not.
You can if you wish. There is some extra time.
I am happy to take the intervention.
How many times has the member called for the cabinet secretary to go? At the last count, I think that it was 11. Is that effective opposition?
I think the interesting stat is the number of the health secretary’s constituents who want her to go. Let us talk about that. A poll for The Courier showed that 73 per cent of people in Dundee want the cabinet secretary to go.
Scotland’s NHS needs change that starts right at the top of the organisation, because the First Minister has misplaced loyalties. Her loyalty should be to Scotland’s NHS, not to her friend. I ask the First Minister to do the right thing for NHS staff and patients and, for the sake of Scotland’s NHS, sack this failing health secretary. [Interruption.]
I move amendment S5M-11984.1, to insert at end:
“; further believes that all NHS boards are experiencing financial pressures, which are added to by a need to deliver financial efficiencies; notes the patient care issues that are being experienced by boards across Scotland, as evidenced by consecutive Audit Scotland reports showing that seven out of eight key performance standards, including cancer waiting times, are not being met; understands that BMA Scotland believes that many staff are ‘under pressure like never before’, and considers that, as well as financial accountability, the Cabinet Secretary for Health and Sport should be equally accountable for the staffing and patient care issues that are being experienced in Scotland’s health service.”
Thank you. I call—[Interruption.] Mr Arthur, nobody can hear me calling the next speaker because you are being so noisy. I call Alison Johnstone.15:13
I regret that we are being called on to address the financial problems that are facing NHS boards. In October, Audit Scotland’s annual report on the NHS warned of “intensifying” pressures on our health service. It told us that financial balance is
“becoming harder to achieve each year”
and that current approaches to making savings are “unsustainable”.
Since then, new issues have come to light, not least the inappropriate transfer of e-health funds in NHS Tayside. We must therefore turn to the matter of charity endowment funds being misused, and to financial difficulties that stretch way beyond Tayside. Many boards require brokerage, and in my health board—NHS Lothian—there is an indication that there is a £31 million gap in funding, as we have heard.
The picture is not uniform, but throughout Scotland there are boards that are struggling with delayed discharges, boards that continually fail to meet child and adolescent mental health services targets and boards where ambulance response times are not adequate. As the Royal College of Paediatrics and Child Health has highlighted, paediatricians, too, are under huge pressure. It advises that we need an additional 110 paediatric consultants over the next five years just to make sure that sick children get the care that they need.
All that raises the most serious questions about oversight and governance of our health service and social care system. However, we cannot place on health boards and IJBs additional pressure to restore financial balance by making unsustainable short-term cuts to spending and services. Labour’s amendment is right to emphasise that financial pressures can be
“added to by a need to deliver financial efficiencies”.
As the Government’s amendment acknowledges, we need to address funding pressures at their root with
“progressive financial and fiscal planning”,
“is necessary to ensure investment in Scotland’s health, care and wider public services”.
NHS boards must be given a greater ability to deliver long-term budget planning. My amendment, which was not selected for debate, called for that.
Audit Scotland has often recommended a longer-term approach to financial planning across the health service. Last year, it said:
“driven by one-year funding allocations from the Scottish Government, and the need to break even each year ... a short-term approach ... makes it difficult for boards to plan and invest in longer-term policy aims”,
which are aims that we all share.
I know that the Government intends to introduce a financial framework for health and social care, but boards need more adaptability in their own right. In 2016, Audit Scotland recommended
“providing NHS boards with more financial flexibility, such as three-year rolling budgets rather than annual financial targets”.
It has also suggested reducing the pressure on boards to break even each year. It has stressed that
“Even a small amount of flexibility at financial year-end ... can make a difference.”
In November, the Health and Sport Committee published its report looking ahead to the draft budget. Many witnesses for that report stressed the need for a more sophisticated budget process. The Convention of Scottish Local Authorities said:
“A short-term input-focused budget process is an inhibitor to genuine reform.”
The Royal College of Nursing Scotland said that
“the constant annual cycle requiring budgets to break even does not allow a step change”.—[Official Report, Health and Sport Committee, 12 September 2017; c 5, 45.]
We all seek that step change, which is desperately needed. I urge the cabinet secretary to act on that advice.
The committee’s report also found that scrutiny of integration authority budgets proved
“very challenging as there is little by way of information available on IA’s financial position even at the most basic level.”
Given that astonishing lack of transparency, I agree that it is wholly appropriate to hold a progress review of integration joint boards. We must afford Parliament greater opportunity to scrutinise the financial reporting, external audit and governance of the health service and social care system. My amendment would, had it been selected for debate today, have called directly for such additional scrutiny. As part of a review of integration joint boards, we should consider new ways of supporting the local services that contribute so much to our health and social care system.
I am confident that a review of integration authority finances and oversight of the challenges that they face will clearly indicate the need for local tax reform. As we know, local authority budgets are under pressure, and are hampered by the out-of-date and regressive council tax. If we are really serious about an integrated approach to health and social care, we cannot simply focus on NHS budgets every time we have a debate about strains on our health service.
If Alison Johnstone’s amendment had been accepted, would such a review have included her concerns about the 494,123 days that have been lost to the health service through bed blocking? Is she happy that her party is supporting the Government in that?
If we review the issue in the round, we see that the pressures on local authorities make it difficult for the change that we need to be delivered in social care. If local authorities were better supported, we would see more social care being delivered in our communities, which would have a significant and positive direct impact on what is happening in our health service.
Alison Johnstone is pleading for better support and better finance for local government. Will she explain why she voted for the budget?
I voted for the budget precisely because I care about local government and I could not countenance sitting back, shouting from the sidelines and doing absolutely nothing.
We have to look to local authority finances, too, and give communities new opportunities to prioritise key services, including social care. More progressive local taxation will benefit not only health and social care but public health. Our being
“bold on local tax reform”,
as Naomi Eisenstadt recommended that we be, will have important implications, especially for working households that are at or just above the poverty line. The Government amendment recognises that
“progressive financial and fiscal planning”
is needed to sustain our health and social care services.
On the recruitment challenges, I have made the point that we need to open up access to medical training places to students from low-income backgrounds. Many of our universities are leading excellent work in that regard, but I worry that the Government is focusing too narrowly on increasing applications from the most deprived postcodes in Scotland. It is not right that a student from a low-income background might miss out on widening access opportunities because they do not live in a priority postcode or go to a target school. I ask for a broader approach.
I would also like members of this Parliament to work together to tackle drug-price inflation.
We must take it as a given that the cabinet secretary is accountable for NHS governance and performance—indeed, she has made it clear that she would not have it any other way. The Greens will support the motion and both amendments at decision time. Demands in the motion and the Labour amendment are reasonable and the Government must take action to realise them. There is no room for complacency.15:21
I am grateful to the Conservative Party for lodging its motion and bringing the debate to Parliament. However, given the national coverage and outrage that met the NHS Tayside scandal over Easter, I am dismayed that the debate is taking place in Opposition rather than Government debating time, in which Parliament could have given the matter the oversight that it deserves.
I remind Alex Cole-Hamilton that I came to Parliament and made a statement on NHS Tayside, which gave members an opportunity to ask any questions that they wanted to ask. We are waiting for reviews: I will be happy to come back to Parliament when we have them.
I freely accept that. I welcomed the statement at the time, but it did not provide Parliament with the opportunity to give the matter the full analysis that it deserves. The issue affects other health boards, too.
Miles Briggs reminded members—it is a matter of public record—that I have called for the cabinet secretary’s resignation. That is not a view that I came to lightly, and I take no joy in it. I have an immense amount of personal respect for the cabinet secretary. However, as Miles Briggs reminded members, there are light bulbs flashing all over the dashboard of our NHS, warning of the many problems that it faces. The cabinet secretary and her Government have repeatedly ignored the will of Parliament on, for example, service redesign—in particular the closure of hospital wards. There has also been a string of missed targets, as Audit Scotland highlighted in its report.
The events at Easter were very much the straw that broke the camel’s back for my party, in that we could go that far and no further. We found that in NHS Tayside not only was there an element of cooking the books, with £5.3 million of digital health money having been recycled to make the books look more healthy, but there was the revelation that charitable donations, which were given to the health board to contribute to things like patient comfort and to make extraneous purchases, were being used to plug gaps in the board’s IT system. The board now has a £44.1 million shortfall. This week I learned that GPs have been banned from prescribing paracetamol, as a means of plugging the gap, such is the abject distress of the board.
The response was to manage out the chair of the health board, Professor John Connell. He was asked to resign. I was intemperate in my response to that, because I thought that it was right that someone should take responsibility, but then I learned that the events that led to Professor Connell’s departure predated his tenure. That was the nature of the cabinet secretary’s search for a fall guy in the case.
I hope that Alex Cole-Hamilton recognises that the events also predated my term in office, but I am taking responsibility for them. [Interruption.]
Perhaps in her remarks at the end of the debate, the cabinet secretary—[Interruption.]
Just a wee minute. Order. I cannot hear anything.
Perhaps the cabinet secretary will want to address exactly what Professor Connell was not doing fast enough that led to his resignation, and consider whether she can extend comfort to chairs of other NHS boards who might be worried that they will have to take the fall for this Government, irrespective of who the cabinet secretary was at the time. As Miles Briggs has rightly pointed out, we then heard that NHS Lothian, my home health board, is £31 million adrift from where it needs to be in order to keep services at 2017 levels.
I am very grateful to the Labour Party for lodging its amendment today, because it widens the debate. It is not just about finance; it is also about the litany of missed targets in the health service. We saw the impact of poor Government policy measured out in the fact that a 23 per cent cut to alcohol and drug partnerships has led to the highest level of drug-related deaths in Europe, which is absolutely scandalous. At times like this, we need to turn to the Government and tell it that it, and its party, have been found wanting.
There is also bed blocking: on any given night in this country, a thousand people who are fit to go home will stay in hospital beds because social care coverage is inadequate to allow them to go home. I pay tribute to the cabinet secretary and thank her for taking up the case of William Valentine, which I raised with her at the Health and Sport Committee’s meeting yesterday. I am grateful for the correspondence that I received. However, William is just one of a thousand people who, on any given day, spend time in hospital that they do not need to spend there. That causes an interruption to flow through the rest of our health service, which sees elective surgical operations being cancelled and four-hour waiting times in A and E being unachievable because there are no in-patient beds for people in acute receiving units.
Will Alex Cole-Hamilton tell us what he is arguing for? Is it for a reduced budget for the health service and more for local authorities so that they can provide more care for people at home? Is that what he wants?
I am very grateful to John Mason for setting me up to make this point. The indicators that underpin the health outcomes in our national performance framework contain not one reference to social care. The landscape of social care in this country is the problem. We are not paying our social care workers enough and there is not enough provision. As a result, people are languishing in hospital when they should be in their communities.
I will finish by making a point on mental health. I always come back to mental health provision because it is a national outrage. If a child were to fall off her bike and break her arm, a parent could expect her to be in plaster by the end of the day. However, if she were to come to them with anxiety, depression, an eating disorder or any other kind of mental health problem, they could expect her to join one of the longest queues in our health service. That is a national outrage—not just in child and adolescent mental health services, but in adult services, as well. This very morning, James Jopling from the Samaritans responded to the national suicide action plan by saying that the Government is not taking suicide seriously, which is an astonishing assertion for the director of that organisation in Scotland. We waited for a year longer than we should have for that action plan, and it has been found severely wanting.
The Government needs a whole-system-change approach to our health service. For my party, unfortunately, such change now needs to start at the top.
We move to the open debate.15:28
Everyone in the chamber can agree that the creation of the NHS 70 years ago was one of this country’s greatest achievements, mainly because it was a universal service based on clinical need rather than on patients’ income. With the passage of time, however, those needs have changed—in some cases, beyond all recognition—and, with them, the ability of the NHS to deliver on its founding principles.
Demographic changes are largely the issue but so, too, ironically, is the success of the NHS. With many more people living so much longer as a result of vastly improved treatments, the challenge of delivering universal care will always be one of the most difficult to confront any Government. There are also many more people living longer with chronic ill health, which includes mental health problems.
Many experts and health professionals believe that the situation makes the case for integrated health and social care incontrovertible. In particular, we need to find ways to ensure that older people do not overstay their time in hospital if they can be looked after at home and in their communities. It is hard to argue against that, which is why no political party is standing in the way of the integrated services approach.
However, debate is raging about how the approach should be managed. It is in that context that Conservatives are this afternoon challenging the SNP on its record. I want to use the example of recent issues in NHS Tayside to give substance to my argument.
I have no doubt that the serious problems that have been exposed in recent weeks at NHS Tayside—and, indeed, in other boards—will have a long way to run until the detail is uncovered about who authorised those bad decisions, including on misuse of charitable endowment funds, which is an issue that has rightly appalled the public. Both the official inquiries and the spotlight from the media will eventually spill the beans on who knew what and when, and who made the mistakes.
It is not for me to comment further until the inquiries report. However, in the meantime, the controversy has thrown up other issues about the SNP’s running of NHS boards. How can it be right that trustees who sit on the boards are responsible for overseeing spending of taxpayers’ money and of charitable donations that are given by patients and their families?
That is an important question, and one that Liz Smith has asked in the chamber before. I hope that she will acknowledge that, as I have said to her previously, the Office of the Scottish Charity Regulator has signalled that it wants to work on the guidance and look at the governance issues. I agree that the situation must be fundamentally changed.
I am glad to hear that, because serious questions have to be answered on those matters. As I have said, I will not comment further until the reports are published, but there will be serious questions to answer about the workings of the OSCR process and how the Scottish Government oversees a lot of the NHS’s financial management.
On the issue of the charitable endowments, four years elapsed before any real action was taken. In a letter to one of my constituents, OSCR confirmed that it did not know about the NHS Tayside scandal until 4 April; it looks as though the Scottish Government might not have been aware of the issue until about the same time. That begs the question: how can four years pass before such events are known about? I know that Jenny Marra has taken up the topic at the Public Audit and Post-legislative Scrutiny Committee. It is inexcusable.
Does Liz Smith agree that lessons are to be learned by all of us, including about the auditing processes? It is important that such issues are flagged and qualified in reports that come to the Scottish Government or to any other public body.
Yes, I do, but the Government has to understand its responsibility in that context, too.
I turn to IJBs. I do not consider—the cabinet secretary has a letter from me about this—that IJBs have clear lines of responsibility. There appears to be inequity in the balance between health and social services expertise, and the tendering process that allows third sector organisations to play their part in assisting in provision of services is not working well. It puts councillors in impossible situations when they serve on an IJB; it undermines the accountability that all our constituents should expect from their local health boards.
After speaking to several councillors, NHS officials and patients, it appears to me that there are considerable concerns about the functioning of IJBs, which is something that I am led to believe the cabinet secretary has been told by members of her own party. Senior health officials are making the point that they find it difficult to know who has ultimate responsibility for many decisions within health and social care, which results in a lack of accountability.
I hope that the seriousness of those concerns will lead the cabinet secretary to authorise a full review of IJBs as they have functioned in their first two years, to examine the issues that have been raised and to make the necessary changes that will ensure that our health and social care services are fully equipped to deal with the extensive demands on them.
As has been mentioned, running the health service will never be easy, but it would surely be given a better chance if ministers were to get a grip of what is wrong with the management process. In that respect, it is an urgent and pressing issue.
I support the motion in the name of Miles Briggs.15:34
The Scottish Government openly acknowledges—and rightly so—that there is still progress to be made within the NHS. The cabinet secretary has been similarly open about the situation at NHS Tayside. She has addressed the matter and put in place measures to resolve it in a timely way and to support positive change.
New leadership is in place—an experienced interim chair has been appointed—and work is under way with NHS Scotland to appoint a new acting chief executive. An independent investigation by Grant Thornton has been commissioned and the Scottish Government is providing on-going support to the board through the transformation support team.
The Scottish Government is also developing a medium-term financial framework to support national, regional and local financial planning for the next five years. That framework will, among other things, outline the broad direction that the NHS and care services need to take to meet the changing needs of the people of Scotland, including shifting the balance of care towards community health services.
However, there is a wider point to be made here about working towards the very highest standards of organisational governance in the public sector, as I believe we are. We need to improve levels of public engagement, transparency in decision-making, and—in the case of health boards—diversity on boards. There also needs to be on-going training and support for members of boards so that they can carry out what is a very demanding role well.
The Health and Sport Committee recently looked at governance in the NHS and some of the board members who came in to give evidence to us expressed frustration about how difficult a role it was to fulfil effectively. They said that a greater level of training and support could be given to them, as well as more opportunities to learn from what is working well in other board areas. I believe that those were constructive comments.
The Conservative motion makes mention of the financial pressures on the NHS but it fails to make the obvious connection to the source of those pressures. They are a direct result of the austerity policies enforced on the UK and on Scotland by the UK Government in Westminster. Under the Conservative Party’s misguided ideological approach—and let us never forget that austerity is a choice, abandoned now by countries across Europe—
In preparation for today’s debate, I looked through a lot of the evidence from the Health and Sport Committee and various other health professionals. Not once were UK Government issues mentioned. However, issues around structures and spending here in Scotland were mentioned.
But the Conservative motion explicitly makes reference to financial pressures on our public services and that is what I am addressing.
We know that the block grant is being affected by declining amounts of money coming to Scotland from Westminster. I would like to know when the Conservatives in this chamber will concede the effects of their own policies on Scottish families across the country.
Miles Briggs rose—
Please sit down, Mr Briggs.
Until that is done, we cannot have a sensible conversation about any of this. The Scottish Government has faced an 8 per cent cut to its discretionary budget over 10 years, worth £2.6 billion in real terms. The block grant from the UK Government for day-to-day spending over the next two years is projected to fall by £500 million. The Scottish Conservatives are right to draw attention to these cuts and to the financial burden that they place on the Scottish Government to deliver its ambitious plans for the NHS in Scotland, but they fail to explain—again—how they would do anything differently.
The Scottish Government has mitigated and continues to mitigate these cuts and to protect and prioritise our NHS. There was an increase to the health portfolio resource budget this year of more than £400 million, taking it to a record high of over £13.1 billion. The Scottish Government is investing £2 billion more in health resource spending by the end of this session of Parliament—the highest investment commitment of any party in this chamber. The Scottish Government is also increasing support for primary care by a further £500 million over this session of Parliament.
These commitments are made possible by an ambitious budget that prioritises the NHS, and aims to create a Scotland that is fairer, more equal and more prosperous. It is a budget that both the Labour and Conservative parties failed to back. The budget is an exercise in the Scottish Government using its devolved powers to protect investment in our NHS and it is delivering that—it is delivering an additional £867 million for investment in public services that would otherwise not have been available.
If I remember correctly, the Tories have made over 100 demands for increased public spending, while also demanding a £500 million tax giveaway to high earners and businesses. It did not add up then, and it does not add up now.
In conclusion, I would like to tell a story that I found this morning on the Care Opinion website, about a patient who was in a hospital in my constituency—Edinburgh royal infirmary.
The person said:
“My Dad was in Ward 106, Base A for his last few weeks. I just wanted to say how amazing all of the staff were, not only did they look after him and gave him great treatment, they were also very friendly and understanding. They were very patient with my Dad even when he was delirious and when he was causing them a lot of work. They were all amazing people and I couldn’t have asked for anyone better to look after my Dad in his last few days. I know he was treated well, with respect and care.”
For parties in this Parliament to come to the chamber without any or many constructive suggestions for how to improve the health service is not credible. It is not the serious approach that this subject and Scotland deserve.15:40
There has been much talk already this afternoon about NHS Tayside, but the issue is not just about NHS Tayside: my mailbag is full of letters from constituents who are rightly scared about the future of local provision. The time for excuses, especially in the Highlands, is definitely over. Why? Because we seem to lurch from one crisis to another, and enough is definitely enough.
Let me be clear: closing wards and centralising services comes at the expense of care to patients. If it is not the suspension in the Highlands of out-of-hours services at Portree hospital, it is the downgrading of wards such as the Caithness maternity unit; if it is not the reduction in the number of beds in New Craigs psychiatric hospital, it is the cuts to palliative care and psychiatric care in Badenoch and Strathspey; and if it is not the fact that more operations are being centralised in Raigmore when patients could be treated in hospitals such as the one in Golspie, it is the constant threat of closure that hangs over the Town and County hospital in Wick and the Dunbar hospital in Thurso. It does not stop there, though, because there are cancellations of operations at Raigmore for just about every reason imaginable and there is the failure to meet the 12-week waiting time target for cancer patients, the shortage of GPs across the Highlands and increasing local costs—I could go on and on and on.
Such shameful leadership in NHS Highland means that patients are not receiving the standard of care to which they are entitled.
Will the member take an intervention?
No. I am short of time and I want to give way to the cabinet secretary in a minute. I will see whether she intervenes; if she does not, I will perhaps let Mr Arthur in.
We know at this stage that there is about £15 million of overspend in 2017-18 in NHS Highland, and we also know of the maladministration of health contracts. Those issues all have an underlying theme of mismanagement and lack of leadership. If the Scottish Government truly had confidence in the management of NHS Highland, why did it commission John Brown to undertake a review of the corporate governance of the health board?
Shona Robison rose—
No, cabinet secretary, that is not the one that I will let you come in on.
Questions are being asked, so I will try a simple one—here is your moment, cabinet secretary. Does the Scottish Government think that it is acceptable that NHS contracts that have been awarded have not been audited for 20 years? Would the cabinet secretary like to come in on that?
I would like to come in on both those points.
Wait a wee minute, cabinet secretary, because I have to call you first. Yes, you can intervene.
First, the member will be aware that one of those contracts dates back to 1998. It is not acceptable that it has not been audited and NHS Highland has said that that is not acceptable and that it will act on the recommendations of Audit Scotland.
Secondly, John Brown’s governance review in NHS Highland is a pilot that is about strengthening governance within our NHS. It has started in NHS Highland, but lessons can be learned from it for elsewhere. Surely the member welcomes that.
First, I am delighted that the cabinet secretary believes that handing over money for 20 years with no record of outcomes is unacceptable. As far as the John Brown review of governance goes, I will wait to see what he says before I comment on what he has produced.
To go back to contracts, Audit Scotland recently condemned NHS Highland by saying that its “contract monitoring” was
“inconsistent, informal and not documented.”
Audit Scotland concluded that
“NHS Highland cannot demonstrate the achievement of value for money.”
Apparently, when it came to it, NHS Highland could not even list the names of patients who had undergone treatment. That is a pretty damning verdict that shows how far the management of NHS Highland has lost control. NHS Highland has promised to fix that and to monitor its performance via its own audit committee—the audit committee that is dysfunctional will audit itself. I am struggling with that one, cabinet secretary, I really am. Surely if there is a problem, it is put out to somebody else so that they can find the true extent of the problem and resolve it.
Real change is needed. I join Miles Briggs in calling for more parliamentary scrutiny of NHS finances and I urge the Scottish Government to publish the current financial position of all NHS boards. The public have a right to know the scale of the financial crisis affecting the NHS, including NHS Highland, and how that will impact on the standard of care that they can expect to receive.
NHS Highland has been tasked by the Scottish Government to find £100 million of savings by 2020, but how will that be achievable when the board failed to achieve the savings that it needed this year and has had to seek £15 million of brokerage for next year? That means that, next year, NHS Highland will have to find not only the £15 million of savings that it failed to find this year but the money to pay back what the Scottish Government is lending it on top of that. That means more pain for the people who are expecting services that they are not getting.
Will the member give way?
No, I am in my last minute.
The member is in his last few seconds.
What does that mean for our health service in the Highlands and Islands? It probably means closing more wards and centralising local services, which I do not believe is the answer.
In times of adversity, our doctors, nurses and healthcare professionals, who continue to work harder than ever before, are being let down by the management of NHS Highland and by the Scottish Government. It is not too late for NHS Highland and the Scottish Government to improve the financial health of our NHS, but it will require good leadership, which we do not seem to have. It is time for change and somebody needs to rise to the challenge—I just wonder who that will be.15:46
A few points have been raised regarding finance and challenges. Anas Sarwar’s amendment refers to finances and Alison Johnstone and Edward Mountain also touched on that. The issue of brokerage has been raised. Brokerage is not new—it has been in the NHS system for some time. Back in 2007, the Parliament’s Audit Committee undertook work regarding the situation of NHS Western Isles. Brokerage was used to try to get that particular health board out of the mess that it was in and into a manageable situation.
Miles Briggs talked about challenges, and the one point that I will agree with him on relates to challenges. There always have been challenges in the NHS, there are challenges now and there will be challenges in future. As the cabinet secretary said in her opening comments, with an organisation the size of the NHS in Scotland, clearly, challenges will always come up from time to time. I think that across the chamber we can all agree on that. If politicians on all sides are going to be fair, it is extremely important that they genuinely recognise the success stories as well as the challenges that the health boards and, accordingly, the Government face. However, it is an important aspect of the health journey to learn the lessons of the past and to work to deliver a service that does not make the same mistakes in future.
I will touch on some of the positives as well as the challenges. Faced with £2.6 billion of Tory cuts over 10 years, including £200 million in this year, the Scottish Government is using the devolved powers to protect investment in our NHS. The Scottish Government is fully funding the NHS, with a £400 million increase in spending this year. Changes to tax mean that we do not have to reduce other services to back the NHS. The budget is now £13.1 billion.
Stuart McMillan and Ash Denham have misled the chamber in relation to funding changes in England and Scotland. NHS funding in Scotland is growing at half the rate of the increase in England. Had health spending under the Scottish Government kept pace, we would have had an extra £1 billion a year in our health service. Those are the facts that members need to tell people about.
Miles Briggs should know that every penny that has come to Scotland as a result of NHS increases in England has gone into the NHS here. If he says otherwise to the Parliament and to the electorate in Scotland, he is being disingenuous.
There is another positive element with regard to finance. The amounts mean that there is an uplift of 3.4 per cent in cash terms and 1.9 per cent in real terms. According to the Scottish Fiscal Commission, the changes to the draft budget that were announced at stage 1 of the budget bill will raise £290 million in 2018-19 to support public services and Scotland’s economy.
In March, there was unseasonably cold weather and we had Scotland’s first ever red weather alert for large swathes of the country. The army provided assistance to get staff and patients to and from hospitals through deep snow. In total, 25,399 operations took place in March 2018 compared with 23,664 in the previous month, which is a 7.3 per cent rise. Members should be saying, “Well done” to our hard-working NHS staff for their dedication and for fighting through snow and dangerous weather conditions to get to work and deliver services.
Only last week, a report to the Inverclyde Council health and social care committee highlighted that Inverclyde’s performance in ensuring that people spend the minimum time in a hospital bed when they are ready to be discharged is among the best in Scotland.
Will the member take an intervention?
In one wee moment.
The report also marked a reduction in bed days lost, which is the number of days that individuals wait to be discharged. The chair of the committee, Labour’s Councillor Robert Moran, is quoted as saying:
“This is excellent news for patients, families and carers ... The Council - through Inverclyde Health & Social Care Partnership - have made delayed discharge a priority to ensure older people do not spend longer than they need to in hospital.”
Briefly, Ms Baillie, as the member is coming to the end of his time.
I am delighted to hear Stuart McMillan praising a Labour council, and I am sure that they will enjoy that, too.
Will the member comment on the fact that £90 million-worth of repairs are required at Inverclyde royal hospital? What is he doing to progress that?
As my constituents know, I am on record as saying that no building lasts forever, as everybody in the chamber will understand. There will have to be either repairs to the current building or a new hospital at some point in the future. The fact that the building was built on the top of a hill is a ridiculous situation.
My final positive point is that we have had the great news that the new Greenock health centre will be progressed and built this year. We also had the official opening last year of Orchard View, the replacement for Ravenscraig hospital.
Those are the positives and, because of interventions, I do not have time to speak about the challenges. However, like any fair-minded MSP, I recognise that every health board has to live within its means. We only have to look back to NHS Argyll and Clyde under the shambles that was the Labour-Lib Dem Scottish Executive. The board had to be disbanded and needed £82.3 million to plug its debt. There was also the NHS Western Isles shambles, which happened when Murdo Fraser and Claire Baker were on the committee. Therefore, I will take no lessons from Labour or the Lib Dems, or from the Tories with the mess that the NHS is in down south. Although there are and will continue to be challenges for the NHS in Scotland, it is only this SNP Government that places NHS Scotland at the forefront and will deliver for the people of Scotland.
I remind members that if they intervene, they must press their request-to-speak button again. You are not listening to me, Ms Baillie, but that was for you.15:53
I declare an interest in that my wife works for the NHS. I hear from her every day about the good that goes on in the health service.
The Scottish Government is very skilled at public relations when it comes to the NHS in Scotland. The First Minister, along with the cabinet secretary, is often seen out and about with the cameras when there are good-news stories, and rightly so. We would be forgiven for thinking that the NHS in Scotland is streets ahead and a beacon of best practice for everyone else to follow but, sadly, the reality is often different.
The NHS must be at or near the top of the postbag of every MSP. Week in, week out at question times and in the media, MSPs of all parties raise cases and concerns about health and social care. Accident and emergency department waiting times are growing; cancer waiting times are again not being met; last year, 16,000 people waited over an hour for an emergency ambulance; Scotland has the highest level of drug deaths in Europe, which is three times the level elsewhere in the UK; and 363,000 bed days were lost last year in Lothian due to delayed discharge.
Before we hear any more patronising nonsense about talking down the NHS or undermining its staff, let me say this: it is the staff who are raising many of those issues with us. They are burned out, shattered, under pressure and stressed like never before in their careers. They are the ones who care most and who have invested their careers in the NHS. We have a duty to stand up for them and be their voice in the Parliament.
Let me focus on how the situation is impacting people on the ground. In Lothian, patients are having to wait 44 weeks just to see an orthopaedic specialist—not for treatment but merely for a consultation. A constituent of mine who works in a gym was forced to go off work with a leg injury. She waited so long for an appointment that her employer was threatening her with the sack. She is far from alone. I have many orthopaedic cases in my constituency case load.
I see patients who have moved into new communities and are unable to register with their local GP because 40 per cent of the lists in Lothian are closed. I have a relative who is in St John’s hospital. She is ready and willing to go home but cannot because she is waiting on a package of care. That bed space could be freed up for another patient. A total of 1.6 million bed days have been lost since the cabinet secretary said that she would eradicate delayed discharge.
We are rapidly heading for the first anniversary of the closure of St John’s children’s ward to in-patents out of hours. Parents are having to drive—if they have a car—their sick and injured children past their local hospital to Edinburgh because the ward is closed at evenings and weekends. The Royal Alexandra hospital children’s ward has already closed.
We all know that general practice is so critical to the wellbeing of the NHS, yet it is in crisis. According to the Royal College of General Practitioners, there is a shortage of 856 GPs across the country. Last night, in the village of Stoneyburn in my region—a village of just 2,000 people—300 residents turned out to a public meeting to protest with one voice against the proposal to leave the village with no GP provision. That is more than one in seven of the population. As in many other practices across the country, the local GPs there are retiring, and there have been zero applicants to take over. I am told that, 10 years ago, there would have been a dozen applicants—now there are none. What does that mean for people? If they have a car, they can travel. If they do not, as there is no footpath to walk, they need to use the very poor and infrequent bus service at a cost of £4 for a return ticket or £7 if they have a sick child with them. I have to say to the cabinet secretary that, for people in that position, healthcare is no longer going to be free at the point of need.
This situation is an abject failure of long-term planning for general practice across Scotland by successive health secretaries. The age profile of GPs cannot have been a surprise to the Government. We now have a system that would collapse without locum cover, which costs around £500 per day in Lothian and £850 a day in Lanarkshire. In Orkney, the health board is paying up to an eye-watering £1,400 a day for locum cover to try to keep the system going. When we add to that the millions lost through the increased use of agencies that charge extortionate amounts, is it any wonder that health board finances are at a critical level?
The Government’s stewardship of our NHS has been dreadful. In the past, a First Minister resigned because of an issue with an office lease and Stewart Stevenson resigned because it snowed. Today we have a cabinet secretary who is overseeing the worst waiting times on record, delayed discharge increases, a crisis in general practice, wards being closed and NHS finances in such a state that boards are robbing the charity box to try to keep services going, yet she retains the confidence of the First Minister.
The Government likes to claim credit for good things. Now the cabinet secretary and the Government must accept responsibility for the bad.15:59
I refer members to my entry in the register of members’ interests, as I am a registered mental health nurse and I currently have an honorary contract with NHS Greater Glasgow and Clyde.
As a mental health nurse who has worked in the NHS for more than two decades, I am well aware of the challenges that it faces today. Thankfully, our population is now living longer due to advances in medical treatments and care, but that means that the pressures and demands on our NHS are growing. To meet the challenges that our health service faces, the Scottish Government has undertaken major reforms by integrating health and social care, as well as investing record levels of funding in our NHS, which has topped £13 billion this year, in spite of on-going Tory austerity.
Today’s Conservative motion refers to financial difficulties that are being faced by health boards across Scotland. That is, of course, true, but I would go much further. Financial problems are being experienced in Northern Ireland and in the NHS in Tory-run England and Labour-run Wales. The challenges that are faced by NHS Ayrshire and Arran, NHS Tayside and NHS Lothian are not unique to Scotland. For example, 83 per cent of acute hospital trusts in England were in deficit to the tune of £1.5 billion according to figures that were released in September last year. The Hywel Dda University Health Board in Wales, which serves Carmarthenshire and Pembrokeshire, has a budget deficit of around £69 million. The largest health board in Wales is also subject to a charity cash probe.
Being a healthcare professional myself, I fully appreciate the concerns of the public and politicians regarding the spending of charitable donations in NHS Tayside. It is imperative that health boards use such money appropriately and for its intended purposes. The inquiry into the NHS Tayside endowment fund by OSCR is the correct step and, rightly, NHS Tayside has proactively agreed to repay the money to the endowment fund. If any expenditure in any health board across Scotland is deemed to be inappropriate, I agree with the Scottish Government that it must be paid back to the charitable funds from which it came.
I hope that Opposition parties will join me in welcoming the request that was made by the Scottish Government to the chief executive of NHS Scotland to write to every NHS board chair seeking assurances that endowment moneys are being spent for the correct purposes. When the issue was brought to the attention of the cabinet secretary, she took the “immediate action” for which the Conservative motion is calling. She has taken the decisive step to replace NHS Tayside’s leadership team, she has authorised further brokerage to the health board and the Scottish Government is continuing to work to improve governance and organisational performance across the public sector.
I hoped that today’s debate would be one in which proposals and ideas about how we can improve the governance and performance of our NHS would be forthcoming from Opposition parties. Instead, Opposition parties have merely sought to add to the witch hunt against the Government. Labour and the Conservatives have been incredibly predictable. When a challenge faces the Government—rather than suggesting reasonable proposals and working with it—they revert to the only two things that they know: calling for the Government to spend more money and urging ministers to resign.
Will the member take an intervention?
Will the member take an intervention?
It seems clear that Clare Haughey is not taking interventions.
I will take them later.
It is noticeable that the Scottish Conservatives have been silent on the sham of the health service that Jeremy Hunt is presiding over in England. The Red Cross once described the English NHS as facing a “humanitarian crisis”, and it was rocked by junior doctors’ strikes. Indeed, the silence has been deafening from Scottish Labour, too. The Welsh NHS is consistently among the worst performing in the UK, yet the cabinet secretary who is presiding over it is a favourite to become the next First Minister of Wales.
I am a member of the Scottish Parliament and responsible for my constituents, as is the member. What comfort or advice can she give to the 300 people who came to the public meeting in Stoneyburn last night? They said that they did not accept the fact that they will no longer have a GP in their local community.
We cannot always compare health systems across the world, but we can compare health systems across the UK. [Interruption.]
I would like to hear Clare Haughey, please.
The Scottish NHS consistently outperforms every other NHS on these islands. The fact that Labour and the Conservatives voted down the Scottish Government’s budget earlier this year shows that they are happy to play political football with our health service. The budget would have allocated more than £400 million in additional funding, yet neither party voted for it. The fact remains that, at the last Holyrood elections, Labour promised less money for the NHS than the Tories did. If we couple that with Tory austerity, I do not know how either party can keep a straight face when it complains about health service finances.
I am resolute in my belief that our NHS is better off in SNP hands. The proof of that lies in the woeful state of the NHS in England and in Wales, where the Tories and Labour are in charge. They do not want to hear that, but hear it they must. Privatisation by the back door and the front door, trusts cancelling weeks of planned surgery and eye-watering waits at accident and emergency departments—you would almost think that there is a plan to run down this most cherished of services so that wholesale privatisation is seen as the only viable alternative. [Interruption.]
Can we have some quiet please?
Today’s debate comes in the same week as three positive news stories about Scotland’s health service. [Interruption.]
Mr Dornan, you will get your turn shortly.
Part 3 of the national health and social care workforce plan was published, with £7 million of investment in nurse training, and I warmly welcome that. Scotland’s A and E figures were once again shown to be the best in the UK. Further, this was the week when the Scottish Government’s minimum unit pricing policy finally came into force.
Yes, our health service is under pressure and, yes, particular health boards have more challenges than others, which must be addressed. However, we have not heard from any MSP today why the issues that are facing particular health boards are the direct fault of the cabinet secretary, and petty games such as those being played in this chamber today trivialise our politics. We should let the cabinet secretary get on with her job of improving our NHS, which is already outperforming all the other ones in these islands.
I remind members that they should always speak through the chair.16:06
I am pleased to have the opportunity to speak in today’s debate about the severe financial problems that are facing NHS Scotland. We see daily news articles on financial problems up and down Scotland, and people are rightly very worried. The Scottish Conservatives wish to see a Government that has control over health spending and one that promotes financial transparency, which is why I, too, echo the calls that have been made by Miles Briggs.
The SNP has been in charge of the NHS in Scotland for more than a decade, so it is absolutely right that we shine a light on this issue. Despite the SNP’s spin, spending is not keeping pace with increased demand, nor is it keeping pace with increases that Scotland has seen in Barnett consequentials. Health spending in Scotland has increased by just 5 per cent between 2012-13 and 2016-17.
Does Annie Wells accept that every penny of health resource consequentials has been passed on to the health budget in Scotland, and that there has been more money in addition to that? If she thinks that more money is needed for the NHS, will she tell us how much, and from where it will come?
Maybe we need to look at how the money is being spent in the NHS to make sure that we are focusing on the places where it is needed.
In my region, Glasgow, spending has stagnated. In the Government’s draft budget, the NHS Greater Glasgow and Clyde budget shows a real-terms cut of £22.5 million, and it has been reported that the health board is facing a funding deficit of up to £20 million. Quite clearly, it is under huge financial pressure, and that is only being made worse by the mismanagement of the NHS by the SNP Government.
As confirmed by last year’s Audit Scotland report, the SNP has failed to plan effectively for the future when it comes to the workforce. One in four GP practices in Scotland has a vacancy, for example, and there are more than 2,500 nursing and midwifery posts lying vacant. As a result of that, spending on temporary staff has soared. Last year, spending on plugging staffing gaps broke the £300 million mark for the first time. That was an increase of more than £100 million on 2014-15 figures.
As a ripple effect of the SNP’s failure to provide adequate community care for elderly people, we have also seen increasingly high levels of bedblocking. In 2016-17, more than half a million bed days were accounted for by patients who were fit to leave, the majority of whom were elderly. Delayed discharge is estimated to cost £132 million a year and, only yesterday, new figures showed a 3 per cent rise between March 2017 and March 2018.
I would argue, too, that there is little preventative spending, which would ease financial pressures in the long run. On alcohol and drugs, for example, there has been a 22 per cent cut to ADP funding, which the BMA described as a false economy. In Glasgow—a city that has a complex history with drugs and alcohol—NHS Greater Glasgow and Clyde has used endowment funding for a proposed safe heroin injecting space when that money could instead have been used to get people off drugs altogether.
The impact of that is huge. We can see the effect that understaffing and underfunding have had on performance. Last year, the NHS achieved only one of its eight key waiting time targets. More than one cancer patient in eight waits more than 62 days for urgent treatment and more than a quarter of children wait far too long for mental health treatment.
Will the member give way?
Not at the moment, thank you.
I am currently dealing with the case of a young girl in Glasgow with spina bifida who needs an operation that could dramatically change her life. However, she has to wait until the end of the year due to a lack of consultants. That means that, since March last year, she has been attending A and E on average twice a week. I say to the cabinet secretary that that is not on.
I echo my colleagues’ calls for better control of, and more transparency about, NHS spending in Scotland. The SNP can no longer bury its head in the sand when it comes public health spending. We have a health service that is underfunded, understaffed and, to put it simply, under pressure. Our hard-working front-line NHS staff throughout Scotland are suffering as a result of the SNP’s inability to deliver proper investment and resources.
Will Annie Wells give way?
I am just concluding.
Those staff deserve better for the great work that they carry out each day in difficult circumstances. I hope that the debate finally jolts the SNP members into action.16:11
I was going to start by doing one thing, but I have just decided to go in another direction.
The party that sits to my left but is politically to my right—the party to my right is still to my right—calls itself the party of the union but, as soon as there are any comparisons with other parts of the union that it holds so dear, that we are all so much a part of and that it, the Labour Party and the Lib Dems worked so hard to keep together, its members go up in smoke and say that it is not right and nothing to do with anything. We all work under exactly the same conditions. The national health service might well be in Scottish control, but the budgets—[Interruption.] The budgets are dictated by what happens in Westminster.
The only way that we could see what the NHS in Scotland would look like if the Tories were in control would be to look at what they do, not what they say. Therefore, we have to look at what the NHS is like in England. It is an absolute shambles. The BMA itself said that the NHS in England is in complete chaos, that the health service could
“suffer a repeat of scenes experienced during winter 2016”
and that that
“would equate to just 87.5% of patients being seen”,
as opposed to the 90-odd per cent that are seen in Scotland.
I have not even started on the Labour Party yet. We have the ridiculous situation—[Interruption.] We have the ridiculous situation of the two parties with the worst health service records where they are in power trying to get rid of the best health secretary in the United Kingdom. If it was not for petty party politics, you would not come to the chamber and blooming demean it with motions such as the one that we are debating.
Last week, Ruth Davidson came and told us that our party was working in the nationalist interest and not in the national interest. I would have thought that she would have been here today to tell us how that was all wrong but, of course, Labour and the Lib Dems put a stop to that when they said that she would be the isolated one on the UK Withdrawal from the European Union (Legal Continuity) (Scotland) Bill. The best way to reunite that unholy trinity is for you to jump on the back of the bandwagon that was started by Willie Rennie and Anas Sarwar.
Oliver Mundell (Dumfriesshire) (Con) rose—
Excuse me, Mr Dornan. I ask that members speak through the chair, cut down on some of the noise and remember that we should always be courteous to fellow members.
Willie Rennie and Anas Sarwar were fighting over who could be first to demand the sacking of the cabinet secretary. It was unseemly, and the speech that Anas Sarwar made today should be taken out of the records of the Scottish Parliament. It was nothing but scandalous.
Labour members have a record that nobody could be proud of—not even their mothers, and certainly not their founders. We come here today on a motion that is based on the misuse of charity funding. If we look at Labour in Wales, we find a situation with an organisation called Awyr Las, serving the Betsi Cadwaladr University Health Board in north Wales. It did exactly what NHS Tayside has been accused of here in Scotland, but that was agreed by the Welsh Government, which is run by Labour. It was a system in which £450,000 of charitable donations was being used for staff improvements—and Labour members are trying to tell us that we have got it wrong.
The health secretary was not in post when the charitable trust in question was put in place. If she had been, it would not have been put in place in the way that it was. She is dealing with it in the way that she has been asked to deal with it, and we still get the ridiculous situation of Labour members asking for her to go—for something that is completely outwith her—
Will the member give way on that point?
If it is not at the feet of the current health secretary that the blame should rest, should it rest with the former health secretary, by which I mean the First Minister of this country?
The difference between you and I, Alex—
Speak through the chair, please.
I am sorry, Presiding Officer. I think that the difference between myself and Mr Cole-Hamilton is that I am not always trying to personalise the issue. [Laughter.] What? This is about trying to solve the problem. In all seriousness, this is about trying to solve the problem.
The cabinet secretary has already taken steps. We have heard two absolutely pathetic interventions from Mr Sarwar and Mr Findlay on the Labour benches—nothing that we would not expect from either of them—that were all about personal attacks. They had nothing positive to say, made no moves towards improving the health service, and refused to take responsibility for anything that could be laid at their door. It is just another cheap political stunt by the two sides of better together.
Will Mr Dornan take an intervention?
You were not here for the beginning of the debate. You are not taking part now. My apologies, Presiding Officer.
Will the member give way?
He is not taking interventions, Ms Marra.
The two sides of better together have got together to try and take down one of the best cabinet secretaries in this country and the best health secretary in the United Kingdom. It is nothing but cheap politics. I think that we should rule out the motion and all vote for the SNP amendment.16:17
I am not sure how to follow that, Presiding Officer.
In all seriousness, there does not appear to be a day that passes when the NHS is not in the news. Unfortunately, it is not for the enormous achievements that we know are made by NHS staff who work so hard to help us get well. [Interruption.]
Excuse me, Ms Baillie. Can we stop the conversations flying between benches, please? It is very rude, and I am sure that Ms Baillie has a lot to say.
I do indeed, Presiding Officer.
The NHS is increasingly in the news because it is underresourced, undervalued and overworked. The news is increasingly about the missed targets, the lengthening waiting times and the lack of staff, and it is increasingly about the NHS being failed by the Scottish Government. Of course, the NHS is operating in a financial straitjacket. Audit Scotland identified a real-terms cut to the health budget. The Conservatives have focused on financial accountability and transparency, and it is important to cut through the Government spin to understand the scale of the challenge faced by health boards across Scotland.
A number of speakers have already covered that, so instead I will focus on the patients’ experience of the NHS today. Let us try to see it through their eyes. I say as gently as possible that they are not impressed by the sight of the health secretary on television, as she was last night, telling everyone that things were improving. Maybe that is the case in a parallel universe, but it is not based on my constituents’ experience here in the Scottish NHS.
Let me tell members about my constituents’ experience of waiting times. In orthopaedics, urology, ophthalmology, A and E and cancer, waiting times are all up. Some constituents have been waiting for more than a year, crippled with pain and now housebound as a result of the fact that they could not get surgery. The absurd situation in my constituency is that access to the Golden Jubilee, which is minutes down the road, is rationed—or, indeed, denied—by NHS Greater Glasgow and Clyde. There is also the waiting time to see a consultant, never mind the time to get treatment. In ophthalmology in my area, constituents with cataracts have been told that it will be 30 weeks before they can see a consultant, never mind get any treatment.
Will the member give way?
No, not at this stage.
For cancer patients, the situation is heart breaking. We all know that early detection, diagnosis and treatment increases people’s chances of recovery. However, even here, targets are not being met.
I have raised screening for suspected breast cancer patients with the cabinet secretary before. This is about patients who are referred urgently by GPs because they suspect breast cancer. It is meant to take less than 14 days to get a clinic appointment, and in practice it used to be much quicker, but now it takes more than six weeks. That could cost a woman her life.
I raised that with you on 24 October 2017, and you replied on 13 November to reassure me that matters had been resolved and remedial action had been taken.
Please speak through the chair, Ms Baillie.
I wrote again with the same problem on 11 December, and the cabinet secretary replied on 23 January, saying that there was no problem and that everything was fine. Either the cabinet secretary was deliberately misleading or NHS Greater Glasgow and Clyde was pulling her leg. I still have constituents who, just a month ago, were waiting for six weeks.
I wrote again to the cabinet secretary—
Will the member give way?
Allow me to finish. I wrote again to NHS Greater Glasgow and Clyde and to the cabinet secretary on 19 March. I have not yet had a response. How many letters will it take before action is taken?
I was absolutely assured that those issues had been resolved. If Jackie Baillie is telling me that they are not resolved, I will certainly look into it and get back to her as a matter of urgency, as I am sure she appreciates that of course I would.
I very much welcome that commitment, because it is outrageous for any Government to fail women in that way. I regret that there appears to be a degree of complacency when people do not even bother to respond.
How disappointed I was to see that a review of cancer waiting times has been sneaked out today. There is no press release—it was just sneaked out, which is truly shocking.
It is easy to blame the cabinet secretary, but she is not the boss. It is Nicola Sturgeon’s responsibility, and it is a failure of leadership by her: Nicola Sturgeon keeps the cabinet secretary in place when she is struggling because Nicola Sturgeon is too scared to have a reshuffle.
Will the member give way?
No, I will not give way.
It is not just the Opposition that is saying that the Government is failing the NHS. Audit Scotland has said it, too, and—perhaps more politely than we would say it—the BMA, which represents doctors and consultants, has told us that the NHS is “at breaking point”. Patients are contacting their MSPs with heart-breaking stories to complain that they have been let down by a system that is not working and a Government that is in denial. There is no denying the Scottish Government’s record: 107,000 patients waiting longer in A and E; 3,000 planned operations cancelled; and 1.6 million bed days lost due to delayed discharge—I could go on and on.
I know that SNP members like to deflect attention—we have heard that today—but they cannot blame Westminster, Brexit, local government, or even Wales. The Scottish Government is in charge. Health is devolved. There is no-one else to blame but themselves. Frankly, trotting out the excuse that we are doing better than elsewhere in the UK demonstrates a depressing lack of ambition. To simply accept that, although we are bad, we are not the worst is not good enough for patients in Scotland. The cabinet secretary and her Government inhabit an alternative reality, but her sticking-plaster approach to the NHS is letting down staff and patients. It needs to stop now.16:24
First, I would like to say something positive about the wording of the motion, which is slightly better than the wording in some others that we have seen on the subject. This time, we are not overusing the word “crisis”, but we are using the word “problems”, and “challenges” have also been mentioned. I think that we all accept that there are problems and challenges.
We then need to consider what is meant by the words “financial problems”, because there are several types. First, there are accounting problems, when something is not recorded properly or money for one fund has been used elsewhere. Secondly, the problem could be that the money that is available to the health service is not being used as well or as efficiently as it could be. Thirdly, the financial problem could be that there is not enough money. If that is the case, we need to consider whether there is not enough money for all that we would like to do, or for all that the health service could do.
The reality is that our health service could use almost any amount of money. It could always employ more nurses and other staff, replace old equipment, build new buildings and buy new drugs and equipment, however expensive they might be.
Will John Mason take an intervention?
Let me get a bit further.
We will never have unlimited resources, so we will always need to choose our priorities. Should we spend less on hospitals and more on primary care? Should we spend less on physical care and more on mental health? Those are not easy choices, and clearly they should be made after serious investigation and discussion among health professionals, patient representatives, managers in the health service and politicians, to name but four groups.
At this point, I will say how I think we should not allocate resources: we should not put a vulnerable person in the gallery of this Parliament and demand that the cabinet secretary or the First Minister immediately provide them with the latest drug or treatment irrespective of how expensive it might be or how uncertain the outcome might be. In my opinion, that verges on abuse of vulnerable people, and it is potentially damaging to the NHS because it risks upsetting the balance of how it is trying to use its resources.
I am happy to take Brian Whittle’s intervention now.
Does John Mason agree that it is very difficult to recruit to the NHS when people are leaving faster at the other end?
If Brian Whittle’s argument is that it is difficult to forecast how many teachers we will need in 10 years, or how many nurses or whatever we will need, I agree. At times in the past we have had too many nurses or too many teachers and the complaint has been, “You’re not giving them jobs.” It may be that, at other times, we do not have enough of them, but that is not just a Scottish problem: it is a problem all over and it will, I suggest, always be a problem for any Government.
Does John Mason agree that Brexit will hamper work to get more people into the NHS, compared with the situation that we currently have?
I completely agree with that.
I note the demand in the motion for
“the immediate publication of the current financial position”.
I am not sure how literally that was meant to be taken or whether it is just slightly poor wording, but I would like to comment on it as an accountant. From a practical point of view, members will realise that, even with modern technology, it takes time to prepare financial accounts. The more accurate we want them to be—with a balance sheet, valuation of stock and all such things—the longer it takes to get reliable figures. I note that the cabinet secretary suggests in her letter today to Lewis Macdonald that April and May figures will be available at the end of June. I absolutely support transparency in principle, but I urge a little realism on timescales.
The motion also uses the word “accountable”. I checked the meaning of that in the dictionary, which says that the definition is:
“required or expected to justify actions or decisions”.
That is certainly what is happening today. The cabinet secretary is here, is accountable and is justifying her actions and decisions. She is answering questions in the chamber. Again, the wording in the motion is poor when it says
“should be held accountable”.
The cabinet secretary is being held accountable. However, it does not mean that she is responsible for every single little decision that is made in every part of the health service, and it certainly does not mean that she should resign if one or two of those decisions were wrong.
I turn to another issue that has been raised both in the Labour amendment and by the Lib Dems. The Labour amendment mentions “financial pressures”, and the Lib Dems suggested that budgets and policies have not been sufficiently adjusted. Again, exactly what that means is unclear to me.
If the key message is that more money should be put into health, that raises more questions. Health has been one of the best-protected sectors under the SNP. Spending on it is now at £13.1 billion, which represents 43 per cent of the Scottish budget, and is up from 38 per cent in 2008-09.
Will John Mason take an intervention?
I am sorry. I have taken two interventions already and cannot take another.
When I was on the Finance Committee, some business organisations said that we were spending too much on health. If Opposition MSPs are arguing for more money for the NHS, where is it to come from? Should we raise taxes? I do not think that the Tories would support that. Labour has said that it would raise a huge amount of money, but it cannot tell us where it would come from, and nobody has checked that.
Should we cut expenditure in some other sector in order to give more to health? Would that mean cuts to colleges, councils or what? The reality is that all of us—all organisations and all parts of the public sector—have to live within our means. We have to make difficult choices and prioritise the most important things over those that are good and desirable but are not high priorities. Opposition politicians would have more credibility and be more respected in here and outside if they came forward with realistic alternatives.
Shona Robison does an excellent job on what is clearly one of the most difficult and challenging portfolios. I would not want her job: I congratulate her on sticking to the task despite the unjustified criticism.16:31
I refer members to my entry in the register of interests, as I have a close family member who is a healthcare professional in the Scottish NHS.
I agree with John Mason that the health brief is one of the most challenging in the Government. It is a brief in which achieving constructive dialogue and effective change can be problematic, not least because of the adversarial environment that politics engenders.
However, we cannot ignore the situation that has evolved in the past decade. We are debating the financial crisis that is enveloping the NHS. That crisis follows the GP crisis, the poor mental health provision crisis, the social care crisis, the recruitment and retention crisis, the continuing rise in drink and drug deaths, the obesity crisis and so on. The lack of cohesive joined-up planning is becoming all too evident.
I will give an example. Ayrshire and Arran NHS Board is considering closing the Ayr hospital cancer unit and amalgamating it with the one at University hospital Crosshouse. Consideration of the merits or otherwise of such a move has failed to take into account the lack of adequate infrastructure and public transport from outlying areas. It will take someone who happens to live in Ballantrae in South Ayrshire more than three hours and two bus changes to get to Crosshouse for their cancer treatment, and then they will have to make the return journey. If people take their cars, where exactly will all the extra patients park? The car park at Crosshouse is absolutely rammed.
It is clear that patient care is not the top priority and that the decision is most certainly financial. Given that NHS Ayrshire and Arran is more than £23 million in debt, how can it be expected to deliver the four satellite treatment centres that are in the cancer treatment plan? Inevitably, patients are the ones who suffer the consequences of that poor financial planning.
The reality is that the barometer by which we should be judging the management of the NHS is the health and wellbeing of our nation. By just about any measure one cares to mention, the Government is failing. Scotland is the unhealthiest nation in Europe and the unhealthiest small country in the world. As I have previously stated, we hold the top rank in too many unhealthy tables.
Perhaps more important is the fact that the health of our healthcare professionals continues to decline. In fact, our healthcare professionals’ health is below the national average, which is already poor. As the Convention of Scottish Local Authorities stated in evidence to the Health and Sport Committee, healthcare professionals will sacrifice their own health to look after the health of others. It is not overstating the case to say that if the SNP does not address that issue by giving our NHS staff an environment in which they have access to a decent work-life balance, which we want them to promote to others, every Scottish Government strategy is doomed to join the litany of failures over which the Government has presided in the past decade.
Much has been made of recruitment to the NHS—which I asked John Mason about—to alleviate the chronic staff shortage that has been created by consistent poor workforce planning by the Government. However, looking after our healthcare professionals speaks to the retention of staff and the invaluable experience that is lost if they leave, and to reducing the high levels of absenteeism in the healthcare profession due to stress and the unhealthy working environment in which the Scottish Government makes our healthcare professionals work.
Has Brian Whittle given any thought to, or made any assessment of, how Brexit and his party’s budget, which has reduced funds to the public sector, could affect the workforce in the NHS?
I thank Fulton MacGregor for his intervention, because it allows me to point out to him that although SNP members are quick to say that there is a record amount of investment in the NHS, we are in a financial crisis. We have a record number of staff vacancies in the NHS, yet SNP members say, “It’s Brexit!” You have been in power for 10 years; 10 years—
Please speak through the chair, Mr Whittle.
When I raise the preventative health agenda, the cabinet secretary and her team are always enthusiastic in their desire to shift in that direction, and I believe them. The trouble is that we cannot judge them on the matter, because they cannot effectively address it while they are continually firefighting problems of their own making. This is not the environment for the long-term strategy planning that is required to support our NHS staff and put the service back on an even keel.
The cabinet secretary must get firm control of finance. It is not all about the money that is spent; it is also about what the money is spent on. As we heard today, and as the Health and Sport Committee has heard in evidence on NHS governance, the spending patterns of health boards and IJBs are not being properly tracked and accounted for.
Where does responsibility lie? There are members in this Parliament who have been calling for the cabinet secretary’s head. I am not going to join them. For the most part, I think that calling for a minister’s resignation is a card that becomes ineffectual if it is overplayed in the political arena. Anas Sarwar has proved that.
It is the Government’s responsibility to appoint its front bench, and the performance of the front bench therefore reflects the SNP. The fact that the cabinet secretary is still in place indicates that the Scottish Government is happy with how the NHS is being managed. We should all be concerned about that.
Patience might be a virtue, but as Miles Briggs said in his motion, if “sustained and immediate action” is not taken,
“the Cabinet Secretary for Health and Sport should be held accountable”.
The cabinet secretary and the SNP cannot keep pointing the finger elsewhere. It is time to accept responsibility and to take the crucial action that is required, or step aside.16:36
I thank Miles Briggs and his colleagues for bringing this important and pressing matter for debate this afternoon.
This has been a well-informed debate, with passionate and interesting speeches from members of all parties. In a spirit of consensus, let me say that Labour endorses Liz Smith’s comments about the management of integration joint boards. She made an excellent point and I put on record that we fully support what she said.
Of course, this debate is not about numbers on a spreadsheet, but about the conditions that are faced by staff and patients in our hospitals and communities. As Anas Sarwar, Neil Findlay and Jackie Baillie said, NHS staff in Scotland have been underpaid, undervalued and underresourced, and patients have been feeling the pain of that, with A and E targets being missed, planned operations being cancelled, bed days being lost to delayed discharge, social care budgets being slashed and seven out of eight key targets being missed for two years, according to Audit Scotland.
Like every member in this chamber, I am passionate about the NHS. It is not just another issue, another debate or another headline. Again, like many members, I have family and personal connections with the service. My brother-in-law is a mental health nurse, my neighbour is a midwife, and my close friend is a senior staff nurse.
Members talked about the history of the NHS, and I, too, am aware of its creation, although I was not there at the time. On 5 July 1948, Sylvia Beckingham was admitted to hospital to be treated for a liver condition. That was a big event in her life but it was an even bigger event in British history. The 13-year-old was the first patient to be treated by the national health service. The NHS—our NHS—will be 70 years old in July.
As we all know, the Labour Party created the NHS. Three score years and 10 later, we are still defending it. In 1948, when the service faced a shortage of nurses early on—a familiar story—Nye Bevan pushed up nurses’ wages to attract recruits. That is a solution that I recommend to the cabinet secretary.
The 1960s saw the first British heart, liver and kidney transplants. Indeed, the first kidney transplant took place in Edinburgh royal infirmary. The 1970s saw the first test-tube babies, as well as computerised tomography scans, which revolutionised how doctors examine patients.
Like everyone in this chamber, I am proud of what the NHS achieves. I am prouder still of its hard-working front-line staff—the junior doctors, nurses, midwives, consultants, GPs, allied health professionals, porters and receptionists.
Despite the hard work and commitment of its staff, the NHS faces challenges. Alison Johnstone, Alex Cole-Hamilton, Liz Smith, Ash Denham, Edward Mountain, Annie Wells, Miles Briggs and Brian Whittle talked about challenges such as our ageing population, the pressures on social care, the need for robust workforce planning now and post-Brexit, and the growing mental health crisis. Such public health challenges may look modern, but, under the surface, the root causes are the same old story: poverty, social deprivation and inequality are significant contributors to poor health expectations, and it is the least well-off who are most at risk. We need to reverse the inverse care law, under which patients who are most in need of healthcare have the least access to it.
Back in 1948, the NHS represented the advance of egalitarianism in our nation. There was great hope for the new future that it heralded. A news article in The Manchester Guardian from the time noted that the changes were
“designed to offset as far as they can the inequalities that arise from the chances of life, to ensure that a ‘bad start’ or a stroke of bad luck, illness or accident or loss of work, does not carry the heavy, often crippling, economic penalty it has carried In the past.”
Inequality in health was a serious issue then and, sadly, it remains one now. Life expectancy in the UK has stalled and, in the past 50 years, the chasm between the health outcomes of the rich and the poor has widened. Is it not an outrage that, in the 21st century, individuals’ health expectations are intrinsically tied to their postcodes?
The theme of the debate has been NHS financial accountability and the need for change. However, members should not just take my word that change is needed. As Professor Sir Harry Burns said to the Health and Sport Committee this week, we need “complex system change” in the NHS. Elsewhere, Dr Peter Bennie, the chair of the BMA’s Scottish council, said that the NHS workforce was stretched to breaking point. In a survey, RCN Scotland showed that nine out of 10 nurses say that their workload has got a lot worse. In a brief to our Health and Sport Committee, NHS Lothian said:
“Over the last 3 years NHS Lothian has not been able to present a balanced financial plan at the start of each financial year and has increasingly relied on non-recurrent resources to achieve financial balance.”
I close by reminding members that Nye Bevan famously said:
“The NHS will last as long as there’s folk left with faith to fight for it.”
At 5 o’clock, let us put our faith in front-line NHS staff across Scotland.
I call Shona Robison. You have around seven minutes, please, cabinet secretary.16:42
I vote for Dave Stewart to be Labour’s health spokesperson. That was a considered and well-informed contribution to the debate and, I have to say, a bit of a stand-out one from his party’s benches.
I will try to respond to as many members’ contributions as I can. I apologise if I do not manage to do that for them all. First, I want to respond to remarks made by Anas Sarwar and Jackie Baillie about the clinical review of cancer waiting times standards. They are both simply wrong. First, we will not scrap cancer waiting times targets. The report to which they referred is from an expert group of cancer clinicians who are looking at specific cancer pathways to ensure that they are in line with best clinical evidence and practice. The chair’s foreword to the report said:
“the retention of the CWT standards was agreed ... from the outset.”
What the report is looking at is potentially shortening some of those pathways for certain cancer types. We will consider the cancer clinicians’ recommendations in due course, as members would expect us to.
I want to be very clear in response to those who have commented on the budget for the health service. The uplift to our health budget amounts to 3.4 per cent in cash terms and 1.9 per cent in real terms, taking the budget £360 million higher than real terms-only increases since 2016-17. For our front-line NHS boards, that is a 2.2 per cent increase in real terms—not a reduction. It is important to put that on the record.
As I said earlier, if Scottish health spending had kept pace with increases in English health spending, an extra £1 billion would be being spent on health in Scotland today. Does the cabinet secretary not accept that point?
What I accept is that all resource consequentials—and some more—have been passed on to health in full in Scottish Government funding. I also accept that health spending in Scotland is 7.5 per cent higher per head than it is in England, which should surely be welcomed. That equates to more than £880 million more spending on health services in Scotland. I hope that that puts to bed the Tories’ arguments.
I turn to Alison Johnstone’s remarks. I hope that she agrees that I have acted on some of the concerns that she raised on the transparency of finances, and that she welcomes my action. She mentioned longer-term funding. The situation has been challenging. Given that we get a one-year budget—the budgets are set by the UK Government and it is only once it does so that we know what our budget is—it is difficult to project what the funding will be over a longer period. However, I accept that we need to try to do that, and the framework that we will publish in the next few weeks is an attempt to look at a five-year funding horizon. Again, I hope that Alison Johnstone will welcome that action.
Alex Cole-Hamilton cited a Daily Mail article that says that Scots patients cannot get painkillers prescribed on the NHS in Tayside. I categorically say that NHS Tayside has said that there are no plans to stop prescribing such medicines in primary care, where it is clinically appropriate to do so. I hope that that reassures Alex Cole-Hamilton, and anybody else for that matter.
On the resignation of John Connell, the previous chair of NHS Tayside, I want to be clear that there is no question about his probity or his contribution to public services. We had a combination of events—not a single event about the endowment fund, which predated his time in office, as it did mine—which resulted in the conclusion that new leadership was required in NHS Tayside. Consequently, I took the action that I did. The new chair and the new chief executive in NHS Tayside are making rapid progress on a number of the issues.
The cabinet secretary knows that we are in this chamber initially because of problems in our local health board. Figures released last night show that there have been 72 drugs deaths in the city of Dundee since this time last year, which is a shocking doubling of the figures on the previous year. Will the cabinet secretary take this opportunity to tell me what she is doing about the drugs crisis in Scotland and how she will fund services?
Jenny Marra will be aware that a commission has been set up in Dundee to tackle the matter. She is aware of the complexity of the issues in the cohort involved. I have met those on the commission. I hope that the member has done likewise, because it is important to understand the commission’s programme of work; if she has not, I suggest that she does.
I welcome the tone that Liz Smith took in her speech; hers was another important contribution. I agree that it is time to review the IJBs, and I have said that I will do that. I also agree with her about the governance issues on endowment funds. That situation has taught us a number of things, including the need for us to have far better auditing of the processes, so that such issues are pulled out for people to see. With the best will in the world, it is difficult for me as a minister or for Government officials to plough through every report of every public body. We require our auditing processes to highlight and red flag such issues. Many of the organisations involved must learn that lesson. I give Liz Smith the commitment that, on the endowment funds governance issues, we will take action in partnership with OSCR to make the improvements that she called for.
How long have I got, Presiding Officer?
You have another minute and a half, cabinet secretary.
Edward Mountain raised a number of issues. Although I have had this exchange with him on a number of occasions, it is worth while reminding the chamber that the decision on Caithness maternity unit was taken due to patient safety concerns after the death of a baby. Taking decisions on such issues are never easy. As a minister, I must listen to the clinical advice that I am given from the chief medical officer and others. It would have been impossible for me not to have taken that advice.
The governance review in NHS Highland, as I hope that I said in my intervention, will help us to make the changes that are required elsewhere and strengthen the governance of our NHS.
Stuart McMillan recognised many successes in the examples that he talked about. He mentioned the difficulties faced by the service across the winter and the heroic efforts of staff to meet those.
I know about the GP issues in Neil Findlay’s community, which he raised. That is why we have a new GP contract, and that is why I published the primary care workforce plan on Monday, with its nearly £7 million of additional investment in our district nursing workforce—something that I hope people will welcome.
Will the cabinet secretary take an intervention?
The cabinet secretary is in her last few seconds.
Clare Haughey raised an important point. Some of our boards have brokerage arrangements. We put patient care first and foremost and that is why those brokerage arrangements are important. However, she was right to highlight the eye-watering £1.5 billion deficit of acute trusts south of the border, which the Treasury—year after year—bails out.
I accept that brokerage arrangements are sometimes required, but it is a bit rich not to recognise that financial position south of the border while criticising the position here. On that point, Annie Wells said very clearly—I am sure that the Official Report will confirm this—that the NHS is underfunded. If she believes that, there is an onus on her party to come to this chamber and say how much the NHS is underfunded by, how much it proposes to put into the NHS and where that funding will come from. It is not good enough to say that the NHS is underfunded without coming here with those answers. I hope that we might hear about that in the closing speech from the Conservatives.
I hope that I have been able to set out today the actions that I will take as health secretary. I am not complacent in any way and I am sure that members realised that from the tone of my opening speech. I recognise the problems, and that is why we are taking all the actions that I have set out. I hope that members will recognise that.16:51
The Scottish Conservatives called this debate to allow members across the chamber to raise their concerns about the NHS in Scotland. There are a broad range of concerns, as we have heard from members from across the country this afternoon, whether it is Edward Mountain from the Highlands, Annie Wells from Glasgow or Brian Whittle from Ayrshire.
None of that takes away from the fact that there is much good work going on in the NHS across the country. Indeed, I join the health secretary in paying tribute to all those who work in the NHS for the care that they deliver. It is important that all members recognise that.
What we are doing in this debate is putting the health secretary, and indeed the Government, on notice that we need real action to improve the situation across the country. We need to strengthen Parliament’s oversight of our NHS finances, starting with full publication of the current financial position of every NHS board and monthly updates to the Parliament’s Health and Sport Committee and Public Audit and Post-legislative Scrutiny Committee. We also need more information about IJBs and their progress, and we need full transparency around budget scrutiny and local decision making.
I am pleased with the response that we have had from the health secretary, as she is accepting our motion today and she has given guarantees to make that information available. I hope that the approach that we have taken to the debate has been constructive.
What the Conservatives are not doing in this debate—unlike some others—is calling for the health secretary’s resignation. That is not because we are great supporters of the health secretary; it is simply because we believe that such calls are a distraction from the more important business of trying to sort out the problems in the NHS for the benefit of all the people whom we represent. Simply appointing a new captain to the ship will not make any difference unless the ship changes direction. It is that change of direction that we think is more important than the personalities involved.
I listened with great interest to the contributions from many of the SNP members. Some of them seemed to be in denial about some of the issues that people are facing across the country. Ash Denham and Clare Haughey wanted to talk about health finances but did not want to take interventions from Conservative members who wanted to answer their questions. To be fair, Stuart McMillan allowed Miles Briggs to intervene.
Let me deal with the question of finances, because it has come up in the debate and it is important. Over the past year, we have spent £170 million on agency staff in the NHS. With better workforce planning, we could substantially reduce that amount. We have spent £150 million in the past year on the cost of delayed discharge—delayed discharge that the health secretary promised she could eliminate. As Annie Wells said, if we could better use the resources that we are currently allocating to the NHS, that would make a huge difference in tackling the problems that we face.
If Murdo Fraser is backing up his colleague Annie Wells, does that mean that he too does not want additional resources for the NHS?
I have just made the point that Annie Wells made, which is that the Government needs to make the best use of its current resources and ensure that money is not being wasted.
I will make another important point about funding. I remind SNP members—particularly those who are drawing comparisons with the situation south of the border—that we have nearly £1,500 more to spend every year for every man, woman and child in Scotland compared with the average for the rest of the UK, and we have much more than England thanks to the Barnett formula. However, what does the SNP want to do to the Barnett formula? It wants to tear it up, which would mean that we would not have the benefit of that money at all.
The highlight of the debate for many members was the contribution from James Dornan, who at least brings some comedic value to such debates. Mr Dornan spent his time denouncing the Tory motion that is before us—a motion that his front bench has accepted and which he will presumably vote for in five minutes’ time. However, he thought that the motion was worth denouncing. What a shame it is that Mr Dornan has withdrawn his name from the race to be his party’s deputy leader. What a joy that would have been for the nation.
I was not criticising the motion so much as criticising the rank hypocrisy of the Tory members.
I think that the Official Report will show Mr Dornan’s denunciation of the motion.
I return to the issue of NHS Tayside, to which a number of members have referred. There is a range of serious problems in that board area. NHS Tayside is missing five out of eight key waiting time targets and has failed to provide data for another, which means that it is meeting only one quarter of its vital targets. We also had the recent, well-documented episode of the misuse of endowment funds, which have now had to be repaid. The cabinet secretary’s response was to sack the chair of NHS Tayside, the hugely well-respected health professional John Connell, who had been in office for just 18 months. That was done despite the fact that the problems that had arisen in NHS Tayside predated his period in office. However, he was thrown to the wolves by the cabinet secretary. He and other senior figures in NHS Tayside have been treated as human shields by the health secretary and made to take the blame for failures that were not of their making.
What is most concerning about the situation in NHS Tayside is the financial position. We now have total brokerage supplied by the Scottish Government of over £33 million, with another £12 million expected, all of which we assume the board will be asked to pay back at some point. It is impossible to see that being done without its having a major impact on the patient experience. The money will not be saved simply by cancelling one-off prescriptions of paracetamol.
I have already clarified the issue of the paracetamol. We have said to NHS Tayside that it does not have to repay that money for a period of three years in order to ensure that patient care is not impacted. Surely the member would welcome that.
The people whom I represent in areas such as Perth and Kinross want to see what impact that cost-cutting will have in the medium term or long term on the delivery of local services. We have seen plans mooted, of which the health secretary will be aware, to remove all emergency surgery from Perth royal infirmary and relocate it to Ninewells, and to replace that with elective surgery moving in the other direction. However, what guarantees do we have that that programme will continue? They could not be given by the management of NHS Tayside when a number of colleagues and I met them just two weeks ago. What does it mean for the future of accident and emergency at Perth royal infirmary if cost savings are having to be made? Communities across Perth and Kinross have fought hard over recent years to retain services, but they potentially face a risk again to those services because of financial failures on the health secretary’s watch.
My colleague Liz Smith referred earlier in the debate to the question of integration joint boards and many people’s concerns about them. There are huge issues over lines of governance and accountability, and the IJB model is fast losing public confidence; it is calling out for review and for greater transparency around the decision-making process.
We are not calling today for the resignation of the health secretary, although if press reports are to be believed even some of her SNP colleagues are expecting her to be reshuffled. That, in itself, will not make anything better in the NHS. Instead, we need a new focus on sorting out the problems in Scotland’s health service and that needs to start with the Parliament having much greater sight of exactly what is happening with health service spending. We need to know that the money is being properly spent and we need to stop being in denial about the scale of some of the problems that we face. That is what staff in the NHS need to give them the reassurance that they require, it is what patients want to see and it is what our constituents expect from us.
I urge Parliament to support the motion in Miles Briggs’s name.