Section 1 — Health Boards' functions: provision of primary medical services

Primary Medical Services (Scotland) Bill: Stage 3 – in the Scottish Parliament at 9:57 am on 18 December 2003.

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Photo of Trish Godman Trish Godman Labour 9:57, 18 December 2003

Amendment 16, in the name of Carolyn Leckie, is grouped with amendments 17 and 18.

Photo of Carolyn Leckie Carolyn Leckie SSP

I am glad that you are keeping me right, Presiding Officer.

It is with regret that I address the chamber. Previously, members have indicated a consensus on the bill, and it is noteworthy that no non-Executive amendments have been lodged other than those that the Scottish Socialist Party has lodged, which leads me to think that there should be serious concern that there has been a lack of scrutiny of the bill. Why is that? Our amendments address our very serious concerns about the increased threat of privatisation. The Labour and Liberal Executive tries to pretend that the bill will not lead to increased privatisation—that is how it deals with the concerns behind our amendments. The Tories are quite happy to acknowledge that there is a concern and that there is an increased opportunity for private provision. They are absolutely delighted to welcome that; they are almost licking their lips—at least they are honest.

Then there is the Scottish National Party. Could it be that its members missed this, and that they are so mortified that they, too, have to pretend that there is not an increased threat of privatisation? Is it that Jim Mather, who was courted by the Tories just last week, has extended his right-wing economic influence to SNP health policy? As the bill has been considered, we have witnessed the SNP joining the privatisation bandwagon. [Laughter.] Absolutely. I will tell SNP members exactly how big the threat of privatisation is and why they have joined the privatisation bandwagon—they might not even know why themselves.

From 1 April 2004, general practitioners will be able to withdraw from out-of-hours cover and additional and enhanced services. However, there will still be a duty on health boards. We are still not clear about how services will be provided, where and by whom. Who will take up the slack in cervical screening, immunisation and out-of-hours services? The British Medical Association acknowledges that 95 per cent of GPs in Glasgow are likely to opt out. Glasgow has the four poorest and sickest constituencies in Britain. There are already fewer GPs per head of population in poorer areas. Those in the greatest need receive less care, and it is exactly those populations who are set to suffer most.

A BBC survey has found that, of 3,000 GPs and 950 local practices, 80 per cent intend to opt out of out-of-hours services. Throughout the UK, £140 million has been allocated to fund new out-of-hours arrangements. That is less than what is currently spent funding out-of-hours services. Early official figures—the Executive's figures—show that, on any one night, 60 GPs are on call in the Highlands. All but six of them will opt out of out-of-hours provision. Mr Chisholm has been made aware of that.

Thousands of GPs have said that, once the new contract is in place, they will no longer provide out-of-hours cover. In an area of North Yorkshire covering 200,000 people, only three out of 545 GPs have said that they are prepared to continue to provide emergency cover. With no disrespect to the Executive, I look forward to seeing its plans for recruiting the GPs who will be supposed to provide health boards' out-of-hours services. Who has been recruited, where are they and how will that recruitment have been achieved by next April or October at the latest?

The other day, I attended a meeting about emergency out-of-hours services in Lanarkshire. I asked representatives of Lanarkshire NHS Board whether they expected the new GP contract to lead to an increase in the use of private providers. At present, four private agencies provide locum services to that health board area. The board is concerned that 52 per cent of referrals to acute services come from locums, which puts additional pressure on acute services, contrary to the spin that we hear, which says that the pressure on acute services will be relieved. The answer that the health board gave to my question was, "We're in discussions about that." The health board recognises that there is an opportunity for increased private provision and I think that the health board is seriously worried about it. Is the Executive worried, or is that its intention?

The current situation in relation to nursing agencies will be replicated with implementation of the new contracts and the opportunities for the private provision of out-of-hours and enhanced services. According to Robert Black, 50 per cent of wards are currently understaffed. That has led to an increase in agency costs from £25 million a year to £35 million a year last year, which has allowed such organisations as the parasitic Scottish Nursing Guild to hold hospitals to ransom if they need an intensive therapy unit nurse, for example. We are told that nurses will plug the gap in out-of-hours services. Will the Executive please tell me where they are going to be knitted?

Members should be warned: there is nothing in the bill to stop GPs opting out and joining agencies, taking the more profitable route to providing out-of-hours services. The bill will explicitly allow that. That is before companies such as Boots and BUPA, pharmacies and whoever else can spot a scam a mile off jump on the bandwagon. This week, we have been talking about fraud in the NHS. I will tell members who is being defrauded: it is the patients, especially the poorer ones, who will be piling up in waiting rooms in queues for telephone switchboards and on trolleys, as private profiteers pile up the swag. The £100 million of pilfering pales into insignificance beside the fortune that is being and will be made by pharmaceutical companies, private finance initiative consortia, construction companies and nursing and locum agencies—the expanding businesses of the future. The Tories ask us where the money is going. They need look no further: the money is going straight to private profiteers.

Given the staff shortages in the national health service, and without measures to allow health boards to employ directly—leading NHS boards to contract with private health care providers—without our amendments, the bill is likely to result in the total loss of a comprehensive NHS service. I do not make that claim lightly. We have the experience of the NHS, of PFI and of nurse agencies to look to—

Photo of Carolyn Leckie Carolyn Leckie SSP

On you go, Phil. I am surprised that nobody has asked me to give way already.

Photo of Phil Gallie Phil Gallie Conservative

Is it not the case that the NHS is built upon the professionals in it? Is there not a problem with GP recruitment, GP morale and staff morale in general practices? Surely Carolyn Leckie must care about those issues, and surely the bill attempts to address them.

Photo of Carolyn Leckie Carolyn Leckie SSP

I agree with the points about morale, pay and recruitment problems—we have never disagreed with them. However, although the bill might deal with them on a short-term basis, we are storing up massive problems for the future. Instead of having an enhanced service and instead of the increased spending going on front-line patient care and on improving access for poorer people and the quality of care, the spending will go down the plug of profit. That is our concern, which our amendments address.

Why has the SNP, in particular, not lodged amendments that it might consider to be better or possibly more technical than ours? Does the SNP not believe that there is an increased threat of privatisation, or is it that, like the Tories, it is quite happy to welcome that? The SNP should be clear about this. There is an ideological question here: does profit have a place in the NHS or does it not? Yes or no: that is the question.

In case they have not read it, I refer SNP members to the definition of those that this group of amendments deals with:

"For the purposes of this section "private healthcare provider" means a company limited by shares (other than a company of the type mentioned in the definition of "qualifying body" in section 17D(2) or section 17L(1)(c)) one of whose purposes is the provision of medical services on a for profit basis." Do SNP members accept the aim of the amendments and the ideology behind them or do they reject them? Their votes will determine where they stand on profit in the NHS. I ask them, please, to support our amendments.

I move amendment 16.

Photo of Trish Godman Trish Godman Labour

Before calling those who have signalled that they wish to speak, I remind new members that, if they wish to speak to amendments, they should press their request-to-speak button when the amendment is called.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

First, let me say that I am a bit disappointed to see these three amendments reappear at stage 3. I am also disappointed that the business managers have allowed an hour and a half for the debate on this non-issue. I appreciate that they want a fair debate, but this debate was well and truly hammered out in the Health Committee, which voted nine to zero against the amendments.

Photo of Phil Gallie Phil Gallie Conservative

I am slightly puzzled at Mike Rumbles's opening remarks. He regretted the fact that we have an hour and a half to debate the issue, but he did not step in when the Presiding Officer suggested that anybody who opposed the business motion could do so. Why did he not take that opportunity?

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I certainly did not want to oppose the Scottish Executive's business motion. I was indicating only my disappointment that the business managers decided to devote an hour and a half to this issue. I did not oppose the business motion.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

No. Let me get started, Tommy.

In the committee, which is, above all, where such debates should be held—

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I will not take an intervention yet. I will take it in a moment. Just hang on.

The point about the amendments in group 1 is that they were thoroughly examined in committee. The Presiding Officer is quite right to select them for stage 3 if he so wishes. I do not question his right to do so, but I am disappointed that we seem to be here again. I have a sense of déjà vu.

Given what happened during our consideration of the bill at stage 1, I find Carolyn Leckie's statement that the bill has lacked scrutiny outrageous. The scrutiny of the bill was quite remarkable, because the committee ensured that the draft regulations were brought before members. Ministers had not done that before but it happened at the committee's request. Ministers moved heaven and earth to bring draft United Kingdom and Scottish regulations before the committee. That is why the committee is unanimous on these matters.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I will in a moment, but let me get to the meat of the subject. There is hypocrisy writ large here.

The Scottish Socialist Party has brought the amendments to the chamber yet again, but on no occasion during the whole process did any member of the Scottish Socialist Party appear at the committee. It did not question any of the witnesses that appeared before the committee. When the minister came before the committee to be grilled by members, any member of the Parliament could have attended the meeting, but not one Scottish Socialist Party member turned up. We have hypocrisy all right, but it comes from the SSP benches. Quite simply, the amendments should be seen for what they are.

Photo of Carolyn Leckie Carolyn Leckie SSP 10:15, 18 December 2003

I find it quite astonishing that Mike Rumbles should in effect argue against the democracy of the chamber, but I suppose that exposes his position. Will he tell us why, if the Health Committee was so vigilant in scrutinising the bill, the Executive felt it necessary to amend its bill at stage 2 and now at stage 3? Why did members of the Health Committee not pick up a single issue for amendment?

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

That is pathetic, I must say. Carolyn Leckie talks about democracy, but democracy is about engagement. Carolyn Leckie is not engaged in the democratic process but is grandstanding, which undermines the whole democratic process.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

I wonder whether Mr Rumbles has observed Mr Colin Fox's peregrinations in Australia. An article reports:

"'The parliamentary road to socialism', he said, will be found 'alongside the weapons of mass destruction in Iraq'".

The article also mentions his case

"for why fundamental social change will never be achieved via parliament."

Does that perhaps answer Mr Rumbles's question?

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I do not want to be drawn on Colin Fox, so perhaps we can just leave it at that.

Photo of Tommy Sheridan Tommy Sheridan SSP

Perhaps Mr Rumbles will be drawn on another matter. I was surprised at what he said earlier and I wanted to draw the matter to his attention as early as possible. He expressed disappointment that amendments have been brought back to Parliament, whereas the amendments have not in fact been in Parliament as they were discussed only in committee. How can Mr Rumbles argue against a political party that is denied representation on the very committee to which he referred—[ Interruption. ]

Photo of Tommy Sheridan Tommy Sheridan SSP

I think that the children are a wee bit demob happy today, Presiding Officer.

How can Mr Rumbles argue against a party bringing amendments to the chamber to enable it to vote on those amendments, given the fact that it and other parties were denied that opportunity at committee—

Photo of Tommy Sheridan Tommy Sheridan SSP

The children willnae be quiet for a minute. Is there any chance that I could finish my intervention, Presiding Officer?

Photo of Trish Godman Trish Godman Labour

Mr Sheridan, ask the question, please.

Photo of Tommy Sheridan Tommy Sheridan SSP

I am trying to, but the well-paid kids down the front willnae be quiet.

Does Mr Rumbles accept that any party in the Parliament without representation on a committee has the right to present its amendments to that committee and then, because it does not have a vote in the committee, bring those amendments to the chamber where the party has a vote? Is that not basic democracy?

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I wish that Tommy Sheridan would understand a little bit more about the procedures of the Parliament. The committees are integral to the Parliament. They are the powerhouse and driving force of the Parliament. Tommy Sheridan should know that, so he should stop pretending. The SSP was not denied an opportunity to make its case in the committee.

Photo of Trish Godman Trish Godman Labour

Mr Sheridan, you must not intervene from a sedentary position.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

The SSP is just not interested. If Tommy Sheridan wants me to keep digging, I will point out that the stage 2 meeting at which the three amendments were first discussed took place in the chamber. I suppose that we were privileged that Carolyn Leckie stayed for those three amendments, as she did not stay to speak to the other amendment that she had lodged at that stage. She could not even be bothered to hang around to do that. Members need to be aware of the behaviour of Scottish Socialist Party members in the democratic process. The SSP members are not engaged. That is the point.

Let me return to the issue. The reason why the SSP members are not engaged is that they are not engaged with the subject. At no time was the subject matter of the amendments an issue for the witnesses that came before the committee. It is a non-issue. The issue has been raised only to allow the Scottish Socialist Party to stand up and make dogmatic statements, which we must put up with to get through consideration of the bill. I am sure that the vote at the end of today will reflect that. The Scottish Socialist Party is involved in a travesty of the democratic process.

Photo of Shona Robison Shona Robison Scottish National Party

Where do I start? For the record, let me say that the SNP has never been backward in coming forward to defend our public services against privatisation. Our record in opposing the private finance initiative and public-private partnerships is consistent and long term. I will take no lessons from the SSP on that front.

Let me get to the nub of the issue, which I think should be debated. I do not subscribe to the conspiracy theory that the SSP promotes that somehow the entire bill has been engineered to open the door to a mass influx of the private sector into the health service; that is just not the case. The paranoia exhibited by Carolyn Leckie is staggering even by SSP standards. It extends to suggesting a right-wing takeover of SNP policy.

Photo of Shona Robison Shona Robison Scottish National Party

No, thank you.

The bill is about trying to reverse the real recruitment and retention crisis in our GP services that is there for all to see—all apart from the SSP. The jury is still out on whether that will be achieved. The SNP is prepared to give the bill the benefit of the doubt to try to turn the crisis around. That is why we have lodged an amendment to the motion to pass the bill.

Let us pause for a second and reflect on what the result of the SSP amendments would be. They would stop community pharmacists—because they are private providers—providing services such as smoking-cessation services, diabetes checks and blood pressure checks in the deprived communities that the SSP claims to represent. Those services would stop overnight if the SSP amendments were agreed to. Are the community pharmacists the great private profiteers that the SSP talks about? They provide such important services to our most needy to try to turn around the dreadful health situation in Scotland. The health promotion and the prevention work that community pharmacists carry out is an essential part of our health service. The SSP members would have learned about those issues if they had listened to and taken part fully in debate on the bill. The SNP will be quite happy to vote against the SSP amendments on the basis that I have outlined.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

The context for the amendments is clear. At stage 2, Carolyn Leckie said:

"the SSP's political position is for full public ownership of the NHS, including GP services."—[Official Report, Health Committee, 2 December 2003; c 390.]

That is fair, unambiguous and clear. The question is whether that serves the interests of patients, and that is far less clear.

Amendments 16, 17 and 18 do not even serve the purposes that the SSP intends. For example, they do not exclude along with companies that have shares, partnerships or contractual arrangements; they do not exclude a variety of things. Not only did the SSP not contribute to the evidence-taking at stage 1, submit to the committee a position paper or attend with due diligence the stage 2 committee debates, it has not even been able to draft the amendments in an appropriate way to achieve its objectives. Rather than there being a lack of scrutiny, as Carolyn Leckie said in her remarks on amendment 16, the SSP has shown a lack of commitment, energy and care in promoting its case.

I was brought up in a primary care household. My father was a GP before the health service was introduced and he welcomed it, because it changed forever the discrimination that existed before, when people came to the door for treatment and the issue was whether they could afford treatment. My father absolutely refused to take private patients, because the health service gave him the ability to treat patients on the basis of their medical needs. Of course, he was a private contractor of the health service—that was part of the deal that was done in 1948. Providing the public with an ability to choose the doctor that they wish to treat them is important.

Photo of Colin Fox Colin Fox SSP

The member mentioned me earlier on. I am glad that he has so much interest in my Australian tour and that the SNP seems to have found it as popular as did the people of Australia. He talked about people's ability to afford treatment. Does he accept that the national health service is undermined by profiteering, given that Audit Scotland said last week that the relationship between the NHS and drugs companies is not delivering a good deal for the NHS?

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

I hope that Colin Fox is not seeking to deceive members, as he did in The Dominion Post in New Zealand, where he claimed to have been thrown out of the Parliament on the day that he was sworn in. Exaggeration is a hobby of the SSP in which it indulges at every possible turn.

I return to the matter at hand. We are asked whether there is a place for profit in the NHS—yes or no. We have been and remain consistently opposed to the funding associated with PFIs, because that takes money out of the health service and there are other ways of ensuring that we get value for money. I have answered Carolyn Leckie's question.

The key thing is that we have private contractors in primary medical services, including GPs.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

Not now, as I am closing. They have delivered value since the health service's inception. Their commitment and sacrifice have kept primary health care afloat for many years. We are now in crisis; the Executive is responding to that crisis and we are prepared to give it a fair wind.

I oppose amendments 16, 17 and 18.

Photo of David Davidson David Davidson Conservative

I declare that I am a registered pharmacist, although I no longer have any connection with primary care services. I mention that because I recall that, in my youth—I had one once—when I was newly qualified in partnership, I worked with a private firm to deliver out-of-hours care and dispensed services for a good chunk of the county of Kent. But for that facility's coming together, the GPs with whom I was involved would have found it impossible to deliver that care.

This morning should not be about political posturing—we have had enough of that already. There are opportunities for scrutiny in the Parliament. Any member can go to any committee at any time and, with the permission of the convener and the committee, they can even attend some of the private sessions. That has been done, with discretion, over the past four years. I suggest that the SSP try to find out a little more about how it could use the opportunities for democratic input that the Parliament offers every member, without exclusion.

We have heard proposed again this morning nationalisation—under another name—of the health service. Yes, as Tommy Sheridan said, Ms Leckie is entitled to lodge the amendments—I take it that that is the view of the Presiding Officer—even though they were thrown out at stage 2. However, we have to recognise that the great national institution of the health service in this country was based on a public-private partnership—a coming together of the private and public sectors for the common good. That principle has never altered and the bill will not alter it. The bill is about the attraction and retention of GP services for the benefit of patients. It is not about takeovers of the NHS; it is about guaranteeing that wherever people live in Scotland they have fair access to GP services.

We must ensure that we not only produce enough doctors for our needs, but encourage them to participate in the primary care services, including in rural and remote areas. We must do all in our power to ensure that that is an attractive proposition and that the patients are at the heart of the NHS. That is where we are coming from.

Photo of David Davidson David Davidson Conservative

Before I talk about working with the private sector, I will take an intervention from Ms Leckie.

Photo of Carolyn Leckie Carolyn Leckie SSP

I wonder whether David Davidson is willing to repeat what he said during the stage 1 debate, when he confirmed that he saw opportunities in the bill for increased private provision in primary medical services. Does he foresee the extension of the use of agencies in providing locum services?

Photo of David Davidson David Davidson Conservative 10:30, 18 December 2003

I cannot remember my exact words at stage 1, but I say to Ms Leckie that what the health service needs is additional capacity, which could be provided cost-effectively by the private sector in appropriate partnership. The question is not "instead of"; it is "in addition to".

Yesterday morning, I visited a Huntercombe hospital near Larkhall. It is a dedicated residential unit for people with eating disorders, with staff who are highly skilled and motivated and who are provided by the private sector. The unit has yet to have any referrals from the NHS. I find that scandalous, because the services that it provides are not duplicated in the NHS and the unit's weekly charge is less than the similar NHS tariff. That is why I talk about value for money and additional services. However, that is not the issue today. The issue today is that the Parliament has to provide mechanisms that will attract staff to primary care services and ensure the delivery of those services to every person in Scotland on a reasonable basis.

Later on, Ms Leckie might support an amendment of mine. Amendment S2M-698.2 is not about political posturing; it is about ensuring that due scrutiny will continue—not on the voluntary basis that the minister has very kindly conducted with the committee so far, but on a more formalised basis so that, when all the regulations begin to deliver the outcomes that we seek from the bill, they will be scrutinised by the Health Committee. If that happens, I hope that the SSP might send a representative to participate in the discussions.

Photo of Tommy Sheridan Tommy Sheridan SSP

Amendments 16, 17 and 18 relate to the definitions and provisions in the bill that will allow NHS boards to contract with "any person" to provide primary care services. The bill defines "any person" to include companies where at least one of the shareholders is a GP or other health professional. The opponents of the three amendments may accuse the SSP of grandstanding, but that does not undermine the fact that the bill will facilitate a bonanza for the private health sector. The bill will allow health boards to contract with private providers for primary medical care services. The Tories recognise that, which is one of the reasons why they are very relaxed and happy for the bill to be given such a good wind. They clearly believe that their friends in the business of making profit out of providing health care will now be able to make even more profit—the bill facilitates that.

It is incredible that the SNP, the Tories and the Executive—who consistently preach to public sector workers about the need for modernisation and progress, which everyone in the public sector knows is about cuts in services—will, when it comes to GPs, defend a 55-year-old deal, struck in 1948 when the NHS was founded. No modernisation or progress there—they defend the archaic deal that allows GPs to be private providers instead of employees of the national health service, which is what they should be.

Even though members throughout the chamber might support other provisions in the bill, I say to them that, if amendments 16, 17 and 18 are not agreed to, the bill could open up wholesale privatisation in primary medical care. The SSP will not stand by and let that happen without opposing it.

I am glad that the Presiding Officers have recognised the need to defend democratic rights in the Parliament. When only four political parties are represented on a parliamentary committee—despite the fact that six political parties are properly registered, and seven parties are represented, in the Parliament—it is quite proper for any of the political parties that are not represented on that committee to be able to lodge amendments.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

Tommy Sheridan muses about how appropriate it is for parties to use their democratic rights, but his party was not interested in using its democratic rights at stage 1. We have made that point clear and I would like Tommy Sheridan to explain why his party did not turn up.

Photo of Tommy Sheridan Tommy Sheridan SSP

That is not a point at all in relation to this debate. The point that Mike Rumbles made was that it was shocking that someone dared, after lodging an amendment at stage 2 that got beat 9-0, to bring the amendment back at stage 3. I remind him that the Health Committee has members from only four political parties, despite the fact that six parties are registered and seven parties are represented in the Parliament. When Mike Rumbles's party is in the minority, I guarantee that we will allow him to introduce amendments at stage 3 even if his party is not represented on all the committees. That is a democratic right and I would have thought that Mike Rumbles, who is supposed to be a Liberal Democrat, would defend that.

I support the amendments. We have to defend our health service from further privatisation—led by the Executive, with support from the Tories and, unfortunately, the SNP.

Photo of Tom McCabe Tom McCabe Labour

As the debate continues, we will demonstrate the fallacy of the arguments that have been made. A charitable interpretation would be that there has been a failure to understand the various sections of the bill; a less charitable interpretation would be that amendments 16, 17 and 18 represent the promotion of outright hypocrisy.

As others have said, Carolyn Leckie has already made one attempt to amend the bill. At stage 2, the Health Committee had the good sense to reject her amendments. This morning, she has said that the committee was less than diligent in its scrutiny of the bill—simply because it disagreed with her point of view. It is surely inappropriate for members, simply because there has been a disagreement, to challenge the diligence of the work of any committee of the Parliament.

I want to return to a point that was raised by Mike Rumbles and, to be frank, dodged by Tommy Sheridan. The fact is that Mr Sheridan's party lodged an amendment at stage 2 and then left the meeting before the amendment was called. That is not participation in the democratic process; it is grandstanding.

It is disappointing, although not surprising, that, having lost the argument once, Ms Leckie is prepared to put her party's ideological hang-ups before what is good for patients in Scotland. However, this is a welcome opportunity to refute the SSP's arguments once again. I strongly urge members to reject the three amendments. What we heard from Ms Leckie was blatant scaremongering.

I said a moment ago that we could have a charitable interpretation, suggesting that there had been a misunderstanding, or a less charitable interpretation, suggesting that there had been the promotion of outright hypocrisy. A few moments ago, Mr Sheridan spoke about the definitions in the bill. He referred to a proposed new section that lays down the condition that

"at least one share in the company is legally and beneficially owned by a medical practitioner".

He stopped there, but that is not the whole story.

The next condition lays down that all the other shareholders must be individuals who would qualify under the conditions listed to be partners in a partnership that could hold a general medical services contract. The bill therefore provides protections. It is incumbent on members to ensure that, when they put forward arguments, they quote all the relevant provisions in the bill. They should not selectively quote the provisions that suit their argument.

Surely quality and availability of care is more important than the nature of the provider and surely we must allow health boards to make decisions that are based on the best needs of patients. Let us not forget—even though Mr Sheridan does not like the argument—that the vast majority of GPs are independent contractors and have been since the very start of the NHS.

Photo of Tommy Sheridan Tommy Sheridan SSP

Would the minister care to state categorically that he defends that settlement? Does he think that that 55-year-old settlement is right? Is that part of the modern health service in the 21 st century?

Photo of Tom McCabe Tom McCabe Labour

No. Mr Sheridan has just summed up his misunderstanding; our purpose today is to modernise that 55-year-old settlement. That was a timely intervention, because I remind the Parliament that, during the stage 1 debate, even Carolyn Leckie accepted that the employment status of that hard-working group of employees did not affect their dedication.

Carolyn Leckie has said that her amendments seek to prevent the private sector from piling up the swag. That is a strange logic. As we move on in our consideration, we will break down that argument.

I fail to understand why it is acceptable for private health care providers to be involved in the provision of primary medical services at certain times of the day but not at others. That seems to suggest that piling up the swag is okay during the hours of daylight but unacceptable during the hours of darkness. I simply do not understand the logic of that.

If it is thought that private health care providers in some way provide a lower-quality service, why is it somehow safer for them to provide it during the hours of daylight than at night? That is what amendment 17 suggests in practice. If the argument against private health care providers is about profit, why is it acceptable to make a profit from a patient during the day, but not at night or at the weekend? I hope that Ms Leckie will take the opportunity to explain that rather strange logic when she sums up. [Interruption.] The children are getting a bit loud again; perhaps the Presiding Officer could address them.

As Malcolm Chisholm and I have said before, we expect GP practices to continue to provide the vast majority of care, just as they have for the past 55 years. The bill is not about the mass privatisation of primary care; it is about improving the position of GPs and patients and sustaining general practice rather than replacing it with private companies.

Under the proposed arrangements, existing practices will have the right to continue to provide essential and additional services. In other words, a practice that provides those services on 31 March 2004 will not have the right to provide them taken away on 1 April. Under the bill, that right will not be given to a private health care provider, whoever that may be. Let me be explicit. Big, private health-oriented companies will not be able to hold a GMS contract. The fact that we expect that the vast majority of primary medical services will be provided through the GMS arrangements considerably reduces the scope for private health care providers to provide services.

I am sure that Ms Leckie has investigated whom her amendments would affect. We believe that, strangely, amendment 18 would not catch an organisation such as BUPA. Our information is that BUPA is a provident association that does not pay out to shareholders and that any profit that it makes is put back into the association. Amendment 18 would bar "a company", but BUPA is not a company, so it is unlikely that it would be caught by the SSP's definition of a private health care provider. In the stage 1 debate, Ms Leckie expressed concerns about what she called the "BUPA bunny" taking on primary care medical services, but the way in which her amendments are drafted means that they would fail to prevent just that.

I urge members to reject amendments 16 and 17. Moreover, if they agree with the Executive that those amendments should be rejected, they must also reject amendment 18, which seeks to define "a private healthcare provider"—the phrase that is used in amendments 16 and 17. I urge members to reject the amendments, which are ill advised and unnecessary.

Photo of Carolyn Leckie Carolyn Leckie SSP

The response to that is to ask where in the bill the Executive excludes the BUPA bunny or whomever else. The truth is that there are no such exclusions, because the Executive does not want any. It wants to have the opportunity, through a ministerial directive some time down the line, to plug the gap using that very method.

The Executive just has not listened. No one has addressed the question of who will provide out-of-hours services. Ninety-five per cent of GPs in Glasgow say that they will opt out of out-of-hours provision and rural practices are struggling to provide cover—in the Highlands and Islands, only six practices will be left to provide cover. Who will provide the cover? Why is Lanarkshire NHS Board concerned about profits?

Photo of Tom McCabe Tom McCabe Labour 10:45, 18 December 2003

There is a fundamental misunderstanding about GPs who want to move away from their responsibility to provide out-of-hours care 24 hours a day, seven days a week and GPs who are prepared to sign up to the new provisions on out-of-hours care without taking on the burden of responsibility for such care 24 hours a day, seven days a week.

Photo of Carolyn Leckie Carolyn Leckie SSP

I would appreciate an answer from the minister on how many hours of out-of-hours services GPs will provide through the GP contract. Will all the hours be covered? In Lanarkshire, is it the case that the four private agencies that provide locum services will not increase their profits? I wish that someone would address those questions.

If members vote to pass the bill, they should not cry crocodile tears or complain a year, two years or three years down the line when they see astronomical rises in agency costs, just as we have seen such rises in nursing costs. If we are wrong, members will be able to come back and tell us that we were wrong, but I have 100 per cent confidence that we are not wrong.

Does the Executive deny that opportunities for privatisation are inherent in the bill? The Tories do not deny that such opportunities exist. The Executive should put some substance to its arguments; it should lodge amendments that ensure that the bill will not offer opportunities for privatisation. If we are being paranoid or unduly nervous or if we are grandstanding, why does the Executive not give us the assurance that we want? Why does the bill—unless it is amended by the SSP—contain no such assurances? We should not be blamed for not lodging enough amendments. If the Executive's political position is that the BUPAs of this world should not profit from the GMS contract, where in the bill is there such an assurance?

Stewart Stevenson is a laugh. I was not going to tell him this, but I will. Last night, my daughter told me that her English class was having the usual end-of-term Christmas debates and that she moved—completely of her own accord—that Stewart Stevenson be placed in room 101. The class voted unanimously that he should be placed in room 101. That is about all that I will say.

Although the Liberals in the Scottish Parliament are in favour of the bill's proposals and foresee no difficulties with them, Dr Evan Harris—the Liberal Democrat health spokesperson in Westminster—is against the new contract and says that it will result in

"the end of the one-stop shop. It means less access to some services, which will now be classed as optional ... Patients know that this is a sticking plaster over the fundamental problems of understaffing and lack of access to family doctors."

There we have it. The Liberal Democrats are never afraid to be completely inconsistent, as long as that results in a few more votes.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

I did not hear that remark, but I am sure that it was amusing.

On a United Kingdom level, we are not against the bill, even though some concerns were expressed about the GP contract. I do not share those concerns in the context of the bill, because the Executive is putting in a huge amount of resources to ensure that the bill will bring about successful modernisation of the NHS in Scotland. Those resources are at a much higher level.

Photo of Carolyn Leckie Carolyn Leckie SSP

We are discussing legislation, but Mike Rumbles says that the issue is not legislative but a question of resources. Although the Liberal Democrats are opposing the proposal south of the border, it is all right here in legislative terms, because the Liberals here are so confident that the resources are guaranteed. For goodness' sake—how ridiculous!

Photo of Carolyn Leckie Carolyn Leckie SSP

I beg your pardon. On a point of order, Presiding Officer. Is it not against rule 7.3 of the standing orders for a member to call another member ridiculous?

Photo of Trish Godman Trish Godman Labour

That is normal debating. Please carry on. [ Interruption. ] Order, please.

Photo of Carolyn Leckie Carolyn Leckie SSP

All right. If that is normal debating phraseology—

Photo of Carolyn Leckie Carolyn Leckie SSP

I was quoting Mike Rumbles. In the words of my daughter, "You're a tube." [ Laughter. ]

Photo of Trish Godman Trish Godman Labour

Please be careful. My ruling was that Mike Rumbles's comment was made in normal debate. I suspect that what you said might have been slightly outside normal debate. Please finish now.

Photo of Carolyn Leckie Carolyn Leckie SSP

Well. Somebody has already mentioned hypocrisy. I will finish.

The SSP has a small party group of only six MSPs. There has been much ranting and raving because members cannot deal with the ideology around stage 1 evidence taking. I am not a member of the Health Committee, although I would have liked to have been. However, I am an active member of the Public Petitions Committee and an active MSP. If there is a serious question about the political commitment of SSP MSPs—it cannot be a serious question: that is almost a contradiction in terms—I will swap schedules with Tom McCabe. I will shadow him for a week and he can come and shadow me for a week. We will see who is still standing at the end of that week.

Photo of Tom McCabe Tom McCabe Labour

That is a very tempting offer, but I have decided to resist it.

Photo of Trish Godman Trish Godman Labour

The question is, that amendment 16 be agreed to. Are we agreed?

Members:

No.

Division number 1

For: Byrne, Ms Rosemary, Curran, Frances, Fox, Colin, Leckie, Carolyn
Against: Adam, Brian, Baillie, Jackie, Baker, Richard, Barrie, Scott, Boyack, Sarah, Brankin, Rhona, Brocklebank, Mr Ted, Brown, Robert, Butler, Bill, Chisholm, Malcolm, Craigie, Cathie, Crawford, Bruce, Cunningham, Roseanna, Curran, Ms Margaret, Davidson, Mr David, Deacon, Susan, Douglas-Hamilton, Lord James, Eadie, Helen, Ewing, Fergus, Fabiani, Linda, Ferguson, Patricia, Fergusson, Alex, Fraser, Murdo, Gallie, Phil, Gibson, Rob, Gillon, Karen, Glen, Marlyn, Gorrie, Donald, Grahame, Christine, Henry, Hugh, Home Robertson, Mr John, Hughes, Janis, Jackson, Dr Sylvia, Jackson, Gordon, Jamieson, Cathy, Jamieson, Margaret, Johnstone, Alex, Kerr, Mr Andy, Lamont, Johann, Livingstone, Marilyn, MacAskill, Mr Kenny, Macdonald, Lewis, Macintosh, Mr Kenneth, Maclean, Kate, Macmillan, Maureen, Martin, Campbell, Martin, Paul, Marwick, Tricia, Mather, Jim, Matheson, Michael, Maxwell, Mr Stewart, May, Christine, McAveety, Mr Frank, McCabe, Mr Tom, McFee, Mr Bruce, McMahon, Michael, McNeil, Mr Duncan, McNeill, Pauline, McNulty, Des, Milne, Mrs Nanette, Morrison, Mr Alasdair, Muldoon, Bristow, Mulligan, Mrs Mary, Mundell, David, Murray, Dr Elaine, Neil, Alex, Oldfather, Irene, Peacock, Peter, Peattie, Cathy, Pringle, Mike, Purvis, Jeremy, Radcliffe, Nora, Robison, Shona, Robson, Euan, Rumbles, Mike, Scanlon, Mary, Scott, John, Scott, Tavish, Smith, Elaine, Smith, Iain, Smith, Margaret, Stephen, Nicol, Stevenson, Stewart, Stone, Mr Jamie, Swinburne, John, Tosh, Murray, Turner, Dr Jean, Wallace, Mr Jim, Welsh, Mr Andrew, White, Ms Sandra, Whitefield, Karen, Wilson, Allan
Abstentions: Baird, Shiona, Ballance, Chris, Ballard, Mark, Harper, Robin, Ruskell, Mr Mark, Scott, Eleanor

Photo of Trish Godman Trish Godman Labour

The result of the division is: For 4—[ Interruption. ] Order. Are members finished? The result of the division is: For 4, Against 92, Abstentions 6.

Amendment 16 disagreed to.

Photo of Trish Godman Trish Godman Labour

Amendment 17, in the name of Carolyn Leckie, has been debated with amendment 16. I ask Carolyn Leckie to move amendment 17.

Photo of Carolyn Leckie Carolyn Leckie SSP

I move amendment 17 and ask everybody to pull their finger out and get their act together.

Photo of Trish Godman Trish Godman Labour

The question is, that amendment 17 be agreed to. Are we agreed?

Members:

No.

Division number 2

For: Byrne, Ms Rosemary, Curran, Frances, Fox, Colin, Leckie, Carolyn, Sheridan, Tommy
Against: Adam, Brian, Baillie, Jackie, Baker, Richard, Barrie, Scott, Boyack, Sarah, Brankin, Rhona, Brocklebank, Mr Ted, Brown, Robert, Butler, Bill, Chisholm, Malcolm, Craigie, Cathie, Crawford, Bruce, Cunningham, Roseanna, Curran, Ms Margaret, Davidson, Mr David, Deacon, Susan, Douglas-Hamilton, Lord James, Eadie, Helen, Ewing, Fergus, Fabiani, Linda, Ferguson, Patricia, Fergusson, Alex, Fraser, Murdo, Gallie, Phil, Gibson, Rob, Gillon, Karen, Glen, Marlyn, Gorrie, Donald, Grahame, Christine, Henry, Hugh, Home Robertson, Mr John, Hughes, Janis, Jackson, Dr Sylvia, Jackson, Gordon, Jamieson, Cathy, Jamieson, Margaret, Johnstone, Alex, Kerr, Mr Andy, Lamont, Johann, Livingstone, Marilyn, MacAskill, Mr Kenny, Macdonald, Lewis, Macintosh, Mr Kenneth, Maclean, Kate, Macmillan, Maureen, Martin, Campbell, Martin, Paul, Marwick, Tricia, Mather, Jim, Matheson, Michael, Maxwell, Mr Stewart, May, Christine, McAveety, Mr Frank, McCabe, Mr Tom, McFee, Mr Bruce, McMahon, Michael, McNeil, Mr Duncan, McNeill, Pauline, McNulty, Des, Milne, Mrs Nanette, Morrison, Mr Alasdair, Muldoon, Bristow, Mulligan, Mrs Mary, Mundell, David, Murray, Dr Elaine, Neil, Alex, Oldfather, Irene, Peacock, Peter, Peattie, Cathy, Pringle, Mike, Purvis, Jeremy, Radcliffe, Nora, Robison, Shona, Robson, Euan, Rumbles, Mike, Scanlon, Mary, Scott, John, Scott, Tavish, Smith, Elaine, Smith, Iain, Smith, Margaret, Stephen, Nicol, Stevenson, Stewart, Stone, Mr Jamie, Swinburne, John, Tosh, Murray, Turner, Dr Jean, Wallace, Mr Jim, Welsh, Mr Andrew, White, Ms Sandra, Whitefield, Karen, Wilson, Allan
Abstentions: Baird, Shiona, Ballance, Chris, Ballard, Mark, Harper, Robin, Ruskell, Mr Mark, Scott, Eleanor

Photo of Trish Godman Trish Godman Labour

The result of the division is: For 5—[ Applause. ]—Against 92, Abstentions 6.

Amendment 17 disagreed to.

[Amendment 18 moved—[Carolyn Leckie].]

Photo of Trish Godman Trish Godman Labour

The question is, that amendment 18 be agreed to. Are we agreed?

Members:

No.

Division number 3

For: Byrne, Ms Rosemary, Curran, Frances, Fox, Colin, Leckie, Carolyn, Sheridan, Tommy
Against: Adam, Brian, Baillie, Jackie, Baird, Shiona, Baker, Richard, Ballance, Chris, Ballard, Mark, Barrie, Scott, Boyack, Sarah, Brankin, Rhona, Brocklebank, Mr Ted, Brown, Robert, Butler, Bill, Chisholm, Malcolm, Craigie, Cathie, Crawford, Bruce, Cunningham, Roseanna, Curran, Ms Margaret, Davidson, Mr David, Deacon, Susan, Douglas-Hamilton, Lord James, Eadie, Helen, Ewing, Fergus, Fabiani, Linda, Ferguson, Patricia, Fergusson, Alex, Fraser, Murdo, Gallie, Phil, Gibson, Rob, Gillon, Karen, Glen, Marlyn, Gorrie, Donald, Harper, Robin, Henry, Hugh, Home Robertson, Mr John, Hughes, Janis, Jackson, Dr Sylvia, Jackson, Gordon, Jamieson, Cathy, Jamieson, Margaret, Johnstone, Alex, Kerr, Mr Andy, Lamont, Johann, Livingstone, Marilyn, MacAskill, Mr Kenny, Macdonald, Lewis, Macintosh, Mr Kenneth, Maclean, Kate, Macmillan, Maureen, Martin, Campbell, Martin, Paul, Marwick, Tricia, Mather, Jim, Matheson, Michael, Maxwell, Mr Stewart, May, Christine, McAveety, Mr Frank, McCabe, Mr Tom, McFee, Mr Bruce, McMahon, Michael, McNeil, Mr Duncan, McNeill, Pauline, McNulty, Des, Milne, Mrs Nanette, Morrison, Mr Alasdair, Muldoon, Bristow, Mulligan, Mrs Mary, Mundell, David, Murray, Dr Elaine, Neil, Alex, Oldfather, Irene, Peacock, Peter, Peattie, Cathy, Pringle, Mike, Purvis, Jeremy, Radcliffe, Nora, Robison, Shona, Robson, Euan, Rumbles, Mike, Ruskell, Mr Mark, Scanlon, Mary, Scott, Eleanor, Scott, John, Scott, Tavish, Smith, Elaine, Smith, Iain, Smith, Margaret, Stephen, Nicol, Stevenson, Stewart, Stone, Mr Jamie, Swinburne, John, Tosh, Murray, Turner, Dr Jean, Wallace, Mr Jim, Watson, Mike, Welsh, Mr Andrew, White, Ms Sandra, Whitefield, Karen, Wilson, Allan

Photo of Trish Godman Trish Godman Labour

The result of the division is: For 5, Against 98, Abstentions 0.

Amendment 18 disagreed to.