National Health Service

– in the Scottish Parliament at 10:53 am on 14th March 2002.

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Photo of George Reid George Reid Scottish National Party 10:53 am, 14th March 2002

The next item of business is a debate on motion S1M-2882, in the name of Nicola Sturgeon, on the national health service, and two amendments to that motion.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 11:01 am, 14th March 2002

The purpose of the debate is not to criticise the Government's health record purely for the sake of it. My criticisms have a purpose. The debate stems from a belief that the problems in the health service will never be put right while we have a Government that sticks its head firmly in the sand or witters on about a patient-centred health service at a time when more than 100,000 people languish on waiting lists, unable to receive treatment. The Government seems to think that, as its amendment says, investing

"substantial real-term increases in ... resources" makes everything fine, notwithstanding the fact that the resources are not delivering substantial improvements in patient care and seem destined to be lost forever in the bureaucracy that stifles our NHS.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I ask Bill Butler to wait a few minutes.

The problems in the NHS will not be put right until their principal underlying cause is acknowledged and addressed. That cause is declining capacity. No matter how much money goes into the NHS nor how much effort goes into redesigning services around the needs of patients, we will get out of the NHS only what it has the capacity to deliver.

On the evidence of the past three years, the NHS is delivering less. That is happening in spite of the very best efforts of the men and women who work in the service. They do a sterling job; however, they are not miracle workers. They cannot be expected constantly to do more with less, and to treat more patients more quickly when they have fewer staff and beds at their disposal.

Photo of Bill Butler Bill Butler Labour

Will Ms Sturgeon be good enough to tell us what additional moneys or resources an SNP Administration would direct to the NHS? From which other budget would those moneys be taken, or would the money be found through a combination of that and raising tax?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

It is always comforting to find out that Labour members have their briefing papers out in time for a debate. If Mr Butler will be patient, I will come to resources in a moment, because the Labour lot is completely incompetent on that issue.

In spite of the best efforts of those who work in the service, the NHS is not delivering because it cannot. There are now more than 100 fewer whole-time equivalent nurses in our NHS than there were in 1999, and 250 fewer than there were in 1997. Scotland is the only part of the UK where nurse numbers are declining. In England, nurse numbers have increased by almost 30,000, while in Scotland they are down by more than 100. Furthermore, since 1999, when the Lib-Lab coalition came to power, there has been a reduction of nearly 700 staffed beds in the acute sector.

The result of those cuts in beds and nurse numbers is that fewer patients are being treated on the NHS. Five thousand fewer elective in-patients were treated in the last three months of last year than were treated in the first three months of 1999.

Of course, the Government will argue that that does not mean that patients were not being treated, but that it means simply that more were treated without having to stay overnight in hospitals and that the redesign of services meant that more patients were treated as day cases and as out-patients. Although that argument is persuasive, it has one major flaw: it is not true. Nearly 9,000 fewer patients were treated as day cases in the last quarter of 2001 than were treated in the first quarter of 1999. I repeat; the number of day cases is down by 9,000. I suppose, then, that all those people must have been treated as out-patients. Well, no. When we compare the same two periods, we find that the number of outpatients has fallen by 64,000. It is not that more patients are being treated in a more appropriate setting, but that more patients are not being treated at all. No amount of spin will disguise the fact that, under Labour, the NHS is treating nearly 80,000 fewer patients.

We have had much wringing of hands from the Government about waiting lists and waiting times; even the First Minister said last month that the figures remain "stubbornly high". Of course they are and there is really no mystery about it. If the service treats fewer patients, more patients will be waiting for treatment. Indeed, 16,000 more patients are waiting for treatment now than when the Government took office, and that is before we take account of its various fiddles to keep lists artificially low.

Nor is the increase in waiting times a mystery. They are now 10 days longer than they were in 1999 and fewer patients are being treated within the Government's target times. However, if there are fewer beds and nurses, it is no surprise that people wait for longer to be seen. This is not rocket science, but it seems to have outwitted the Scottish Executive.

However, to be fair—as I always am—one part of the NHS is expanding and treating more patients. It seems that more patients are being treated as emergency cases, which means that there has been expansion in the one part of the system that no Government can control—the number of patients who go through the doors of accident and emergency departments. I wonder how many of the extra patients who end up in accident and emergency do so only because they cannot get treatment in the parts of the system that the Government controls.

No matter what measure is used, we reach the same stark and simple conclusion: the NHS is shrinking under Labour. We know that the Tories are happy with that situation, because a smaller NHS will leave more room for the private sector in the delivery of health care. The Tory amendment reaffirms that they want to expand the private sector at the expense of the NHS. Indeed, they want to privatise the health service.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Ben Wallace should just listen. Before he and the other Tories rise and start talking about bed reductions in the health service, they should reflect on a parliamentary answer that was given yesterday to one of Mary Scanlon's questions. The answer revealed that, in the last six years of the previous Tory Government, bed numbers in Scotland fell by 10,000. Labour is simply continuing the decline that the Tories began.

Photo of Mary Scanlon Mary Scanlon Conservative

Will Nicola Sturgeon also compare the figures from that time with the rise in the number of patients and in-patients who were treated, the increase in the number of procedures that were carried out in the NHS and the reduction in waiting times that all happened under the Tories?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I will leave to Mary Scanlon the impossible task of defending the Tory record on the issue.

We know the Tories' agenda; however, what is Labour's excuse? Is it simply following the Tory agenda—as it certainly is south of the border—of shrinking the NHS to make more room for the private sector, or is it just incompetent? Bill Butler should listen carefully to the point that I am going to make about resources. A Government that invests

"substantial real-term increases in health resources" and yet gets fewer beds and nurses and treats fewer patients for its money is not a Government that is managing the country's health service well. Patients want to know where the money goes in the health service.

I hope that we can all agree that, whatever the reasons for the shrinking NHS, it cannot be allowed to continue. There must be a determination to halt and reverse the decline in capacity in the health service, and such a process should start with the number of acute beds in the system.

The decline in acute bed numbers has gone too far. Any room for reduction as a result of shorter stays in hospital has already been used up. On the figures that I mentioned earlier, there is no evidence of a shift from in-patients to day cases and out-patients that would justify the reduction. That is my firm view. I dare say that Malcolm Chisholm will stand up in a few moments and argue the opposite, although—given the statistics I have just cited—he will struggle. It is Labour's policy to oppose anything that is suggested by the Scottish National Party. If we said that free fruit for children was a good idea, Labour would say that it was not; in fact, it did so last year.

That is why I am calling for an end to the polarised debate between the SNP—which says that there are too few beds in the health service—and the Government, which says that there are too many. It is time for an independent assessment of how many beds will be needed in the health service in the medium to long term, taking account of all the developments and redesign of health care delivery that the Scottish Executive talks about.

We need a national beds review. That has already happened down south, when Alan Milburn recognised that

"the trend of the last decade or more of reductions in hospital beds cannot keep pace with changing" needs.

The outcome of that national beds review south of the border was a commitment to 7,000 extra beds in the national health service—7,000 extra beds in England, while bed numbers in Scotland continue to fall, and fall further with every private finance initiative contract that is signed by the Government. The NHS cannot go on like that. We need that independent process here in Scotland because only when we have an educated assessment of how many beds patients in Scotland need can other resources be properly planned.

There is no doubt that the NHS is shrinking. The Minister for Health and Community Care should acknowledge that, halt it and plan to reverse it. It is not—and should not—be beyond us to design a health service that works for a population of only 5 million. However, to begin doing so we need less rhetoric and more honest action.

I move,

That the Parliament notes that there are fewer nurses and fewer acute beds in the NHS now than in 1999, that the NHS is treating fewer out-patients, in-patients and day case patients now than in 1999, that fewer patients are being seen within the Scottish Executive's target times than was the case in 1999, that there are 16,000 more people on NHS waiting lists now than in 1999 and that median waiting times are 10 days longer than in 1999; is concerned that the NHS is shrinking, and calls upon the Scottish Executive to pursue policies that will reverse this reduction in capacity and deliver an NHS of the standard that patients in Scotland are entitled to expect.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 11:12 am, 14th March 2002

Like Nicola Sturgeon, I like debates that have a purpose and would like an end to polarisation. However, for that to happen, we require a sophisticated and balanced analysis of the situation. We must acknowledge that there is complexity and we must recognise problems and progress.

For the 15 weeks during which I have been Minister for Health and Community Care, I have been prepared to be up-front about the difficulties that we face, whether in relation to unacceptable delays, staff recruitment and morale or any other issue. I am not, however, prepared to pretend that everything is bad and that no progress is being made. Such a pretence is insulting and demoralising for staff. It is contrary to the experience of patients and it is contradicted every week as I go around the country and see the superb service that is provided by staff, and the many different ways in which they are leading the redesign of services around the needs of patients.

I could mention many recent visits. For example, in Ayrshire this week I saw at Ayr hospital many redesigned services involving urology, cataracts and nurse endoscopy services. The previous week, I saw information technology services in Fort William, where services for patients are being improved and time is being freed up for front-line staff. The week before that, I was in Dundee, where I saw the improved quality of care that has been brought about by a new linear accelerator. I also saw work with patients throughout the hospital to develop patient information and use patient feedback to improve the quality of care.

Quality and patient focus are words that are absent from today's motion, but which are crucial for patients and are at the heart of our health agenda.

The motion talks of nurses, beds, waiting, activity and, most of all, 1999. On activity, I remind members that until now only consultant activity has been counted. The work of the nurse endoscopist to whom I spoke on Monday has not hitherto been recorded. Work is now in hand to develop recording systems that will capture the full range of NHS activity. I also remind members of the many advances that might reduce headline activity figures. They include quality improvements, which might involve spending more time with patients or in preparing treatment; reductions in junior doctor hours, which is good for quality but also has an effect on activity; and the working time directive, which has benefited other staff groups.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

If all the figures can be explained away by improvements in the way in which patients are cared for, why do we have rising waiting lists and rising waiting times in Scotland?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

We actually have falling waiting lists and falling in-patient waiting times. However, I acknowledge that we have a problem with out-patient waiting times. We are the first Administration to focus on that and will take action on it.

Notwithstanding the issues that I mentioned before the intervention, I will select a few figures—it is important that Mary Scanlon should hear this. Compared with 1997, the NHS is treating 25,000 more emergency in-patients and 58,300 more day cases each year. It is dealing with 50,300 more in-patients and day-case episodes, 11,000 more first out-patient appointments and 60,000 more accident and emergency attendances each year. Compared with 1997, the NHS has 17 more adult intensive care unit beds, 220 more one-stop clinics, 450 more qualified nurses and 230 more consultants.

Photo of Ben Wallace Ben Wallace Conservative

The minister is guilty of misleading the chamber. He says that there are 200 one-stop clinics more than in 1997, but a ministerial answer to me listed renamed departments in hospitals that had seen no change or reconfiguration. To claim that those 200 one-stop clinics are extra is to mislead the chamber.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I have seen the list. I have visited quite a few of the clinics and hope to visit more. I have seen the excellent work that they do, and what the member has indicated is certainly not what they are telling me.

Similar and corresponding staff increases since 1999 can be recorded, although there are two issues in that. First, there is a very short time scale because the latest staff figures are for 2000. Secondly, the other fact that we must take into account is that, during the winter of 1998-99, there was a waiting list initiative that cleared a backlog of people who had been waiting for a long time for surgical procedures. That was an unrepresentative blip in activity rates—we must bear that in mind when we make comparisons with 1999.

The other thing to bear in mind in relation to the trend since then is that, in many cases—if I had time I could quote figures to show it—the number of qualified acute nurses is increasing and the number of qualified nurses in the community is increasing. However, the number of learning disability nurses in hospitals is decreasing. That is quite right because we want people who have learning disabilities to be cared for in the community. Many of those nurses go on with their caring role as council employees and are no longer recorded in the nurse statistics.

I have only two minutes left, so I will not quote the array of statistics from 1999 until now that show that progress is being made in relation to staff numbers, intensive care beds, waiting times for heart bypass surgery—which have been halved—and so on. I do that not out of complacency, but in the interests of balance. The NHS is not shrinking, but it is rightly and most certainly changing.

More people are being treated closer to home in local primary care practices and health centres, with procedures that were previously performed only in hospitals. The number of local fast-track clinics in Scotland has increased since 1999. Given that nine out of 10 patient contacts with the NHS come through primary care teams, it is astonishing that primary care is not mentioned in the motion.

I have addressed waiting and I have only a short time left, so I will not say more about that. I have said how we are increasing the number of doctors and nurses—that will continue, not only because we want to do more to tackle waiting, but because we want to improve the quality of patient care.

Scotland has led the way in improving outcomes for patients in the NHS. The experience of the Bristol inquiry has made improving the quality, and not just the quantity, of care all the more critical. That is why we have provided funding for nearly 500 more junior doctors in Scotland, to reduce their hours and improve the quality of the care that they can provide to patients.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I have no time, I am afraid.

More progress has been made in improving junior doctors' hours and conditions since 1999 than was made in the previous decade—in quality and not just quantity. We are building up our nursing work force, so that it can spend more quality time with patients in aiding their recovery and rehabilitation. More qualified nurses are working in our hospitals compared with 1999 and earlier this month I announced new initiatives to get more nurses into training, to get nurses back in the NHS through the return-to-practice courses, and to guarantee nurses a year's employment as soon as they qualify. There is a series of other initiatives, with £5 million attached to them, that are being driven forward by the implementation of the recruitment and retention of nurses policy. I am chairing the group that is doing that.

Many initiatives are under way to deal with some of the problems, which I acknowledge. I repeat that today's debate should be not only about quantity, but about quality. I have not had time to mention the work of the Clinical Standards Board for Scotland, whose important report on cancer services will be published next week. We are determined to improve the quality of care as well as the quantity of care. Both objectives are now being driven forward with determination.

I move amendment S1M-2882.2, to leave out from "notes" to end and insert:

"congratulates the staff of the NHS in Scotland on their commitment and dedication; welcomes their leadership role in redesigning services around the needs of patients; notes that this often leads to a different configuration of services and to some new activities that have not traditionally been counted; applauds the on-going and varied work to improve quality in health services, and acknowledges the substantial real-term increases in health resources since 1999, which are supporting the programme of patient-centred reform."

Photo of Mary Scanlon Mary Scanlon Conservative 11:20 am, 14th March 2002

Another week, another health debate. Last week we debated the shrinking provision of community care and this week we debate the shrinking provision of the NHS.

I challenge Nicola Sturgeon, because she concentrates far too much on the number of beds rather than on the number of procedures. Cataract surgery, for example, is now done in hours instead of five days. With advanced technology and shorter stays in hospital, we would expect lower waiting lists, but that is not happening.

Anyone who pledged their troth to Labour in 1999, given the promise of support in sickness and in health, would now have serious grounds for divorce on the basis of promises that were made but not kept. If we could have an open, honest and transparent debate, in which issues were addressed in an accountable manner, people would have the right to feel reassured about our national health service. Instead, despite all the failings over five years by Labour, and then by the Labour-Liberal coalition, we get an amendment from the health ministers that fails to acknowledge, let alone address, the problem. We would all congratulate NHS staff on their commitment and sheer hard work and their provision of quality care against all the odds. At least the ministers are honest enough not to congratulate themselves; surely that is progress.

I hope that the ministers realise that the consultations, reviews, strategies and glossy brochures of the past are not translating themselves into improved levels of patient care. After three years of devolution and the ability to manage the health service in Scotland, instead of the progress that we expected, we are being left behind England in creating a modern, forward looking and patient-centred NHS that utilises all the health care resources in Scotland. The dogma against the independent and voluntary sectors is insulting to patients who want simply the best standards of treatment. We owe it to them to provide that service.

It is worth reminding the Labour party at the outset that it has now been in Government for five years. After five years, it is striving to cut waiting times to a maximum of nine months. Nine months was the maximum waiting time under the Conservatives; that was branded as scandalous by Malcolm Chisholm. In Labour's 1997 and 1999 manifestos, we saw promises to raise spending and to spend the money on patients and not on bureaucracy. We had no idea that that would mean an increase in the staff who are in charge of that bureaucracy. Yesterday, I received a written answer from the minister, which confirmed that there has been an increase of seven administrative staff per 100 NHS beds during Labour's five years in office. In this age of advancing technology, we now have two administration staff per NHS bed. If similar investment were to be made in infection control, we could save lives, reduce suffering and free up hospital beds.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

If Mary Scanlon revisits the question that I answered last week, she will see that the number of administrative staff rose to a peak at the height of the internal market in 1995, has reduced by more than 1,000 since then and will continue to reduce.

Photo of Mary Scanlon Mary Scanlon Conservative

It has not reduced in line with the number of hospital beds. That is what the question was about.

Photo of Mary Scanlon Mary Scanlon Conservative

It was not a daft question. It was a daft answer, because the minister confirmed that there are now two admin staff per NHS bed, according to his own figures.

The increase in administrative staff has come on the back of the abolition of the internal market, which was hailed by previous health ministers as the cause of so much bureaucracy; however, the abolition of the internal market has created even more bureaucracy. The figures not only confirm the reduced capacity and longer waiting lists and waiting times, but behind those figures are closed waiting lists and reclassification of figures. At a recent meeting of MSPs from all parties and Highland NHS Board, we were told that 300 names could instantly be wiped from the waiting list of 3,000 for Raigmore hospital through a reclassification process that has been recommended by the Executive. A cut of 10 per cent throughout Scotland would enable the Executive to claim a cut in waiting lists, but not one more patient would be treated.

The waiting times co-ordination unit is undoubtedly a step in the right direction, but the Executive is—with its action on delayed discharge—admitting its failure to improve the health care system. Scotland's independent hospitals have claimed that they can help to cut NHS waiting lists by up to 10,000. With the situation deteriorating to such a level, will the minister now take a leaf out of Alan Milburn's book and fully utilise that capacity by signing a concordat for a permanent agreement in Scotland to put patients first?

I move amendment S1M-2882.1, to insert at end:

"by signing a 'concordat' with the independent and voluntary sector in similar terms to that already established in England, and further calls upon the Executive to initiate a debate in Scotland about how to improve the delivery of health care to standards similar to the best European countries, whilst ensuring that access to high quality care is guaranteed for all."

Photo of Margaret Smith Margaret Smith Liberal Democrat 11:26 am, 14th March 2002

Health remains the No 1 issue for the people of Scotland and the key spending priority for the Scottish Executive, with a third of the Executive budget being spent on it. We are committed to record levels of investment in the NHS and in Scotland's health generally, and we are making that investment against a background of growing demand, which was highlighted by the minister. There are 58,000 more day cases, 50,000 more in-patient cases and 60,000 more accident and emergency cases. In comparison to England, we have 20 per cent more spend per head of population and greater numbers of doctors, nurses and beds. While Mr Blair and Mr Brown may slug it out over whether or not to raise general taxation to bring England to a European average health spend, Scotland is already there.

The minister has made it clear in statements, today and in the past few weeks, that he appreciates the challenges that lie ahead and that there remains a mixed picture of problems and of progress in the NHS. For any health debate to be credible, it must acknowledge both sides of that picture. The No 1 concern for all our constituents remains that of waiting times. The Liberal Democrats certainly welcome the Executive's recent shift to focusing on waiting times rather than on waiting lists, which was our policy prior to the 1999 election. That is what the people whom we represent are interested in.

We also welcome the minister's recent announcement of £20 million to tackle NHS waiting times. That much-needed investment includes £15 million for local NHS boards to make progress towards the Executive's 2003 target of reducing the maximum waiting time for an operation to nine months. Crucially, it also sets up a £5 million national flexible fund to allow the national waiting times unit to clear, from April onwards, certain bottlenecks, including tonsillectomies and angioplasty. That will allow targeted use of nurses and other staff in endoscopy and other tasks that have previously been done by doctors. Such approaches have already been developed in Fife and the Forth Valley area. In Fife, nurses undertaking endoscopies on patients with gastric problems has reduced the waiting time for the procedure from 16 weeks to four weeks and has freed up a significant amount of consultant time.

The major flaw in a very flawed SNP motion is that it does not highlight the fact that a major shift in service delivery is under way in our health service. Major changes are happening. If we look at selective activity figures and indicators, we may sometimes see evidence of a fall in the numbers of patients. If we look at other selective figures, we may see completely the opposite. However, such figures fail to show that, in many cases, a fall in numbers is due to advances in clinical practice and changes in service delivery. The fall in numbers began from a high point in 1999, when a major waiting list initiative got under way. That may also distort the figures.

Unfortunately, many innovative changes on the ground have not been recorded so far, because many of the data collected centrally reflect only consultant-led activity.

Photo of Shona Robison Shona Robison Scottish National Party

I agree that there are many innovative ways of treating patients in the NHS, and we all welcome that. However, if those innovations are delivering what the member claims, why are people waiting longer?

Photo of Margaret Smith Margaret Smith Liberal Democrat

We are delivering more against growing demand. More people are making demands on the NHS and many procedures that are delivered at community level are not recorded and set against the figures that the SNP quotes from previous years.

I welcome the fact that the chief executive of the NHS in Scotland, Trevor Jones, has asked the information and statistics division to put in place new recording procedures to capture the work that is undertaken outwith the acute hospital setting, whether in local health centres or in Scotland's 300 one-stop clinics, which have trebled in the past two years.

Photo of Margaret Smith Margaret Smith Liberal Democrat

No. The fall in the number of in-patients reflects advances in practice and a shift from the acute sector to primary care—again, that is not mentioned in the motion—with more patients now being treated as day cases, out-patients or in the community. The percentage of elective admissions treated as day cases, for example, has risen from 25 per cent in 1986 to 62 per cent now.

That is good news for patients, as they are treated closer to home, and it is due to the hard work and flexibility of the 130,000 people who work in our health service. It is important that we treat patients in the best possible location for them and it is essential that we listen to what they want. The shift from long-stay institutional care for those with mental illness, learning disabilities and geriatric needs is continuing and is to be applauded.

I am sure that all MSPs know of examples from their own areas, but I would like to highlight the work that is being done in Edinburgh by assertive outreach mental health teams. Yesterday, with colleagues from other parties, I met and talked to staff to learn how their multidisciplinary, hands-on and holistic approach is keeping people out of the wards of the Royal Edinburgh hospital and in their own communities. Patients who would once upon a time have been seen as candidates for prolonged hospitalisation or institutionalisation can now remain in their own homes.

I am talking about trends.

Photo of Margaret Smith Margaret Smith Liberal Democrat

One trend is clear. For three years, we have had to sit and listen to SNP health motions and all we hear is criticism of the Executive and the people who deliver the health service in Scotland. Not once in three years have we heard anything positive, constructive or radical from the SNP—independence is all that it offers to the people of Scotland. We have yet to hear one positive suggestion as to how we can improve the health service in Scotland.

Photo of George Reid George Reid Scottish National Party

We now move to open debate. If speeches are restricted to four minutes, all members who want to speak will be let in.

Photo of Richard Lochhead Richard Lochhead Scottish National Party 11:32 am, 14th March 2002

I want to begin by telling the chamber about Dr Donald Bissett, who is a cancer specialist in north-east Scotland. Nine months ago, he was involved in a tragic hill-climbing accident and was paralysed from the neck downwards. Only a few weeks ago, he returned to work in the north-east as a cancer specialist and now sees 50 patients a week with the help of full-time personal nurses and carers. We all associate bravery, determination, courage, dedication and professionalism with Donald Bissett and pay tribute to him.

We also associate dedication and professionalism with our NHS staff. The difficulty is that our professional and dedicated NHS staff are being undermined by the Executive's policies. NHS services in Grampian are in danger of shrinking—that is one reason why we are having this debate. In Grampian, the local trust carries out 10 per cent of NHS activity in Scotland with only 9 per cent of funding. As a result, hospitals in Grampian have cut their services to the bone in recent years. In fact, they are probably the most efficient hospitals in Scotland. Indeed, Alec Cumming, who gave evidence to the Audit Committee in February, said:

"Our cost-base—the average cost per patient—is very low. It is 10.6 per cent below the Scottish average. That is a major issue. In any speciality area, our costs of keeping patients in hospital are well below the Scottish average."—[Official Report, Audit Committee, 5 February 2002; c 985.]

Against that backdrop, Grampian NHS Board has brought forward reviews to make further cuts, as it faces a £6 million deficit. The first review proposed cutting £1.9 million of services as a result of duplication with the creation of Grampian NHS Board. I do not think that many members could argue with cutting some jobs and services; however, as a result of the deficit and the funding difficulties, it has brought forward a second review, which proposes cutting £4.3 million of non-clinical services. It would be a disaster for the NHS in Grampian if that proposal were implemented. It would mean that the non-clinical functions would be transferred to the front-line staff. That would have a tremendous impact on patient care.

Nicola Sturgeon and I visited a hospital in Grampian a couple of weeks ago.

Photo of Bill Butler Bill Butler Labour

Richard Lochhead's colleague Nicola Sturgeon, the SNP's spokesperson, mentioned waiting until there is a national bed review. For the sake of argument, let us say that a national bed review concluded that we need more beds. I want to ask about resources. If there was an SNP Administration, where would extra moneys come from? Would they come from additional tax, from another budget or by a combination?

Photo of Richard Lochhead Richard Lochhead Scottish National Party

I get the point. Perhaps the member could make different interventions in future debates and contribute something positive.

A couple of weeks ago, Nicola Sturgeon and I visited a hospital in Grampian. We discovered a service that is underfunded, overstretched and understaffed. It cannot handle any more cuts. We met the staff—nurses, management and consultants. The situation in Grampian is serious. Some 12 per cent of beds are blocked and there are nursing vacancies—the area is short of 17 paediatric nurses. How will people be attracted to work in Grampian if there are even more cuts?

No one is denying that there are challenges ahead for the NHS. However, we are talking about Scotland's—and Europe's—oil capital. The NHS is struggling to cope. It is discriminated against in respect of Government funding. The situation is ludicrous. I urge the minister to visit Grampian to see the situation at first hand and to act. If he takes the trouble to visit the hospital, I hope that he will see that there is a strong case for a slice of the £200 million underspend to go to Grampian to improve patient care and help people such as Dr Donald Bissett and his colleagues to continue to deliver a first-class service for patients.

Photo of Bill Butler Bill Butler Labour 11:37 am, 14th March 2002

It is not surprising that I rise to support the Executive's amendment to the SNP's motion on the NHS. I could say that I was disappointed, surprised and shocked by the tenor and content of the motion, but that would be disingenuous of me, to say the least. I am afraid that the motion is all too typical of the SNP's approach.

Miss Sturgeon's motion and how she presented it convey an almost surreal, strange world of peculiar ingredients—a mixture of "Dad's Army" and Voltaire. In that world, according to the SNP, we are all doomed, doomed, I tell ye. According to the SNP—pace "Candide"—this is a time and place where all is for the worst, in the worst of all possible worlds. Such unremitting pessimism is not supported in any way by people's experience. Things are much more complicated than that.

Photo of Bill Butler Bill Butler Labour

In a second.

That is not to pretend in any way that an organisation as large and complex as the NHS, which seeks to provide modern health care services to all communities throughout Scotland is perfect. I gently suggest to the SNP that that would be as unreasonable as the logic of its motion, which suggests that the Executive has presided over a total collapse of the NHS.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I think that the motion referred to "shrinking" rather than total collapse. As one of Mr Butler's constituents, I suggest to him that the experience of the NHS that I described is that of his constituents. If he does not know that as a constituency member, I respectfully suggest to him that he should get out more and see more of the people whom he professes to represent.

Photo of Bill Butler Bill Butler Labour

I am glad about Nicola Sturgeon's consideration that I should get out more, but I do get about my constituency and see people.

The minister referred to the problem with out-patient waiting lists. There are problems and I do not for one minute deny that there are challenges—it would be foolish to do so. However, the picture that is painted by the SNP motion is of unremitting doom. Miss Sturgeon is a modern-day Cassandra, except that her prophecies do not have substance. The NHS is not a picture of doom—it is about people delivering.

Let us have a few facts in the debate. For instance, public expenditure on health, as a percentage of gross domestic product, is higher than in the majority of smaller nations in the European Union. That is incontrovertible. The number of acute in-patient beds per thousand of population is among the highest in the European Union and the number of general practitioners per 1,000 of population is the highest of all of the small nations in the European Union.

On the vexed question of waiting lists, I accept that there is much to be done. However, I say to Ms Sturgeon that the total number of people waiting has decreased by 4,631, or 5.4 per cent, since December 2000. That is according to a national statistics release from the information and statistics division Scotland.

Of course, all of us in the chamber want to make provision to accelerate treatment and cut lists. We are all agreed on that. I believe that it is clear that the Executive is tackling that complex challenge. It is not a simplistic challenge or a simplistic picture, as put forward by the national party. It is complex because an increasingly sophisticated range of treatments is available and we are investing record resources to deliver the treatments that people demand.

I will end with a fact. The resources that the Executive has put into the NHS in Scotland will have risen from £4.9 billion in 1999/2000 to almost £7 billion by 2003. When national party members are asked how they would invest additional moneys they are less than convincing, as is their party's motion. That question will be asked time and again by Labour and Liberal members. Opposition is about criticism, but it is also about providing constructive alternatives and we have yet to hear those from the national party. Therefore, I urge support for the Executive's amendment. It is realistic and it paints the real picture of the NHS in Scotland.

Photo of Roseanna Cunningham Roseanna Cunningham Scottish National Party 11:42 am, 14th March 2002

What an odd and entertaining performance that was from Bill Butler. When my constituents come to my surgeries to complain about the national health service, I will be sure to let them know that Bill Butler thinks that they live in a fantasy world. I am sure that they will be pleased with that response from the Labour party.

The truth is that the NHS is not only shrinking in terms of numbers—some of the numbers have been mentioned already—but it is contracting in terms of its physical presence. I know about that from Tayside. Following the interminable Tayside acute services review, I am convinced that the managers of the health services in Tayside are thirled to a centralising agenda. Across a wide spectrum of health care provision—from Perth royal infirmary's children's ward, kidney dialysis and maternity provision through to the helicopter ambulance service—that fear has been real and of great concern to my constituents and to many others throughout the health board area.

As the minister knows, the most active campaign has been to preserve maternity services at Perth royal infirmary. Last December, I expressed my concern about the lack of progress on the midwife-consultant partnership as a national demonstration project. The impression then was that the partnership was being set up to fail so that the centralisation option could be pushed ahead.

There are now rumours of an Executive ultimatum to Tayside NHS Board, which would result in the imposition of a midwife-led unit, but nobody involved in the maternity services in Perth—from the professionals through to the patients—wants that or believes that that is appropriate. Even more important, the people of Perthshire showed that they did not want that during the review. I hope that the Deputy Minister for Health and Community Care will take the opportunity today to disavow any such behind-the-scenes manoeuvring and to put people's minds at rest. The deputy minister could also advise of progress on the demonstration project in her closing speech, since neither she nor the Minister for Health and Community Care are leaping to their feet now.

If the midwife-consultant partnership is not to be, the only feasible option for maternity services at PRI is the existing consultant-led unit, unless of course the Minister for Health and Community Care is intent on completely destroying public confidence in Perthshire.

This is not only about maternity services. Clinical nurse specialists who work in the field of psychotherapy have recently contacted me. The service that they have been providing has been curtailed and it is now clear that not all areas of Perthshire will be covered by the service. That is the shrinking NHS in Tayside. That is the answer to the Minister for Health and Community Care's comments at the beginning about how those services are being rolled out to offer greater provision. The reality is the opposite.

I have no doubt that, in summing up, the Deputy Minister for Health and Community Care will try to assert that the NHS is doing well under the Executive and that it is safe in their hands. Facts tell a different story. What matters to my constituents is the experience that they have and they are not satisfied.

I will copy the correspondence on a recent case to the Minister for Health and Community Care, but I think that outlining it will help the debate. One of my constituents attended his GP and was told that he would have to be referred to a specialist at PRI. He received a letter dated 22 February 2002 informing him that the out-patient appointment was on 4 March 2003. That is absolutely ludicrous. That is a waiting time of more than a year and that is the reality being experienced by my constituents.

The NHS is shrinking. The 1999 to 2001 activity statistics from Tayside University Hospitals NHS Trust show that: elective in-patients are down; day cases are down; the percentage admitted within three months is down; total out-patients are down; bed numbers are down throughout Tayside generally and in particular at PRI; and the median waiting time for in-patients is up. That is the answer to Bill Butler. Those are the realities that my constituents and those right across Tayside have to face. Fewer beds are available, fewer patients are treated and there are fewer nurses to care for them, and there is rampaging centralisation. The Executive has utterly failed the NHS, throughout Scotland and in Tayside in particular.

Photo of Brian Monteith Brian Monteith Conservative 11:46 am, 14th March 2002

Before I enter into the main body of my speech, it is worth picking up a couple of points that have been made.

First, Nicola Sturgeon suggested that the root of the difficulty faced by the health service is the lack of beds. If Nicola Sturgeon was the transport spokesman for the SNP, she is the sort of person who would say, "the difficulty with public transport is that we do not have enough buses." I am sorry, we do not measure the success of public transport by the number of buses: we measure its success by the number of people who make their journeys on the buses. The problem with the NHS is not the number of beds, but the lack of operations—the falling number of operations and the lack of attentiveness to operations in the NHS. A beds review will not solve the problem. I will not take Nicola Sturgeon's intervention; I have only four minutes.

Photo of Brian Monteith Brian Monteith Conservative

For Margaret Smith to suggest that the problem for the NHS is greater demand is tantamount to saying, "People are more sick under Labour and the Liberal Democrats."

Photo of Brian Monteith Brian Monteith Conservative

No. I will not take Margaret Smith's intervention either. We know that people are not more sick, but they are more sick of Labour and the Liberal Democrats being in power and failing to manage the NHS.

Last month, a constituent contacted me about his grandfather in Strathblane, who appeared to have suffered a stroke. It could not be anything but noticed that the GP was there to help out within three minutes, but that it was a further two hours before an ambulance came to Strathblane to take the grandfather to hospital. I appreciate that the incident occurred in rural west Stirlingshire and that that poor standard of service is a rarity. However, we subsequently found out that rare it may be, but it does happen from time to time in that part of Stirlingshire. Many Scots recognise that the standard of service has, in many areas, deteriorated rather than improved since Labour and the Liberals formed their coalition.

The motion mentions the shrinking NHS. I suspect that people in Dunfermline will identify with the shrinking of the NHS when they consider what might happen to the Queen Margaret hospital there, which is currently under review. The people in Stirling—which I am glad to believe might become a city today—and Falkirk will be concerned about the review of their royal infirmaries. The people in Perth, as Roseanna Cunningham has pointed out, are concerned about the provision for maternity care and services at Perth royal infirmary. Those people, who see the result of acute services reviews, are concerned about the shrinking of the NHS.

In the Forth valley, the length of time that people have to wait for treatment has shot up since the Scottish Executive assumed responsibility for health matters in 1999. Residents are now waiting more than a week longer for treatment in hospital: it has gone up from an average 32-day wait almost three years ago to a 40-day wait now. The number admitted for treatment within three months has also declined, from about 82 per cent to 77 per cent, over the same period. Out-patients in the region are now waiting more than a week-and-a-half longer. They wait on average for 65 days for a hospital appointment, compared to 54 days in June 1999. The number of out-patients that are seen within nine months has also declined. The figure for the Forth valley, which is replicated in other parts of Scotland, is down from 57 per cent to 49 per cent.

Tangible improvements in the service require a change of policy from the Scottish Executive. All that has been delivered so far is yet another addition to the Government's ever expanding health team, this time in the shape of a ministerial parliamentary aide. The Executive does not seem to understand that the growing team is not the solution, but part of the problem. Unfortunately for residents in the Forth valley, Fife and elsewhere, there seems to be little prospect of ministers allowing the simple truth to sink in, that it is not inputs, but outputs that matter.

I support the Conservative amendment.

Photo of Tavish Scott Tavish Scott Liberal Democrat 11:50 am, 14th March 2002

The Conservative's worst attack is that Mr Chisholm has a ministerial aide—that is pretty devastating stuff. In his opening speech, Mr Chisholm made some sensible remarks about the problems that face the NHS, which is a refreshingly honest approach from a ministerial team. He also illustrated what is being done about the problems by mentioning the resources and the philosophy that the Liberal Democrat and Labour Administration has introduced.

Some refreshing honesty from the other parties would not go amiss. Despite Mr Butler's efforts, he did not get an answer to his pretty straight question about resources. Perhaps the SNP will answer him in the winding-up speeches. The minister gave a precise answer to the Conservative spokesperson's question about administration, but the Conservatives did not appear to hear it.

Photo of Tavish Scott Tavish Scott Liberal Democrat

No, I want to make some progress. We heard what Nicola Sturgeon had to say earlier on.

I will take the opposite tack from that of SNP members, who ducked the question of resources, and will illustrate where resources could be used more effectively. At present, NHS Shetland spends £1.1 million on flying patients from Shetland to Aberdeen for various treatments and procedures. In the Western Isles and Orkney a comparable amount is spent on flying patients to the mainland. To be frank, £1.1 million spent on British Airways is a scandal. I would rather that the money was spent on front-line care in the Shetlands, such as doctors, nurses and treatments. I encourage ministers to consider closely—and to tackle constructively—the money that island health boards spend to fly patients to hospitals, such as those in Glasgow, Inverness or Aberdeen.

Photo of Mary Scanlon Mary Scanlon Conservative

Does Tavish Scott recognise that the expertise and specialism in Glasgow, Edinburgh, Inverness and Aberdeen hospitals does not exist in Shetland? Does not he wish that patients in Shetland should have access to that expertise?

Photo of Tavish Scott Tavish Scott Liberal Democrat

I accept that, but Mary Scanlon completely misses the point. My concern is why my constituents who travel to Aberdeen for specialist treatment must pay £300 for the round trip on British Airways. That is the point; if Mary Scanlon knew anything about island life, she would understand it. I hope that ministers will consider alternatives in that area. I suggest that resources might be reallocated.

We must consider how we can best spend resources. Those who make the system work, such as staff nurses, doctors and ancillary staff, are a great resource. However, more needs to be done in supporting their work. That means supporting the physical infrastructure and providing new equipment, and also improving terms and conditions. This week, I received a letter from a GP in my constituency. He said:

"There is always more pressure to do things in GP that were done in hospitals, but there seems no transfer of money with the transfer of workload, so therefore there is more pressure on time for all staff."

I hope that among the measures that will be introduced, initiatives for isolated rural GPs will be considered carefully.

Expectations are rising in the general population. New procedures are devised to meet those expectations, which will rise again as a result. Local staff gave me three examples of such procedures. They were dual energy X-ray absorptiometry—DEXA—scans to determine the need for protection against osteoporosis, new drug treatments such as statins to protect against heart disease by lowering blood fats and new procedures such as joint replacements and coronary artery bypass grafts.

The aging population and the change in the aspirations and requirements of the population lead to increased demand on the system. I do not accept the utterly spurious argument that some members have put forward that demand is not rising—that is demonstrably not the case. Anyone who is closely involved in constituency work will know that and should try to find constructive ways around it. For example, if we tackle the moneys that are spent wastefully on British Airways flights, we could find more money for the delivery of health services in constituencies such as mine.

Photo of Janis Hughes Janis Hughes Labour 11:55 am, 14th March 2002

As Mary Scanlon said, another week, another health debate. Earlier this week, I wondered what topic the SNP would choose for today's debate. Health is a wide-ranging subject and I mused on which specific area the SNP would focus. When I saw Nicola Sturgeon's motion yesterday morning, I was not surprised that the SNP had not chosen one of the diverse areas of the health remit. Yet again, we have the usual moaning and groaning and doing down of the NHS, which helps only to demoralise staff and to frighten patients. How many times must we listen to that in the chamber? How many times must we emphasise the facts before they finally filter through?

As Bill Butler mentioned, it is a fact that health spending in Scotland increased from £4.9 billion in 1999 to nearly £7 billion in 2003. We must emphasise that.

Photo of Janis Hughes Janis Hughes Labour

No. Nicola Sturgeon had a good opportunity to say what she had to say. We have heard it all.

It is a fact that health spending will continue to increase at record levels year on year under this Government. It is a fact that six new hospitals have been built and that two more are on stream as part of the biggest hospital building programme in the history of the NHS in Scotland.

Photo of Janis Hughes Janis Hughes Labour

We do not need lessons from Ben Wallace on rebuilding the NHS.

I have given the facts, not the type of scaremongering that those in opposition—I use the term widely—put about. The SNP motion mentions

"fewer nurses and fewer acute beds", but 10,000 more nurses will qualify by 2005, which is 1,500 more than was planned.

As the minister mentioned, the Executive recognises that the recruitment and retention of nursing staff is vital. The many new initiatives, such as fully funded return-to-practice courses and guaranteed employment for newly qualified nurses, go some way towards addressing the issue. However, as I have said on other occasions, we must go further by considering how we train our nurses and whether we can offer a less academic route into the profession. There is a vast, untapped resource of people who would prefer that type of career.

The fundamental point about bed numbers escapes some members. Working in the NHS is a continual learning curve. New technology, new surgical techniques and new research findings lead to continually changing protocols and ways of working. Minor surgery once necessitated a stay in hospital, but that is not now the case. Each month, more procedures become suitable for day treatment, which reduces the need for beds. Some members get hung up on reductions in bed numbers because they simply do not understand the issue.

The SNP motion claims that the NHS is shrinking, which shows a complete lack of understanding of the way in which the service works. The SNP members are laughing—I am glad that it is amusing to them because it is not amusing to me.

As a constituency MSP, it would be remiss of me to say that everything in the garden is rosy. I am the first to say that we have not yet got things right. Like that of other members, my postbag reflects the fact that some people wait too long for treatment. The minister acknowledged that out-patient waiting times are not as we would wish. However, for the first time in many years, work is under way to address the problem.

There is a good story to tell on health and it is time that we told it. I will never forget the 18 years of Tory rule. In opposition, it is easy to blame those in Government, which is what we hear from the SNP day in and day out. I speak from first hand experience of those years. What would the SNP do if, heaven forbid, it had the chance? Nicola Sturgeon and her colleagues should put their money where their mouths are. They should show us their policies and tell us exactly how they would fund them. Independence tomorrow would immediately reduce Scotland's health budget by £1 billion. How many more patients would suffer then?

For every patient who has a complaint about the NHS, thousands more are delighted with the care that they receive. It is time that we started to focus on the positives. As the Executive amendment says, we commend the commitment and dedication of NHS staff. We owe it to them and to patients to look to the future in a positive light.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent 12:00 pm, 14th March 2002

I am not sure what Janis Hughes—who is an excellent member of the Health and Community Care Committee—means when says that she addresses us as a constituency MSP. She has one constituency, but she should try dealing with three in the east end of Glasgow. List MSPs have to hold surgeries and have a huge work load as well.

I want to address an issue on which I think all members agree. Postcode prescribing is one of the greatest injustices in the NHS. Imagine a battlefield casualty-receiving station and many soldiers with the same serious wounds. A doctor asks one, "Where do you come from?" "Edinburgh," the soldier replies. "Oh, you are all right," says the doctor. Others say, "Tayside," and they are okay. However, if anyone says, "Glasgow," the doctor says, "Sorry." That is what it is like. Certain drugs are not available to people if they live in the west of Scotland. Where a person lives is still where they die—and they die earlier, if they live in Glasgow. That happens not just for social reasons such as appalling housing, but because the funding is refused for certain drugs that are funded elsewhere.

The Executive set up the Health Technology Board for Scotland to try to end postcode prescribing and NICE blight—blight caused by the National Institute for Clinical Excellence in England, which has caused huge delays in the approval of drugs by health boards. NICE is being investigated by the House of Commons Select Committee on Health. However, what has been achieved in Scotland? The Health Technology Board for Scotland seems to be an exercise in putting a kilt on it, or making it seem Scottish. The board will report three months after NICE reports. That is ridiculous. I stress to the ministers the need to get on to the Health Technology Board for Scotland, to find out what on earth it is doing.

One patient in Glasgow, to whom I have referred before, has broken through where the Health Technology Board for Scotland, NICE and everyone else failed. She is a very brave woman from the Gorbals who has appealed to just about every MSP, pleading for her life, because she could not get the drug herceptin prescribed in Glasgow, because the health board would not fund it. After months of trying, she has succeeded. Yesterday came the very good news that the Greater Glasgow Health Board will fund herceptin and that four other health boards in the west will comply. That determined, very ill woman teamed up with my assistant—Evelyn McKechnie, to whom I pay tribute—who is a breast cancer survivor. Those two formidable women did a massive amount of work over 17 months on campaigning to get herceptin prescribed. Why should individuals have to try so hard? We cannot accept the continuation of postcode prescribing in any civilised society.

Turning to a consensual issue, I notice that Lord Palmer, at the House of Lords, is trying to abolish the Scottish Parliament. We all say to him, "Dream on." When we do what the public want us to do—when we try to do something sensible and obey public wishes—people approve. I am delighted to inform Parliament that there have been more than 100,000 hits on the Parliament webpage on the subject of chronic pain, which those of us on the cross-party group are trying to highlight as an issue. To find a way of restructuring the NHS, we must ask why people bother to use the NHS at all. The No 1 reason is that they are in pain, through some disorder or other. That is why surgeries are overcrowded. Back pain is the No 1 complaint at doctors' surgeries. Operations often do not work, and the queues for operations could be eased. We need proper specialist pain services to lift some of the 550,000 pain sufferers out of the operation queues. We should treat them properly and improve the NHS—it can be done.

I hope that we will get a positive response from the ministers. I am an incurable optimist and I believe that we will get a response that will enable us to progress down that road and do what the public are telling us to do.

Photo of George Lyon George Lyon Liberal Democrat 12:05 pm, 14th March 2002

We have heard a lot of doom and gloom from the Opposition parties about the state of the national health service. As usual, no solutions have been offered and we have not been told what those parties would do differently.

Earlier this week, I attended an event in my constituency at which 22 NHS staff were honoured for 20 to 30 years' service to the NHS. Those men and women had entered the service in the 1960s and 1970s. Some of them had worked for almost 39 years in the service and had shown dedication and loyalty throughout that time. Several of them told me afterwards that they were sick and tired of the NHS being used as a political football. Most important, they did not recognise the description of the NHS that was given in the media—of a service that was falling apart, in meltdown and lurching from one crisis to another. That was certainly not their experience of the NHS. Those who portray the service as on the point of collapse would do well to remember that. We need balance in this debate and we must approach the issues in an even-handed manner.

There can be no doubt that there are problems in the national health service. Only a fool would deny that the service faces many difficulties. However, judging from my constituency casework, waiting times seem to be the No 1 issue among service users. That is the main area of complaint from constituents. I am therefore delighted that the coalition has taken action on that issue. A waiting times unit has been set up and is beginning to produce solutions based on identifying spare capacity in the system and matching it with patients who are waiting. That is to be welcomed. Senior officials in Argyll and Clyde NHS Board believe that there is enough capacity in the NHS to deal with the backlog. However, there are massive questions about how beds, nurses, doctors, consultants and patients can be matched and brought together in the same place at the same time to ensure that the extra capacity can be used. The issue is not as simple as the number of acute beds—that is a simplified way of considering the problems in the NHS.

The fundamental problem facing the NHS is the lack of investment in it over the past 20 to 30 years, against a background of growing demand and an aging population. As the technology improves, people are living longer. The statistics show that clearly, although, disappointingly, because of the poor health record in Scotland, our statistics are much poorer than those south of the border. That creates extra demand on the NHS in Scotland. It is no coincidence that the United Kingdom sits at the bottom of the European league for health spending.

Photo of David Davidson David Davidson Conservative

I ask Mr Lyon to give us a definitive answer. Are the Liberal Democrats in favour of the continuation of the Arbuthnott formula as it stands—yes or no?

Photo of George Lyon George Lyon Liberal Democrat

I will come to that in a minute or two.

Currently, we spend only 6.8 per cent of gross domestic product on our health service, compared with an average of 8.4 per cent in the rest of Europe. The top spender is Germany, which spends 10.3 per cent of GDP on its health service. It is no coincidence that Germany has spare capacity in its health service and is accepting patients for treatment from other countries that have waiting lists. It is only in the past two years that the UK Government has, at last, woken up to the fact that, if we are to improve the NHS, more resources have to be found to bring us up to the European average—never mind trying to match the likes of Germany and France. Investment in the health service has started to be increased only over the past two to three years, and it will take time before that investment will begin to pay dividends. A service such as the NHS cannot be turned around in two to three years.

As a result of the UK Government's increase in spending and the Barnett formula, Scotland—which is currently at the European average for NHS spending—will move towards the kind of spending that Germany and France enjoy. That must be welcomed. The increase means that the Executive can sustain increasing investment in the NHS in Scotland to deal with our poor health record. That gives the SNP a problem, because its answer to everything is separation. The SNP says that independence will cure all the health problems. Well, I think not. Separation would solve nothing, but would create only a financial black hole. Scotland currently spends £1,059 per capita, compared to £885 south of the border. I ask the SNP spokesperson to explain in her winding-up speech how the SNP would fill that financial black hole.

Photo of Ben Wallace Ben Wallace Conservative 12:10 pm, 14th March 2002

As was said earlier, it is another Thursday and we are having another health debate. I make that observation not with resentment, but to underline how important the health service and health provision is becoming in Scotland.

The Scottish Executive claims that only it knows the way forward on health and that only its vision will solve the problems. Anyone who suggests otherwise is accused of trying to privatise the NHS or of running down the service. I warn the Executive that if it continues on that course, which is an outmoded and stubborn view of how the NHS should shape up, the Labour party will eventually crash against the rocks. Anyone who lives in the real world, to which Bill Butler referred, knows that a survey commissioned by the Executive showed that nearly 70 per cent of people thought that the NHS was worse than, or at least the same as, it was under the Conservatives.

The amendment from the Lib-Lab Executive is an example of its blinkered attitude to the NHS. The amendment does not give a hint of the failings in the current system or of the fact that the regressive policies that Labour has followed since 1997 have produced worse, not better, results. It is amazing that no one questions the fact that after £6.1 billion extra has been spent, the outcomes for the patients have got worse. Malcolm Chisholm's amendment asks us to acknowledge the increase in health funding. The Conservative party recognises and welcomes that increase. However, given that the Executive has spent all that money but the problems are worse, we also think that the Executive's policies are wrong.

Photo of George Lyon George Lyon Liberal Democrat

Surely if the Conservatives, during their 19 years of rule, had spent anywhere near the European average, the NHS would not be in its current poor position.

Photo of Ben Wallace Ben Wallace Conservative

Mr Lyon said that he would come to the point about the Arbuthnott formula, but he did not. Unlike him, I will come later to the point on European spending and gross domestic product.

The Executive amendment refers to patient-centred services. However, as Dorothy-Grace Elder alluded, it is obvious that the Executive does not recognise that we cannot be said to have patient-centred services when we have lost commissioning, which would have allowed more empowerment at the health service's front line. In fact, there has been an increase in postcode prescribing. I do not consider that to be patient centred; it is a consistent problem of the current system.

The SNP motion points out the facts since 1999. It is interesting that Nicola Sturgeon did not go back to 1997, perhaps because to do so might have vindicated many Conservative policies. Like last week's motion on bedblocking, the SNP motion does not contain an idea on health care. After years in this Parliament, the SNP has not made many suggestions that contribute to the debate for reforming the NHS and solving its problems.

Recently I looked at the SNP's 1999 manifesto. I have a copy of it in my hand. It has a photograph of Alex Salmond on the front, with a map of Scotland behind him. He should have had a photograph of Westminster behind him, as he was going to nip off there a few years later. The manifesto did not allude to that. Health is not included in the manifesto's top 13 priorities. I know that the SNP ditched independence as a top priority, but health priorities also disappeared further down the priority chart. We will waste no more time on the SNP motion, until the SNP comes up with solutions. That is how we should treat the SNP. Until the SNP produces solutions in the health debate, it is wasting the time of most of the peoples of Scotland.

Malcolm Chisholm made several points in his speech. His defence was that the NHS and health treatment formed a much more complex issue than the SNP suggests. I hope, therefore, that he will join us in condemning the 1997 Labour slogan, "48 hours to save the NHS". Malcolm Chisholm cannot claim that the issue is complex when his party produced a scandalous slogan that raised people's expectations. Let us restore the facts, as Malcolm Chisholm was selective about them. In 1997, Labour said that there would be 200 extra fast-track, one-stop out-patient clinics. I have with me the current list of those clinics. One example on that list is the diabetic and obstetric clinic in Bellshill hospital. Is that a new, extra, one-stop clinic? Bellshill has had a department doing that for decades. However, the Executive would like to reclassify that facility.

Bill Butler referred to GDP spending. Yes, Scotland has almost the European average of GDP spend on health care. However, other European countries' GDP spend on health consists of a mix of public and private funding. Germany spends less public money than we do on health as a share of GDP. George Lyon quoted the benefits of the German system of social insurance. Would he support our having a similar system? Not even the richest countries in Europe contribute public spending only to health care. They mix health care spending to deliver better health care.

The Scottish Conservatives will look at many health care systems around Scotland. To produce a better solution for patients, we will do our best to ensure that we do not just use ideology. We will use all the facilities—voluntary, independent and public—to ensure that we have an optimum health care system in Scotland that will be for the benefit of the patients and not for the benefit of a dogma or a manifesto.

Photo of George Reid George Reid Scottish National Party

Replying to the debate for the Executive is the Deputy Minister for Health and Community Care, Mrs Mary Mulligan. You have five minutes, minister.

Photo of Mary Mulligan Mary Mulligan Labour 12:16 pm, 14th March 2002

Thank you, Presiding Officer.

I am pleased to hear that Ben Wallace thinks that we should be looking at the benefits for the patient, because my concern about a debate such as this morning's debate is that the argument becomes a sterile one in which we trade figures. I could say that the numbers of heart bypass operations, cataract operations, and patients attending accident and emergency departments have increased. However, as it is unreasonable to suggest that everything is rosy, so is it unreasonable to suggest that everything is bad, as the SNP motion does. We do the health service no favours, as Nicola Sturgeon accepted, by making claims such as have been made in the debate The numbers of qualified nurses are increasing and a great deal of effort is going into recruiting, training and retraining nurses. Other members have outlined the proposals, so I will not repeat them. However, I will answer Janis Hughes's point about the less academic route into nursing by saying that we must consider that.

As far as acute beds are concerned, numbers are reducing in line with changing patterns of medical care. Patients are now more appropriately cared for in the community. An increasing proportion of cases is being dealt with as out-patient cases. Bed numbers are being used flexibly. For example, last winter an additional 400 acute beds were brought into service. It makes sense to adjust bed numbers to reflect changing clinical practices.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Does the minister accept that it is cold comfort that 400 temporary beds have replaced the 700 permanent beds that have been lost? Does she recognise that many of those beds—for example, at the Southern general hospital in Glasgow last winter—were not brought into use because nurses could not be attracted to staff the beds? That is the problem when one runs down the service and then tries to build it up again on a temporary basis. That just does not work.

Photo of Mary Mulligan Mary Mulligan Labour

The two claims must be brought together. We are reducing numbers of beds because of the reconfiguration of the service, but we are also leaving flexibility within the service to react to situations. That is the right way of taking the service forward.

As many members said, the waiting lists issue is a stubborn problem. I am pleased to hear that Nicola Sturgeon listens to the First Minister when he says that. However, we are trying to address the problem. We have set up the national waiting times unit, which will monitor waiting times and take appropriate action to identify and deal with outstanding issues. The unit has arranged for patients to move across NHS board boundaries to access shorter waiting times. Work on that will continue.

The view of the NHS in the SNP motion is far too narrow. Ninety per cent of patient contact is with primary care services. In a typical day, 60,000 people visit a general practitioner, pharmacists dispense 188,000 prescriptions, and 8,500 people visit a dentist. The SNP cannot concentrate only on the acute service and then claim that the NHS is shrinking.

Photo of Mary Mulligan Mary Mulligan Labour

No, I am sorry. I must get through the points that members have made. That includes Richard Lochhead's point; if he sits down, I will answer it.

The motion does not look at the modernisation programme or the health improvement programme, which are huge issues that we need to address if we are to tackle the problems in the health service. The SNP bases its argument on crude statistics, which can show anything. We need a more detailed description.

Record resources of £6.9 billion by 2003-04 are being put into the NHS by the Labour-Liberal coalition. Where will the SNP find cash like that? Will it come out of Kenny MacAskill's roads budget or out of the schools budget? What is the cost of independence? The SNP has not yet answered those questions.

The NHS is not shrinking. It was totally unhelpful of Nicola Sturgeon to use the example of Alan Milburn increasing bed numbers in England, where the ratio is 3.7 beds per 1,000 in comparison, with the position in Scotland, where the ratio is 6.2 beds per 1,000.

Richard Lochhead tried to intervene, so I will reply to his comments. Grampian Health Board's budget is increasing. It increased by 5.6 per cent last year and 6.8 per cent this year, and an increase of 7.1 per cent is planned for next year. It is important that local health boards deal with their own budgets. It is not for the Parliament to tell them how to do that.

Roseanna Cunningham mentioned the maternity review. I chair the maternity review working party and I reassure her that no ultimatum has been delivered to Tayside Health Board. We will concentrate our efforts on looking at the safest possible way for women to deliver their babies, which will be decided in discussion with a host of people.

Photo of Mary Mulligan Mary Mulligan Labour

I am sorry but I cannot take Roseanna Cunningham's intervention on that point.

The NHS would not be safe in Tory hands. Once again, we heard the Tories trying to introduce private health care into the NHS. I say to Mary Scanlon that that approach is a marginal issue in Scotland and that it would not answer the problems that we must address. We will use private resources when it is necessary to do so, but we will not bolster the private sector by allowing it to use NHS staff and moneys. We believe in the NHS and we will support it.

Ben Wallace said that there were fewer one-stop clinics than we claimed that there were. A survey that was conducted in April 1999 showed that there were 80 one-stop clinics, whereas a survey that was conducted in the summer of 2001 showed that there were 300 such clinics. Therefore, Ben Wallace's figures are wrong. Mary Scanlon referred to Alan Milburn's concordat, but the point of the Scottish Parliament is to address Scottish problems.

The Executive and Labour and Liberal Democrat members will make a concerted effort to try to address all the problems in the NHS. We are not saying that there are no problems—we are saying that we should have a reasoned discussion on how to solve them. I did not hear suggestions from SNP members about how to do so.

Photo of Shona Robison Shona Robison Scottish National Party 12:23 pm, 14th March 2002

Facts are facts, or so we thought. However, it seems that the Labour-Liberal Executive wants to dispute the facts that are provided by its own departments. Perhaps the Executive should take a closer look at the facts, some of which I will remind members about in a minute.

It was interesting that the Minister for Health and Community Care rejected the use of 1999 figures as a baseline—he said that to do so would be to make an unfair comparison. However, he then moved swiftly on to use figures that were the same but for the fact that they were taken from a 1997 baseline. That was a little disingenuous of him.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

Actually, I quoted figures from both 1997 and 1999. I said that I could find good figures from 1999, but went on to explain some of the issues around the unusual activity that took place that winter.

Photo of Shona Robison Shona Robison Scottish National Party

I am glad that the minister has confirmed that he uses figures selectively when he talks about the health service.

Let me remind members of the facts. In particular, I want to ensure that Margaret Smith is aware of them. There are more than 100 fewer nurses in the health service than there were in 1999. There are nearly 700 fewer acute beds than there were in 1999—not more, but fewer. It is a fact that the NHS is treating fewer people than in 1999. There are 64,000 fewer out-patients, 5,000 fewer in-patients and nearly 9,000 fewer day-case patients. Members cannot get away from the facts, but we must analyse what the facts tell us. The SNP believes that they tell us that the NHS is shrinking. The consequence of that is that people are waiting longer for treatment than they waited in 1999. More than 16,000 more people are on waiting lists and median waiting times have increased by 10 days. I am not clear about which of those facts the Executive disputes.

Margaret Smith mentioned that recording procedures are becoming more sophisticated and have expanded. That is true. However, the opposite is also true. Some recording procedures have contracted—people are being taken off waiting lists and put on to deferred waiting lists.

Photo of Margaret Smith Margaret Smith Liberal Democrat

There has been a shift in the way in which services are delivered. Many more services that might previously have been dealt with in a hospital setting are being delivered in the community and in primary care. Those services are not being recorded. That shows up in the figures that Shona Robison is using selectively to show a fall in activity. The activity is still going on and in some cases it is being increased.

On acute beds, which the member challenged me about earlier—

Photo of Margaret Smith Margaret Smith Liberal Democrat

Sometimes closing acute beds is the right thing for the service.

Photo of Shona Robison Shona Robison Scottish National Party

It is interesting that the Liberal Democrats are advocating the closure of more acute beds. That will not be very popular among patients.

Photo of Margaret Smith Margaret Smith Liberal Democrat

I meant in relation to the community services that we visited yesterday. I was referring to the specific case of long-term mental health beds.

Photo of Shona Robison Shona Robison Scottish National Party

Excuse me—one singer, one song. As the member will know from speaking to mental health patients and carers, there is a need to preserve a level of psychiatric acute beds. The member should bear that in mind.

The overall picture is clear. The NHS has shrunk under the present Administration.

Photo of Shona Robison Shona Robison Scottish National Party

Not at the moment.

Some members seemed to argue that the shrinking of the NHS was not a bad thing and that a reduction in acute beds was not a problem. I will return to that in a minute.

There are growing demands on the health service, which Tavish Scott recognised. Although I would not argue with that, greater demand for the NHS surely means that we need greater provision for the NHS. That means building up NHS capacity. We advocate precisely that. I am glad that the member has come round to our way of thinking on that.

Bill Butler's Shakespearean performances are quite enjoyable from a spectator's point of view, but no amount of such performances will change the facts of the matter.

Photo of Bill Butler Bill Butler Labour

I thank the member for taking my intervention.

Before the member reaches her last minute—she is well within time—will she throw some light on an SNP Administration's way of adding extra resources? Will the member take the opportunity to do that specifically?

Photo of Shona Robison Shona Robison Scottish National Party

I would be delighted to. First, we would get to grips with the way in which resources are being spent in the NHS. The Executive has not done that. We would use the resources more effectively; there would be better stewardship of the NHS under the SNP. We would not preside over a situation in which more money was put into a shrinking NHS. We would not inject resources at the same time as allowing the NHS to shrink, which the present Administration is doing. Quite frankly, that is incompetence and an SNP Administration would never allow it.

The first step in the reversal of the decline in NHS capacity should be an independent review of acute bed numbers. We must examine the reduction in acute bed numbers. Brian Monteith—who has left the chamber, unfortunately—argued that more patients need to be treated and that that would solve the problems. However, it was silly of him to suggest that the loss of acute beds is somehow unrelated. It is obvious that if the number of acute beds is reduced, the number of people who can be treated is reduced. That concept is not difficult to understand.

The Executive's response is the stock response of higher levels of investment. I have said to Bill Butler that we accept that there is more investment, but we do not accept what the Executive says that higher level of investment is delivering. People in Scotland are being told that more of their money is being invested in the NHS. They should expect something for that. With higher levels of investment, they should not have to wait longer for treatment.

Photo of Shona Robison Shona Robison Scottish National Party

I am sorry, I do not have time.

Are some members seriously arguing that the capacity of the NHS is adequate to meet the health needs of our population? I detected that argument in the speeches of some members. I am extremely concerned that such things are being said.

Photo of Shona Robison Shona Robison Scottish National Party

No.

Given the fact that activity levels are increasing because we have an aging population that is placing growing demands on the health service, I am extremely concerned that members who have stewardship of the health service say that there is no problem with the NHS's present capacity. The SNP totally rejects such complacency.