Section 2 — Community health partnerships

National Health Service Reform (Scotland) Bill: Stage 3 – in the Scottish Parliament at 9:31 am on 6 May 2004.

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Photo of Malcolm Chisholm Malcolm Chisholm Labour

Amendment 1 is a minor technical amendment, or perhaps I should say a very minor technical amendment, as the words that it deletes are reinserted, albeit in a different place.

The error that amendment 1 corrects occurred in the printing of the marshalled list of amendments at stage 2. The amendment affects subsection (2)(a) of proposed new section 4A of the National Health Service (Scotland) Act 1978. That paragraph provides for the general community health partnership function of co-ordinating the planning, development and provision of certain services. In turn, the relevant services are set out in subparagraphs. The effect of the error is that the words

"with a view to improving those services" are currently attached to subsection (2)(a)(ii), although the intention is that they should apply to all the functions that subsection (2)(a) covers. Amendment 1 ensures that the bill reflects the original policy intention.

I can appreciate what Duncan McNeil is trying to do with amendment 6, and I pay tribute to all the work that he has done on patient information. It is clearly very important that patients and the public should know about the services that they can expect the national health service to deliver and the targets that we have set for the provision of those services. We are committed to ensuring that that information is made available at national and local levels so that patients are comprehensively informed.

We consulted last year on the document "Patient Rights and Responsibilities: A draft for consultation", which sets out what patients can expect from the NHS, and we are currently working with the Scottish Consumer Council to finalise the document. It will be produced as a national document that states what the NHS is committed to deliver to the people of Scotland. We will require each health board to publish a local version of the document, which will show how those rights and responsibilities will be delivered locally. We are already working on, and are committed to, ensuring that patients have information on the services that they can expect to receive. When that local information is issued, we will ensure that it gives the full information that is necessary to inform the public of their rights as well as specific local services and provision that are available. We will also ensure that NHS boards disseminate that information widely in different forms so that it is available to the largest possible number of people locally.

Amendment 6 is not the best way to achieve what we are determined to do, and there are a number of reasons for that. For example, it covers all health services, whereas CHPs' remit will not extend to all health services. If any such duty were to be placed on a body, it would need to be placed on NHS boards, and, as I have already stated, we shall require boards to provide information.

We are committed to reducing waiting times in general and specific waiting times in some key areas of treatment, such as heart surgery. We fully agree that the public need to know which services are subject to waiting times guarantees and how they can ensure that their health board can fulfil those guarantees. The purpose of having a guarantee is to impose a requirement on NHS boards to ensure that the guarantee is fulfilled. If a board cannot itself offer treatment to fulfil a guarantee, it is required to arrange and fund treatment through another health board or through an alternative public or private provider in the United Kingdom or elsewhere. That reflects our absolute commitment to ensuring that guarantees are fulfilled.

If patients have any difficulty in obtaining access to treatment that should be available under a waiting times guarantee, that will be followed up in the first instance with their local health boards and then with the national waiting times unit in the Health Department, which is working with the NHS in Scotland to reduce delays for patients through more efficient use of capacity within and outwith the NHS and to help to ensure that waiting times guarantee commitments are fulfilled. The national waiting times unit will then ensure that a provider that is able to offer treatment is identified and that the necessary arrangements for treatment are completed through the local health board.

I am happy to provide the assurance that the commitments to waiting times guarantees will be set out in the patient information documents that we will issue nationally and locally and that that will include information on what patients should do if they feel that they are not receiving treatment within the guaranteed waiting times. Duncan McNeil might say that that has not happened yet, but I remind members that the guarantees started only this January, and I give another guarantee that the information that I have described will be disseminated nationally and locally in the near future. That is the most effective way to ensure that patients know which treatments are subject to targets and the rights that they have to ensure that those targets are hit.

I move amendment 1.

Photo of Duncan McNeil Duncan McNeil Labour

I will make some brief statements of fact. The more socially disadvantaged and less well-educated members of our communities have the poorest health and shortest life expectancy. Our constituents, especially the more socially disadvantaged and less well-educated, are not conversant with their rights to NHS treatment. It is not possible for somebody to exercise a right if they do not know that it exists, and a right that cannot be exercised is no right at all.

Amendment 6 seeks to put right that situation by placing a statutory duty on community health partnerships to take active steps to make the public aware of what they are entitled to, the timescale within which that should be provided and which alternative sources of treatment they can access in the event that the service cannot be delivered within the timescales. The amendment would also place a duty on CHPs to ensure that access to that information is as wide as possible. It would require that the information be made available in a range of formats—for example, Braille and languages other than English.

With amendment 6, I am determined to improve the health record of our most deprived communities and to close the opportunity gap, and so I am sure that I can count on Executive support for such a modest move.

Photo of David Davidson David Davidson Conservative

I accept the minister's explanation of amendment 1 and I have great sympathy with what Duncan McNeil is trying to do with amendment 6. It is important that we stress at the beginning of the debate that the patient should be at the centre of the health service, not added on to it. We should do anything that we can to provide patients with the right information. We hear a lot of groups talking about patient empowerment, and I have great sympathy with what Duncan McNeil has said, so I do not understand why the minister wants to produce expensive, glossy documents for national distribution given that when people have difficulties, they seek local health care in their communities. I beg the minister to change his mind about Duncan McNeil's amendment 6, which I will certainly support.

Photo of Karen Gillon Karen Gillon Labour

I am generally sympathetic to Duncan McNeil's amendment 6, because it is essential that patients should know what they are entitled to. I welcome the minister's comments, which are a step forward from the position at stage 2, but I would like more information from him about what he proposes and how he will ensure that that will reach the targets—the kind of people about whom Duncan McNeil is talking—and will not be just another glossy pamphlet that reaches only those who already know their entitlement, stand up for their rights and ensure that they get their treatment within the waiting times guarantees. How will he ensure that the people whom we are trying to target—those who have the worst health records and who might not read a glossy pamphlet—know what they are entitled to, what they should do to obtain that entitlement and the steps that they can take if a health board stands in the way of their accessing the health care that we in the Labour Party were committed to in our manifesto and are beginning to deliver?

Photo of Dr Jean Turner Dr Jean Turner Independent

I support Duncan McNeil's amendment 6. General practitioners are used to giving patients information and to making patient leaflets that are updated with changes and contain maps. GPs' staff also help them to convey information.

Glossy leaflets are not enough. They are often found lying around health centres, where people may walk on them. They are just waste paper to gather at the edges of fences.

The Health Department frequently employs much cash to convey information to the public. Sometimes, £85,000 is not considered too much to spend on one publication.

Providing information is health boards' responsibility, as they are supposed to interact with the public and communicate information. If they are to place more responsibility on general practitioners, they must think about the money and time that will be spent on producing materials, such as posters and leaflets, in addition to postage and staff costs.

Given the new regulations that will mean that not all practices have to provide the same service, it is essential that patients have knowledge. A patient's own general practice is a good place of contact. Greater use of health visitors would also enable information to circulate in the community.

Photo of Mike Rumbles Mike Rumbles Liberal Democrat

Duncan McNeil's objective is good and perfectly achievable. The only question is whether it should appear in the bill. We are establishing community health partnerships by giving them aims and objectives and specifying the practices that they must undertake. Duncan McNeil is arguing for good practice—it is good practice that patients should receive such information. However, I am not convinced that it is necessary to put that in legislation and I urge him not to move amendment 6, because it would not be helpful to make such provision when we have not yet established the CHPs.

Photo of Shona Robison Shona Robison Scottish National Party

I support Duncan McNeil's amendment 6, which is reasonable. I remind members that it says that "all reasonable steps" should be taken

"to provide information, in such formats as may be reasonably requested ... about ... the health services to which" people

"are entitled ... the timescales within which such services will be provided, and ... any alternative sources of treatment which they are entitled to access in the event that such a service cannot be delivered within such a timescale".

I do not understand why the minister is reluctant to accept the amendment. People should be fully informed and should receive information in a format that they understand. That is not too much to ask from our health service.

In answer to Mike Rumbles's question, the reason for putting the provision in the bill is simple: it would state from the start the principle of what we expect from the new bodies that are being established. That would send out the right message about what we expect from community health partnerships. I hope that the minister will reflect on that and accept Duncan McNeil's amendment.

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I agree with almost everything that has been said, but I do not draw the conclusion that it is therefore appropriate to put in the bill a duty on community health partnerships, which are new bodies that will already have massive responsibilities and challenges.

My fundamental point is the same as that which Jean Turner made. She said that she supported Duncan McNeil's amendment 6 but that providing information was the health boards' responsibility, which is the fundamental point that I made. Community health partnerships are committees of boards, so they will obviously have a key role to play, but the fundamental duty is on health boards. As I described in detail, we shall ensure that boards fulfil that responsibility.

I agree entirely with Duncan McNeil that people cannot exercise rights if they do not know that those rights exist. That is precisely why we are working with the Scottish Consumer Council on finalising a statement of patient rights and responsibilities. I assure him that that will be available in a range of formats.

Of course I agree with David Davidson that patients should be at the centre of the health service, but I am again astounded that he should imply that we think otherwise. As he thinks in stereotypes about the Executive's health policy and does not pay attention to what we are doing, he talked about national distribution and blotted out all my remarks about the information that would be available locally. The thrust of what I said was that information would be in local formats.

I agree with Karen Gillon that it is essential that patients should know their rights. She asked how we would ensure that the target was hit. To do that, we will not only produce the new document to which I referred, but ensure that boards disseminate that information, as I outlined. The reality is that the way in which we will ensure that that happens will not be fundamentally different from the way in which Duncan McNeil's amendment would be enforced. If his amendment were agreed to, we would have to ensure that community health partnerships provided information, just as we will ensure that boards fulfil that responsibility. In many cases, boards will act through community health partnerships to do that.

I dealt with Jean Turner's comments and I thank her for saying that providing information is the health boards' responsibility. I do not disagree with Shona Robison that all reasonable steps should be taken to provide information. I certainly agree that that should be done—I might even want to state it more strongly than that.

I implore members to accept that the primary responsibility must be on the health boards. Community health partnerships could be the most exciting part of the bill. They have enormous challenges. To place on them alone the duty to provide information, which would have quite a lot of ramifications, and to do so without consultation—although a massive consultation document on the partnerships was issued—would be received extremely negatively by those who are involved in the partnerships. It is not that they do not want to be part of fulfilling the responsibility, but I repeat that the primary responsibility rests with health boards. We shall ensure that they discharge it.

Amendment 1 agreed to.

[Amendment 6 moved—[Mr Duncan McNeil].]

Photo of George Reid George Reid None 9:45, 6 May 2004

The question is, that amendment 6 be agreed to. Are we agreed?



Division number 1

For: Aitken, Bill, Baird, Shiona, Ballance, Chris, Ballard, Mark, Brocklebank, Mr Ted, Canavan, Dennis, Crawford, Bruce, Davidson, Mr David, Douglas-Hamilton, Lord James, Ewing, Mrs Margaret, Fabiani, Linda, Fergusson, Alex, Fraser, Murdo, Gallie, Phil, Gibson, Rob, Gillon, Karen, Goldie, Miss Annabel, Grahame, Christine, Harvie, Patrick, Hyslop, Fiona, Johnstone, Alex, Lochhead, Richard, MacAskill, Mr Kenny, Mather, Jim, Maxwell, Mr Stewart, McNeil, Mr Duncan, McNeill, Pauline, Milne, Mrs Nanette, Mitchell, Margaret, Muldoon, Bristow, Neil, Alex, Robison, Shona, Scanlon, Mary, Scott, Eleanor, Scott, John, Stevenson, Stewart, Swinburne, John, Turner, Dr Jean
Against: Alexander, Ms Wendy, Baillie, Jackie, Barrie, Scott, Boyack, Sarah, Brankin, Rhona, Brown, Robert, Butler, Bill, Chisholm, Malcolm, Craigie, Cathie, Curran, Ms Margaret, Deacon, Susan, Eadie, Helen, Ferguson, Patricia, Finnie, Ross, Glen, Marlyn, Godman, Trish, Henry, Hugh, Home Robertson, Mr John, Hughes, Janis, Jackson, Dr Sylvia, Jackson, Gordon, Jamieson, Cathy, Jamieson, Margaret, Kerr, Mr Andy, Lamont, Johann, Lyon, George, Macdonald, Lewis, Macintosh, Mr Kenneth, Maclean, Kate, Macmillan, Maureen, Martin, Paul, May, Christine, McAveety, Mr Frank, McCabe, Mr Tom, McMahon, Michael, McNulty, Des, Morrison, Mr Alasdair, Mulligan, Mrs Mary, Munro, John Farquhar, Murray, Dr Elaine, Oldfather, Irene, Peattie, Cathy, Pringle, Mike, Purvis, Jeremy, Radcliffe, Nora, Raffan, Mr Keith, Rumbles, Mike, Scott, Tavish, Smith, Elaine, Smith, Iain, Smith, Margaret, Stephen, Nicol, Stone, Mr Jamie, Wallace, Mr Jim, Watson, Mike, Whitefield, Karen, Wilson, Allan
Abstentions: Byrne, Ms Rosemary, Fox, Colin, Kane, Rosie, Leckie, Carolyn, Sheridan, Tommy

Photo of George Reid George Reid None

The result of the division is: For 38, Against 57, Abstentions 5.

Amendment 6 disagreed to.