Meeting of the Parliament

Meeting date: Tuesday, February 4, 2020

Official Report 1036KB pdf

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Topical Question Time

The next item of business is topical question time. In order that I can get as many people in as possible—I know that this is quite rightly a hot topic—I would prefer short and succinct questions and answers.

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NHS Lothian (Leadership)

To ask the Scottish Government what plans it has for the leadership of NHS Lothian, in light of the recent resignation of its chairman and forthcoming retirement of its chief executive. (S5T-01996)

Arrangements for an interim chair for NHS Lothian are under way and will be announced shortly. We will work closely with NHS Lothian on the recruitment of a new chief executive, with the aim of appointing the new chief executive before the current chief executive retires, later this year.

NHS Lothian is in crisis. We have a sick kids hospital with no sick kids and repayments stand at £1.4 million every month. Elsewhere, we see patients waiting more than a year to be discharged and children waiting up to two years for first-line mental health treatment. How does the cabinet secretary intend to mitigate the leadership vacuum and organisational memory loss in NHS Lothian?

I accept that NHS Lothian undoubtedly faces challenges. That is why it is at level 4 in our escalation ladder, which brings significant Government support. However, I do not accept that the board is in crisis and I do not think that that kind of language is particularly helpful or supportive to the many NHS Lothian staff, who are working hard every day.

We cannot forget that the current chief executive, who has considerable experience, will remain with us for some time to come and will undoubtedly make sure—as good leaders do—that his organisational memory and experience is passed on to his senior team, some of whom also have significant experience with NHS Lothian health board and all of whom have significant experience from elsewhere in our health service.

We will make sure that any new chief executive is properly experienced and meets the standards of leadership, experience and expertise that we require for our national health service boards, and we will do similarly, although in a different role, for the chair. In all those ways, including through the significant Government funding and support that are being offered to the board—as to others—we will ensure that they meet those challenges and continue to improve in the areas that we require them to.

I assure the cabinet secretary that I hold the staff of NHS Lothian in the highest regard and that it is in their interest that Opposition members ask questions such as this.

In resigning, Brian Houston said that there is a “blame culture” in the NHS and that NHS Lothian had not been treated with the

“values of openness and honesty, dignity and respect by some areas of the Scottish Government.”

This is not the first time that there has been a breakdown in the relationship and communications between the Government and a health board. We saw it with the Queen Elizabeth University hospital, too. In NHS Tayside, the chairman quit just a month after being appointed by the health secretary. Numerous boards are in special measures. Does any of the fault lie at the cabinet secretary’s door?

The short answer to that is no—I do not believe it does. What lies at my door is a responsibility, which I am taking, to ensure that our boards, including their leadership, rise to the challenges that they face and are supported properly and appropriately by the Scottish Government.

I remind Mr Cole-Hamilton that the resignation of the chair of NHS Tayside had nothing to do with how the board was performing or not performing and nothing at all to do with the Government or our interaction with the board, but had to do with his promotion in his academic career. We therefore need to be careful in how we deal with these issues.

Of course, Opposition members should—as they are doing—challenge what we do as a Government in health or any other matter. However, I remind Mr Cole-Hamilton of what the Sturrock report said in relation to the values-based culture that should exist in our health service. It said that it relies not only on

“openness and honesty, dignity and respect”,

but on “humility”, “responsibility”, “accountability” and “self-discipline”. With those things in mind, I reject the particular view that was expressed by Mr Houston.

Quite a lot of members want to get in and I want to get as many in as possible, so I ask for short questions, please.

Senior management in NHS Lothian have expressed concerns to MSPs regarding the timescale for the opening of the new sick kids hospital in autumn 2020, which the cabinet secretary outlined. Is that the source of one of the fundamental differences that the retiring chairman had with the cabinet secretary? Will ministers take responsibility if the timescale slips once more?

The timescale for opening the new sick kids hospital—which, I remind members, I closed because it was not safe for patients or staff—was reached following consultation with NHS Lothian, which remains a member of the oversight board that is led by the Scottish Government and charged with making sure that all the work that is needed to ensure that the site is safe and meets the appropriate standard is done.

NHS Lothian, including its senior team, has been actively involved. I am not sure what concerns have been expressed to MSPs, but I am very happy to look at them if they are raised with me. The current programme remains on time to meet the timescale that I set out. That is the timescale that I require, and if there are difficulties or problems with that—in any respect and at any point—I will, of course, return to the chamber and inform members.

I want to return to Brian Houston’s resignation letter, because he paints a pretty bleak picture. He said that the Scottish Government’s behaviour has been

“totally counter to a values-based culture”.

The cabinet secretary said that the Scottish Government is providing support to the health board, so there is a contrast between what the outgoing chair is saying and what Government officials are telling the cabinet secretary.

Is it really the case that there is nothing to see here? Can the cabinet secretary advise what steps are being taken to look into Mr Houston’s claims and give some reassurance not just to MSPs but to the workforce and patients and their families?

Mr Houston is, of course, entitled to his views. They are not views that I share. He and I have had more than one conversation on this matter. Through the chief executive, the board has been in discussion with the director general of NHS Scotland.

As Mr Houston rightly said, there is a difference of views. That does not mean that Mr Houston is entirely right or that I am entirely right. I am not prepared to rehearse in public the conversations that I have with all the chairs of our NHS boards, individually and collectively. They need to be confidential in some respects, so that they can be as frank and open as I know that Ms Lennon would hope they would be. I have no intention of going through point by point the view that Mr Houston expressed. Suffice it to say that he has resigned, I have accepted his resignation, and plans are in process to appoint an interim chair for NHS Lothian and begin the formal appointment process, through the public appointments procedure, for a full-time chair.

Does the cabinet secretary consider that the NHS Scotland resource allocation committee formula, which resulted in NHS Lothian being £11.6 million short of its funding target for 2019, has placed extra pressure on the health board, which services the fastest-growing part of Scotland?

Since 2006-07, NHS Lothian’s budget has risen by 31 per cent above inflation, compared to an increase of 21 per cent above inflation for the budgets of territorial boards as a whole. In addition, in this financial year, NHS Lothian has received the highest uplift of any territorial board, 16 per cent of our waiting times money and an additional share for winter pressures and other matters.

NHS Lothian faces financial challenges, as do all our boards. The pressures are different in Lothian from those in some of the other boards, but that does not necessarily make them any harder. All boards, including NHS Lothian, have to meet their challenges. We have moved so that all boards are within 0.8 per cent of parity. Would I like to do more? Yes. If the United Kingdom Government had not cut the Scottish budget by as much as it has done over many years, our health service would be receiving more funding. As it is, we receive the highest proportion of funding of all the portfolios in the Scottish Government.

The cabinet secretary allegedly told the out-going chair to accept accountability. We have 1,300 drug deaths, a mental health crisis, social care delays, waiting time targets being breached hundreds of thousands of times, bedblocking on an industrial scale and a budget crisis. Which of those issues does the cabinet secretary accept responsibility for? Why has she put the two biggest health boards on special measures if there is no crisis?

I am not going to get into a debate or a discussion about what Mr Houston has said or what my response is to that. That is entirely inappropriate in a public forum. Mr Houston has decided to make his views public, but I will not engage in a discussion about them.

As the cabinet secretary for health, I am of course accountable for how our health service performs and for all the steps that need to be taken to improve that performance, and that is precisely what I am doing. [Interruption.] Mr Findlay shouting at me from the back will not assist us to have a mature, grown-up conversation about health—it would be nice to have such a conversation with Mr Findlay one of these days. Of course, as cabinet secretary, I accept accountability and I expect leaders across our health service to accept accountability. That is entirely right and appropriate and it is in accordance with the Sturrock report.

The cabinet secretary’s refusal to explain the resignation is simply not good enough. We have a health board that is in special measures and a hospital costing £1.4 million a month that cannot open. It is in the public interest to understand what this fundamental difference of opinion is. Will the cabinet secretary now take the opportunity to explain to the public why the chair has resigned?

No, I will not. As I said, I will not get into a public tit-for-tat debate with Mr Houston about what he put in his resignation letter. It would be entirely inappropriate to do so.

As the cabinet secretary, I expect the leadership across our NHS to accept proper accountability for the failures, decisions, actions and performance of individual boards, just as I accept overall accountability for how our NHS is performing. If an individual leader does not accept that accountability and does not agree with me that that is part of their role as chairs, as is clearly set out and clearly exercised elsewhere in our health service, we will not continue to work together productively.

Other than that, there is nothing more that I intend to say about this resignation. I have accepted it and I have set in train procedures to appoint an interim chair and to engage in the public appointments process for a chair. Meanwhile, I will focus on what is important: improving the performance of NHS Lothian and our other boards on waiting times, on cancer targets and on mental health targets; and ensuring that, thanks to our intervention, NHS Lothian opens a new hospital that is safe for patients, staff and all those who attend.

This is our Parliament and, in her last two answers, the cabinet secretary has said that she supports accountability but that she is not prepared to explore the explanation of the fundamental differences between her and the chair of the health board. Surely this matter goes to the heart of accountability. Between the cabinet secretary, our health boards, underfunding and the crisis measures that have been imposed in several health boards across Scotland, we need a proper answer and we need it today.

Short of repeating what I have already said, there is nothing more to say in response to that question. I am not prepared to discuss that; I think that that would be entirely inappropriate. It would damage my relationship with chairs and chief executives across our health boards if I had a public discussion about confidential matters that are between me and those individuals in the meetings that we have. If an individual chooses to make those confidential discussions public, that is their decision, but that does not require me to engage in giving my version of those events—nor would it be right for me to do so, given the relationship that I have with other boards across our NHS.

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Gross Domestic Product (Revised Estimate)

To ask the Scottish Government what impact there will be on the economy and public finances of the downwards revision of estimated GDP from £180 billion to £175 billion. (S5T-01989)

Nominal gross domestic product is an estimate of the total cash value of all goods and services that are produced in the economy. The downward revision to the total for Scotland relates primarily to changes in the estimates of the economic contribution of North Sea oil. That reflects revisions by the Office for National Statistics that were published in December 2019, and which the Scottish Government’s statisticians use to inform the quarterly national accounts estimates for Scotland. Revisions to the nominal value of GDP are a routine occurrence and have no impact on the real economy, household incomes or Government revenues.

There is, of course, a connection between GDP growth, income tax growth and the amount of money that the Scottish Government has to spend. Last week, we learned that, for the most recent four quarters, growth in the Scottish economy was 0.6 per cent. The United Kingdom economy grew by 1.3 per cent in the same period, which is more than double the Scottish rate. How does the Scottish Government account for that difference in performance?

I see that Murdo Fraser has changed the subject from the GDP revisions coming out and his ludicrous positioning over the past couple of days. He accused me of hiding the statistics. Let us stick to transparency for a moment. Mr Fraser should not take my word for it: the Fraser of Allander institute said on 3 February 2020 that

“Suggesting that the statistics have been buried to hide questions about Scotland’s fiscal deficit is simply bizarre. There will of course be an important debate to be had about Scotland’s relative fiscal position, but this should only take place when all revisions—not just to GDP but the underlying public finances—are published in the annual GERS report in the summer.”

It is interesting that Murdo Fraser has revised his position on GDP statistics.

There are, of course, some quarters in which Scottish growth will have been higher than UK growth. We are investing in our economy and growth. If members look at economic performance, they will see that our economic performance is growing. I remember when the Tories said that we would be in recession: all economists are pointing to evidence that shows that, if we get a no-deal Brexit, we will indeed be in recession.

We are exceeding the performance of other nations in the UK on exports, we are second only to London and the south-east of England on attractiveness, and we have had more gains in productivity than the rest of the UK. We have strong economic performance and strong economic foundations and—of course—could do much more if we were an independent country and had not faced Brexit being forced on us by the UK Government, which totally disrespects the people of Scotland.

Members are aware that I have launched an economic action plan that includes a range of actions to help to grow our economy in the face of UK Government intransigence.

I say to front benchers and other members that I want shorter questions and, certainly, shorter answers, because other members want to get in, and I want to get them all in. [Interruption.] Mr Fraser—do not chunter. You have asked questions, and you are getting to ask another one.

What is “bizarre” is that the cabinet secretary read out a pre-prepared answer to a question that I did not ask, but totally ignored the question that I did ask. There was no answer to it in the five minutes of irrelevant waffle that we have just heard. Let me try another question, because he could not answer my previous one.

Scotland’s notional deficit now stands at £12.6 billion, or 7.2 per cent of GDP. That is the highest in Europe and is well above the European Union maximum of 3 per cent. An independent Scotland, which the cabinet secretary referred to, would face eye-watering austerity as a result of that. Where would the cuts fall, if the cabinet secretary had his way?

My forecasts are so good that I knew that Murdo Fraser would go with his question. That is exactly why I put out the information that I put out—which was, incidentally, in response to the question that was in the Business Bulletin. It was entirely appropriate that I responded to that.

All that I can say in response to Murdo Fraser is that I quoted the Fraser of Allander institute earlier, and that I will take its opinions more than I will take the economic analysis of the Fraser of bluff and bluster—that is, Murdo Fraser. His arithmetic is not very good, and neither is his political positioning.

Scotland’s current estimated notional deficit is actually a consequence of our current constitutional position—it is not what we could do with independence. Austerity is the price of the union, not of independence. We could grow our economy and spend more on our public services if we had the levers of control that most normal nations have, rather than being bound by such things as a migration policy that does not suit our country’s economic needs. That is just one example on which the business community agrees with this Government. We could do much better with all the levers of independence that are so resisted by the Tories, who of course will welcome the fact that polls are at 51 per cent in favour of independence.

I must ask again for shorter questions and answers. I live in hope. Mr Rennie—I am sure that you will not disappoint me.

Surely Mr Mackay should show a scintilla of embarrassment that, in the context of a debate about the constitution and about Brexit, he is not open about the figures. There should be a proper debate in that context, so that we can all understand the state of Scotland’s finances and what future we would like for our country. Is he not a little bit embarrassed about that?

I am just embarrassed by Willie Rennie, who clearly has not read the documents and does not understand the position that has been set out. There was some press coverage about the figures not being sent out in a transparent fashion. That came from people who say that Scotland is too poor and too wee to be independent—the kind of things that the Liberals are now saying, along with the Tories.

Regarding transparency, the figures were published proactively, as part of a timeline of published reports that follow the report by the UK Office for National Statistics. Willie Rennie is shaking his head, but these are facts—what I am saying is true. Independent statisticians produced the figures. The problem is with Opposition members who misinterpret them in order to try to undermine the economic strength of their own country. That is what I find embarrassing.

The cabinet secretary should give all Opposition members a calculator.

The latest export statistics that have been released by the Scottish Government show that Scotland’s exports to the European Union grew faster than those to the rest of the UK and those to other international markets. Does the cabinet secretary agree that leaving the EU will make it more difficult for Scotland to reach its target of international exports being 25 per cent of GDP by 2029?

Richard Lyle is correct to showcase that economic indicator, which shows how Scotland is out-performing the rest of the UK in exports. Any form of Brexit will make it harder for Scotland to export, because it involves not just loss of access to the single market, but loss of access to the raft of preferential trade agreements that the EU has concluded with third countries, and from which our exporters currently benefit. Even a free trade agreement in the form that the UK Government has stated it would like to pursue would result in GDP being 6.1 per cent lower. That is equivalent to £1,600 per person.

In his answer, the cabinet secretary referred to North Sea oil. The oil price today is below $55 a barrel, which is less than half the price that the SNP forecast in the white paper on independence. Will the cabinet secretary now acknowledge that he and his colleagues got it fundamentally wrong in the white paper?

The Scottish Government has said that we are updating the case for independence, but Dean Lockhart—like all the other Conservatives and most other unionists—has not even read the Sustainable Growth Commission’s report, which covered that position. The commission’s forecasts do not include North Sea oil revenue, which could, of course, be invested in the Scottish economy to support future generations and provide an immediate economic boost.

Dean Lockhart should get with it, and read the current economic analyses: he should read those documents. I know that the unionist argument is now performing so badly that they are back to saying that Scotland cannot afford to be an independent country. The issue is really that Scotland cannot afford to be part of this failing union.

The urgent question that needs to be addressed is why our GDP deficit is 7.2 per cent when the rest of the UK’s deficit is 1.1 per cent. The Scottish Government has levers to hand to grow our economy, but it will not use them for the benefit of the whole of Scotland. What is its industrial strategy? How will it deal with the deficit?

We are using our devolved economic powers to the full in order to stimulate the economy, support our public sector and deliver a fair and progressive tax system. The Sustainable Growth Commission looked at evidence from countries that are outperforming Scotland—the only thing that they have that we have not is independence. That is the big tool that would allow a change in our fiscal position.

Rhoda Grant should understand this: the estimated notional deficit is not the projection for an independent Scotland, but is a reflection of, and an estimate that is based on, the current constitutional position. It is a reflection of the union, not of independence. The sooner the unionists educate themselves on that matter, the better. [Interruption.]

I remind members that the meeting is not suspended, but is just paused. The cameras are on us all.