National Health Service

– in the Scottish Parliament at 9:31 am on 3rd February 2000.

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Photo of Kay Ullrich Kay Ullrich Scottish National Party 9:31 am, 3rd February 2000

First, I must say how sorry I was to hear the news this morning that Rhona Brankin has been diagnosed as having breast cancer. Rhona is to be commended for speaking out openly and publicly about her illness. It will give support to many other women throughout Scotland. I am sure that everyone in the chamber will join me in wishing her a full and speedy recovery. [Applause.]

The last health debate took place in the middle of the flu crisis. The debate was somewhat marred by the Minister for Health and Community Care's refusal to accept the obvious—that the health service in Scotland was struggling to cope and was only able to cope thanks to the dedication and good will of health service staff, who worked extra hours, forwent days off and, in many cases, worked back-to-back shifts. I am sure that every member of this chamber will want to acknowledge the debt that we owe to health service staff for seeing us through the flu outbreak.

The outbreak exposed the fact that the NHS in Scotland is struggling throughout the year to provide high-quality health care. The previous health debate was a somewhat heated affair, with the minister desperately trying to stick to the new Labour line of, "Crisis? What crisis?" Of course, that was before noble Tony Blair's admission that there are

"fundamental problems we have to address".

Tony said that we need

"more doctors, more nurses, more beds, more long-term financing and a different system and structure in the health service".

We can all agree that, coming from the Prime Minister, those words are a damning indictment of the state of the NHS after almost three years of Labour rule.

Now that Mrs Deacon no longer has to pretend that all is well and to view the health service as she would the emperor's new clothes, I hope that we will be able to examine the problems that exist and have an open and constructive debate on the state of Scotland's health service.

Before I leave the subject of Tony Blair, I ask the minister whether, in the light of the Prime Minister's commitment to increase health spending south of the border by 5 per cent each year to bring NHS spending up to the European average, she will give the same commitment for the national health service in Scotland? Blair says 5 per cent. What does the minister say?

I admit that I was a little saddened by the tone of the minister's amendment to the Scottish National party motion. There is still a clear reluctance to accept responsibility, in spite of now having permission from above to do so. The minister seems unable to grasp that in order to address a problem, one must first acknowledge that a problem exists. By consistently denying that there is a problem, the minister is rapidly becoming a substantial part of the problem.

I will spend a little time examining the cost in human terms of the failures within the health service today. There cannot be a member in this chamber whose mail has not included harrowing stories of people suffering pain and distress because of the inadequacies in health service delivery. All over Scotland, patients, relatives and health service workers are genuinely concerned about the state of the NHS. We in this Parliament have a duty to address those concerns, and to do so without resorting to the spin-doctoring of figures. We should resist the temptation to indulge in party political posturing.

I am sure that we were horrified to hear recent stories of patients being driven across Scotland in search of intensive care beds. One patient was taken from Inverness to Glasgow; another was taken from Shetland to Edinburgh. It was a sobering moment when we learned of three patients from Fife being sent to the private Health Care International hospital at Clydebank because no intensive care beds were available in their health board area. Let us be clear: those patients were transferred to a private facility because the NHS had failed them at their time of need.

Throughout the year, it is common practice for patients in the Greater Glasgow Health Board area, for example, to be transferred from one hospital to another in search of any available intensive care bed. The figures speak for themselves. In the first six months of last year, there were 270 intensive care transfers within the Greater Glasgow Health Board area, more than double the figure for the same period of the previous year. The minister will claim a 12 per cent increase in intensive care beds, but, given that 50 intensive care beds have been lost in the past 10 years, we still have a long way to go before the crisis in Scotland's intensive care units is addressed.

As ever, we are subjected to the usual smoke-and-mirrors approach on what actually constitutes a new bed. Take the situation at the Southern general hospital in Glasgow. It had four intensive care beds and one high dependency bed. It received additional funding for half a nurse, and the high dependency bed was upgraded to an intensive care bed. Instead of four, they now have five intensive care beds, but no high dependency bed. Is that what the minister calls progress?

The Labour Executive makes great play of improvement in waiting times and waiting lists. Here again, we have a tale of failure. The real failure, however, is the Executive's inability to recognise the price being paid in human suffering for its failure.

I have selected a few examples from my mailbag. An elderly woman in Edinburgh waited 20 painful, immobile months for a hip operation. A man in his 60s has two growths on his back, which tend to bleed on contact. He has been told that his earliest appointment with a consultant dermatologist is in 11 months' time.

Surely the most poignant example is of a man of 76, living in Lanarkshire. He is a widower, living alone. He was diagnosed as suffering from cataracts in both eyes, and was told that he would have to wait at least eight months for an operation. In the meantime, his sight deteriorated quickly, and he was virtually blind. He returned to his general practitioner, who advised him that he could still not expect to receive treatment for seven to 10 months. On receiving that news, he used his life savings of £2,500 to have one eye operated on privately, because he could not afford an operation on both eyes. That was in December 1999, and he has now been told to expect to wait another seven or eight months before his other eye can been operated on under the NHS.

All those examples have been of painful, distressing, but probably not life-threatening, conditions. It is in considering life-or-death situations that we begin to realise the full truth behind the waiting list claims.

I learned from the letter of the daughter of a man who had been diagnosed on 19 November last year with lung cancer that he was told that his radiotherapy treatment, at the Beatson oncology clinic, would not start until 24 January this year, a wait of eight weeks. The daughter knew that that was too long. She wrote to the clinic and was told:

"The waiting times are unacceptable . . . It is difficult to explain to patients each week that they will wait unacceptably long times . . . We do not enjoy the hopelessness of it all."

Those are directs quotes from a letter that the cancer sufferer's daughter received from the Beatson clinic.

People are given waiting times of eight weeks, when the waiting time recommended by the Joint Council for Clinical Oncology is no more than two weeks. The situation is truly dire. The Beatson clinic is possibly Scotland's finest but it has to buy time at HCI in Clydebank to enable 30 patients a week to have radiotherapy treatment there. The clinic is four radiotherapy machines short of being able to offer treatment within recommended guidelines. Scotland needs a further 11 radiotherapy machines to stop those life-threatening delays.

The Executive has pledged £12.5 million for the purchase of new linear accelerators. That is to be welcomed, but let us not kid ourselves: due to the fact that more than 40 per cent of the equipment that is currently in use is more than 10 years old and in need of immediate replacement, the new machines will probably only replace the machines that are in use; and, of course, there is no funding for the extra staff to deliver the treatment.

A GP told me about a 70-year-old woman whom the GP suspected had the symptoms of early bowel cancer. She was given an appointment to see a specialist in four months' time. She, too, spent her savings on private treatment, which was carried out within a week. Her GP is in no doubt that, had she waited four months to see the NHS specialist, her chances of a full recovery would have been greatly reduced. We are told that cancer is the No 1 health priority of the Executive. We have heard the pledge. When will we see the action?

The NHS is unable universally to provide the most up-to-date and effective treatment for cancer—that is a scandal. Drugs such as Taxol and Taxotere are widely accepted to be the best drugs available and are widely used in the treatment of cancer in the United States of America, which has a substantially better recovery record than Scotland. In Scotland, health boards are unable to fund the use of the drugs, which cost around £8,000 for a course of treatment. That is expensive, but we spend roughly the same amount of money on drugs to treat cancer as we do on drugs to treat acne. Professor Elaine Rankin, professor of cancer medicine at the University of Dundee, says:

"The Government is talking about making cancer a priority, but it is not making the money available to build on that public promise."

The people in the front line are speaking out. Is the minister listening?

The minister is fond of talking about how much extra funding is being invested in the health service and boasting of how well the NHS is doing under her stewardship. It is obvious, however, that there is a wide gap between what new Labour claims is happening and what is actually happening in the health service. Now that Tony Blair has spoken and the minister is allowed to admit failings in the health service, I await her response with interest. More important, the patients, health service staff and the people of Scotland want answers—not spin. They deserve nothing less.

I move,

That the Parliament recognises the debt owed to NHS staff at all levels in relation to their commitment over the winter period and through the flu outbreak; acknowledges that without this commitment on the part of the staff, the NHS in Scotland would not have coped over this period; recognises that the flu outbreak exposed an NHS in Scotland that is struggling to deliver high-quality patient care, and calls upon the Scottish Executive to acknowledge the problems that exist and to provide the necessary resources to ensure that the health service is adequately equipped and funded to provide optimum health care for the people of Scotland.

Photo of Susan Deacon Susan Deacon Labour 9:44 am, 3rd February 2000

I am pleased that the Opposition has chosen health as the subject for debate today. I welcome the opportunity to set out the Scottish Executive's policy on health and to put on record our thanks for the contribution of and the commitment shown by all NHS staff.

Photo of Susan Deacon Susan Deacon Labour

Over this winter, they have faced unprecedented pressure, as I set out in some detail in my statement to the Parliament a few weeks ago.

More than 136,000 people work for the NHS in Scotland, both within the NHS and as self-employed contractors, such as GPs and dentists. Their work embodies the best values of public service in this country, and it is those people who are at the heart of our NHS.

Photo of Susan Deacon Susan Deacon Labour

We need to support them, if we are to improve care and treatment for patients.

Photo of Brian Adam Brian Adam Scottish National Party

On several occasions, the minister has rightly praised the commitment of NHS staff and their hard work. However, will she explain to us why she has persisted in the Tory habit of paying the non-pay review body staff less than the pay review body staff? If there is such great appreciation of the staff, will she show that by treating the staff equitably?

Photo of Susan Deacon Susan Deacon Labour

As Mr Adam and other members will be aware, there is proper machinery for negotiating pay in the NHS, which has existed for some time. We are reconsidering the way in which that machinery can work most effectively in the future. The non-pay review body staff have an offer on the table and are consulting their members. I, as much as anyone, hope that a settlement will be reached as soon as possible.

If we are going to act effectively in the interests of NHS staff, we must address real issues and devise practical policies for pay and other issues. That means that we must deliver real change. It is easy to stand up and identify problems; it is much harder to deliver solutions. However, that is what this Executive is determined to do, for staff and for patients.

I now turn to what we are doing for NHS staff. I shall focus on the record of this Executive and its plans for the future. I have said before that investing in our NHS means investing in our staff. Two weeks ago, I announced pay increases well above inflation for all NHS staff in Scotland who are covered by the independent pay review bodies. For the second year running, those pay increases will be implemented in full, with no staging. Real increases, not empty promises.

Experienced nurses will receive pay rises that are worth more than £100 per month—that is 7.8 per cent, way ahead of the rate of inflation. NHS consultants will start to benefit from an extra £5 million per year to fund payments in recognition of their work load and work intensity, and their commitment to the NHS. General dental practitioners will benefit from a £2 million package to reward quality and commitment to NHS dentistry.

We can afford those increases as a result of the additional resources that this Executive has earmarked for the NHS. We are committed to fair pay for NHS staff. However, pay is only the start.

Photo of Susan Deacon Susan Deacon Labour

As NHS staff and their representatives tell me, day in, day out, staff want more. They want to be valued, to know that their views count and to have their needs recognised. They want action, not words.

Photo of Susan Deacon Susan Deacon Labour

I shall tell members just some of what this Executive has done, in just seven months in office, for those NHS staff.

We have taken action to reduce junior doctors' hours and to provide training and development opportunities for all NHS staff, through the first NHS education and training strategy. We have taken action to bring about a safe and healthy NHS working environment, through new occupational health and safety measures. We have taken action to raise the number of entrants for graduate nursing courses, and that number has increased by 14 per cent this year.

We have taken action to involve trade unions and staff representatives in decisions that affect them through national and local partnership forums. We have taken action to put in place child care and flexible working to retain staff by creating family-friendly working environments. We have taken action to recruit and train more doctors and nurses, and to retain experienced nurses in front-line patient care through the introduction of nurse consultants posts.

It is not just what we have done, but the way in which we have done it that matters.

Photo of Susan Deacon Susan Deacon Labour

All those measures have been developed, and are being implemented, in discussion, in co-operation and in partnership with NHS staff.

Hand in hand with that, we have taken steps to improve the care and treatment of patients.

Photo of Ben Wallace Ben Wallace Conservative

If the Executive's staff policies are working so well, why, in January 1999, according to the Unison survey, was staff morale lower than it had ever been? That reflected the fact that staff morale is lower under this Government than it was under the Tories. In December of last year the Royal College of Nursing conducted a similar survey and found that after a year of Labour policy the situation was no better. Twelve months after the Unison survey, morale was still low.

Photo of Susan Deacon Susan Deacon Labour

I speak to NHS staff week in, week out. The one thing that they do not believe is that life was better under the Tories than it is now. The RCN survey to which Mr Wallace refers shows improvements in many areas, and it shows that there is recognition among nurses that steps have been taken to improve the value that is assigned to them by the NHS. I am never done saying this and I will repeat it here today—we can always do more and I want us to do more. We can do more for staff and more for patients.

Allow me to set out some of the action that we are taking for patients. We have started taking action to develop new measures to speed up treatment and reduce waiting times. Cataract operations have been mentioned. In one major service redesign project in Ayrshire, cataract operation waiting times have been reduced from 12 months to one month through staff teams working together to redesign services to meet patients' needs.

We have taken action to ensure better joint working between the NHS and local authorities so that they can provide effective care of the vulnerable and elderly. We have taken action to take forward radical proposals to direct NHS resources fairly and according to need throughout Scotland.

We have taken action to set up a Clinical Standards Board for Scotland, to drive up the quality of care that is delivered by the NHS. Just this week, we have taken action to take forward our mental health policies through the creation of a new national mental health support group and we have taken action to develop a new national framework for maternity care.

This week we have also taken action to further strengthen the bond of trust between patients and family doctors in the wake of the horrific Harold Shipman case. I am sure the whole Parliament will want to join me in extending sympathy to the families of the victims of that evil man. I want to assure the people of Scotland that, in conjunction with the medical profession, the Executive will ensure that every step is taken to prevent such an occurrence ever happening here in Scotland.

Let me turn now to the issue of NHS spending and resources, which have, of course, featured in the debate.

Photo of Susan Deacon Susan Deacon Labour

I stress that much of what I have described is dependent not only on money, but on changes to the way we work. However, our programme of change is backed by real additional investment, including £300 million more for health next year.

Photo of Susan Deacon Susan Deacon Labour

That will allow health boards' allocations to be increased by more than 5 per cent at a time of historically low inflation.

Photo of Susan Deacon Susan Deacon Labour

I find it interesting when Opposition members make comparisons between England and Scotland. It might be worth noting that health spending in Scotland is 20 per cent higher than it is in England.

Photo of Susan Deacon Susan Deacon Labour

Health service spending in Scotland is already at the level of the European average as a proportion of gross domestic product.

Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament

Order. There cannot be three members standing when the minister is not giving way.

Photo of Susan Deacon Susan Deacon Labour

In Scotland we have more consultants and nurses per head of population than England does, and we are training and recruiting more.

Photo of Susan Deacon Susan Deacon Labour

I am keen to set out constructively and openly the Executive's actions and policies on the NHS. We are investing more in health, but I have said repeatedly that that is not an end in itself—it is what we do with the money that matters. We must ensure that resources are channelled directly to front-line patient care.

That is why we have taken action to abolish the expensive and divisive bureaucracy of the internal market and, instead, to put in place new controls over senior managers' pay. That is also why we have taken action to develop proper work force planning by linking today's spending on training with tomorrow's patients' needs.

Cancer care has been mentioned. We have taken action, through the Scottish cancer group, to address not only the needs of cancer patients today, but the needs of those five and 10 years from now, through long-term planning and long-term investment, including £12.5 million for radiotherapy equipment for cancer care.

We have also taken action to establish the Scottish health technology assessment centre, which will provide independent, expert advice on the clinical effectiveness and cost-effectiveness of new drugs. We have invested in infrastructure and taken more steps to end mixed-sex accommodation. Along with that action, we will take steps to improve accident and emergency services and to undertake more planning for the future.

Kay Ullrich mentioned intensive care, which I also spoke about in my statement a few weeks ago. This week, the Scottish Intensive Care Society audit group published its latest report. We will work with the society to examine the implications of that report for future provision. Again, actions, not words; planned improvement, not arbitrary promises.

As I have said repeatedly, of course we will learn from the events of this winter. There is always scope for learning and room for improvement. To develop that work, I am commissioning a group that represents a wide range of interests to reflect on existing winter planning arrangements and to consider how those arrangements can be improved in future, for the benefit of patient care—exactly as I said I would do when I spoke about winter planning in the chamber a few weeks ago.

It is just seven months since we assumed our powers as a devolved Government. In that time, we have taken action to set about the task of building an NHS in Scotland that is fit for its purpose, fit for patients and fit for the 21st century. We are doing that not just through warm words or empty rhetoric, but through real, practical action, and not just through offering quick fixes but through taking steps on the road to lasting, sustainable change.

The issues are complex and the challenges are immense, but we will not shirk from addressing them. We want continuous improvement in the NHS in Scotland. That is the road that this Executive has started upon and which we will continue to take, now and in the future.

I move amendment S1M-482.1, to leave out from "without this commitment" to end and insert:

"the hard work and outstanding commitment of NHS staff, better preparation and contingency planning than ever before, record levels of investment and effective partnership working brought about by the abolition of the internal market has enabled the NHS to deal effectively with exceptional pressures and unprecedented levels of activity over the winter period; and welcomes the commitment of the Scottish Executive outlined in Making it Work Together: A Programme for Government to work in partnership with the health service for the people of Scotland."

Photo of Mary Scanlon Mary Scanlon Conservative 9:56 am, 3rd February 2000

There is certainly room for improvement and scope for learning. I am delighted that the minister now talks about "action, not words" because that will delight the NHS in Scotland. However, we will wait and see.

The saddest part of the NHS debate in Scotland to date has been the arrogance and complacency of the Minister for Health and Community Care in terms of the unwillingness to accept responsibility and the refusal to acknowledge serious problems that exist in our NHS.

If the Labour Government is able to take pride in the success of the economy for three years, surely it can take responsibility for the failures of the NHS in the past three years. If the minister would acknowledge the difficulties and work together with us—although it looks as if there is a change in mood this morning, which I welcome—the people of Scotland might just feel some reassurance. Instead, so far we have had constant political dogma.

The worry about this Executive is that the Minister for Health and Community Care believes her own spin-doctors, who say the opposite of what is happening in the world of patient care. I will talk about the contrasting situations in Scotland, many of which were raised by Kay Ullrich.

Raigmore hospital, in its January update, probably reflects the situation of the NHS throughout Scotland. In fact, Raigmore is in a much better financial position than the majority of hospitals in Scotland. An overspend of more than £1 million is likely to worsen by year-end. Staff work 16-hour shifts, and many have forgone days off and holidays to keep the service running.

In January, all routine elective surgery at Raigmore had to be cancelled for two weeks. Out-patient waiting times have increased and there is a shortage of intensive care beds. When the intensive care consultant prayed for help, the reply from the Scottish Executive was that

"no additional funding will be made available this year to address the ITU situation, millennium pay costs and winter pressures" or to cover the inflation element of the pay award for staff covered by the pay review body. Yet Raigmore's difficulties are minute in comparison with many other health trusts in Scotland, particularly Tayside University Hospitals NHS Trust, which faces a deficit of more than £12 million. That picture is replicated throughout Scotland.

Today, I ask the minister what she will do for Scotland's hospitals, given the total financial deficit of in excess of £50 million. How can that serious financial deficit be overcome? What would the deficit be if all the staff, including doctors, were paid for the long hours that they work, well outwith their contractual hours? I hear what the minister and the SNP say about the commitment of staff, but should we be asking staff to work double shifts? Should it always come down to the good will of the staff? Is it not the Government's responsibility to support the staff?

I also hear what the minister says about the nurses' pay rise, announced at the height of the flu epidemic. Is she aware that hundreds of GP practice nurses have not yet received their pay increase for last year? She may laugh, but it would do her some good to listen sometimes.

Photo of Mary Scanlon Mary Scanlon Conservative

No chance.

The system of payments to GPs and their nurses for Tayside, Grampian and the Highlands and Islands, newly centralised in Aberdeen, has been described by GPs as a system in chaos, a total shambles. Let us stop talking about this year. How about paying the GP practice nurses for last year? That would be very welcome. Again I say, "Get a grip on reality".

Photo of Mary Scanlon Mary Scanlon Conservative

The deputy minister will have an opportunity to speak. He can write down what I am saying and answer the points that we raise, breaking the habit of eight months.

Instead of using agency nurses, which reduces the continuity of care and is more expensive, the Scottish Executive should start looking after the nurses that it has. According to the Royal College of Nursing, nearly half the nurses in Scotland agree that they are unable to take time off for training, compared with only a quarter of nurses in England. Nurses have to fund their education and study in their days off. I quote from the RCN:

"If the NHS is to be a good employer, it must stop taking nurses for granted."

With funding so tight, the training budget is often the first to be cut, affecting health and safety, the updating of skills and career development.

With regard to the flu vaccine, there is no consistent approach throughout Scotland. Grampian Health Board managed the flu vaccination programme by obtaining a list from GPs of all those at risk, writing to them, inviting them in and advertising the centres that people could go to. In the Highland Health Board, by contrast, GPs were sent a letter outlining the at-risk group and left to get on with it, with no assistance. There, again, is the difference between the minister's rhetoric and spin-doctoring and what is happening to people in Scotland.

One Highland GP practice, serving a population of 10,000, identified around 1,500 in the at-risk group. It estimated a staff time of around 240 hours, with no payment. If partnership means anything, we must appreciate that preventive care saves money in hospitals and that it should be given financial support. It would be helpful if the minister would recognise the inconsistent approach across Scotland's health boards that leads to inequalities in access. We might then be able to move forward.

Waiting times were mentioned. The latest report, covering the period up to 30 June 1999, shows an increase in waiting times of 7 per cent, compared with the previous quarter. Again, the minister needs to keep in touch with reality.

The minister boasted about the abolition of the internal market. I would like to give a prime example from this city of what has happened as a result of that. Previously, GP practices in Edinburgh could refer patients to private physiotherapy clinics, where they were seen within days. Now, because of political dogma, all those patients have to be referred to the NHS. Instead of being treated in days, they have to wait months. That not only increases pressure on the NHS but damages patient care, as conditions worsen because of the long time that more complex treatment takes. Yet Alan Milburn said:

"there is no reason why the NHS should not be collaborating with independent sector and other providers in developing new innovative forms of intermediate care."

Will health policy in Scotland be driven by political dogma or by the needs of patients? The Minister for Health and Community Care should get a grip on the NHS, get in touch with it, stop bullying and dictating to it, and start working with it to solve problems, rather than deny that they exist.

Photo of Robert Brown Robert Brown Liberal Democrat 10:05 am, 3rd February 2000

I welcome the minister's announcement of a study group into winter care arrangements. That is a good idea, which will allow—this was one of the few positive points in Mary Scanlon's speech—the disparity of approach by health boards to be examined in detail and appropriate measures to be taken to deal with it. I congratulate the minister on the tone and content of her speech, which I hope will set the style for this debate.

We must consider realities. Few things are more important to the people whom we represent than the state of the health service. All sensible commentators accept that there is a growing gap between aspiration and reality. Modern medicine can do amazing things. It can enable people who suffer from epilepsy or diabetes to live normal lives. It can carry out on a day-care basis microsurgical techniques that previously involved long stays in hospital. It can help people who have had heart attacks and—on another illness about which we have sadly heard—it can make steady progress against the once unnameable scourge that is cancer.

However, the cost of those miracles, of people living longer and of treating the ill-health that is caused by tobacco, alcohol, drugs and poverty—not least in Glasgow—has led to growth in demand that is significantly above the rate of inflation. It is to the credit of the Executive that, in only seven months, the list of measures to which Susan Deacon referred has been introduced in such a pointed and targeted fashion.

The SNP called the debate—

Photo of Robert Brown Robert Brown Liberal Democrat

I will not take interventions until I have made some progress.

This debate offers a further opportunity to explore the issues. To the SNP's credit, its amendment does not seek to blame the Scottish Executive for the flu outbreak. It identifies the growing pressure on the NHS and calls for more money. The Liberal Democrats accept those calls and have argued at Westminster that to cut the standard rate of tax in April by a further 1p is nonsense. We did not get rid of the Tories in 1997 so that we could continue with a Thatcherite economic agenda at Westminster under new Labour. In the furore surrounding Lord Winston's attack on the Labour Government's position, Tony Blair, whose populist instincts are more finely tuned than those of most people, might consider that 76 per cent of the public would forgo the 1p tax cut so that more money could be spent on health.

Politics, as they say, speaks the language of priorities. In the farrago of examples given by Mrs Ullrich, I listened in vain for positive suggestions on how, within budget constraints, we might meet the calls for more and better spending on health.

Photo of Bruce Crawford Bruce Crawford Scottish National Party

Does Robert Brown agree with Tony Blair's sentiments about increasing health spending by 5 per cent? Is he aware that the impact of such an increase in Scotland—we did not hear whether it would apply to Scotland—would be £500 million less over a five-year period, because the Barnett formula would deliver only an increase of 4.3 per cent in Scotland? Perhaps that is the reason why the minister did not ask us about that and was afraid to give us the figures.

Photo of Robert Brown Robert Brown Liberal Democrat

The minister dealt with that in her speech. I am sorry that the SNP continues to peddle the tale of the Barnett formula. Health spending is at significantly higher rates in Scotland than in England. In an independent Scotland, additional resources would have to be found to make up for the benefits that we derive from membership of the United Kingdom.

My colleague Keith Raffan told the chamber on 5 December that the SNP had made spending commitments of £1,381 billion.

Photo of Robert Brown Robert Brown Liberal Democrat

I am sorry; I meant £1,381 million. Since then the SNP has made further spending commitments of £930 million, including £755 million on health and community care. The running tally is now £2.3 billion—£16.2 million a day, which is equivalent to 10p on income tax. A separate Scotland would come with an expensive price tag. Let us get back to the real world.

Our immediate concern is to get best value from existing resources. We need to look at the drugs budget and at the increased cost of hospital infections—a problem recently identified in a Public Health Laboratory Services report—which is running at about £100 million a year. A targeted attack on such problems could yield additional financial savings.

In summary, we need to spend a greater percentage of our national resource on health but we need to be scrupulous in wiping out unnecessary costs and waste in the system. We cannot avoid the issue of NHS priorities. I support the Executive amendment.

Photo of Lord David Steel Lord David Steel Presiding Officer, Scottish Parliament

Thank you. Speeches should be limited to four minutes.

Photo of Bruce Crawford Bruce Crawford Scottish National Party 10:11 am, 3rd February 2000

Looking through the Official Report of last week's budget debate, I was struck by the number of times that Jack McConnell repeated the claim that Scotland's health service receives substantial extra financial support. That repetition of that misleading spin reveals the true level of insecurity and anxiety that the Lib-Lab Government feels about its spending record. Repeating and spinning one's message ad nauseam to ensure that it becomes received wisdom might work on the voting fodder who sit on the Government back benches, but it does not work with us and I am sure that it does not work in the hospital waiting rooms and wards throughout Scotland.

The spin is also not working with the chief executives of Scotland's acute services trusts. Perhaps the Deputy Minister for Health and Community Care will explain when he is winding up why 19 of the 26 acute trust managers have said recently that they cannot meet the financial targets set by the Government. He might go further and tell us which of the acute trusts will meet the financial targets set by the Government.

We have all seen press headlines such as "Budget threat to 600 health jobs". That is a reference to Tayside, where the Tayside University Hospitals NHS Trust is struggling to come to grips with a so-called budget deficit of £12 million. The director of finance for that trust recently issued a statement saying:

"To assure safe and sustainable services in Tayside there is a need for a major injection of additional resources."

In Fife, the health board is in disarray as it struggles to deal with the financial constraints placed on it by the Government. Fife Health Board stated in its integrated health care consultation document:

"Health services in Fife will not be affordable within the next five years given the existing resource framework and demand projections."

That is, for Fife Health Board, what living with the realities behind the Government's propaganda means.

Photo of Robert Brown Robert Brown Liberal Democrat

Mr Crawford was kind enough to intervene on finance in my speech. Let us assume that we have heard and accepted the point about the problems. Can we hear about the SNP's financial approach to the solutions?

Photo of Bruce Crawford Bruce Crawford Scottish National Party

One word would sort that out: independence. It is obvious from what we have heard today that you lot have swallowed hook, line and sinker the spin put on by the Government—I apologise, Presiding Officer, for using the word "you".

The reality is a 0.8 per cent real-terms increase in health spending that is predicated on inflation of 2.5 per cent. However, everyone in the health service knows that inflation means nothing as an indicator because the pressures with which the NHS must deal are over and above inflation. Those pressures include: increases of about 10 per cent so that medical staff can deal properly with the issues identified in the Calman report; drugs and radiology costs rising by anything up to 20 per cent; the increase in the number of patients treated, owing to advances in technology and drugs; and increases in the ratio of nurses to beds, due to the complexity of care—increases that are between 16 per cent and 21 per cent. We need to add to that the cost of the recently announced increases—the Minister for Health and Community Care announced them again this morning—in salaries for some NHS staff that are well above the rate of inflation.

Photo of Iain Gray Iain Gray Labour

Can I take it from that last remark that the SNP sees above-inflation pay increases for NHS staff as a problem?

Photo of Bruce Crawford Bruce Crawford Scottish National Party

What I am saying is that we have heard spin after spin. In fact, ministers are like a bunch of peeries now, they are spinning that much. They are not putting enough money into the system to pay for the reality, despite the pressures that I have outlined.

What do we hear from the minister in parliamentary question after parliamentary question? She attempts to pass the buck by telling members that the matters that they raise are for the health boards to deal with. She is happy to indulge in spinning and misleading statements about the financial position of the national health service in Scotland, but she is not prepared to carry the can in Parliament for the reality of her own propaganda. She and the Government are damaging Scotland's health.

Photo of Scott Barrie Scott Barrie Labour 10:15 am, 3rd February 2000

As Robert Brown said, Kay Ullrich outlined a catalogue of perceived problems in our national health service but did not give us an inkling of how she thinks they could be tackled.

Kay Ullrich drew attention to the case of the three people who received treatment at HCI in Clydebank rather than in Fife. When I visited Queen Margaret hospital last week, I spoke to one of those people who had received treatment at Clydebank. I think that that example shows that, when faced with difficulties, the health service can come through. Someone who needed treatment for a tumour that was diagnosed early last month was treated within two weeks because they needed that life-saving surgery. That is the story of the health service. When the people of Scotland need life-saving treatment, our national health service provides it, and provides it well.

The motion and the amendment that we are debating today both pay tribute to the hard work that health service staff at all levels have done over the past two months. I certainly echo that sentiment. Anyone who has received treatment in a hospital, as I did last year, will know about the sheer dedication of the staff who provide care at all levels.

Photo of Tricia Marwick Tricia Marwick Scottish National Party

Will Scott Barrie join me in condemning the actions of Fife Acute Hospitals NHS Trust, which has betrayed the staff and patients of Fife by seeking to introduce car parking charges at the Queen Margaret hospital in Dunfermline and at the Victoria hospital in Kirkcaldy? Will he also condemn the fact that the trust claims that it needs the £300,000 that it will raise through those charges to pay for vital patient care? Does he agree that it is a betrayal of the low-paid workers of Fife Acute Hospitals NHS Trust that they must now pay for car parking?

Photo of Scott Barrie Scott Barrie Labour

Tricia Marwick raises an important point. I am concerned about the fact that, as a result of yesterday's decision, charging is to be introduced at Forth Park, Victoria and Queen Margaret hospitals. However, I do not condemn the trust for taking that action, because we must consider why it has done it. One of the main reasons— [Interruption.] Just let me answer, please. The trust claims that one of the reasons for introducing charges is that there is insufficient car parking space. When I visited the Queen Margaret hospital a week past Monday, I could not park my car there.

The policy needs to be revisited. I certainly do not want parking charges to be introduced. In the case of the Queen Margaret hospital, it would result in neighbouring residential areas and the carpark at the new railway station being used by those people visiting the hospital who wanted to avoid charges. I join Fife Council in calling for that policy to be considered again.

Mary Scanlon touched on the subject of training. Last August, I attended the launch of a training partnership between Lauder College, Fife College and Fife Acute Hospitals NHS Trust. That partnership is an innovative way of approaching training at all levels in the health service and demonstrates the commitment of those three bodies. It could act as a model for other parts of Scotland, and I urge other colleges and trusts to study it.

We have already heard comments about the percentage of resources spent on health in Scotland and in Britain compared with what is spent in other European countries. Sometimes, however, people's aspirations for health spending are greater than the available resources. Only this morning, I heard on the news that industrial action is being taken in the French health service because people feel that insufficient resources are being allocated. However, France is often cited as a country that spends a greater percentage of its gross domestic product on health. We must consider what we expect from our health service and what resources we will put into it.

Photo of Dennis Canavan Dennis Canavan Independent 10:20 am, 3rd February 2000

First, I pay tribute to the dedicated staff in our national health service for all the hard work that they do in treating and caring for patients, often in difficult circumstances. I am pleased that the motion and the amendment recognise the work of NHS staff. I pay particular tribute to the staff at Falkirk and District royal infirmary in my constituency. That hospital has a fine reputation, and I am sure that many of my constituents are grateful for the standard of service that it provides.

However, I would be grateful if Iain Gray, in replying to the debate, would comment on recent revelations about certain operations at Falkirk and District royal infirmary. I refer to the amputations of limbs from patients with body dysmorphic disorder. I find it almost incredible that any reputable surgeon would amputate a perfectly healthy limb, and I am surprised that the General Medical Council does not have an ethical code or guidelines on such a practice. Apparently, few surgeons anywhere in the world are prepared to do such operations in such circumstances.

I am sure that many people will be concerned about the report in today's Daily Record that one of the patients who had a leg amputated at Falkirk runs a website for those attracted to people with disabilities, and that the website features pictures and stories of amputees and those who are sexually aroused by them.

I am also concerned that, without even informing the chairman of the trust, the hospital management accepted fees for the operations to be done in private practice. I understand that the surgeon waived his fees and that the entire sum of £8,000 was put into the hospital budget, but the fact remains that the operations were done in private practice in an NHS hospital, using NHS facilities and NHS staff, at a time when NHS patients are having to wait for essential operations. I would like all private practice removed from NHS hospitals so that, when people have to wait for an operation, the person at the head of the queue will be the person who is most in need, rather than the person who is able and willing to pay.

As the Minister for Health and Community Care is aware, I have lodged parliamentary questions asking her to investigate those operations and to issue to all NHS trusts in Scotland appropriate instructions or guidelines. I understand that the chairman of Forth Valley Acute Hospitals NHS Trust has given an assurance that such operations will not be done again privately at Falkirk, and I welcome that assurance, but I would be grateful if the minister would say what actions the Executive intends to take at national level.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent 10:23 am, 3rd February 2000

While we are paying tribute to NHS staff, we must make it clear that we are not limiting that tribute to hospitals alone, but extending it, of course, to the ambulance service and to the blood transfusion service.

As a member of the Health and Community Care Committee, I was out in Glasgow on hogmanay and new year's day visiting ambulance stations and hospitals. Some of the staff were ill, but had none the less turned up to do their public duty. I wish that, instead of just paying tribute by talking—talk is cheap—the Government would give the staff a bonus for what they did in bringing us through the millennium and in coping with the flu crisis against all odds.

Instead of rewarding the staff for their work, we see that the situation in Glasgow's hospitals is so bad that the hospitals are £11.5 million in debt—hospitals that are manned by the very staff whom we are praising today. I say to the minister, "Please attend to those hospitals." The Executive has refused them extra help, despite the investment that they and their staff have had to make to tackle the flu epidemic and the millennium problems.

The NHS is no longer the NHS. It is the PHS—the private health service. That is why bizarre and disgraceful operations, such as those at Falkirk, can happen. They were done not just through the decision of an individual surgeon, but through a horrible climate, which says, "Okay, we will take the money." Scotland chopped off those healthy legs when no other country in the world would take those two very disturbed patients—one from Germany and one from England. What a reputation to land Scotland with, minister. That is what Blairism has done to our reputation internationally.

The country that gave the world its key medical advances—the land of Fleming, Simpson and Lister—is now degraded internationally by the atmosphere created by this Government and its money-first approach, which in the long run has led to legs being chopped off that should not have been chopped off. That is utterly disgraceful. We do not need the macabre entering into surgery in Scotland.

I will now talk about Glasgow—the most sick city in Britain. In modern Europe, it is mathematically almost impossible for one city to contain six of the most unhealthy constituencies of more than 600 in the British Isles. However, Glasgow has that toll of shame, despite the fact that it consists of only 10 constituencies. That is what the health service has to cope with.

I visited a young mother in Easterhouse—I hope that this Parliament or its committees will meet in Easterhouse and see the schemes and how the people suffer—who is a chronic asthmatic with an asthmatic nine-year-old child. She lives in a house that has so much damp that I felt it settling round me like a clammy shroud. The young woman had been admitted overnight to Glasgow royal infirmary—for the eighth time in one year, she was admitted as an emergency case who needed oxygen. The child was also in a bad state in that house, which was immaculately kept but had damp seeping through the walls.

There are no proper housing repairs in Glasgow; 47 per cent of Glasgow council housing is damp. That is a disgraceful record for Labour, particularly for the First Minister, who has been a Glasgow MP since 1979—what has he done about the suffering of our people?

In Glasgow, angiograms for heart patients were being cancelled because of a shortage of beds. One patient, Mrs Denise O'Kane, who has a severe heart condition, is calling for an inquiry. She could not obtain an angiogram at Glasgow royal infirmary because of the flu crisis.

Our people are being treated shamefully. Why should Scotland, at the beginning of this new century, be the only country in western Europe with such a shocking and degrading health record? I will tell you why: it is because Mr Blair and his smarmy army are ripping us off. The Trident programme costs £30 billion to run. Just think what only £1.5 billion would do for our national health service.

Photo of Cathy Jamieson Cathy Jamieson Labour 10:28 am, 3rd February 2000

I stand here with a sense of déjà vu, because it seems that yet again this morning we have had the single transferable whinge about the health service rather than a positive attitude about what can be done to bring about change.

The last time that I spoke on health, I said that I hoped that members would not continue to use the NHS as a political football and that we would get into a no-blame culture and away from the notion that the Opposition just attacks the Government without proposing any positive solutions. I am disappointed that we have not moved forward.

I will move forward and talk about some of the positive initiatives in health care. This morning, there has again been a fixation with beds. Let us remember that the health service is not just about beds and in-patient services; it is much wider than that. The health service includes all the community care services, many of which deliver day in day out—without any reward—a positive service that is welcomed by people in local communities.

I echo the comments made in support of NHS staff. However, I take it ill when the Conservatives lecture me—a trade unionist all my working life—about positive working practices and the need to recognise the workers. When Mary Scanlon talks about—

Photo of Mary Scanlon Mary Scanlon Conservative

I used figures from the Royal College of Nursing about training, about nurses working double shifts and about nurses not being valued; I also used figures from Unison. Does the member agree with the Royal College of Nursing and Unison?

Photo of Cathy Jamieson Cathy Jamieson Labour

I have probably spent more time talking to people in Unison and other trade unions than many of the Tories have had hot dinners. Again, I take it ill having the Tories lecture me on trade unionism. [MEMBERS: "Hear, hear."]

I want to talk about the positive issues. I agree that Unison and others have raised serious questions, as have some people in the health boards and the health trusts. However, the answer is not for us to sit here and whinge; the answer is to look for positive action.

I attended the primary care trust board meeting in Ayrshire last week. The question of how we improve patient care services was discussed. For example, we talked about dental provision—which constituents of mine, among others, have been saying does not meet their requirements—and the possibility of extending it out of hours. A positive plan is being drawn up to improve the way in which complaints procedures are dealt with. Again, that is being carried out in conjunction with the local health council. In the "Designed to Care" health care programmes, the minister has discussed such measures, which are aimed not only at reducing waiting times but at giving a better patient experience.

The minister visited Ayr hospital, as I did, at the height of the flu epidemic in Ayrshire. She will have seen for herself the dedication of the staff. However, those staff were saying that their priority was the patients who were in the hospital at that time. Despite the difficulties, and despite knowing that they would have to cancel some non-urgent appointments, they continued to provide a service. What is more, they took the decision that they would not scaremonger; the last thing that the staff wanted was for people out in the community not to approach their GP or hospital for the health care that they needed. The staff coped with the situation under difficult circumstances—we can all learn from that.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

If the SNP is being accused of whingeing when we ask for adequate resources in the NHS, are the staff also whingeing when they ask for more resources?

Photo of Cathy Jamieson Cathy Jamieson Labour

My point about whingeing is that the SNP is not making any positive proposals. I would be delighted to hear the SNP describe its approach rather than merely promote independence as a solution.

I hope that the minister will give more information about what she will ask health boards to do in relation to the Shipman case. It has been brought to my attention that people are concerned that there may be people working in the NHS somewhere in Scotland who have been convicted of serious offences. I would like some reassurance for my constituents on that point.

Photo of Brian Adam Brian Adam Scottish National Party 10:33 am, 3rd February 2000

I do not want to labour some of the financial points that have been debated back and forth on many occasions; for example, the wonderful spin about the £1.8 billion that, in reality, is an additional £300 million this year, £300 million next year and £300 million the year after that. Such doubling—or tripling—of the figures, by the use of mirrors, is now utterly discredited.

I should like Mr Gray, who I assume is summing up, to address a point that was made earlier. Mr Blair has committed 5 per cent, year on year, to put our health service on a par with other European ones, instead of at the bottom of the league. Can Mr Gray tell us whether we will receive the same 5 per cent—not 4.3 per cent or any other form of Barnett squeeze effect—in Scotland in the coming years? I should like such a commitment from him.

I have just had the usual response from the minister on my question about how we differentiate between pay review body staff and non-pay review body staff. It is my impression that, consistently since 1982, the Government has differentiated between those two groups of staff and has given the latter group lower pay rises. As far as I am aware, the offer that is currently on the table is again less for non-pay review body staff than it is for pay review body staff. We must ask why that differentiation is persistent in the health service under the Lib-Lab Government.

While we welcome £12.5 million for new oncology equipment, we want to know how much of that will be spent on additional equipment and how much will replace out-of-date equipment. One of the ways in which budgets have been met in recent years is by continually extending the lifespan of equipment that is often redundant, less safe and less efficacious than it should be. Will Iain Gray tell us how much of the additional £12.5 million for that equipment will be spent on new, additional equipment, rather than on replacement equipment?

The health debate that is taking place outwith the Parliament has brought to my attention the effect on individuals. The local newspaper in Aberdeen, the Evening Express, highlighted the case of a 25-year-old marine engineer, a non-smoker, who was diagnosed with lung cancer. His consultant advised him that he should have an operation immediately. The NHS was not in a position to offer him the operation for another month. However, he and his family raised enough money for the same consultant to carry out the operation, privately, within a week. That is the reality of our health service.

The national health service is not capable of coping with immediate needs, unlike the private sector. Like Dennis Canavan, I am concerned that we are abusing NHS facilities to deal with private practice. This is not the SNP whingeing—we are public representatives saying that the NHS has never been in such a poor state.

In response to the articles that appeared, further issues were raised in the newspaper. When a GP sends a referral letter to the hospital, requesting an out-patient consultation, the letter is processed—sat on—for six to eight weeks before an appointment is sent to the patient. Out-patient waiting times are being massaged. Another story that was reported was that of a patient awaiting a crucial hernia operation, which had also been delayed. The minister must accept that clever figures and a positive spin do not reflect the current situation.

Photo of Margaret Smith Margaret Smith Liberal Democrat 10:37 am, 3rd February 2000

I welcome the opportunity to debate health and to pay tribute to the hard work and dedication of the 136,000 professionals working in our health service.

I want to focus on some of the issues that have arisen from the winter pressures. During the past few weeks and months, NHS staff have been working extra shifts and have given up their holidays to deliver the best possible health care in difficult situations. In Lothian, for example, there was a 42 per cent increase in admissions compared with last year's worst seven-day period. The peak activity also came earlier than last year, demanding flexibility not only from the system, but from the staff.

I am particularly glad that the minister outlined the reasons why the Executive is engaging with staff to tackle issues such as training. I am also glad that the Executive has agreed above-inflation pay rises for many NHS staff, ranging from 3.3 per cent to 7.8 per cent for grade E nurses. I hope that that goes some way towards improving morale, which is lower than it should be. The Executive must examine the situation of non-pay review body staff as a matter of urgency. It cannot be right that cleaners and auxiliary staff in the NHS have to do themselves out of money to give of their best to the public, rather than earning more by cleaning city centre offices.

It is clear that there has been a particularly bad bout of flu. We must learn from such outbreaks. I have already alerted the minister to the fact that the Health and Community Care Committee wants to consider the wider issue of on-going winter pressures, to discover the lessons that can be learned. The situation could have been so much worse if winter pressure funds had not been available and used to open 160 beds in Lothian. If the winter weather had been more severe, if acute and primary care trusts and services had not worked together to plan ahead and if the millennium bug had caused problems—today we heard that the worst thing that happened at the millennium was Dorothy-Grace Elder roaming the streets of Glasgow—things could have been much worse.

We have heard a great deal over the past few months about the role of general practitioners. The committee will address that role. GPs obviously have a crucial part to play in handling winter pressures and in being gatekeepers to the acute service.

Health boards also have a crucial role. Mary Scanlon is right to say that there are inconsistencies in service provision, but those inconsistencies are there not because the Executive wants them to be there, but because of decisions taken by local health boards. She talked about equity of access, but then gave an example of people being able to pay for better care. There was inconsistency in her approach.

People live longer nowadays, and survive diseases that once would have killed them. More people are admitted to hospital time and again. There is evidence that when they deal with elderly people in winter, GPs, locums, out-of-hours service practitioners and hospitals are practising more defensive medicine. That leads to more admissions and, crucially, longer hospital stays. That is why pilot schemes that enhance domiciliary care and support patients in their homes—which allows them to leave hospital sooner—must be encouraged and properly funded in the long term, once the pilot comes to an end. They represent good practice and good value for money. There was one such scheme at the Royal Victoria hospital in my constituency, which was visited by the minister and me on new year's eve—so Dorothy is not alone in roaming around at new year.

Various pressures—including a lack of social work cover over the winter holiday—lead to problems such as bed blocking. We have lessons to learn. Across Scotland, much planning has gone into working through those problems. I have seen some of that in Edinburgh and, I say to Dennis Canavan, in Falkirk. Innovative ideas are being channelled into providing appropriate care pathways that focus on the patient much more closely than before.

Demand will always outstrip supply in the NHS. Despite our Executive's best efforts, there will be unmet need. Despite record spending levels, all parties in the Parliament should urge Gordon Brown to think again and to reverse his decision to cut tax by 1p this spring. Liberal Democrats would rather see that £200 million freed up to allow greater additional investment in the Scottish health service next year. While politicians and the public buy into the big lie that service can improve at the same time as taxes are slashed, staff will continue to struggle to cope year on year.

Photo of David Davidson David Davidson Conservative 10:43 am, 3rd February 2000

I welcome the Scottish National party motion, and I heartily agree with the sentiments that have been expressed in all parts of the chamber towards health service staff, who have been struggling at tremendous personal cost.

The second part of the motion relates to resources, and unfortunately it exposes once again the nationalists' naive approach. They believe that simply throwing money at the health service is a solution; it is not.

The Executive must take on board the fact that, after 1,000 days of the Labour Government, problems due to underfunding of the health service are being compounded by mismanagement and lack of planning, by the Executive in particular.

Last year, we held a debate on public health, in which I called for a more creative approach to health provision. I hope that Cathy Jamieson notices that I am attempting to give details of that.

The first step is to ensure that we run effective and timely advice campaigns for the public. Why did the Executive not run the same advertising campaign on flu that was run elsewhere in the United Kingdom? Any public health campaign must also give practical advice in a form that the public can act upon. I was disappointed that there was no mention by the minister of community pharmacists, professionals whose services are freely available all over the country, and who are ready, willing and able to filter out some of the problems so that the health service does not suffer the full impact. We cannot have a situation where every time there is a cough or a sniffle, people start to queue at the doctor's door. Pharmacists are a resource that we must use more carefully, and I was disappointed that the minister made no mention of the role that they can play.

The debate is not really about flu; it is about the ability of new Labour, and the Executive in particular, to manage our health service. The Executive fails to demonstrate that management responsibility lies in its hands. I agree with the Executive when it expects people working in the health service to deliver more service for the same buck—but they are not miracle workers.

Although Jack McConnell grinds on about the 2.6 per cent deflator—which was mentioned by an SNP member—it cannot be applied as a blunt instrument to a service that sees year-on-year demand rise by three or four times that figure before sectoral inflation kicks in.

Where is the recognition that new treatments and procedures require additional investment and resources? We hear many pathetic claims from the Minister for Health and Community Care and the Minister for Finance that there is no rationing in the health service. The same claim is made in the occasional written answers that I receive from Susan Deacon, one of which was published in the journal of the Royal Pharmaceutical Society of Great Britain and went worldwide. I am sure that that is a first for the minister.

The idea that there is no rationing in the health service is nonsense. In the real world, prioritisation and good management cause rationing. We have to plan to make sure that resources are correctly applied, and if resources are not available, alternative means must be found to provide services.

Is the Minister for Health and Community Care clairvoyant? When she writes to me regularly, if belatedly, she states that she does not know the answers to my questions because the statistics are not available centrally. If the Executive does not have those figures, how does it make strategic management decisions on health? It is incredible; no other organisation in the world can be run in that way. For example, I find it appalling that the Executive does not know how many diabetics are diagnosed each year and whether they are type 1 or type 2. How can we plan long-term to invest in Scotland's health service in a truly focused way that will save money for the health service and prevent personal suffering for the individual? I ask that question time and again, and I am disappointed that I have not received an answer.

Photo of David Davidson David Davidson Conservative

I am sure that the minister will use his time at the end of the debate to answer my question. I have to press on.

The Executive should recognise what the health service could gain from contracting out into the private sector and use that expertise, which is cost-effective and well managed. That would not be privatisation, but it would be co-operation between the public and private sectors to provide the health service that we need. Finally, the next time a member of the Executive goes down to London, could he or she ask the Chancellor of the Exchequer to give back about £1 billion from the stealth taxes that he has taken out of Scottish pockets in the past two years?

Photo of Malcolm Chisholm Malcolm Chisholm Labour 10:47 am, 3rd February 2000

January was a very important month in the history of the NHS. Michael Portillo said that a health service that was free at the point of use and funded from general taxation was a "historical accident", and Tony Blair reaffirmed the fundamental principles of the NHS as laid down by Aneurin Bevan, when he rejected insurance models and established the best demonstration that we have ever had of socialism in action. That is what so many Tories do not like, and why William Hague and Liam Fox are so obsessed with private health insurance rather than a fair NHS.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

As I know that Scottish Tories are often embarrassed by their English colleagues, I hope that David Davidson will take this opportunity to distance himself from Michael Portillo, William Hague and Liam Fox.

Photo of David Davidson David Davidson Conservative

I am happy to answer Malcolm Chisholm's point, which is the point that I made a few minutes ago. We need to examine creative alternatives, so that the health service is available for people who cannot afford health care elsewhere. We need to expand opportunities in and access to health. If someone is prepared to buy insurance and go to a private hospital in Glasgow, that saves money for the health service and allows more services and access for others.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

David Davidson could not be more wrong. Private health insurance is expensive; is focused on people who are good medical risks; rarely extends to the over-75s; is deeply divisive and creates a two-tier service; and would not ease any burden on the NHS.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I have to move on; I have only two and a half minutes left.

Margo MacDonald, in her Edinburgh Evening News column, recently supported an alternative social insurance model. That would be a more expensive and bureaucratic system, in which costs would perpetually escalate. By contrast, in an important interview, Tony Blair said that the public finances had been sorted out and the economy had been put on a stable path, so that the Government could afford to put the money in.

Photo of Kay Ullrich Kay Ullrich Scottish National Party

Does Mr Chisholm agree with our Health and Community Care Committee colleague, Dr Richard Simpson, who said on "Newsnight Scotland" on 17 January:

"We are going to need some higher expenditure. There is no doubt about that"?

Dr Simpson is becoming our Lord Winston—a very honest man indeed.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

Of course I do, and on this occasion I agree with Tony Blair, who said that more money was going in.

Kay Ullrich asked what money was going in. The answer is: the same per head as in England. It is a matter of basic maths—because we have a higher base, we receive a lower percentage. If Kay Ullrich has £10 and I have £12, and we each get a £1 increase, Kay gets a higher percentage increase than me, but I still have more money.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am sorry—I have only one minute left.

Whether we look at the increase in terms of percentages or money, in the current three-year period there will be 11 per cent—or £546 million—real growth in the health service.

Kay Ullrich outlined several real problems, which I acknowledge; I believe that the Executive acknowledges them, too. She talked about intensive care beds; a review of such beds is being carried out. She talked about unacceptable waiting times; a commitment on waiting times is central to Executive health policy. She also talked about the recent flu outbreak and other January difficulties; a commissioning group that represents a wide range of interests has been formed to reflect on existing winter planning arrangements and how they can be improved.

There is no room for complacency and I do not believe that anyone is being complacent, but we must have a sense of proportion. A Scottish Association of Health Councils report, this week, said that waiting times in Scottish accident and emergency departments had been halved since last January.

I am not complacent—we need to go further—but let us remember that much activity is going on. For example, in Edinburgh, three wards were opened in January especially because of the flu emergency. Perhaps that is how we must move forward. If, instead, we just have massive increases in bed numbers throughout the year, we must realise the cost implications for the development of primary care and the broad public health agenda that we all support.

Photo of Fiona McLeod Fiona McLeod Scottish National Party 10:52 am, 3rd February 2000

I will speak about children's health. I am disappointed that I, as the last speaker from the floor, am the first to raise that issue. I should have thought that the minister, in her opening speech, would have wanted to talk about health and services for our future. She also failed to mention children's health services in her introduction to her first annual report, "Making it work together".

We must consider two aspects of children's heath services, the first of which is acute services. We must ask, again, why the 1998 review of acute services had to be persuaded to set up a sub-group to examine children's health services in Scotland. That area has to be given a higher priority than it receives at the moment.

We have heard much this morning about how we have adequate funding in our health service. I question that view, when—for children's health services—we have had to move from funding to fund raising. We have to wait for the likes of the Evening Times to hold an appeal to buy a scanner for Yorkhill sick children's hospital in Glasgow. This year, the Blue Peter appeal raised money for incubators for hospitals not in Peru or Africa, but in the United Kingdom. Is that the way in which we should fund health services for children in this country?

Palliative care is particularly close to my heart. In Scotland, we have one hospice for children, Rachel House; it does a wonderful job, but it is a charity. We are looking for a second such hospice and we will raise the money by public appeal and by charity. Is that the way in which we should treat the most vulnerable people in the health service?

Secondly, many children's health services are about prevention, so that we can give children a good start in life and continue in that way. The statistics on children's dental health show that Scotland has a dreadful record. What is worse is that the target that the Government set itself to reduce cavities, fillings and extractions in the under-fives was missed this year and has had to be extended to 2010. Why did we miss that target? Again, it comes down to funding.

Funding for the dental service is put into general dental practice rather than into the community dental service. We need general dental practice, but the community dental service is at the forefront of prevention in our most deprived areas, which is where the targets have been completely missed.

Photo of Cathy Jamieson Cathy Jamieson Labour

Does the member accept that it is a question not just of throwing more money at dental health problems, but of tackling the Scots' traditionally appalling diet? We need a programme of education and work on healthy eating and nutrition, as well as measures to improve opportunities for children and young people to attend dental clinics.

Photo of Fiona McLeod Fiona McLeod Scottish National Party

That is exactly the point that I was making. Dental health is affected by diet and nutrition, but dentists will explain that the problem is also one of poverty. The way in which we fund the service is another issue. If we fund dentists through payment for treatment rather than for prevention, the dental service will continue to treat the caries rather than prevent their occurrence.

Recently, I attended Breakfast Daze, the breakfast clubs' annual conference. Within two years, a 50 per cent reduction in cavities had been achieved by introducing young children to healthy eating, fruit and daily teeth brushing. Breakfast clubs need to be supported with resources and—just as important—through joined-up government.

I echo what David Davidson said about the evidence base in the health service. I tried to get statistics on child health services; it was a nightmare. It was difficult to extrapolate statistics on psychiatric services for teenagers from the statistics on provision for adults. If we want to provide resources and a health service that treats people when they need it, we need to collect statistics on children and undertake research into child health.

I leave the minister with two thoughts. We are doing away with mixed-sex wards, but what about mixed-age wards? Teenagers continue to fall between the lines, sometimes being put in with children, sometimes with the dying elderly. Finally, article 24 of the UN Convention on the Rights of the Child says that every child has the right to a healthy life.

Photo of George Reid George Reid Scottish National Party

Before we move to winding-up speeches, I inform business managers that we are running about 15 minutes early. Business managers should inform their colleagues that the debate on air freight may start 10 or 15 minutes early.

Photo of Nora Radcliffe Nora Radcliffe Liberal Democrat 10:58 am, 3rd February 2000

I join everyone else in paying tribute to NHS staff. It almost goes without saying that we owe them a tremendous debt for their dedication. They care deeply about the services that they provide and the way in which they deliver them.

In the NHS, as elsewhere, service delivery is all about resources, which means money and people. Money is important. Bruce Crawford said that we must face financial reality. There is not an infinite amount of money, so emphasis must be put on the way in which to make good use of resources.

David Davidson pointed out that we need good information to make good decisions about how resources are allocated. Cathy Jamieson said that we should not have a blame culture. We should have a culture that ensures that we know where we are, where we want to go and how to get there. It is therefore important to think about the information that we collect, how we collect it and how to make effective use of it.

There are issues about money in the health service that must be faced, one of which is the fact that inflationary pressures on the health service are far greater than general levels of inflation. That is especially true of the drugs bill and spending on equipment.

We must examine the way in which we fund pay awards. If we spend more on pay, we take money away from services. Members have raised the issue of staff in different categories being treated differently. I do not know whether that is right or wrong—we should not apportion blame—but we must examine the issue and find the best way forward.

If there is one message about using money wisely that former health service colleagues want me to give, it is to stop wasting money on organisation and reorganisation. They say that they have all the organisation and reorganisation that they can take, and want us to leave the structure alone, stop managing change and start managing services. I am glad to have been given the opportunity to pass that message on.

On the sensible use of resources, let us consider what it costs to train a nurse: £35,000. If we then take the fact that 3,000 nurses leave the service every year, which poses a real problem, we need to consider ways in which to retain staff.

Positive measures have been taken to do that, including reasonable pay awards—although Mary Scanlon identified the question of how to look after ancillary staff and staff employed by practices, not trusts.

I was delighted to hear about the training budget for staff who are not doctors. Doctors' professional development is well catered for; other health service staff have been envious of that. Having a decent budget for training will raise morale and increase retention. We must take account not only of how much it costs to train somebody, but of how much it costs to provide realistic cover to give that person access to training.

I want to mention a matter that Brian Adam raised, on the sensible use of resources: consultants who work both in the national health service and privately. Again, I will not say what is right or wrong, but it is an issue that must be addressed.

Mary Scanlon talked about health boards. I have no difficulty with different health boards having different priorities. That is a good thing. The boards are given a budget to manage, to provide local services with local accountability. If they do things differently, some will do better than others, but that will give rise to examples of good practice, which will then be shared.

Cathy Jamieson correctly reminded us that the health service is not just about acute services. We should appreciate the enormous amount of work that is carried out in community health services. David Davidson mentioned community pharmacists, who form an important resource that has been underutilised in the past, and which should be used better in the future.

Dentists deserve a mention. We need to consider how they are reimbursed so that we retain them in the health service, and how we do so in a way that changes the emphasis from filling holes in teeth to preventive measures.

Malcolm Chisholm mentioned public health, and Dorothy-Grace Elder talked about the underlying causes of ill health. Cathy Jamieson talked about education, and persuading people to take better measures to protect their own health.

I should like to finish by returning to money. Where do we get the resources? Some come from private fund raising—that is fine. Mainly, they come from taxes. Tax is not a dirty word. We cannot have services without taxes. I join my colleagues in urging the Chancellor of the Exchequer to forgo his 1p decrease in income tax and to put the money into front-line services.

Photo of Ben Wallace Ben Wallace Conservative 11:03 am, 3rd February 2000

Just over 1,000 days ago—not seven months ago—the Labour Government came to power. It does not get two starts to this race, I am afraid. In opposition, Labour used the words "crisis", "verge of collapse" and "sick". It then declared that waiting lists were the be-all and end-all of health measurement and that staff were better off in Labour's hands.

A thousand days later, we are all lectured about the reckless use of the word "crisis". We are told to grow up, to forget waiting lists—in the same way as the Executive has been forgetting about the people on them—and that winter pressures, which I am sorry to inform the minister do happen annually, have been a one-off event.

The Minister for Health and Community Care chose to ignore the warnings given by the SNP and us last June, as she did those given by the British Medical Association. Dr Kenneth Harden said in January that the BMA had argued strongly for an orchestrated campaign; that, in fairness, some health boards took that up and resourced and arranged a proper flu campaign, but that the majority did not and that, sadly, there was no central support from the Government. That is not from me—it is from the BMA.

The minister talks about action. She says that she is happy to compare statistics from England and Wales with those from Scotland. However, she is not too happy to compare statistics from different parts of Scotland. She talks about the dubious record of increases, but the highest increase in health spending in Scotland was 10.4 per cent in 1992-93. Health spending between 1993 and 1996 rose by 23.3 per cent. Under Labour, from 1997 to 2001, the increase will be 23.7 per cent. That 0.4 percentage point difference does not take into account the much higher rate of health inflation that goes on every year.

Perhaps Malcolm Chisholm, who quoted Michael Portillo, agrees with Alan Milburn, who said that there is no reason why the NHS should not collaborate with the independent sector in developing new and innovative forms of intermediate care. The wonderful thing about devolution—which the Scottish Conservative party fully supports—is that we can take a different view from our colleagues in England. It remains to be seen whether we do that with regard to our health policy.

The Executive amendment acknowledges the role of staff—but that is all it does. Actions speak louder than words. The Executive's amendment refers to the document, "Making it work together". I infer from that title that the minister is trying to spread the blame. If everyone is working together, why is morale in the NHS now at its lowest point? Why do half of the staff express a wish to follow another career? Why were the staff at Stracathro left out in the cold while their future was discussed?

Perhaps the minister means that her department should work together better with the Parliament. Her department gives the Health and Community Care Committee statutory instruments once they have become law, not 40 days earlier so that they can be discussed.

Young doctors know all about Labour's idea of working together: they were almost forced to take strike action last year by an Executive that chose to ignore their demands. At the moment, there are 140 unfilled consultant posts in Scotland—the number of doctors in training does not keep pace with the number of doctors leaving. That information comes from the BMA.

I am afraid that the Executive is determined to do the opposite of working together. It is doing its thing its way and hell mend them. With professionalism and hard work, the NHS staff is saving the skins of the Executive. From my past as a soldier, I know that morale is built by talking straight, not by coming out with doubtful statistics on spending and pay increases that are not backed up by new money. When new Labour talks about new money, it should understand that that money must be new, not a collection of fiddled statistics.

Morale is built up by making people feel valued and important. One of the reasons I got into politics is that I believe that staff in the NHS feel undervalued. The Executive is doing nothing to improve that situation. I see bad leadership every day from the Executive when it deals with staff in the NHS.

Morale is built not by leading through rank but by example. People will not respect the Minister for Health and Community Care simply because she is a minister. They will respect her because of the initiatives that she brings forward and the way in which she deals with staff. Susan Deacon is failing in those respects and that is why morale is low. We want the Executive to acknowledge the problems, to make fair and necessary changes and—above all—to recognise the contribution of all staff in the NHS.

One thousand days ago, people voted for Labour in the hope that it would do better in health and education. The Executive is failing in both areas. The electorate will not forget that. I will be interested to see the result of the Ayr by-election, as I doubt that the people of Ayr will forget it either.

I support the motion.

Photo of Iain Gray Iain Gray Labour 11:09 am, 3rd February 2000

This has been an interesting, if rather short, debate. When we last debated health—just before the recess—I said that the relentless denigration of the national health service, which amounted to a counsel of despair, failed to acknowledge the care delivered by NHS staff 24 hours a day, 365 days a year—366 days this year. I am glad that the Opposition has seen its error and has attempted to put that right in its motion today.

There has been a lot of loose talk about private health care in this debate. I want to make it clear that NHS staff deliver 95 per cent of health care in Scotland—we have only a tiny private sector. The only people who are interested in privatising the NHS are the Tories, as David Davidson made clear.

Photo of Iain Gray Iain Gray Labour

Not just now.

David Davidson's speech was also extremely confusing, as it seemed to criticise us for not running the NHS as some kind of soviet-style command-and-control centralised organisation.

Back in December, in the debate I mentioned, Susan Deacon and I expressed our confidence—not complacency—in our doctors, nurses and ancillary staff and their preparations for the winter period. We did not know then that they would in many cases face unprecedented levels of activity in January. Nevertheless, they did and our confidence was not misplaced. Our confidence was based on visits to hospitals, meetings with staff and the close examination of planning. The Opposition could choose to have confidence, too, as Cathy Jamieson did in forming an excellent contribution to today's debate.

We are already—just into February—beginning to plan for next winter with staff. We are looking forward, not back.

Photo of Jamie McGrigor Jamie McGrigor Conservative

The minister said that she found it difficult to find solutions. Lorn and Islands district general hospital in Oban has had the generous offer of a new computed tomography scanner worth £310,000 and a further offer, from another charity, to run it for two years. Why is that offer not being accepted, if the Executive is pushed for money?

Photo of Iain Gray Iain Gray Labour

As we have said many times, such decisions are for local planning. The on-cost of a decision such as that must be properly taken into account by the health board.

I want to talk about a different kind of investment in the health service. Susan Deacon called the 136,000 NHS staff in Scotland the heart of the service, which they are. That is why the pay increases that were announced in January are among the most important and effective investments that we can make in the health service. Investment in staff pay is not the problem, as the SNP seems to think, but part of the solution. Those pay increases are significantly above inflation—7.8 per cent for experienced nurses—to reward them, recognise them, respect them and retain them.

Photo of Iain Gray Iain Gray Labour

No, sorry.

Mary Scanlon raised the specific case of GP practice nurses. Indeed they should be recognised and rewarded by their employers. The point is that practice nurses' employers are the GPs themselves, who are independent contractors to the health service. Not for the first time, Mrs Scanlon's grasp of the facts is sorely lacking.

Photo of Iain Gray Iain Gray Labour

No, I am sorry. You did not pay me that courtesy, Mary, and I shall not pay it in return.

Photo of Iain Gray Iain Gray Labour

This is an especially significant investment in Scotland, where there are 808 nurses per 100,000 people, compared with 620 in England. That is a reflection of the 20 per cent higher spend on the health service, which is being spent where it matters most—at the heart of our service.

The fact bears repeating that public health spending in Scotland, as a percentage of gross domestic product, is one of the highest in Europe—and we are increasing health boards' allocations by more than 5 per cent next year although Scotland will receive the same spending review increases per head of population as England. All staff who are covered by independent pay review bodies will receive their pay increases in full—with no staging and no messing—backed up by a further range of measures on training, health and safety, and involvement in decision making. They will receive reward and respect.

If staff are the heart of patient care, it must also have a home. That is why we are delivering the biggest ever hospital building programme in Scotland. This very day, Grampian University Hospitals NHS Trust will announce the go-ahead for the new children's hospital in Aberdeen.

This is about investment in the future, but let us, for a moment, look at the past. We are reinvesting in and rededicating ourselves to a service that was ill served for 18 years under the Tories. No investment was made in radiotherapy equipment between 1992 and 1997, but we are now investing £12.5 million to try to put that right.

Photo of Iain Gray Iain Gray Labour

I am sorry—I will not give way.

That investment of £12.5 million is part of the process in which we are replacing outdated buildings, eliminating mixed-sex accommodation and improving NHS pay in real terms. That is action.

Robert Brown was right to draw attention to the absence of positive suggestions from the Opposition. Kay Ullrich mentioned the story from her mailbag about someone having to wait eight months for a cataract operation. She is right to be concerned about that, but Susan Deacon described how redesigned health care in Ayr has reduced the waiting time for such an operation from 12 months to one month. We acknowledge that there are problems and we seek solutions to them—that is government.

Saying that independence from the UK is the solution to the problems of the NHS is nonsense. Of the SNP members who have spoken, I can excuse Fiona McLeod, who made a constructive contribution. I assure her that children's health is a priority.

Can we do more? Yes. Are we listening? Yes. This week, Susan Deacon and I met 30 leaders in mental health. Today and tomorrow we will meet the chairs of all Scotland's health boards and trusts so that we can push forward the modernisation of the NHS. We must match the commitment of staff with resources and vision.

The problem with the SNP motion is that it calls for an optimum health service. I do not know what that means. We will never reach the optimum—we can always do better. There must be continuous improvement and endless action to drive up the quality of care. There must be no limit to our vision.

An endless quantity of words that are used to drive down confidence in the NHS, and vision with no beginning is, sadly, what passes for opposition in the chamber.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party 11:17 am, 3rd February 2000

I enjoyed part of the minister's speech, which is more—I can say with some confidence—than can be said for Fiona McLeod, whose political career with the SNP has just been ended by the minister's praise of her constructive contribution.

I would like, if possible, to do three things in the 10 minutes that are available to me. First, I would like to look at what we, as the Opposition, keep being told we should be doing. We have been accused of whingeing every time we complain. We are accused of having nothing positive to contribute. We should examine those accusations.

Secondly, I would like to talk about the main focus of the SNP's proposal. We want to refocus the debate in the Parliament and throughout the country. We want to move it away from being a debate that sometimes alienates people, towards being a debate that concentrates on the needs of patients. That is something Susan Deacon, when she started out in office, said that she wanted to do in regard to patient-centred care. That is not what has happened. What the SNP wants to do today is highlight real-life human problems to show why we need further action.

Thirdly I will examine what has happened in terms of financial commitments. The minister has called that debate sterile—it might be so to her, but it is vital to the health service that it knows what funding is dedicated to it.

On the accusation of whingeing, I suggest that it is the Opposition's role in the Parliament to point out what exactly is wrong with the current situation and how we can improve it. All we hear from the Executive is that the SNP has nothing to say. That simply does not stack up against what we say must happen, particularly in financial terms, in the NHS.

Nora Radcliffe seemed to suggest that everybody is right. She nearly pulled out a candle and started to sway at one point. She was saying that there are major problems in the NHS—we all accept that. She also said, however, that no one is to blame for them—that no one should be criticised. That is the route to the death of debate and of proper accountability. Real accountability means that the Executive and the ministerial team that is before us should be called to account.

The main thrust of the SNP motion, lodged in the name of Kay Ullrich, is the human cost of the failings in the NHS. We heard what that means from a wide range of members, representing all areas of the country. Kay talked about patients being driven from Inverness to Glasgow for intensive care beds. We talked about what that means for people's lives and the problems that that represents for them. She talked about a woman in Edinburgh who had to wait for 20 months for a hip operation. There was talk about patients being unable to access the drugs that would be most effective in treating their condition.

Those problems affect people day in, day out in the health service. Brian Adam mentioned a case in Aberdeen, which highlighted exactly that problem. An operation performed by a consultant could be undertaken privately in two weeks, whereas the NHS was unable to cope with that kind of proper, optimum health care.

The Deputy Minister for Community Care seemed to be confused about what the SNP means by the optimum health care in Scotland. If this Parliament does not aspire to the optimum health service in Scotland, we are not doing our job. It is simply not enough to sit back and agree, "Yes, there are problems, but we're going to make progress."

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

No, not at the moment.

The Executive must say, "Here is where we can go. Here is our strategic vision. Here is the kind of health service we want in Scotland. Let's work together to get there." We are not getting that vision from the Executive, which is why there is frustration in the chamber.

Photo of Iain Gray Iain Gray Labour

While we can argue about the meaning of optimum, we must have a vision of the kind of health service to which we aspire. The point that I was making, which has been made by many members during this and other health debates, is that we have no concept of the SNP's vision, because it has not been presented to us.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

Our vision is right at the heart of the SNP motion—the health service should be driven by the needs of real people. The whole idea behind this Parliament was that it should be accessible to the people of Scotland, but it is in danger of becoming divorced from mainstream Scotland. Today, we have an opportunity to refocus.

Some points about finance have been raised. We hear a great deal these days about joined-up government, but it appears that not only is the Executive not joined-up, but ministers do not talk to one another.

The minister said that the percentage of gross domestic product in Scotland spent on health is already above the European average, but that does not seem to match the figure of 6.9 per cent given by Mr Jack McConnell in an answer to Andrew Wilson. That point is important because it is the very measure that the Prime Minister, Tony Blair, chose to evaluate the success or failure of his policies.

Let us compare Jack McConnell's 6.9 per cent with the 8.9 per cent of GDP spent on health in France, or with the 10.4 per cent spent in Germany. Those figures suggest to me that France and Germany are nearer to the elusive optimum that the Deputy Minister for Community Care does not appear to understand. We can even compare the 6.9 per cent with the European Union average of 8.02 per cent. These are not my figures; they come from the Organisation for Economic Co-operation and Development. The minute we start to approach those kinds of figures, we can consider being self-congratulatory about where we are with the health service—but where we stand now is not good enough.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

No thank you, George.

We should also bear in mind where we are heading. If underfunding, in terms of the percentage of GDP being spent on the health service, is the context of where we are now, what are the Executive's proposals for future years? It depends which one of the Executive's budget statements we read: next year's increase will be either 0.8 per cent or 1.6 per cent, in comparison with an increase of 4.4 per cent south of the border. Figures published in October show that the three-year average increase in Scotland is 3.5 per cent, in comparison with 4.3 per cent south of the border.

Throughout the debate, we heard the argument that those figures are justifiable because Scotland already spends 20 per cent more on health per capita. It is fair to say that Scotland gets more per head of population, but why is that? Perhaps the Minister for Health and Community Care, during one of her late-night television sessions, saw Richard Simpson on "Newsnight Scotland". When asked why Scotland gets more per capita, he highlighted the fact that the needs of rural Scotland and the historic detriment in the Scottish health system meant that that 20 per cent was justifiable. On 17 January, he said:

"There are two problems: we have a poorer health record and rurality. The difference is accounted for therefore."

Does the minister accept that? Which member in the chamber would want to admit that the current settlement is overgenerous? Do we really believe that the extra 20 per cent is not justified? I do not think that there is one member who would stand up to contradict that.

Photo of George Lyon George Lyon Liberal Democrat

We have heard Duncan Hamilton mention numerous figures. Can he say to what figure the SNP believes spending should rise? Is it the French figure or is it the German figure?

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

Of all the parties to intervene on this issue, the Liberals are the most interesting, because today they have adopted the penny for Scotland that was much derided by Mr Lyon and his colleagues throughout the election campaign. Every Liberal member to speak has jumped on the back of a poll in The Observer suggesting that people want to forgo the cut in income tax and invest that money in the health service. If that is where the Liberals are at, I welcome their latter-day conversion.

On this I agree with Malcolm Chisholm—for once, perhaps, Tony Blair has got it right. Maybe when Tony Blair says that the NHS is chronically underfunded and that we must do better, he is right. However, the Scottish Executive has still not given us an adequate answer to whether the 5 per cent real-terms increase will happen. At this week's meeting of the Finance Committee, Jack McConnell gave us two answers.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

No, thank you.

Jack McConnell gave us two answers. He said, first, that the money would be available, but then he added that that would not be the case in areas where Scotland gets historically higher spending per capita. Which is it? The Executive must tell the people. If Tony Blair is claiming in London that there will be a 5 per cent increase, what is the Executive saying in Scotland? If it is suggesting that the NHS will get 5 per cent, what does that mean? Does it mean 5 per cent, or does it mean 4.3 per cent, taking into account the Barnett squeeze on health spending? I refer members to the comments not of an SNP researcher, but of a parliamentary staff researcher, on what this proposal would mean. Mr McVicar said:

"Therefore, in total, Scotland will lose over £500 million through this process."

That is the result of the iniquitous system of funding in Scotland. Until the Executive recognises the problem, all the warm words and self-congratulation will not count for anything—not in this chamber, not in the NHS and not in wider Scotland.