NHS Scotland

– in the Scottish Parliament at on 19 August 2014.

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Photo of Tricia Marwick Tricia Marwick None

The next item of business is a ministerial statement on the future of the national health service.

Photo of Alex Neil Alex Neil Scottish National Party

Last week, Malcolm Chisholm asked for a statement on the consequences for the national health service of yes and no votes in next month’s referendum. As I said last week, I am happy to oblige.

In short, the people of Scotland have a choice between two futures: one in which this nation’s vast wealth can be marshalled to help to create a fairer society; and one in which the budgets that are available for Scotland’s public services are consigned to the whim of Westminster.

Nye Bevan’s founding principles for the national health service were that the institution should be owned by the people and should give access to the highest attainable standard of health services, which would be free at the point of delivery and based on clinical need and not ability to pay.

Those principles must be protected, and a yes vote gives this nation a chance to do just that by framing a constitution that reflects the values and aspirations of our nation. As the First Minister set out last week, we will take to the independent constitutional convention a proposal to enshrine the national health service as an institution in the constitution. That would ensure that, in contrast to what is happening south of the border, our health service could never be privatised against the wishes of the people. I note that all members of this Parliament say that they do not favour privatisation, so I trust that after a yes vote they will join us in the constitutional convention in making the case for constitutional protection for the national health service.

Scotland is a wealthy nation. We do not need to limit our ambitions to the parameters of the Barnett consequentials. With the full powers of independence, the Scottish Government could do yet more to strengthen our economy, create more jobs and make the transformational investment that would help thousands of people back into work. More people in work is not just good for the economy but essential to improving the nation’s health.

A no vote is a very different and disturbing prospect for our national health service and wider public services. Under the current arrangements, every £10 that is cut from health spending in England through austerity, privatisation and patient charges will consequently reduce Scotland’s budget by around £1. Privatisation that leads to further patient charges, enabled by the Health and Social Care Act 2012 in England, means that services that were previously free will have to be paid for by patients. The replacement of public funding with private money will have a consequential impact on Scotland’s budget.

We should be in no doubt: a reduction in free services in England and extended charging for health services are exactly what is happening and will continue to happen in England. As Unite the union has warned:

“the public will increasingly have to pay for aspects of their care that used to be free at the time of treatment.”

The Labour Party in England shares that concern. It said in its publication, “The Choice: NHS”:

“there is the prospect of more NHS services being charged for, and fewer services being provided free at the point of need.”

That is also the view of the Labour Party in Wales, where my opposite number, the Labour health minister Mark Drakeford, said:

“The fundamental issue ... is the impact on public services in Wales of the cuts being made by” the

“administration in Westminster, and passed down to Wales. That is what the fundamental problem is here: we have a Westminster Government that believes in shrinking the state, which believes in doing less through the public realm, and passes less money down to us in order to be able to do it.”—[Record of Proceedings, National Assembly for Wales, 17 June 2014.]

Labour’s English health spokesman, Andy Burnham, has given the same signal. He warned:

“Five more years of the same would push the NHS off the cliff-edge where it now finds itself.”

Andy Burnham has also said that the coalition

“sees no limits on the extent of privatisation in the NHS.”

Here in Scotland, however, Labour members would have us believe that their colleagues in England and Wales are wrong and that there will be no impact from the austerity, privatisation and charging agenda of the current Westminster Government. Of course, that was not always the case. In 2009, the warning from Labour in Scotland was that the Tories were

“relishing the chance to swing the axe at the public services millions rely on”, with “Cuts driven by ideology”. That warning came from one Alistair Darling.

Strangely, this morning, Alistair Darling defended Osborne’s budgets on the radio and claimed that national health service spending in England has been

“increasing for the last four years under the present Government”.

However, in 2012, Andy Burnham warned that the Conservatives had

“cut the NHS budget for two years running” and that they owe it

“to patients and NHS staff to be honest about that.”

In the 2010 election, Scottish Labour’s election campaign broadcast, upon which Mr Darling and all Labour members of Parliament were elected, said that the Tories had

“starved our schools and hospitals of funding and there’s a real risk they would do the same again.”

Even after the Conservatives took office, Labour warned again:

“What’s going to happen when David Cameron’s cuts start to hit? Scotland is worried and they are right to be worried.”

So said Iain Gray. This year, Labour MP Michael Meacher has gone further still on the future of the health service in England, saying

“we know the latest steps being proposed to make the NHS into a full-blown private health service”—[Interruption.]

The Presiding Officer:

Order. Let us hear the cabinet secretary.

Photo of Alex Neil Alex Neil Scottish National Party

Mr Meacher continued:

“the truth has been let out of the bag that the Tories and their big corporate friends had in fact intended all along that it would become a fully paid-for service, only they didn’t dare say so before now.”

Perhaps the no campaign would have us believe that, despite the warnings of the Labour Party in England, Labour in Wales, the Jarrow marchers and myriad warnings from trade unions, the Tories are actually privatising the health service in order to increase public spending. As Mark Drakeford outlined, we already know that the Tories’ spending plans are for yet deeper cuts. Ed Balls has pledged to keep Labour within the Tory spending plans and George Osborne has pledged to force through another £25 billion-worth of cuts.

Since 2010, when the coalition came to office, we have already had a 7.2 per cent cut in real terms to our resource budget, plus a 26 per cent cut in our capital budget. Despite those cuts, the Scottish National Party Government has managed to protect the front-line resource NHS budget in Scotland and, in each year since 2010, we have increased it above real terms. I do not think that anyone in the chamber can think it a realistic prospect that, if further deep cuts through austerity are forced on Scotland by Westminster, services will be left unscathed.

The solution that the no campaign proposes is that taxes should be hiked in Scotland to offset the planned Tory cuts. That is unacceptable and would be a double whammy for Scotland. That is why a no vote would put our health service at serious risk. The consequences of a no vote would be reduced budgets as a result of privatisation, patient charges, fragmented pay arrangements for health staff, with further pay restrictions, and austerity as a matter of ideology south of the border.

That is why we on this side of the chamber choose the path where the power and wealth of Scotland are put in the hands of the people of Scotland. We choose a future where Nye Bevan’s founding principles for the health service are not simple articles of aspiration but part of our constitution. We choose to ensure that those who come after us can have the guarantee of a health service that is free at the point of need, just as we and our families have benefited from that throughout our lives. We invite the people of Scotland to choose that path with us. The first step is simple—vote yes for independence on 18 September.

The Presiding Officer:

The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for questions, after which we will move to the next item of business.

Photo of Neil Findlay Neil Findlay Labour

Even the cabinet secretary surpassed himself there. [Applause.]

Photo of Neil Findlay Neil Findlay Labour

At the SNP conference in 2014, Nicola Sturgeon said:

“I can stand here proudly and say this: for as long as we are in government, there will be no privatisation of the NHS in Scotland.”

Yesterday and today, however, the First Minister and the cabinet secretary contradicted that position.

In 2011 the SNP manifesto said:

The Scottish Parliament has responsibility for the health service and that means we can protect NHS budgets.”

The white paper says:

“Without devolution,” the NHS

“would have been repeatedly re-organised” and

“exposed to private competition”.

I am not allowed to call anyone in the chamber a liar, but was Nicola Sturgeon not telling the truth at her conference? Did the SNP not tell the truth in its manifesto? [Interruption.]

Photo of Neil Findlay Neil Findlay Labour

Or is the cabinet secretary not telling the truth now? I am not allowed to call the cabinet secretary and the First Minister liars, but will they condemn a campaign that claims that private healthcare is cheaper and more efficient than public healthcare? I am not allowed to call the cabinet secretary and the First Minister liars—

The Presiding Officer:

Your time is up, Mr Findlay. Do you have a question?

Photo of Neil Findlay Neil Findlay Labour

Do they accept that the greatest threat to the NHS in Scotland is the £6 billion of cuts in public spending that would occur under their plans to break up the country? Will the cabinet secretary focus on his day job and sort out waiting lists, huge problems in accident and emergency, staffing and bed cuts, a social care crisis and a lack of general practitioners, instead of supporting the most scandalous deceit of the referendum campaign to date?

Photo of Alex Neil Alex Neil Scottish National Party

In the spirit of Mr Findlay’s remarks, I thank him for the compliment at the start of his question.

I do not think that Mr Findlay understands what devolution means. Let me remind him that Enoch Powell said many years ago that power devolved is power retained. We must look at not only today and tomorrow but at five and 10 years’ time. With a constitution that embeds and enshrines the basic principles of the national health service, Scotland will never ever have a privatised health service. Our powers in a devolved Parliament are not enshrined and can be overruled at any time by any future Westminster Government.

Photo of Alex Neil Alex Neil Scottish National Party

As far as the money is concerned—

The Presiding Officer:

Order, Mr Findlay.

Photo of Alex Neil Alex Neil Scottish National Party

The biggest problem that I have financially is that the previous Labour Administration left us a legacy of a bill for £220 million every year for its private finance initiative. [Applause.]

Photo of Alex Neil Alex Neil Scottish National Party

That is the biggest spending on the private sector. It was initiated by Labour. It is a rip-off for the health service and Neil Findlay’s party landed us with it for 30 years.

Photo of Jackson Carlaw Jackson Carlaw Conservative

I thank the cabinet secretary for advance sight of his statement, although I am bound to say that I cannot recall one that has relied so much on cut-and-paste quotations from third parties, all of which amounted to nothing more than speculation, rumour and unsubstantiated allegation. [Laughter.]

The Presiding Officer:

Order. Let us hear Mr Carlaw.

Photo of Jackson Carlaw Jackson Carlaw Conservative

In his statement, the cabinet secretary relied on the consequences of the Health and Social Care Act 2012 in England. Here is what the Government said in a statement when that act received royal assent: it is expected that it will produce

“£4.5 billion over the lifetime of this Parliament, with every penny being reinvested in patient care.”

In consequence of that, the Government itself has published figures that show that there have been consequentials of £280 million in 2011, £249 million in 2012, £293 million in 2013 and £284 million in 2014, and that there are anticipated consequentials of £202 million in 2015. That is an increase—the clue is in the word “increase”—of £1.3 billion that is coming to the Scottish Government to spend on health.

Can the cabinet secretary therefore identify today any statement from the Treasury or the Department of Health that, at any time, has identified a reduction in health spending—spending that has been ring fenced throughout the very worst recession that we have known? If he cannot do that, does he not realise how shameful this last-minute attempt to scare vulnerable voters into voting yes really is?

In the spirit of this chamber, I have offered to work constructively with the Scottish Government, as have others, to set aside the course of the health service in England to ensure that we in Scotland work to preserve a public sector health service that is free at the point of need and delivery. Is the cabinet secretary now spurning that offer, which he himself has embraced readily and enthusiastically at every other stage in the lifetime of this Parliament?

Photo of Alex Neil Alex Neil Scottish National Party

First, Mr Carlaw is saying that nowhere is there no increase. I tell him that the nurses and other agenda for change workers in the national health service were refused, by his Government, the pay increase that was recommended by their pay review body not just for this year but for next year. They do not have an increase this year or next year.

We implemented the recommendations, with a view to reviewing them in a year’s time, as normal. However, nurses down south have been treated with contempt by the Secretary of State for Health down there, so I do not think that we will take any lessons about what is promised and said by a Tory Government in London. No nurse in England would believe anything that the Tories said about the health service.

As far as the money is concerned, the reason why we are spending so much additional money on the health service is because the SNP Government has ring fenced the money for health, while Mr Carlaw’s Government has cut our resource budget by 7.5 per cent and our capital budget by 26 per cent. Over the past five years, Scotland’s £8 billion advantage has been taken down to London to subsidise the Treasury down there. If we had had access to our own £8 billion over those years, the increase in spending on public services would have been a lot higher.

The Presiding Officer:

As members would expect, a large number of members want to ask a question. I urge brief questions and brief answers.

Photo of Aileen McLeod Aileen McLeod Scottish National Party

Given that George Osborne has promised £25 billion of spending cuts after the 2015 general election, and the Labour Party has signed up to those spending plans, what will the real-terms impact on the Scottish resource budget be if Scotland remains in the union?

Photo of Alex Neil Alex Neil Scottish National Party

Depending on where the Westminster axe on public spending falls, by 2018-19, if the further threatened cuts are implemented, Scotland’s budget will be cut in real terms by between £4 billion and £5 billion, compared with the position when the coalition Government came to office. That represents cuts of between 14.6 per cent and 18.3 per cent. The worst-cast scenario is the frontline Scottish resource budget being cut in real terms from £27.3 billion in 2010-11 to £22.3 billion in 2018-19. To put that in terms that the no campaign might understand, it is more than the entire schools budget for Scotland.

Photo of Rhoda Grant Rhoda Grant Labour

Would it be fair to say that this new scare story seeks to divert attention from the Scottish Government’s privatisation of the NHS here in Scotland? [Laughter.]

Photo of Rhoda Grant Rhoda Grant Labour

Last year, there was a huge 23 per cent increase in spending on private healthcare in the NHS in Scotland. Does the cabinet secretary agree with Audit Scotland that that shows a strain in the system? Will he now take responsibility, accept Labour’s position and have a comprehensive review of the NHS?

Photo of Alex Neil Alex Neil Scottish National Party

As I have already said, the biggest amount of NHS money that goes to the private sector in Scotland is the £220 million in PFI charges. In five out of the six years for which final figures are available since we came to power, we have spent less on the private sector in Scotland as a percentage of our total budget than the Labour Administration before us did.

I also remind the member—because maybe she has a short memory—that it was not this Government that tried to privatise Stracathro. I think that it was her Government that tried to privatise services at Stracathro, and it took Nicola Sturgeon to reverse that privatisation and keep Stracathro in the public sector.

Photo of Joan McAlpine Joan McAlpine Scottish National Party

Just across the border from my South Scotland constituency the hospitals in Cumbria are struggling to deal with the market system that has been imposed on them. Several are under special measures and the trust is £27 million in debt. The situation has been further exacerbated by a commercial decision to transfer all hip and knee operations to Hexham, further depriving Cumbria of £2.7 million, which is likely to be recouped through further cuts to patient care.

The Presiding Officer:

Can we just get a question that is relevant to the cabinet secretary?

Photo of Joan McAlpine Joan McAlpine Scottish National Party

I am coming to that.

How can the health secretary guarantee that my constituents can always rely on a public NHS rather than the profit-led system that is being imposed on their neighbours in England?

Photo of Alex Neil Alex Neil Scottish National Party

There are two ways. First, when we are independent we will get the Government that we elect, and I do not think that any Scottish Government will ever dare to try to privatise the health service in Scotland. We saw the price that the Labour Party paid in 2007 when it tried a bit of privatisation in Stracathro and in Harthill in my constituency.

The second way to absolutely guarantee that is to write the founding principles of the national health service into an independent Scotland’s constitution and build it into the ethos of this Parliament so that nobody—by accident or by design—can privatise our health service.

Photo of Willie Rennie Willie Rennie Liberal Democrat

I thank the minister for the advance copy of his statement.

The NHS has received more money, not less, under every single UK Government for decades. The share of UK national income spent on the NHS has doubled in the past 50 years. It is the minister’s independence plans that will cut £6 billion from our public services and threaten our NHS. Is he not just a little bit ashamed that he is misusing our NHS to shore up his campaign?

Photo of Alex Neil Alex Neil Scottish National Party

What I would be ashamed about would be my party shoring up the Tories and the privatisation agenda, like Mr Rennie’s is. I find it inconceivable that, at the grassroots, the Liberal party in Scotland supports privatisation or that it supports the benefit and welfare reforms that are doing so much damage to disabled people. If anybody should be holding their head in shame, it is Mr Rennie.

Photo of Colin Keir Colin Keir Scottish National Party

This morning on Radio Scotland Alistair Darling said, “Look, it’s no secret that the Tories have long had their sights on public spending.” Does the cabinet secretary agree that that highlights the hypocrisy of the no campaign, which claims that public spending is safe at Westminster?

Photo of Alex Neil Alex Neil Scottish National Party

Of course, the public spending cuts were started by Alistair Darling when he was Chancellor of the Exchequer, so I can understand why he is defending Tory cuts, although in that interview he seemed to be facing at least two ways. In fact, after the interview I began to think that he had more faces than Big Ben.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

Forced to change his narrative every time he opens his mouth, will the cabinet secretary now confirm that yes campaigners are being mendacious when they say all over Scotland that the Scottish NHS would be privatised following a no vote and ill-informed when they say that privatised services cost less public money, contrary to the view of NHS campaigners in England? Is not the real threat to the Scottish NHS the possibility of a yes vote and the increased austerity that would follow, according to all independent economists?

Photo of Alex Neil Alex Neil Scottish National Party

The last part of that question was just totally factually incorrect. On the impact of charges, privatisation is about imposing charges on services that previously were free of charge. If a service is paid for through charges instead of taxation, which is the direction of travel down south, the amount of revenue through time that is spent on the national health service will decline, because the revenue will come from the charges. If the revenue declines, if we stay under the Barnett formula through time our revenue and our budget will decline as well.

Let me quote from a survey of the leading health and social care professionals in England, which was undertaken on 1 July 2014 by the Nuffield Trust, a highly respected organisation. The survey asked:

“How likely do you think it is that comprehensive health care (excluding charges that already apply), will still be provided free at the point of use in England in ten years’ time?”

The answer from 47 per cent was “Quite unlikely” or “Very unlikely”. They believe that charges are coming in England and they are the leading professionals in the health and social care system in England. They are politically independent. I would believe them before I would believe Malcolm Chisholm.

Photo of Christine Grahame Christine Grahame Scottish National Party

Is the cabinet secretary aware of scare stories put about by the no campaign that the excellent cross-border arrangements for healthcare between Scotland and England, particularly in my constituency, will cease after independence? How does he respond to that accusation?

Photo of Alex Neil Alex Neil Scottish National Party

That is obviously very serious. I make it absolutely clear that, irrespective of the result of the referendum, the cross-border arrangements between Scotland and the rest of the United Kingdom—and indeed the cross-border arrangements between Scotland, the rest of the United Kingdom and the European Union, which are covered by a cross-border directive—will all continue. Beyond that, we quite regularly send patients as far away as the United States if they require very specialist treatment. That will continue as well.

It is two-way traffic. In a typical year, as well as us sending patients outwith Scotland to get specialist treatment, about 7,500 people come to Scotland for very specialist treatment that they cannot get anywhere else. I do not think that any Government representing those people will do anything to endanger the cross-border arrangements.

Photo of Kenneth Macintosh Kenneth Macintosh Labour

Leaving aside the misstatements and inaccuracies of his so-called parliamentary statement, does the cabinet secretary acknowledge the irony of his remarks today when, under his plans for independence, Scotland will no longer be part of the NHS as founded by Nye Bevan? For the first time since 1948, Scots will no longer be part of the NHS throughout the UK. Following his remarks to my parliamentary colleague, can the cabinet secretary address the concerns of a constituent who believes that he might have to use a European health insurance card to access services throughout the UK?

Photo of Alex Neil Alex Neil Scottish National Party

Obviously, the member was up all night thinking of that one.

We do not have a UK national health service, because the divergence between what is happening north of the border and what has happened south of the border renders that impossible. South of the border, they are privatising; north of the border, we are keeping the health service free at the point of use and in public hands.

Photo of Hugh Henry Hugh Henry Labour

So we do not need independence, then.

The Presiding Officer:

Mr Henry, please stop it.

Photo of Alex Neil Alex Neil Scottish National Party

We have free personal care; they do not. We have free prescriptions; they charge £9 per prescription. Despite what Andy Burnham suggested, there is no way that we would allow a publicly owned national health service in Scotland in any way to be absorbed into a partially, and about to be extensively, privatised health service south of the border.

Photo of Maureen Watt Maureen Watt Scottish National Party

The cabinet secretary referred to the document “The Choice”, in which the Labour Party has recently raised the prospect of patient charges in England and of

“fewer services being provided free at the point of need”

In England. Is the Labour Party in England wrong? How would that impact on the budget available for those services in Scotland?

Photo of Alex Neil Alex Neil Scottish National Party

I do not think that the Labour Party is wrong in its analysis, and nor is Mark Drakeford. As I speak, something of the order of £5.8 billion of tenders are being issued in England to invite the private sector—large, profit-making companies—to come in and take over the work of NHS doctors, nurses and other staff. The facts speak for themselves. The health service is being rapidly and extensively privatised south of the border.

The Presiding Officer:

I call Alison Johnstone, to be followed by Margaret McCulloch. I had an indication that Duncan McNeil wanted to ask a question, but he is not here.

Photo of Alison Johnstone Alison Johnstone Green

Is the cabinet secretary concerned about the “profound threat”, as Unison describes it, of the transatlantic trade and investment partnership to public services, including health? Will the Government join the growing number of organisations and individuals who oppose that proposed trade deal?

Photo of Alex Neil Alex Neil Scottish National Party

We do not oppose the trade deal in principle, but we absolutely oppose any inclusion in such a deal of free public services such as the national health service.

My colleague John Swinney and I have made that clear publicly, and we have written to the UK Government and the European Union to make it absolutely clear that, in the TTIP negotiations, the health service must be excluded and no part of that deal should force us in Scotland—or any other country in which the health service is publicly owned—to privatise the health service in any way.

Photo of Margaret McCulloch Margaret McCulloch Labour

According to the British Medical Journal, 60 per cent of Scotland’s doctors are planning to vote no. Why does the cabinet secretary think that that is the case?

Photo of Alex Neil Alex Neil Scottish National Party

In that survey, 14 per cent replied, so I have been trying to talk to the other 86 per cent.

I assure Margaret McCulloch that I am absolutely convinced that the vast bulk of the 158,000 people working in the national health service in Scotland will vote yes, because they see that only a yes vote will keep the health service in Scotland in public hands.