Health Care

– in the Scottish Parliament at 10:33 am on 14th December 2000.

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Photo of George Reid George Reid Scottish National Party 10:33 am, 14th December 2000

The next item of business is a Scottish National Party debate on motion S1M-1453, in the name of Nicola Sturgeon, on health and community care, and two amendments to that motion.

Photo of Tricia Marwick Tricia Marwick Scottish National Party

On a point of order, Presiding Officer. Later this morning, the Minister for Health and Community Care will make a statement to Parliament on the health plan. I understand that, following a briefing on Friday, details of that health plan were carried by the media. Only this morning, the Minister for Health and Community Care gave an interview on "Good Morning Scotland".

Presiding Officer, once again I urge you to intervene. As you are well aware, the Parliamentary Bureau agrees to give the Executive parliamentary time to make ministerial statements. In future, unless the SNP can be guaranteed that those statements will be made first to Parliament, we might be forced into an opposing position.

Photo of Mike Watson Mike Watson Labour

On a point of order. We must draw a line between what is a statement and what is a non-specific comment. Anyone who heard the minister on "Good Morning Scotland" and then on Radio 5 this morning will agree that she gave away no details of the statement and spoke only in general terms. The statement will be made in the chamber.

Photo of George Reid George Reid Scottish National Party

To Tricia Marwick I would say that Sir David Steel has repeatedly made it clear that Government proposals should be announced to Parliament before being unleashed on the airwaves or in newsprint. However, as Mike Watson says, there is a difference between general intention and specific policy. It is a fine line but, on this occasion, I feel that the minister came down on the right side of it.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 10:41 am, 14th December 2000

I will begin by placing on record the fact that this is the second Opposition debate on health and community care within a few weeks that Susan Deacon has not bothered to attend. In more ways than one, the Minister for Health and Community Care is treating Parliament with contempt.

Later this morning, after two years in office, the minister will publish a plan for the future of the national health service in Scotland. If the newspapers are to be believed—and they certainly appear to know more about the contents of that plan than the rest of us—I am sure that it will contain much that members will enthusiastically welcome and support. It is unfortunate that the Executive has chosen not to have a full parliamentary debate on a document that has been billed as the blueprint for the future of the NHS. Instead, the Executive has chosen to announce it in a 45-minute ministerial statement. That is inadequate and is the reason why the SNP has opted to have this debate.

If we are to judge and properly assess the impact of the health plan, it is essential that we first face the reality of the NHS in Scotland today. The reality is that after nearly four years of a Labour Government, the NHS remains in the perilous state it was in when the Conservatives left office. According to the Executive's own opinion survey, only 13 per cent of Scots believe that there have been any improvements in the health service under Labour. What an indictment.

In some key areas, things have actually got worse. Let us consider the facts. In its first year in office, Labour cut spending on the health service. Not even the Tories managed to do that in their 18 long years in office; yet it was one of the first things that Labour did when it returned to power in 1997. Today, there are nearly 900 fewer nurses in our hospitals than there were when Labour came to power. At the start of December, in her announcement on winter pressures, Susan Deacon promised additional nurses in every health board area; of course, she omitted to specify exactly how many. The reality is that it will take an additional 900 nurses just to get back to the position that we were in when the Tories left office. I do not remember anyone—least of all Labour members—asserting that that is satisfactory.

The fundamental question that the minister always fails to answer whenever she promises additional nurses is this: where will they come from? At present, more than 800 nursing posts are vacant in Scotland—and more than 200 of those have been vacant for more than three months. There is a shortage of nurses in Scotland that must be addressed if even the immediate targets of the NHS are to be met.

Let us consider one example. In a letter to me dated 5 December, Greater Glasgow Health Board said that, even at this late stage, it is likely that its winter plans will have to be revised if it is unable to employ sufficient additional staff. The Executive has said that trusts should use agency and bank nurses—notwithstanding the fact that that flies in the face of advice from the Accounts Commission that bank and agency staff should be used only in unforeseen circumstances. Not even Susan Deacon could describe winter pressures as unforeseen. However, even if we accept the use of those nurses as a short-term fix to get us through the winter, it does not begin to address the longer-term problem. The truth is that Scotland is losing nurses hand over fist. According to the Royal College of Nursing, the drop-out rate for nursing students in Scotland is at its highest for four years. The Executive is doing next to nothing to reverse that trend.

Under Labour we are losing not only nurses. Scotland has 3,000 fewer beds now than it did when Labour came to power—another example of Labour's failure to preserve, let alone improve, our health service. A further 3,000 beds are blocked—one in 10 of the total number of beds in Scotland. They are occupied by people who do not need to be there but who cannot access the care that they need in other, more appropriate, settings. Two weeks ago, Susan Deacon promised 700 new beds—less than a quarter of those that have disappeared under Labour. Failure to deliver after failure to deliver—that is Labour's record on health.

On waiting times, it is the same story—failure to deliver. And while I am talking about failure to deliver, it is appropriate that I should give way to a Conservative.

Photo of David Davidson David Davidson Conservative

And one who is asking whether Ms Sturgeon has a solution to something. Do the nationalists have a plan to make better use of the private sector care homes that could help to unblock beds?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

If David Davidson cares to wait, all will be revealed. That is a promise on which I will deliver.

In 1999, the pledge was to bring down the time that patients wait to see a consultant; yet, nearly two years later, there has been virtually no reduction in those waiting times. We also have waiting lists, which no one on the Labour benches is keen to talk about these days. In 1997, we were promised that Labour would get waiting lists down and keep them down. In 1997, 84,600 people in Scotland were waiting for care; this year, 86,500 are waiting, a hike of nearly 2,000 since Labour came into office.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Not just now.

Of course, Ms Deacon will argue that that was not her pledge, but London Labour's pledge, and that it was all Tony Blair's fault. However, her pledge in 1999 was to cut waiting lists by 10,000. Despite that pledge, in the past year waiting lists in Scotland have gone up by 11,000—a 15 per cent increase in just 12 months. It does not matter which way we look at it, or whose pledge we choose: either way, Labour has failed to deliver on the key pledge to run our health service on which it was elected.

Photo of Keith Raffan Keith Raffan Liberal Democrat

Ms Sturgeon focuses once again on waiting lists, yet her predecessor, Mrs Ullrich, said that focusing on waiting lists was crude. Will the SNP make its mind up: is it focusing on waiting lists or waiting times?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

The SNP was not elected on a pledge to reduce waiting lists; that Labour lot was. As an Opposition party, we will hold Labour to account on that pledge.

Let me move on to the implementation of the Sutherland report and the paying of personal care costs for some of the most vulnerable people in our society. There was a broad consensus in support of that in Scotland, including support from the Parliament's Health and Community Care Committee. However, nearly two years after Sutherland reported, we still do not know where the Executive stands on paying for personal care. In October, Susan Deacon said no; a few weeks later, Henry McLeish said yes. Now we hear that that commitment is not in Labour's programme for government. Astonishingly, it is Susan Deacon, the Minister for Health and Community Care, whose job it is to fight the corner of people who would benefit from free personal care, who is arguing against it. Have we ever heard the like—a Health and Community Care Minister who is turning down the opportunity to help pensioners? If that is true, Susan Deacon will not be forgiven. If it is not true, let us hear from Mr Chisholm today a clear and unambiguous statement of the Executive's position. I ask the Deputy Minister for Health and Community Care: will the Executive pay for personal care or not? Yes or no?

Even by the standards that it has set, Labour's record to date is one of failure to deliver: failure to implement Sutherland, fewer beds and nurses, and longer waiting lists. Those are the issues that people want addressed. That is why the plan that Susan Deacon will outline later today is so important. Expectations are very high, and rightly so. Like most other members, I do not know with any certainty what the plan will contain, although I would like to put on record my thanks to Scottish newspapers for giving me some handy hints. I am sure that the plan will contain a great deal that the SNP will support in principle—structural changes to cut bureaucracy, better patient involvement, national standards, a service designed around lives as they are lived today, and initiatives to improve our nation's public health. Those are aspirations that the SNP will support without reservation. However, a document that consists of aspirations, targets and pledges alone will not do—especially from a Government that has already shown that its pledges are not worth the paper that they are written on. Gone are the days when Labour made promises on health and the people of Scotland were expected to take a leap of faith.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Not just now. Scotland wants—and expects to see—a substantial and detailed blueprint for change, a set of proposals and initiatives that will tackle real problems. We are entitled to expect that of a plan that has taken the Government almost two years to produce—not simply a pledge to reduce waiting times by 2003 or some other date but a clear statement of how that will be done; not a vague promise of more doctors and nurses but a detailed strategy to address the shortfall of doctors and nurses. There must be clarity about how each of the initiatives in the plan will be funded.

On the question of resources, I turn to the Executive's amendment. It is the Executive's right to assert that it is spending record amounts on health, just as it is my right to argue that Scotland deserves more, that we should not have smaller increases than those south of the border and that our health budget should not be subject to a Barnett squeeze that will cost us over £300 million over the next three years.

That is an important argument and it will not go away. However, I put it to one side for the moment because there is a more fundamental issue to address, which I hope members can recognise and agree on. Whatever additional money is being invested in the NHS, it is not bearing fruit in substantial improvements in health or in the quality of the health service in Scotland. It is more money for fewer beds, fewer nurses and longer waiting lists and for a quality of care that too often depends on where a person lives rather than their needs. The problems in the NHS are not about just money, but about the management of resources at all levels of the service. There is a lack of transparency and accountability in the NHS that makes it absolutely impossible to track how money is spent, from when it is announced to when it is spent by boards or trusts. That is unacceptable. If democratisation and patient involvement are to mean anything, that must change and change quickly.

If Susan Deacon is determined to cut bureaucracy I will support her. However, after four years of a Labour Government and a reorganisation last year that clearly did not go far enough to solve the problems in the health service, we cannot wait a further five years for a structure that will deliver for patients in Scotland.

This morning the SNP seeks to set the context for Susan Deacon's publication of the health plan later today. That context is an NHS that is sound in principle, served by dedicated doctors, nurses and other staff, but an NHS that, under Labour, is struggling to meet the demands that are made of it every day of every week of the year.

The SNP is also setting out clearly and exactly what is expected of a Government that has a serious credibility problem when it comes to delivering on health pledges. I expect to welcome many of the aspirations in the health plan when they are officially announced to Parliament later today. However, what counts is delivery. On behalf of the SNP, I give an assurance that we will be constructive in our approach. We will inevitably disagree with the Executive on many things, and as an Opposition party we will put forward our own policies and alternative proposals and approaches, but where we can agree we will. For example, if the Executive wants the SNP's support to speed up changes that will benefit patients in Scotland it will be given it. However, I also give notice to Susan Deacon—it is unfortunate that she is not here to hear it—that she will be held to account on the basis of the document that she is about to publish. Whether it is on waiting lists or waiting times, or on doctors and nurses, the days of Labour promising big but failing to deliver for the people of Scotland on its health pledges are over. Labour will be held to account—I give that guarantee.

I move,

That the Parliament is concerned that there are 3,000 fewer beds in the NHS than in 1997 and a further 3,000 beds occupied by patients ready for discharge; is further concerned that there are 900 fewer nurses than in 1996 and that hospital waiting lists have increased by 15% since September 1999; believes that the policies of the Scottish Executive to date have not adequately addressed these issues; notes the imminent publication of the Scottish Health Plan, and calls on the Scottish Executive to include in that plan practical and adequately funded proposals that will ease the pressure on hard pressed NHS staff and deliver real improvements to the quality of care provided to patients in Scotland.

Photo of George Reid George Reid Scottish National Party

There is a discrepancy between the list of members who wish to speak that I have been given, and the information on my screen. I ask any member who wishes to speak and has not yet pressed his or her button to do so now, so that I can do my sums.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 10:55 am, 14th December 2000

As I emphasised in the previous debate on health and community care, we recognise and are acting on the problem of delayed discharges. As Susan Deacon will also say in just over an hour's time, we are determined to make more progress on reducing waiting times. However, the SNP motion completely fails to understand the changing nature of modern health care or to acknowledge the very real progress that has been made.

The health service is treating more patients than ever before. Last year, 43,000 more patients were treated than in 1997. There were 50,000 more day surgery cases in 2000 than in 1997. For example, in 1999, 57 per cent of cataract extractions were performed as day surgery compared to only 28 per cent three years previously. That trend has nothing whatever to do with cost considerations; it is championed by the leading clinicians in Scotland because the results show quicker, better outcomes for patients. That is the modern NHS: built around the patient to provide convenient services while maintaining high clinical standards. I could give many other examples, such as nurse-led clinics, which are particularly effective in the management of chronic conditions such as asthma, or one-stop clinics, of which there now 2,202. That is a pledge made by the Executive and delivered two years in advance of the target.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Is the Deputy Minister for Health and Community Care denying that there are now fewer nurses, fewer beds and longer waiting lists in Scotland than there were when Labour came to power four years ago?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am dealing with exactly those issues: beds first, then nurses, then waiting.

A consequence of the trend that I have outlined is that fewer NHS beds are required. Moreover, the average length of time a patient stays in a hospital bed is also declining. In 1990, for example, the average length of stay in an acute Scottish hospital bed was 6.9 days and now it is 5.2 days. The average occupancy rate of acute hospital beds has risen from 72.3 per cent in 1990 to 76.5 per cent this year. That means hospitals are making better use of the beds.

That said, the reduction in acute beds accounts for a very small part of the overall figure referred to in the motion. As one would expect, almost the entire reduction in bed numbers is in long-stay specialties. That is where the policy of caring for patients in their homes, or in the community as close to home as possible, is having the biggest impact. There has been a substantial transfer of resources and staff from the NHS to social work authorities and that must be remembered when bed and staffing figures are thrown around in debate. For example, there has been a welcome reduction of nearly 900 beds in long-stay, learning disability hospitals. Is the SNP objecting to that? That means not less care, but better care in the right place, which is the community.

There is plenty of scope to increase bed numbers when that is necessary, as evidenced by the 700 extra beds being opened this winter and the 20 per cent increase in critical care beds when required. I will end my comments on beds with a comparison with England, since the SNP likes that. We have 2.96 acute beds per 1,000 population, compared with 2.18 south of the border and we have 6.87 hospital beds per 1,000 population compared with 3.84 in England.

Photo of Shona Robison Shona Robison Scottish National Party

The Deputy Minister for Health and Community Care says that there has been a transfer of resources from the NHS to social work, but is not it the case that many people in Scotland are complaining that services in the community are not in place? For example, there has been a reduction of around 29,000 home care hours over the past two years. Where is the transfer of resources? It is not being felt where people need the services.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

We are building up services in the community and that is precisely what I am about to address. I want to continue without interruption because there is a lot in the motion to which to respond.

The SNP has claimed that 3,000 hospital beds are occupied by patients who are ready for discharge. The SNP is, of course, taking a uniquely narrow definition of the issue. The extensive survey of patients waiting for discharge, which was published on 4 December, shows that just over 1,900 people were waiting for more than the standard planning period of six weeks following a clinical decision on discharge. Of course, that is still too high. That is why we are taking comprehensive and robust action with the NHS and social work departments to tackle delays in discharges. We have allocated £19 million in the current financial year to local authorities and the NHS, specifically to tackle delayed discharges. That money is in addition to the specific winter money for extra beds and nurses and so on.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I must press on as I have only five minutes.

The NHS and local authorities are using the extra resources to work together and develop joint, long-term solutions to tackle the problem of delayed discharges. The Executive will monitor the effectiveness of plans at all stages and we will ensure the spread of good practice in reducing delayed discharges. The problem has existed for 25 years and more, and will not be solved overnight, but solving it will be a key priority. We have already demonstrated that—not just in the delayed discharge money to which I referred, but in the £100 million package announced by Susan Deacon on 5 October. The home care packages, the rapid response teams and the £5 million for aids and adaptations this year will all help to build community capacity and deal with the problem of delayed discharges. That was our top priority in responding to the Sutherland report on 5 October and is the background to our current review of personal care. Without going further into that matter at this point, I want to caution Nicola Sturgeon against believing everything that she reads in the newspaper.

I will move on to health service staff numbers.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am sorry but I do not have time to take interventions.

We have been taken to task this morning on nurse numbers. It is true that total nursing staff numbers are very slightly down on 1996 levels, by about 500 whole-time equivalents. However, at the same time, the number of qualified nurses within the NHS is rising: the whole-time equivalent figure is up by about 270 since 1996 and we have funded an additional 210 specialist nurses in priority areas this year. That is on top of local winter increases, such as 240 extra nurses simply in Lothian.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am sorry, but I have only three minutes left.

The trends are even better in relation to nursing students. The number of nursing and midwifery students has increased steadily over the past four years by around 12 per cent, and the numbers will increase by a further 3 per cent this year. Over the next five years, 10,000 nurses and midwives will qualify in Scotland—that is 1,500 more than previously planned. We should remember that, on top of the numbers of NHS nurses to which Nicola Sturgeon referred, there are many nurses who work in nursing homes. There was an increase of 3,000 places in nursing homes between 1996 and 1999.

I turn to the fourth point in the motion, which is waiting lists. I find that rather odd, since it was not so long ago that the SNP health spokesperson, Kay Ullrich, told us that it was not waiting lists that mattered, but waiting times.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

No. I would love to give way for the rest of the day, but I have less than two minutes.

From the point of view of the person on the waiting list, there is no doubt that it is the time of the wait that matters. Let us remember that 43 per cent of patients receive immediate treatment and do not join the waiting list. Let us remember that for those who have to wait, the median waiting time has declined steadily over the past three years to 31 days. The average wait on a waiting list in Scotland is 31 days compared to nearly 90 days in England. Let us remember that 83 per cent of patients who go on to a list are treated within three months. Of course I would like to see even better figures and a further reduction in the maximum waiting time, which is currently set at 12 months. However, we must wait to hear more on that later.

I have described some of the significant achievements of the NHS in Scotland over the past few years. I want to take the opportunity to record our recognition of the commitment and sheer hard work of health care workers throughout the health service. I want them to know that they have our support and appreciation for the effort that they make on our behalf.

Our support goes much further than words. The last figures that I want to quote are money numbers. The Executive is spending £481 million more in the NHS in Scotland this year than last. In September, we announced that health spending would go on increasing at record levels to nearly £7 billion a year by 2003-04; that means £1.2 billion extra over the next three years, on top of this year's record increase. That record investment will be combined with further reform and change to deliver more and more improvements for patients.

I move amendment S1M-1453.1, to leave out from "is concerned" to end and insert:

"notes the fact that the NHS in Scotland is treating more patients than ever before and welcomes the fact that funding for the NHS in Scotland is being increased by record amounts over the period 2000-04, and looks forward to further modernisation and change in the interests of patients."

Photo of Mary Scanlon Mary Scanlon Conservative 11:05 am, 14th December 2000

Indeed, we have a grand Parliament—we are gathered together to discuss a Scottish health plan about which we know nothing. The plan was delivered about five minutes ago to my colleague, Ben Wallace.

In this Parliament—we who shall not be lobbied, who are so squeaky clean, who cannot accept a gift that that may influence our thinking, who have a Standards Committee and a Procedures Committee and who are so worried about lobbygate and sleaze—such is the way of things that I find that I have to phone up journalists to ask for information on the Scottish health plan in order to contribute to today's debate and respond to statements. If that practice continues, I will have to consider purchasing a few brown paper envelopes and arranging a few clandestine meetings, just to get some information for future debates. We could criticise the SNP for using its time to debate an unreleased health plan. But why not? After all, the health plan was not leaked to the press—it was briefed to the press.

Photo of George Reid George Reid Scottish National Party

I would advise the member to speak to the motion.

Photo of Mary Scanlon Mary Scanlon Conservative

Why do we need a health plan? Precisely because, as the motion states, there are 3,000 blocked beds, waiting lists are rising by 15 per cent a year—in the past year in Tayside they have risen by 48 per cent because our hospital finances are in the red—there is a 10 to 20 per cent increase in emergency admissions, there are more hospital-acquired infections and there was a tragic winter crisis last year. Those are the reasons why we need a health plan. The minister's abolition of the internal market was not a great success. Even the Royal College of General Practitioners has said that clear benefits relating to the monitoring of the quality of hospital services, which were inherent in the internal market, have been lost, to the detriment of patient care. How right that is.

We need a health plan because Labour said that things could only get better. However, after Labour's four years in government, an extensive MORI poll showed that only 13 per cent of Scots—that is one in eight—thought that things had got better. It is time for drastic action. We also need a health plan after Tony Blair's television performance on Tuesday night. He is the man who follows drying paint and is told only the good news. To think that John Swinney and David McLetchie wrote to ITV to express their concerns.

A few weeks ago, the minister briefed us on the health plan. She talked about rewiring rather than restructuring the NHS. Well, the next time that I need an electrician, I know who not to call. The primary care trusts have had 18 months in which to make things work. Even managers in the Scottish Premier League get more time to build a winning team.

We read, courtesy of Tom Peterkin of Scotland on Sunday and Douglas Fraser of The Herald, that savings will be reinvested in patient care. Will that be on the same basis as the previous £44 million savings that were reinvested in the writing-off of Glasgow's housing debt?

We also read—my colleague, Ben Wallace, has just confirmed this—that councillors will be represented on the new health boards. Given the well-documented mess that councils have made of care in the community, the dissatisfaction with councils that was clearly shown by the MORI poll, the wait for assessments, the wait for treatment once assessed and the complete lack of openness and accountability, it is clear that the councils have created many of the problems that the Administration now faces. Unless care in the community is in place under a single budget with personal care being paid for, the NHS will continue to suffer from council-made problems. I do not remember ever seeing or hearing a councillor accept responsibility for the failings of care in the community. The only thing that matters is that people get the care and treatment that they expect, when they expect it, and in the hospital that they want.

Given that people are waiting longer than ever, with 2,000 more on the waiting list in Scotland than when Labour came to power, will the Executive clearly state its policy on the complementary role of the private health sector? If Jim Norris of Dunfermline can be treated privately on the basis that the NHS wait would have put him out of business, and his employees out of work, and then be able to claim the full cost of treatment—£1,500—from Fife Health Board, does that rule apply to all? The Deputy Minister for Health and Community Care must answer that today.

Why is there no word of the use of private beds to treat NHS patients when the service cannot cope, despite that being at the heart of Tony Blair's plan in England? Will the Scottish health plan address many of the points in the motion by agreeing with some of the points in the English health plan? I quote Alan Milburn:

"The time has now come for the NHS to engage more constructively with the private sector."

Again, Alan Milburn said:

"Ideological boundaries . . . should not stand in the way of . . . care for NHS patients."

Finally, Alan Milburn said:

"NHS care will remain free at the point of delivery, whether care is provided by an NHS hospital, a local GP, a private sector hospital or by a voluntary organisation."

Will we have equality of treatment in Scotland, or does no leak mean no commitment?

The thousands of frail and elderly people in Scotland are not interested in grandiose national plans. They want to know simply that they will be cared for with dignity and respect. We need to know whether the elderly will be given Henry McLeish care, Susan Deacon care, or Peter McMahon spin. That is not in the programme for government, so is that an admission that the issue is not at the heart of government? The elderly need to know.

I move amendment S1M-1453.2, to insert at end:

"and further notes the Royal Commission on Long Term Care's recommendation on free personal care and calls upon the Scottish Executive to unequivocally commit itself to this recommendation and come forward with a firm date for its implementation."

Photo of Alex Neil Alex Neil Scottish National Party

On a point of order. Everybody seems to have a copy of the ministerial statement except the MSPs who are debating the subject. Can you instruct the clerks to circulate a copy of the statement to all members in the chamber?

Photo of George Reid George Reid Scottish National Party

Yes, we shall do what we can to assist that request. That is a different matter from the point of order raised by Tricia Marwick earlier. The sufficiency and advance notice of information are matters for the parties, but they are much to be encouraged.

Photo of Keith Raffan Keith Raffan Liberal Democrat 11:13 am, 14th December 2000

It is a bit rich for the Tories to talk about "grandiose national plans" after they messed up the situation in the first place, with the ideologically driven introduction of the internal market, which I opposed. The trouble is that the Tories are now so far to the right that they cannot be seen over the horizon after the next. I see that Frank McAveety is gesturing. That is his interpretation; how could I possibly comment?

I wish to make two important points. I am glad that there is close co-operation between the Executive and the Conservative party—I agree with the Deputy Minister for Health and Community Care that they need all the help they can get—but I do not see why the Conservatives should have advance notice of the national plan before the party in partnership with Labour.

Photo of Keith Raffan Keith Raffan Liberal Democrat

No, I have hardly started. Sit down and be quiet, Mr Neil, and do not be so excitable.

My second point is that I concur with comments that have been made about advance leaking to the press, whether it is briefing or

"sources close to the minister" as some of the press refer to it. It is contempt of Parliament and the Executive has to stop it. It is also not in the Executive's interest because, as the Deputy Minister for Health and Community Care knows—it has been pointed out to me—some of the briefings are open to misinterpretation by the press. He will know that we in this chamber are much more reliable than are the media in the gallery. Their shorthand may be rusty, but I would rather that we gave a first-hand comment on the Executive's plan than that there was a second-hand interpretation through our colleagues in the press, nice though they are. I say that in the spirit of Christmas.

Photo of Keith Raffan Keith Raffan Liberal Democrat

The press are nice, but inaccurate.

Photo of George Reid George Reid Scottish National Party

Order. Mr Raffan, speak to the motion. I dealt with this matter earlier. I made it clear that given what happened this morning, the Presiding Officers will continually review whether members are speaking to the motion. Get on with the subject, please.

Photo of Keith Raffan Keith Raffan Liberal Democrat

I am happy to get on with the subject, but—and I do not challenge your ruling—it is important that members in all parties have a right to make that point, particularly when we are in partnership with the Labour party.

Photo of Ben Wallace Ben Wallace Conservative

On a point of order. I wish to clear up a misunderstanding. I do not have a copy of the ministerial statement; I have a copy of the NHS plan, which was forwarded to all members of the Health and Community Care Committee this morning. It will be sitting in their e-mail inboxes and those of certain members in all parties. Agreement for that was reached through the Parliamentary Bureau and the Health and Community Care Committee. If some members cannot be bothered to look at their e-mails, we should not be blamed.

Photo of George Reid George Reid Scottish National Party

That matter is being given attention by the health department staff in the chamber.

Photo of Keith Raffan Keith Raffan Liberal Democrat

Perhaps as finance spokesman I am just used to a department that has been more co-operative and given us more advance notice of documents. I hope that that will spread to the health department. I am sure that the Deputy Minister for Health and Community Care will take that in the spirit in which it is intended.

I say to the SNP that two of the three dates in the motion are prior to the inception of this Parliament. The spokesman for the SNP made several points about the Labour Government since 1997; we have had a Labour-Liberal Democrat partnership Government in Scotland since 1999.

Photo of Keith Raffan Keith Raffan Liberal Democrat

No. I make that clear because our party has made clear its criticism of the UK Chancellor of the Exchequer, that while he is committed to long-term planning in public spending he has, according to The Economist last week, engaged in "bust and boom spending". It is no good having a commitment to long-term public spending and not practising it. That has led to a lot of the problems that the NHS has faced. We have continuously made that point as a Westminster party.

Photo of Keith Raffan Keith Raffan Liberal Democrat

No, I must get on. I have made a crucial point about resources. We are happy to take our share of responsibility for the current position and for putting right things that are wrong, but we are not prepared to take any share of responsibility for the period before 1999. The SNP wants independence for Scotland, but it perpetually confuses Westminster and Holyrood and the different positions in those Parliaments.

I wish to address delayed discharge, lengthening waiting times and nurse recruitment. One of the key priorities of my party has been a department of health and community care to co-ordinate resource allocation and to co-ordinate the work of health and social services in local government. I know from the three health boards in my area that such co-ordination has not filtered down sufficiently into effective working co-operation between health boards, health trusts and local authorities. We had Executive packages on 4 July and 5 October to help with home care, but more needs to be done.

The issue of waiting times reveals the confusion within the SNP and the difference between the current spokesman and her predecessor, namely the muddled thinking over whether waiting lists or waiting times are the SNP's priority. It was in our manifesto, Labour's manifesto and the partnership agreement that waiting times were the priority. The First Minister was right to say on 23 November:

"It is vital that we have a consistent set of measures that everyone can use as a benchmark."—[Official Report, 23 November 2000; Vol 9, c 401.]

Photo of Shona Robison Shona Robison Scottish National Party

I am happy to take on Mr Raffan on waiting times. Perhaps he can comment on the fact that the number of patients who have been waiting for more than a year has increased by more than 43 per cent since 1997. Does he think that that is a good record?

Photo of Keith Raffan Keith Raffan Liberal Democrat

I made it clear that we take responsibility from 1999.

The SNP chooses whatever date suits it. That is its trouble. SNP members are long on diagnosis and short on treatment. In the last part of Miss Sturgeon's speech, she referred to alternative policies, but gave no details whatever about them. She indicates that the policies will be produced in due time, but we will never see their policies.

Photo of Keith Raffan Keith Raffan Liberal Democrat

I have already given way to Miss Robison.

It is a favourite trick in debates to say that a party will produce policies nearer the time of the election. Which one? When will we see details of the SNP's policies? Until the SNP provides alternative detailed policies, any attack on the Executive will be blunted. It is as simple as that.

I am nearing the end of my allotted time, but I hope that I will have some injury time. I am concerned about waiting times. The emphasis on them is important—they should be the consistent benchmark.

The recent Royal College of Nursing research paints a stark picture on nurse recruitment. There is difficulty in attracting younger nurses and the imminent departure on retirement of a large number of nurses who are over 50 will aggravate the situation. I am concerned about the increasing dependence on agency nurses. I met one of the chairmen of my local acute trusts, who talked about the high expense of the Christmas shifts for agency nurses, yet he has no option but increasingly to rely on them. He said that for the cost of employing 33 agency nurses, he could have 45 full-time, permanent nurses. It is also undesirable for patients continually to see different faces and in some cases to have nurses asking what is wrong with them. There is a problem with agency nurses that the Executive must address.

I will quickly make three proposals on pay, careers and conditions. It is clear that improved pay for nurses must be considered on a UK-wide basis. The recruitment position will not improve dramatically until we do that. A much clearer career structure is needed. The appointment of 12 nurse consultants in Scotland is simply not enough to develop a career structure.

As for conditions, Liberal Democrats have long advocated more flexible hours to help staff to meet family commitments. That issue was taken up in the most recent edition of the Nursing Times. I commend that to members, because it made the point succinctly.

Photo of Sandra White Sandra White Scottish National Party

On a point of order. Will the Presiding Officer give a ruling on the release of statements and information, as was requested? Although the press statement has been requested, no member in the chamber has received it. No copies are available. I think that the Executive is holding Parliament in contempt.

Photo of George Reid George Reid Scottish National Party

I have made it clear that investigations are being conducted about which documents will be available, and when. Members will be informed about that as soon as information comes to hand. We will push on now with the debate. Members have a maximum of four minutes.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent 11:23 am, 14th December 2000

The motion refers to policies that have not adequately addressed issues. Surely the greatest health issue of all for ministers is telling the public and Parliament the truth and listening to criticism. Today, all members can see that Malcolm Chisholm has been dumped with the debate. I have the greatest respect for Malcolm, whom I have known for years, but he is only newly in his job as Deputy Minister for Health and Community Care. He did not conceive the policies. Miss Susan Deacon did that, but the jammy dodger is not with us. She has dumped Malcolm right in it. Where is she? Has she now reached radio Rockall in her desperation for publicity? Is she on daytime TV in Arizona, drowning in the electronic lens of the Executive's narcissism?

Photo of George Reid George Reid Scottish National Party

That is enough of that. Please move on to the motion.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

What members face, and what the Executive's behaviour today exemplifies, is the virus of secrecy and the old ways that have spread from Westminster to this shiny, almost new Parliament, such as the old way of not facing the truth. The most appalling example of that lies in the great duvet of waffle that the Minister for Health and Community Care has cast over the Parliament for the past 18 months. She has almost suffocated us with Labour newspeak.

Failure to tell people clearly and precisely what is happening with health issues can be deadly. The worst case of that is the terrible treatment of Scottish haemophilia sufferers, which is a searing scandal. The missing minister has even dodged their representatives.

One third—some say up to a half—of people with haemophilia in Scotland are estimated to have been infected with hepatitis C through contaminated blood products in the 1980s. Despite that, the minister cleared the so-called experts of the time, skipped over the heinous responsibility of the contemporary politicians and offered not one penny of compensation to people whose lives have been wrecked.

As parliamentarians heard during the transport debate, Railtrack will have to pay £240 million in compensation to train companies because trains have run late. What about the lives that will end early because the wrong political decisions were taken in the 1980s? We now know that, at that time, it was known that something existed that was called non-A, non-B hepatitis. The minister told our Health and Community Care Committee that hepatitis C was not identified until about 1991. That was truthful and correct. It was not identified as hepatitis C but, thanks to The Scotsman, it has been revealed that, in the 1980s—

Photo of Richard Simpson Richard Simpson Labour

On a point of order. Keith Raffan was—rightly—interrupted by the Presiding Officer for failing to address the motion. With due respect, Presiding Officer, I request that Dorothy-Grace Elder be asked to return to the terms of the SNP motion.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

I am addressing the motion. I started by making it clear—

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

I made it very, very clear that the motion referred to policies that were not—

Photo of Patricia Ferguson Patricia Ferguson Labour

Order. I have still to respond to Dr Simpson's point of order.

Photo of Patricia Ferguson Patricia Ferguson Labour

Dr Simpson is absolutely right. Ms Elder has already been advised that she should stick to the terms of the motion. I would be grateful if she did that now.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

I refer to the part of the motion that says that the Executive's policies have not adequately addressed issues. Surely the greatest issue of all in health is telling the truth, and that is the overall policy issue that I am trying to address.

It has now been revealed that, in the 1980s—and, it is suspected, back into the 1970s—non-A, non-B hepatitis existed.

Photo of Richard Simpson Richard Simpson Labour

If we are to have a debate on haemophilia, all members must be allowed to participate. We should not have to listen to Dorothy-Grace Elder's lies. Will she be stopped?

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

I beg your pardon?

On a point of order. Dr Simpson should be censured.

Photo of Patricia Ferguson Patricia Ferguson Labour

Please may I deal with one point of order before the next? Thank you.

Dr Simpson's substantive point is correct. I would be grateful if Ms Elder stuck to the motion, as she has twice been asked to do. However, I ask Dr Simpson to withdraw his previous remark.

Photo of Richard Simpson Richard Simpson Labour

They were gross distortions, rather than lies.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

I think that Dr Simpson should withdraw his remark more accurately.

Photo of Alex Neil Alex Neil Scottish National Party

On a point of order, Presiding Officer. The motion asks that the Parliament

"notes the imminent publication of the Scottish Health Plan, and calls on the Scottish Executive to include in that plan practical and adequately funded proposals".

Haemophilia is a legitimate issue in the terms of the motion.

Photo of Patricia Ferguson Patricia Ferguson Labour

I thank Mr Neil for reading out the motion. I have it in front of me. I ask Ms Elder to stick strictly to the terms of the motion, which I am sure she has read.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

I understand Dr Simpson's reluctance when it comes to this issue being aired. I will ask the minister one question before I finish my speech. I have been told that haemophilia patients from Perth informed the minister, long before The Scotsman was informed, that documents exist to prove that a form of hepatitis C was known to exist in the 1970s and 1980s. I invite the minister to address that point—which should have been addressed in the plan. I urge that truth be brought to bear on all health issues because—perhaps unlike others—health is an area in which lives are often at stake and honesty is needed. I urge members to support the motion.

Photo of Patricia Ferguson Patricia Ferguson Labour

Before I call the next speaker, I want to make it clear that, in a motion as wide ranging as this, members may of course raise points of more general interest, but they must be in the context of the motion.

Photo of Richard Simpson Richard Simpson Labour 11:30 am, 14th December 2000

I am not sure whether I should make a declaration, but I refer members to my membership of various medical societies.

It has taken Nicola Sturgeon only two debates in her new position as Scottish National Party spokesperson on health to reach, in this motion, what is probably the lowest point. To dissect the motion, one needs the skills of a forensic pathologist, since it is so buried in the past that it bears little resemblance to a modern party's approach to health. For a party that would like us to think that it is an alternative Government in waiting, the motion is a disgrace.

Photo of Richard Simpson Richard Simpson Labour

No, not yet.

Let me explain first, then I will allow— [Interruption.] Later.

First, let us deal with bed reductions. If I were in opposition, the aspect of our Government that I would attack is that we are moving too slowly on bed reductions. I have spent a professional lifetime as a psychiatrist trying to persuade Government after Government to provide decent, effective support to people in their own homes—including supported, group and sheltered homes—so that we do not continue the bad old habits of putting people with learning difficulties into asylums and large hospitals and, in essence, forgetting about them.

An 80-year-old constituent was recently given a new lease of life on their release from the Royal Scottish National hospital to a group home. In its motion, the SNP is saying to that patient, "We are sorry—we will reopen your bed and put you back into old-fashioned care."

Photo of Richard Simpson Richard Simpson Labour

I will take the point in a moment.

The 3,000 beds that have been closed are long-stay beds that were long overdue for closure. Will the SNP come back to us in two and a half years' time, in 2003, when we have closed a further 2,300 learning disability beds, and say, "More bed reductions"? Let us have a clear policy—Nicola Sturgeon promised it to us in her speech, but she revealed nothing of the positive policies of the SNP. Will the SNP support us in closing the beds that are long overdue for closure? We should accelerate the closure.

In her new brief, Nicola Sturgeon should indulge in some reading. For her Christmas stocking, I suggest Irving Goffman's "Asylums", which was written in the 1960s, but is a seminal work on institutionalisation. In fact, I will buy it for her.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I thank Dr Simpson. For the record, will he first clarify whether he is denying the essential facts in the SNP motion? Secondly, does he think that when waiting lists are rising at a rate of 15 per cent and waiting times are not going down, a 5 per cent reduction in acute beds is justified?

Photo of Richard Simpson Richard Simpson Labour

I will come to that.

It is not that the facts in the motion are wrong; it is that they are so irrelevant and so damaging to the development of modern health care that they are a disgrace. That is the problem.

Scotland has proportionately substantially more acute beds than England. Why? Because we in Scotland have not moved as fast in introducing day care operations. Will the SNP really say to us, "We want to reverse that policy"? I will give some examples. Is the SNP saying, for example, that we should return to the point in the 1960s when there was a maternity lie-in period of 14 days after having a baby? Or does it accept that the length of time in hospital for maternity is now two days and dropping because we are providing better care and getting people home more quickly?

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

Some women do not want to be hustled out of hospital after two and a half days. As the member knows, some women subsequently develop severe problems and are glad to return to hospital. Some would wish to be in hospital for a week or more.

Photo of Richard Simpson Richard Simpson Labour

And there are others who want to go in, have the baby, and come out again within a few hours—we are not adequately supporting them yet either.

There are plenty of areas on which the SNP can criticise the Government—we are not moving fast enough on many issues—but the motion is a disgrace.

Delayed discharge is also mentioned in the motion.

Photo of Richard Simpson Richard Simpson Labour

I hope that you will give me a little latitude, as I have been interrupted at length.

Photo of Patricia Ferguson Patricia Ferguson Labour

I have to ask you to wind up, Dr Simpson.

Photo of Richard Simpson Richard Simpson Labour

I will wind up.

For the first time, we have a proper information services division survey of delayed discharges. They are the first accurate figures that we have ever had, but instead of concentrating on some positive policies and supporting the suggestions that I have made to ministers—for example, that because we now have the information we should have targets to say that no one should wait in delayed discharge for more than a year or nine months and that we should clear the orthopaedic bed waiting lists to deal with the orthopaedic bed problems—the SNP comes out with a bland statement.

I am utterly appalled at the motion. Of the SNP's motions on health, it will be one of the easiest to vote against. In the past, the SNP has talked some sense. There is plenty of scope for constructive criticism and encouragement, but the motion is appalling and I hope that the chamber will reject it.

Photo of Patricia Ferguson Patricia Ferguson Labour

Before I call the next speakers, I advise members that copies of the ministerial statement are now available at the Scottish Parliament information centre desk at the back of the chamber.

Photo of Brian Adam Brian Adam Scottish National Party 11:36 am, 14th December 2000

There has been much discussion this morning of waiting lists and beds and there have been challenges to discuss waiting times.

I want to highlight the situation in the Grampian health authority area, which contains about one tenth of the population of Scotland. The most up-to-date figures show that almost half of all Scotland's patients who are waiting beyond the guaranteed waiting times live in that area. That is a disgrace. Such significant disparities in what is supposed to be a national health service represent exactly the kind of situation that is not acceptable.

It is not only about waiting longer than the guaranteed waiting times for various procedures; there is a similar problem with waiting for referral to a specialist.

Grampian has the highest percentages of patients who are waiting beyond nine weeks and beyond 18 weeks. Waiting times are a better measure of need than waiting lists, but even waiting times mask the fact that there is greater need in some procedures than in others. We have not yet found a measure that adequately addresses that, but if we consider figures relating to real needs and real demands—not artificial ones—Grampian has the worst figures in Scotland. The balance there is so out of kilter that the Administration must address the matter relatively quickly.

An attempt was made in the Arbuthnott report to address the measure of need across the health service in Scotland, but the Arbuthnott formula will exacerbate the situation in Grampian because the area will be one of the significant losers. I suggest to the minister that, in addressing health needs and in relation to the health plan, we should measure needs directly, rather than use the indirect measures that Arbuthnott relies on heavily. I ask the minister to consider the detail of the Arbuthnott formula to see whether those important measures can be addressed.

On the acute sector, the Grampian University Hospitals NHS Trust medical advisory committee has told us that the trust is in crisis because it does not have the resources to tackle the problems. It is having difficulty recruiting and retaining staff. The difficulty with retaining staff arises because the work load in Grampian is disproportionate. That can be seen in the information and statistics division figures, which suggest that the throughput per member of staff across a range of specialties is much higher in Grampian than in other areas.

The Arbuthnott formula will drive the process in the wrong direction. We will get to a point in the cycle at which it will be difficult to recruit anybody, because no one will be attracted to work in Grampian because the work load there is much higher than it is in other parts of the country. I hope that the minister will address that point.

I recently got a letter from the daughter of a 90-year-old patient who is now ready for discharge. A suitable place is available for her, but the finance is not in place and will not be for another nine months. That is utterly unacceptable. It is terrible economics: it costs £1,600 a week to maintain someone in a hospital bed, but only a little over £300 a week to keep them in a residential home. It makes no sense whatsoever and we must consider the transfer of resources to tackle those specific needs.

Photo of David Davidson David Davidson Conservative 11:41 am, 14th December 2000

Before I get into any deep trouble, I should say that I think I have assessed roughly where the SNP was supposed to be going this morning. It was going to address capacity, discharge, staffing and resources. I hope that you agree, Presiding Officer, that I am on the right subject. However, we have not heard any solutions at all today, and that is what I would like Miss Sturgeon to tell us. The temptress as usual, she said that all would be revealed, but she did not answer a single point today.

The capacity shortage means that we have to balance the access to private facilities that will help out in key areas of the health service. We must do that in a measured and responsible way that does not mean that the health service gives up control or ceases to measure the standards.

I strongly support some of what Brian Adam said about Grampian. He talked about a delay in patients being seen. On Saturday, someone came to my surgery to tell me of a problem with a relative who had only one good eye and had developed a cataract. That patient was told that they will not be seen until next May. When I followed that through, I was told that the situation is a result of a problem with staffing and resources. It is not that the system will not work; it is a question of attracting and retaining people at the right level throughout the Scottish health service.

Scotland's shortages in key hospital medical posts are twice those of the rest of the UK. We produce more people through the Scottish universities, but we export them and cannot attract them back into the system. That is a key part of the problem.

Photo of Pauline McNeill Pauline McNeill Labour

I do not disagree with too much of what David Davidson has said so far about addressing shortages in medical specialties. Will he tell us about the Conservatives' manifesto commitment to have modern matrons? Can he tell Parliament what modern matrons are and how they would be different from ward sisters?

Photo of David Davidson David Davidson Conservative

If Pauline McNeill reads Mr Milburn's plan, she will find that he has adopted that idea in full.

We have now got to a stage—this alters how people get through the system—where much of the equipment in Scotland's hospitals is beginning to approach the end of its fit-for-purpose period. It is still functioning, but spare parts are becoming a problem. In Grampian alone, it will cost £6 million to maintain and upgrade equipment. Across the whole of Scotland, a large sum of money will be required, but it will speed up access and treatment. People will not have to be tied up in hospital if the equipment is in place. If we have the equipment, we also need the trained staff to operate it.

The medics tell us time and again that the medico-political dynamics are causing tensions. In other words, the minister cannot decide that three areas only are the priorities of care when the illness that presents itself at any one time is the most important illness to the patient and to the clinician. We must have an assurance from the minister that clinicians will be free to prioritise according to their specialties.

Staff shortages have already been mentioned, but there is another important aspect of that issue that affects Scotland's teaching hospitals. Where hospitals have an academic role there are also shortages and tremendous pressure on staff. As Brian Adam rightly said, that puts an additional load on them. At the next stage, there is also a problem with the allocation of research funding in teaching hospitals, which must also be examined.

The Arbuthnott report goes very badly against many parts of the health service in Scotland, particularly those where demand is rising. Arbuthnott does not recognise that the health service—the minister put down the SNP for not talking about our modern health service—is now a demand-led service.

There is a range of issues that we must address and I hope that the health plan will address them. We must ensure that we control the rate of removal of beds from hospitals and work to ensure that people can be cared for in the community. That will mean additional resources and staffing will be needed in the community, which is the best place for many patients, as Richard Simpson said. To do that, however, we must also have a proper linkage with our schools of medicine, nursing and dentistry.

Photo of Frank McAveety Frank McAveety Labour 11:46 am, 14th December 2000

I was entertained earlier in the debate when I heard what I thought were rehearsals for the Scottish panto season. We heard cries from across the chamber of "Oh, yes it is!" and "Oh, no it's not!" There seemed to be a discussion between Nicola Sturgeon and Kay Ullrich about whether they were talking about waiting times or waiting lists. One was saying "Oh, yes it is!" and the other was saying "Oh, no it's not!" In my opinion, however, the pièce de résistance was the Widow Twankey performance from Dorothy-Grace Elder, which focused accurately on the issues of today's discussion.

Many members who have contributed to the debate missed some of the key elements of the issue. A whole package of resources is now available throughout Scotland.

Photo of Frank McAveety Frank McAveety Labour

I shall let Nicola Sturgeon intervene in a moment, once she has had a few more rehearsals.

We want to deal with the issue of how to connect health spending to the other fundamental issues involved in changing the health of Scotland. The health plan that Susan Deacon will advocate today will address many of those issues in a much more integrated and strategic way. It is not sufficient to talk about health without addressing housing, educational attainment and opportunity, and employment. Those are the connections that seem to have been missed by the Opposition spokespersons today.

We have substantially more resources in the Scottish health service per head of population than the health service elsewhere in the UK has. It is not solely a question of the resource base; it is a question of managing and advocating those resources.

Photo of Frank McAveety Frank McAveety Labour

I will be happy to take an intervention from Nicola Sturgeon if she will tell me how she would resource and manage the Scottish health service.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I was going to say that it is nice to see Buttons performing from the back benches, but I would like Frank McAveety to clarify Labour's position on waiting lists and waiting times. Is Labour now saying that when it said in 1999 that it would reduce waiting lists by 10,000, it was wrong to make that pledge?

Photo of Frank McAveety Frank McAveety Labour

The only buttons are probably the financial contribution that the SNP would make to the Scottish health service. [Laughter.] I am enjoying myself today. The fundamental issue is that the SNP has not reached a decision on resources. The SNP members who have spoken today have not told us what they would do.

What we are saying is that we are focusing on waiting times and looking at that as part of an overall package. We learn from our mistakes, but I am still awaiting Nicola Sturgeon's admission of failure on the penny for Scotland. I am still awaiting the SNP's admission of failure on a whole series of issues. The SNP did not even have a blueprint for the Scottish health service in its manifesto. Rather than blue being the colour of Nicola Sturgeon's contribution, what she has said this morning has been mainly grey and dark.

How do we make the necessary connections more effectively? The health plan should address the issue of how to debureaucratise the health service that the Tories left us. How do we empower patients more effectively? The minister has taken time to address the needs of patients and allow stakeholders in the health service to arrive at conclusions that will modernise the health service for the future. Malcolm Chisholm identified the resource base from which the Scottish health service will operate now and in the foreseeable future. It bears dramatic comparison to the rather paltry contribution that the SNP has made. I heard no financial contribution from the SNP health spokesperson on the issue of how to invest effectively in the health service.

We have heard enough of folk chasing the complaint syndrome around the Scottish health service and saying that the minister is to blame for everything. Responsibility for every issue is laid at the minister's door. The real issue that Nicola Sturgeon and the SNP must address is whether they can deliver the resources that are needed; I think not. Can they modernise the health service when they are tied into language that derives from a 1970s perspective? I think not. They should join us in welcoming the minister's statement later today, that we have an investment strategy that will make a real difference to the Scottish health service.

Photo of Patricia Ferguson Patricia Ferguson Labour

We now come to winding-up speeches. I apologise to the three members who had hoped to speak in the debate and whom it has not been possible to call.

Photo of Margaret Smith Margaret Smith Liberal Democrat 11:50 am, 14th December 2000

Before I move on to the main part of my speech, I would like to put on record two concerns that I have. First, it is a shame that the Minister for Health and Community Care is not present to hear the debate. It is always right that ministers should hear criticism, whatever its source, and that they should take the opportunity to defend what I regard as a mixed picture. That applies both to the point that we have reached in tackling the problems of the Scottish health service and to the overall health situation in Scotland. Secondly, I agree with the comments of other members about briefings made to the press last week. However, I will say no more on that issue.

To be fair to the SNP, its motion reminds us of the situation in which we find ourselves today—waiting, in a ridiculous fashion, for the curtain to go up on the NHS plan. It reminds us of the extent of the challenge that we face in trying to ensure that people get appropriate, high-quality health services in the right settings, in the right way, from the right people. That will not be easy. We must ask ourselves whether we are not always bound to fail. Will we ever get to the point of having enough resources to invest in health and community care services in Scotland? The chances are that we will always fail in part to achieve that, regardless of personnel, political will or how much investment is made available.

Nicola Sturgeon was correct when she said that it was not disputed that money was being invested in the services. Malcolm Chisholm gave us some of the figures for that. Our concern is that sometimes, despite good plans, consultation and ideas, backed up by resources, on the ground—in our constituencies and surgeries—we hear people say that services are not improving. We hear of problems in specialist areas. David Davidson spoke of difficulties in obtaining treatment for cataracts. Margaret Jamieson, who is poised to intervene, would probably say that cataract services in her part of the country are doing rather well. However, that is clearly not the case in David Davidson's part of the country. People want a national service. They want to be able to say, "I have a problem with my cataract and it will be sorted out by this health service, irrespective of whether I am lucky enough to live in Margaret Jamieson's constituency, or unlucky enough to live in David Davidson's."

Photo of Margaret Jamieson Margaret Jamieson Labour

I thank Margaret Smith for mentioning the good cataract services that Ayrshire and Arran Health Board provides. Does she agree that one difficulty in the health service is that people are not happy about sharing the good practice that exists and the good work that is being done? The issue is not always further investment—sometimes a redesign of services can deliver for patients.

Photo of Margaret Smith Margaret Smith Liberal Democrat

I agree totally. The Health and Community Care Committee frequently comes across examples of good practice in different parts of the country. However, any Government—regardless of party—will always prefer to put money into a trumpeted pilot scheme or new idea, rather than ensure that, where good ideas are working on the ground, they are rolled out across the country. That is better than relying on a plaster, a quick fix or something that the Executive can get into the newspapers.

The debate comes on the back of changing trends in the health service—trends that were alluded to by Malcolm Chisholm and Richard Simpson. There is now greater throughput of patients than ever before. There are difficulties associated with that. Dorothy-Grace Elder was absolutely right. I would not have been happy about being thrown out of hospital after two days when I had just had my second child, but that is happening to some people. The system works for some, but it does not work for others. Throughput is quicker and patients spend less time in hospital beds. Members from all parties welcome the fact that long-stay beds are being closed. I want to ensure that when those long-stay beds are closed—when people are moved out of the acute sector into the community care sector—they are given the best possible integrated, joined-up service. For that to happen, we need to implement the Sutherland commission report in full.

We cannot build a decent health service and a better, healthier Scotland if we do not put patients and staff at the heart of that. We must do everything that we can to bring flexibility back into the work force, particularly for returning nurses. If we fail in that regard, we will lose their services and experience. We would all be the poorer for that.

Photo of Ben Wallace Ben Wallace Conservative 11:56 am, 14th December 2000

The year 1999 was very special for all of us, because it was the year in which we took our seats in the chamber. However, for those members who have forgotten, it was a particularly important year for Labour, because 1999 was its year of delivery. It was to be the year in which it all happened—in which things would get better. Instead, from that year until today, the soundbites have come home to roost.

Labour said that we had 48 hours to save the NHS. If ministers want to know why the Executive's own MORI poll suggested that more than 70 per cent of people think that things have got worse or stayed the same, why NHS staff have lower morale than in 1997, or why even more patients are going private, they should understand that high delusions lead to high disillusion.

What can we expect from the health plan? I urge the minister to ensure that it is not high on spin and low on substance. I hope that the minister will not use it to reannounce announcements. Yesterday I saw on the BBC that the plan would include a 24-hour NHS helpline. I hope that the minister will not be announcing the same telephone service that was first announced two years ago and reannounced in April. Let the plan be to the point. If it is to be useful, it should admit the Government's failings before moving on.

I am sure that there will be a clear attempt in the plan to move away from an emphasis on waiting lists, towards an emphasis on waiting times. That is a good idea. However, the Executive can do that only at a price. That price is to admit that it has failed to fulfil its manifesto pledge and to meet its targets on waiting lists. The Executive must admit that it has failed the electorate that bought into that new Labour product.

Photo of Ben Wallace Ben Wallace Conservative

I cannot give way, as I have only five minutes.

The Executive amendment refers to "record amounts". That is the way in which the Executive often seeks to rebut criticism. However, time and again the Minister for Health and Community Care—who has not bothered to turn up for today's debate—says that it is not just about money. It must then be about policy—or does this minister think that she is always right when it comes to policy? Clearly she thinks so when it comes to community care, even though the First Minister spins otherwise.

In October the previous Deputy Minister for Community Care failed to stick to his reassuring guarantees to the coalition about personal care. I hope that the plan will finally commit the Executive to implementing Stewart Sutherland's recommendations. As I have already said, the First Minister seems keen on that. For more than three weeks, he has alluded to a Government climbdown. "Oh no, he doesn't," says the Minister for Health and Community Care, but "Oh yes, he does," says The Sunday Times. "Oh no, he won't," says The Sun. That makes the Minister for Health and Community Care look as if she is part of a Christmas pantomime. All the time, patient care is getting worse.

To satisfy the Conservatives, the SNP and the coalition partners, I ask Susan Deacon or the Deputy Minister for Health and Community Care to state whether they are fundamentally opposed to Sutherland's key recommendation on personal care. If the deputy minister is not opposed to it, will he give us a commitment to adopt it at some point before the next election? At the same time, will he make it quite clear who is in charge of health policy in Scotland? Is it the Deputy Minister for Health and Community Care, the Minister for Health and Community Care, the First Minister or Jack McConnell?

The Liberal Democrats have no doubt noticed our amendment. All that we look for is a simple commitment. I know that in partnership there are pressures on Liberal Democrat members, but they should value themselves more. Can they see the Labour party breaking up a coalition over care and people who need it? Imagine the headlines. I call on Liberal Democrat members to flex their muscles. Partnership is supposed to work both ways.

There is no doubt that people have been let down by the Executive. Its answer to failing to meet targets is to change them. Its answer to real problems is to spin them. Its answer to criticism is arrogant stonewalling.

Focus groups are no substitute for creative policy making. Spin must not be better than substance. The plan is overdue. It will work only if it lands at the feet of the people in the front line of the health services. The plan will be useless if it stops a few feet above everyone's head, as so many have before, and will do nothing to change the fortunes of our health service. Any plan requires leadership at the basic level; to be part of it, the hospital porter has to understand the plan and change with it as much as the chief executive of a health board does.

The sad thing is the plan's timing. It is an admission of failure by Labour after three years in government. Plans should come before battle, not after it.

I urge members to back our amendment.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 12:00 pm, 14th December 2000

This has been a useful debate, in advance of the statement on the health plan, during which we have been able to analyse the current state of the health service. We are not complacent. I made it clear that issues such as delayed discharges and waiting times are key priorities. However, it is regrettable that there has been so little understanding on the part of so many Opposition members of the current state of the health service or of the nature of a modern health care system.

Mary Scanlon made the interesting point that there has been a 10 to 20 per cent increase in emergency admissions in the past year. That is one of the problems that we have had to deal with, although I am not using that as an excuse.

Mary Scanlon referred to there being more than 3,000 blocked beds, which is a misrepresentation. For the first time, we have published official figures, which indicate that 3,000 patients are ready for discharge. That is not the same as delayed discharge, the common measure of which would be the number of people waiting more than six weeks. However, 1,900 people is not satisfactory and dealing with that will be a key priority. Mary Scanlon also referred to £44 million of health money being reinvested in writing off Glasgow's housing debt. That is ridiculous nonsense. I leave aside the fact that we now regard housing as an important part of public health. That money was from trust surpluses that would have been returned to the Treasury had they not been used in that way.

Mary Scanlon asked about the complementary role of the private sector. The private sector's role is not as big here as in England, but various health boards use it when necessary. We will never go down the route of the Tory party—certainly the Tory party in England—of hiving off whole sections of the health service to the private sector.

Brian Adam made the useful comment that waiting times are a better measure than waiting lists. That is traditionally the SNP policy. He also referred to the problem in Grampian with the 12-month guarantee. I accept that that is a problem, but it is being dealt with quickly.

Keith Raffan referred to lengthening waiting times—that is not true. I repeat that 83 per cent of patients on waiting lists are treated within three months. The average wait for someone on a waiting list in Scotland is 31 days compared with 90 days in England.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Whether the SNP thinks that waiting times are more important than waiting lists is one thing—I accept that that is debatable. However, Malcolm Chisholm cannot deny that this Government was elected in 1999 on a clear pledge to reduce the number of people on waiting lists by 10,000. It has failed to do that. Is Malcolm Chisholm saying that that pledge was a mistake? Is he saying that Labour made a mistake in the past and has changed its policy for the future? Was Labour's manifesto pledge in 1999 a mistake—yes or no?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

In 1997, there was a correlation between waiting lists and waiting times. As more patients are treated, there can be lengthening waiting lists and reducing waiting times. We are sticking with the waiting list pledge. It will be delivered, as promised, by 2002.

Nicola Sturgeon talked a lot about pledges. We have delivered on all the pledges on which we promised to deliver at the beginning of this Administration. I refer specifically to the doubling of the number of one-stop clinics, which was delivered two years ahead of the target.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

When the Government was elected in 1999, one of its pledges was to introduce NHS Direct by early 2000. Yesterday, Susan Deacon announced the piloting of NHS 24 during 2001. Does he consider that to be a pledge that has been delivered on time?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

It is more important to get NHS 24 right, which is precisely what we have done.

The other issue that Nicola Sturgeon majored on was beds. After second thoughts, she referred instead to acute beds. I remind her that an extra 400 acute beds are being brought into use this winter. That is the correct way to deal with the matter.

What has been more significant in the debate is the SNP's appalling, outdated attitude to non-acute beds. Dr Richard Simpson quite rightly said that the nationalists had no understanding of a modern health care system. Are they seriously suggesting that the 2,300 people in learning disability hospitals should stay there in order to provide the SNP with high figures on bed numbers?

Keith Raffan talked about the important issue of nurses and referred to pay. Increases have been significantly above inflation for two years, but I am not complacent about the situation. He also referred to conditions. Although there have been major developments in family-friendly working, I am not complacent about that either. There is a low vacancy rate for nurses in Scotland. This year, we have employed 210 additional nurses in priority areas and, as I said in my opening speech, 10,000 nurses and midwives will qualify in Scotland in the next five years, which is 1,500 more than the figure in the plan.

David Davidson said that the level of vacancies in Scotland was twice the level in England. Although that might be the case for one or two specialties to which he did not refer, the underlying reality is that staff numbers in Scotland are much higher than in England. For example, in Scotland, there are 823 nurses per 100,000 people compared with 621 nurses per 100,000 people in England. The story is the same for GPs and dentists.

Last, but by no means least, I shall address the problem of delayed discharges, which we regard as a key priority. Precisely for that reason, we allocated £19 million of special money to health boards and local authorities to tackle the problem, on top of the additional winter money to provide more beds, nurses and other services. Our statement in October, which allocated £100 million to build up community services to deal with delayed discharges—because that is the right thing to do—was our key response to the Sutherland report.

Ben Wallace asked whether we were fundamentally opposed to free personal care. As he sat with me in the Health and Community Care Committee for more than a year, he knows that I am well disposed to that recommendation. However, anyone who is serious about politics must realise that free personal care is a complex issue. Politics is about choices, such as choosing what we spend our money on. In October, we saw the need to build up community capacity and services, which is why we emphasised the different parts of the package of home care services.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I do not think that I am allowed to—my time is up.

That is not to say that we are not well disposed to the other recommendation, which is precisely why we are reviewing the matter. An announcement will be made in January. Once again, I caution all members not to believe everything—or, in some cases, anything—that they read in the newspapers.

Photo of Alex Neil Alex Neil Scottish National Party

On a point of order, Presiding Officer. It has just gone 12 o'clock and the Cinderella minister Susan Deacon has arrived. On behalf of the Parliament, will you make it clear to her that the contemptuous way in which she has treated the chamber is totally unacceptable to most members?

Photo of Patricia Ferguson Patricia Ferguson Labour

That is not a point of order, Mr Neil.

I draw members' attention to my earlier comment about the minister's statement being available. I am sorry—I inadvertently gave members the wrong information. The statement was not available to members at that point; the NHS plan was. That said, the minister's statement is now available to any member who wishes a copy at the Scottish Parliament information centre desk at the back of the chamber.

Photo of Shona Robison Shona Robison Scottish National Party 12:09 pm, 14th December 2000

Today's debate has offered an important opportunity for the Parliament to set the context for the launch of the national health plan. I am glad that Malcolm Chisholm recognised that the SNP has provided such an opportunity, unlike the Minister for Health and Community Care, who has allocated only 45 minutes to a statement that we will hear soon. I am glad that she has blessed us with her presence, even though she seems otherwise engaged at the moment.

At a time when, as we go into winter, the public regard the health service as the critical issue, it is not good enough that we will not have had the opportunity to debate the plan after we have had the opportunity to read it. This debate is on the current state of the NHS, and anything that is announced by the Minister for Health and Community Care following the debate must be considered in that context.

There has been a reduction in the number of acute beds, and 3,000 beds are occupied by people who do not need them. There are 900 fewer nurses than there were in 1996 and hospital waiting lists have increased by 15 per cent since September 1999. It is interesting that the Government's pledge on waiting lists—the pledge that must never speak its name—has conveniently disappeared from the minister's statement yet again. However, that pledge was clear—it was in black and white—in the Government's 1999 manifesto. I thought that black and white pledges had to be delivered on, but clearly that is not the case when the Labour party is in power.

Only 13 per cent of Scots who were surveyed in an Executive poll believed that there had been an improvement in the performance of the NHS in the past two years. Many believed that the care element of the service has been lost. We need an open and honest debate about the state of the NHS—something that the Minister for Health and Community Care finds difficult to handle. She has consistently denied the scale of the problems in the NHS and that is part of the problem. Her record is one of denial, excuses and damage limitation. When problems were experienced in Tayside, "Crisis? What crisis?" was the call from the minister. That is perhaps not surprising, as she was not even aware of the 47 per cent increase in the number of people on waiting lists in Tayside, or had conveniently forgotten about it.

I am sorry that Richard Simpson feels unable to vote for the SNP motion, but then he has never voted for any SNP motion. If we lodged a motion to say that Christmas day would fall on 25 December, he would probably vote against it because it was an SNP motion. Richard Simpson should know that we will not fall for that one.

The minister and the Executive have failed to deliver on their key manifesto pledges. Members will remember their key manifesto pledge to cut waiting lists. We can talk about waiting times, if that would be preferable, and about the 43 per cent of people who are having to wait for longer than a year. It does not matter whether we talk about waiting lists or waiting times; the pledges have not been honoured.

When will a new Labour politician answer for the Executive's failure to deliver on its commitments? The arrogance of this Administration—I note its self-congratulatory amendment—knows no bounds. Although the minister is no longer the missing minister—she arrived only five minutes before the end of a debate that provides the context for the health plan announcement—she is disrespectful of the Parliament and of the NHS in not taking the opportunity to listen to members from all parties.

Some members have lauded the shift in resources. Let us be clear: the SNP wants resources to be shifted into the community.

Photo of Shona Robison Shona Robison Scottish National Party

Not just now. I would like to make some progress.

We believe that people should be able to remain in their homes. However, the Labour Administration has failed to enable them to do so, because it has implemented cuts in home help services that amount to a loss of nearly 30,000 home help hours. Health visitor numbers and district nurse numbers have fallen, and NHS Direct, which was supposed to have been launched early this year, has not yet been introduced. Pledge after pledge has not been honoured.

Photo of Richard Simpson Richard Simpson Labour

Will Shona Robison tell us how many beds the SNP would close? The motion opposes the fact that we have closed beds. What is the SNP policy on accelerating the bed closure programme, which is the opposite of what the motion calls for?

Photo of Shona Robison Shona Robison Scottish National Party

The SNP believes that it is a problem when people are discharged into the community without adequate facilities to help them to remain in their homes. Many of those people end up back in hospital, in acute beds that are then blocked.

We have a cycle of people going through the system because Labour has failed to invest in adequate resources to enable them to remain at home. This month, Susan Deacon announced that each health board would get additional nursing staff. That sounds good until one considers that Scotland has lost hundreds of nurses since new Labour came to power—nearly 900 nurses since 1996. The Minister for Health and Community Care's encouragement to trusts to use agency staff flies in the face of the Accounts Commission report that said that such staff should be used only in unforeseen circumstances, which winter pressures cannot be described as.

With dropout rates at their highest for four years, the Executive needs to address the key concern in the health plan. Susan Deacon announced that she would be providing more than 700 extra beds across the NHS this winter. However, we have lost 3,000 beds. She is replacing less than one quarter of the beds that have been taken away and she expects us to be grateful. The additional beds that are being provided in Lothian are already full. I see that the minister is shaking her head, but I assure her that that is a fact.

Recently released figures show that more than 3,000 people are awaiting discharge from hospital. The main problem is the lack of public funding that is available to purchase residential or nursing home places, which is an issue that was highlighted in the previous debate that the SNP initiated on the matter. The coalition parties have tried to justify the extensive loss of resources to the NHS by arguing that the resources are showing up elsewhere. By showing that community care services are not as they should be, we have scotched that myth.

Added to all of that is the debacle over the Sutherland report. Now that the minister has graced us with her presence, perhaps she will tell us whether she has a different position on the matter from Henry McLeish. Will one of them clarify what the position is?

Photo of Patricia Ferguson Patricia Ferguson Labour

It is not for members to seek interventions.

Photo of Shona Robison Shona Robison Scottish National Party

Susan Deacon and Henry McLeish have declined to clarify to Parliament what the position on Sutherland is.

We may hear more pledges from the minister, but they are fast becoming empty promises. We need properly funded targets if there are to be improvements. The issue is not the amount of money; it is where the money is spent, why the benefits of additional resources are not being felt and why the Executive is failing to deliver on the targets that it set. I note that Frank McAveety said that the pledge to reduce waiting lists was a mistake. That acknowledgement is some progress, at least.

Photo of Frank McAveety Frank McAveety Labour

Will the member allow me to clarify that point?

Photo of Shona Robison Shona Robison Scottish National Party

No. I am winding up.

We have waited two years for the national health plan. The Executive's press spin has led us to believe that we should expect something substantial. Expectations have been raised. If the minister cannot meet those expectations, the health plan will be added to the growing list of new Labour failures on health. I suggest that a failure to deliver on Scotland's health plan would be a failure too far. We will have to wait and see.

I say to Mr McAveety that, if treating more patients more quickly and with more nurses is considered to derive from a 1970s perspective, I will be happy to get the flares out of the wardrobe and wear them with pride.