The next Cabinet will, as always, discuss matters of importance. Yesterday, the Cabinet paid tribute to Sir Muir Russell after his 33 years' service to the civil service and his period of service as permanent secretary during the early years of devolution. We wished him well, as I am sure the Parliament will want to do, too.
"Those who defend the status quo on public services defend a model that is one of entrenched inequality."
That echoed what the former Secretary of State for Health, Mr Milburn, said last February:
"In 50 years, health inequalities have widened, not narrowed. Too often, even today, the poorest services tend to be in the poorest communities."
Does the First Minister accept that that analysis is just as relevant to the health service in Scotland and that the failure to provide high standards for some of the most disadvantaged of our citizens is one of the most pressing arguments for reform?
I am grateful to Mr McLetchie for recognising that any such development occurred over a period when, I believe, the Conservative party was in government for more years than any other party was. However, it is critical that we recognise that, particularly in the 21 st century, not only the health service but other public services need to reform and to adapt to the demands of current and future generations. That is why, in recent months, we have published proposals for reform in education, in our courts and in our justice system and why we will publish tomorrow our proposals for reform in the national health service in Scotland. I hope that those proposals will meet with support in the Parliament.
I suggest that the First Minister's so-called reforms, which are to be published tomorrow in an NHS reform bill, are simply tinkering around the edges of the problem
Last week at question time, the First Minister told me that
"patients in Scotland for whom our guarantee on waiting times is not met locally will have the right to access their health care elsewhere".—[Official Report, 19 June 2003;
In other words, the system will have failed the patient before anything is done. Does the First Minister agree that it would be better to avoid such failures in the first place and that that means empowering patients and giving them choice from day one, an approach that will be absent from his NHS reform bill when it is published tomorrow?
No, I do not agree with that at all. The reforms that we will publish tomorrow will include significant new opportunities for the involvement of patients, not only individually, but collectively, in the provision of services in their area.
Mr McLetchie should reflect on the fact that it is likely—I do not have the figures to hand and suspect that they are not published, but this is my absolute belief—that a more significant number of NHS patients travel north of the border from England for treatment than patients from Scotland travel in the other direction. We would all be surprised if that were not the case. That is a tribute to the Scottish health service, to the increased capacity in the Scottish health service and to the delivery by doctors, nurses and many other professionals of a quality health service here in Scotland.
Reforms are required, but those reforms should build on our comprehensive service and should not move us to the kind of health service that the Conservative party has taken to putting forward over recent years—a service that would be much more exclusive in its provision.