This is a very good day for the national health service, its patients and the people of Scotland. Today, we can confirm the best performance ever recorded for in-patient, day-case and out-patient waiting. We can also confirm the lowest in-patient and day-case waiting list for a number of years—down 5,504 since last year and the lowest December figure since 2001—while the out-patient waiting list has reduced by 62,000 over the past year, which represents a reduction of more than 26 per cent. Moreover, NHS Scotland has again met and maintained the guarantees and targets for heart treatment: no patient is waiting more than eight weeks for a heart investigation or more than 18 weeks for heart bypass surgery or angioplasty.
I thank all NHS staff for their efforts day in, day out in delivering that outstanding performance. My thanks go to the doctors, the nurses, the surgeons, the porters and the cleaners—indeed, all our health care team in Scotland. A few years ago, thousands of people with waiting time guarantees were waiting more than nine months and even 12 months, but now no one with a guarantee is waiting more than six months. A year ago, many said that those targets were impossible to achieve and, as recently as three months ago, some members said that it was inconceivable that they would be delivered, but NHS Scotland has again confounded its doubters and critics by achieving improvements in access and service delivery to the benefit of patients throughout the country.
I will put that achievement in the context of where we have come from and the approach that has been adopted. I will also look forward to the next steps—what further progress we believe the NHS can achieve. The figures are no flash in the pan: the NHS has made continuous improvements in waiting time performance in recent times and has met and maintained its promise to deliver a maximum wait of 12 months, then nine months, now six months and, soon, 18 weeks.
Before our devolved Government's actions, 18-month waits were common, but 18 weeks is the new standard for the NHS. That has not occurred by accident. Over the past few years, the NHS has introduced many innovative ways of working, from
New ways of working have also been coupled with a new structure inside the NHS. Single-system working is now the norm and, supported by a greater emphasis on regional planning, collaboration provides better, seamless services for patients. Community health partnerships are becoming the champions of local primary health care and social care by bringing services together for the benefit of the people who use them. The NHS could not have achieved its performance without a whole-system, collaborative approach that harnesses all parts of the NHS and encourages them to work together. A good example is the detailed planning that is being undertaken for the east of Scotland elective treatment centre at Stracathro, which will expand elective capacity and separate it from unscheduled care. That centre is absolutely in line with "Delivering for Health" and with a whole-systems approach to reducing waiting times. I acknowledge the role that the independent health care sector plays in helping to tackle the longest waits.
The minister mentioned the steps that are being taken to expand capacity at Stracathro. The expansion is welcome, albeit that we might debate and disagree about the mechanism that is being used to finance it. Has the minister given any consideration to the impact that the attraction of staff to the expanded Stracathro facility might have on the capacity of the public sector NHS and on its workforce?
Yes, absolutely. That is why we have been planning the process for a number of months—indeed, for longer than that—and we will continue to do so. We are confident that we can add additional capacity to the NHS to the benefit of patients.
We see good examples of additional capacity throughout the country. For example, NHS Lothian had a capacity shortfall in the specialty of ear, nose and throat services. The board hired a mobile surgical facility to tackle the backlog of ENT cases, and more than 600 patients were treated there. In the next couple of weeks, NHS Highland will bring a similar mobile surgical unit to Inverness, and NHS Grampian recently announced that it will extend the stay of a mobile operating theatre and ward in Aberdeen to perform a variety of day-case general surgical work and vascular surgery. More than 500 patients will be seen or treated by the end of March. Another first for the NHS in Scotland is the United Kingdom's first mobile endoscopy unit, which started work in
What plans does the Executive have to monitor what happens to patients who receive care in private mobile units? How does the Executive monitor safety? The NHS has to pick up the pieces if people get inadequate care.
I remind the member that the patients that we are talking about are our patients; they are not the private sector's patients. The projects are governed by the NHS according to its clinical governance standards in negotiation with the suppliers. If one meets patients who have received better, quicker and safer treatment under such projects, it is clear that they do not give a jot about that—they want the service, and we need to deliver it to them.
We hear a lot of talk about the Golden Jubilee national hospital, which is our national waiting times centre. When it was purchased by the NHS in 2002, it undertook 2,500 operations per year. We took it from the private sector into the public sector and we have increased the number of procedures more than tenfold.
With due respect, I was saying that any patients whom I have met have said that they are happy to receive that service. It reduces the wait for them and their families and, if they are in employment, it gets them back to work more quickly. [ Interruption. ] Listen to the prophets of doom and gloom. Everything is better and quicker in our national health service in Scotland, including the use of the independent care sector. The benchmark against which I measure people is the improvement in public service in our NHS. That is at the heart of all our improvements. It is the key driver for change, and it is making a real difference.
Contrary to recent reports, the Golden Jubilee national hospital is not underutilised. It has exceeded its activity targets year on year and has made a substantial contribution to the success that we are celebrating today by reducing waits for patients from throughout Scotland. I remind the doubters in the chamber—there are a few—that almost 95 per cent of the hospital's capacity to the end of March 2007 has already been allocated by NHS boards.
I would be concerned by that. Every month I remind our NHS board chairs that we want to achieve better choice for patients. I argue strongly that more use should be made of the Golden Jubilee national hospital and other parts of our national health service. I want patients to be empowered, and I want general practitioners to use the national waiting times database to allow their patients to have better, more appropriate and quicker choices if they are able to take up such offers.
There have been lots of changes and improvements in our national health service, but I reiterate that one thing remains the same—our absolute commitment to comprehensive health services that are available to all according to their clinical need and that are, of course, free at the point of delivery. That is the foundation of the NHS, and it will remain so under this Administration.
Because we believe that the people of Scotland want to see further improvements to their NHS that build on that foundation, I launched "Fair to All, Personal to Each" a year ago. It set out a comprehensive package of improvements on behalf of patients and introduced more demanding waiting times targets, including a maximum wait for out-patients, in-patients and, of course, day-case patients of 18 weeks by the end of 2007. To the doubters I say again that I am absolutely confident that we will meet that target. Our NHS will respond to the challenge and deliver for patients.
Reflected within "Fair to All, Personal to Each" is the fact that we also want to improve the quality of life of our older people, which is why we have introduced shorter maximum waits for procedures such as cataract removal and emergency surgery following hip fracture.
It also set new standards in other areas of waiting, including accident and emergency departments and key diagnostic tests. We are determined to work with our NHS to ensure that those new levels of performance move from aspiration to delivery.
"Fair to All, Personal to Each" also included our commitment to abolish availability status codes and to introduce a new system of defining and measuring waiting that is fairer, more transparent and more consistent. There is a great deal of misinformation about ASCs, which comes largely from the SNP, sometimes followed by the Tories. I often hear opponents in this chamber refer to ASCs as "hidden waiting lists". Nothing could be further from the truth. NHS board information on the numbers of ASCs is published regularly on the
It is important to remember that nine out of 10 ASCs are driven by patients—it is they who say that they are not available to receive the service that we offer. They ask for delayed admission for personal reasons, or they do not attend at the arranged appointment time, or they have an underlying clinical condition that affects their ability to undergo treatment. In other cases, patients are waiting for highly specialised treatment or treatment of low clinical priority, such as tattoo removal.
If the member had been listening—and she probably was not—she would know that we want to be more open and transparent and fairer to patients.
I hear Mr Swinney laughing, and ask him whether he is willing to blame the NHS for the 18,401 patients who were unable to attend despite getting reasonable offers of treatment. Is he asking the 3,914 people who did not show up when they had an appointment if they want to blame the NHS for that? I think not. It is inappropriate and unfair that the SNP wants to blame the NHS for that.
ASCs are applied by the NHS in line with the national guidance that was issued in March 2005. I have asked Shona Robison umpteen times to bring me one case where an ASC has been misapplied by an NHS board. If she can, I will deal with it. I asked her that more than 12 months ago, and she has not come up with the name of one person, one clinician or one GP who has misapplied an ASC. Let us hear no more of that; it is an insult to the NHS and to those who work in our NHS.
The member might say that, but that is because she seeks to undermine the achievement of the NHS by abusing the statistics. It is quite appropriate that we should spend time talking about those matters.
We want the NHS to change for the future. We are working hard on the redesign of diagnostic services such as barium studies, endoscopy, magnetic resonance imaging and computerised tomography scanning. Alongside service
Patients will be able to rely on even shorter waiting times. By the end of 2007, no one will wait more than 18 weeks for in-patient or day-case treatment or for a first out-patient consultation. Neither will anyone wait more than nine weeks for key diagnostic tests. Those waiting for cardiac or cataract operations will experience a start-to-finish waiting time that will stand comparison to best European practice.
Members will agree that Scotland is building an NHS that is responsive to patients and that is tackling the diseases and conditions that affect the quality of life of so many Scots. The NHS is also bringing the values of its foundation into the modern age—local, accessible and caring, but still free at the point of need. It is consigning lengthy waits to the past, and looking to the future with confidence.
That the Parliament welcomes the significant progress made by NHS Scotland to reduce waiting times; applauds the dedication and hard work of all NHS staff who have helped meet the targets for patients; acknowledges the contribution made by the Scottish Executive through additional investment in the NHS; notes that partnerships with the independent healthcare sector have also contributed to the capacity available to treat NHS patients; supports the continuing work by the NHS to modernise and redesign services to further improve access and accelerate diagnosis and treatment, and supports the Executive's commitment to achieve further improvements in waiting times while securing a modern sustainable health service for Scotland on the basis of Delivering for Health.
I pay tribute to the hard-working staff of the NHS who have done their best to deliver progress in meeting targets for patients with waiting time guarantees. There is no doubt that the NHS treats those patients more quickly than was the case under the minister's predecessor. Staff have delivered what they were asked to, and we recognise their achievement.
While recognising the progress that has been made for patients with waiting time guarantees, we should also recognise that it is a different story for those who are without one. I remind the minister that they are not simply a handful of patients, but one third of all patients who are on waiting lists in Scotland. Those patients have no right to be treated according to the waiting time targets, yet most of them will still require to be treated by the NHS at some stage. The Executive's policy is at
Last week's report into waiting times from Audit Scotland was balanced. It recognised the progress that has been made, but also raised major concerns on several fronts. From the waiting list census information, the report revealed the true extent of hidden waiting lists in the NHS for those who are without a waiting time guarantee. It revealed that, as of September last year, the number of people without a waiting time guarantee had increased—approximately 24,000 patients were waiting more than six months. That is unacceptable.
What is the Scottish National Party's policy on patients who are unable to attend appointments or treatments despite reasonable offers from the NHS? That is often the case with patients whose treatments are of low clinical priority, such as tattoo removal, or patients whose highly specialised treatments are not readily available. Some people simply do not attend their appointments, and others cannot attend because of medical constraints. How does the member propose to deal with those cases?
I would abolish ASCs and ensure that all patients have a waiting time guarantee. As the minister will do the same at the end of 2007, why does he not do it today? If ASCs are fundamentally flawed—which the minister accepts, because he will abolish them—he should abolish them now.
The situation is even more concerning if one considers the waiting time information that is collected by ISD Scotland. The minister should recognise those figures, as they are Government ones. They show retrospectively how long people actually waited for treatment—that is, the actual time patients waited from the point they were added to the waiting list to the date of treatment or appointment. Today, the SNP released figures that show that by the end of 2005, approximately 40,000 Scots had waited more than six months for treatment. They undermine the minister's claim that no patient waits more than six months for treatment and add weight to the SNP's numerous calls for the immediate abolition of ASCs, which are widely discredited and are regarded as hidden waiting lists.
The member referred to 38,755 referral patients who were treated in 2005. It is disingenuous to claim that the ISD Scotland figures show that on 31 December 2005 only two patients with a guarantee had not received their treatments in six months. The figure quoted merely illustrates the scale of effort put in by the NHS to treat those very patients.
The minister seems to misunderstand the point that it took more than six months for those patients to actually receive treatment. The minister can shake his head, but that is what retrospective waiting times mean. They mean looking back at how long people waited. The minister may need a briefing from ISD Scotland to explain how that works.
I want the immediate abolition of ASCs. They should go now, because patients deserve cast-iron patient rights, not fiddled waiting time figures.
I am not denying that: I am saying that for 40,000 patients it took more than six months to be treated. That is not a difficult concept to grasp—I do not know why the minister has difficulty with it.
We must now look to the future. We need to be ambitious when it comes to waiting times. Audit Scotland says that future waiting time targets are challenging, but the Executive's target for the whole patient journey is 36 weeks, which is double that in England. Surely we need to raise our sights and expect the system here to deliver a waiting time commitment that is similar to that south of the border, especially given the level of investment in the health service in Scotland.
With the right policies, Scottish patients will not have to wait longer for treatment than patients south of the border. That will require us to address a number of fundamental issues, not least the lack of capacity in the NHS in Scotland. Audit Scotland recommends better use of the Golden Jubilee national hospital and a better split between elective and emergency procedures. We agree, but we need to do more. It also makes the point that the increased use of the private sector to cut waiting times comes at relatively high cost.
The private sector may be a short-term fix, but only by making the NHS more efficient and productive can we deliver real, long-term reductions in waiting times. Funding methods such as payment by activity are just one way of improving productivity in the system and encouraging the NHS to do more by rewarding extra work.
Audit Scotland also suggests strengthening patients' rights within the system and giving them more choice about where they are treated, which it says would reduce waiting times. We agree with Audit Scotland that patients should be more involved in decisions about their treatment. Through our patients' rights proposals, on which we will consult soon, we want patients to have greater involvement in and choice about where
There is a need for an honest debate on waiting times. Today, we have been honest in acknowledging the progress that has been made in meeting waiting time targets for patients with a waiting time guarantee. It is unfortunate that that has not been replicated by a more honest response from the minister, who should acknowledge where there is a need to do much better for all patients who are still waiting for treatment in Scotland.
I move amendment S2M-3990.3, to leave out from "welcomes" to end and insert:
"congratulates NHS staff for their hard work in delivering progress in meeting targets for patients with waiting time guarantees; however recognises the recent concerns of Audit Scotland that the number of people without a waiting time guarantee has increased, that nearly 24,000 patients have been waiting more than six months for in-patient and day case treatment and that the total number of people waiting for in-patient and day case treatment has changed little in the last two years; further notes that Audit Scotland's report, Tackling Waiting Times in the NHS in Scotland, regards the increased use of the private sector as being "relatively high-cost" compared to the NHS; welcomes the report's recommendation that there should be greater involvement and choice for patients, and therefore commends the SNP's Patient Rights proposals to provide every patient with an individual waiting time guarantee appropriate to them within national waiting time targets."
There has been quite a build-up to today's debate. Following this morning's self-congratulatory press conference, it is no surprise that the minister is in good fettle this afternoon. After the previous two speeches, my head is reeling with confusing statistics.
To be fair to the Executive, there have been significant achievements in the NHS. Over the past decade, there has been a 38 per cent drop in premature deaths from coronary heart disease. Cancer deaths are down by 8.5 per cent, with an improved prognosis for most types of cancer. By next year, spending levels in the NHS will be up by 89 per cent since 1997—a huge financial investment by any standards. Of course, that trend was started by the previous Conservative Government, which put major investment into human resources in the NHS and into hospital
Despite today's encouraging figures, all is not well in the NHS. There are stark health inequalities between the rich and the poor. Although most patients with waiting time guarantees are now being treated within target times, there are still—as we have just heard—more than 35,000 patients without such guarantees, most of whom have been waiting for more than six months. According to Audit Scotland, the total number of people who are waiting for in-patient or day-case treatment has changed little.
We all know of local NHS facilities that are being closed or threatened with closure, against the wishes of local people who are vociferous in their opposition to what they see as centralisation of services that they hold dear.
By no means are all the Executive's targets being met. According to recent figures, only three quarters of cancer cases are being treated within the target of two months. That results in great anguish and worry for the remaining 25 per cent of patients.
Despite a target of reducing excessive alcohol intake, recent figures have shown that alcohol-related deaths have gone up by 21 per cent in the past five years and there has been a huge increase in emergency admissions for chronic liver disease and its complications.
Delayed discharge from hospital is still a problem because many councils do not have enough funding to provide care packages for the elderly patients who need them. That is despite the pledge that by 2005 all those with unmet need for free personal care should be identified and receiving the services that they need.
I am told that nurse recruitment is on target to bring 12,000 new nurses and midwives into the service by 2007, but that will only replace the nurses leaving the NHS and will not allow for the expansion in the nursing workforce that is needed if the delivering for health programme is to be achieved. That is a matter of great concern to the Royal College of Nursing.
There is a significant shortfall of capacity within Scotland's NHS. Admittedly, the Executive has begun to tackle that by entering into partnerships with the independent sector, but it has done so only in the past year or so. It has taken all this time to get back to where the Conservative Government was in the late 1980s when we started to use spare capacity in the private sector to treat NHS patients—and we were not half lambasted for that by the Labour Party of the day, which continually accused us of privatising the NHS, just as the Scottish National Party and
According to Audit Scotland, the Golden Jubilee national hospital is still not being used efficiently. There are marked geographical variations in its usage, not because patients do not want to travel there—50 to 60 per cent of patients who were surveyed by Audit Scotland said that they would be willing to travel for treatment—but, as we know, because some health boards do not encourage their patients to go there. I was pleased to hear the minister's response to Mary Scanlon when she intervened on that point. Why did it take from 1999 to 2002 for the hospital to be used for NHS patients at all? Why did the hospital have to be bought at a cost to the taxpayer of many millions of pounds before the Executive would even consider using it for NHS patients? That money could have been used for patient treatment.
Short-term measures that were put in place under the Executive's waiting times initiative have been successful in helping to meet targets and to clear the backlog of patients who have been waiting a long time. However, as Audit Scotland stated,
"Over-reliance on short-term measures, such as staff working in the evenings and at weekends, can be expensive" and does not address the balance between demand and capacity.
What about NHS staff, who nearly all work flat out to try to meet patients' needs and to deliver a good service? By and large, the people to whom I speak are fed up with having to work under pressure to meet targets set by central Government that often get in the way of their professional judgment. Every time that I visit a hospital or meet a doctor or nurse, I am asked, "Why don't they lay off? Why don't they get rid of these targets and let us get on with our jobs?" I am convinced that until patients are given more choice and control over their care and until health professionals are allowed to plan their work according to clinical priority rather than to satisfy Government targets, morale will remain low; recruitment and retention will continue to be a problem; and patients will continue to wait unnecessarily for appropriate treatment when it is required.
The minister has certainly achieved some good results, but to do better he will have to loosen the reins.
"You have to move faster in reforming public services, as the Prime Minister has done in England. You have to crack down on failing services, work even more closely with the independent sector, and extend choice in a much more ambitious way. Trust people, and drop the paternalistic idea that the state should provide a gradually improving uniformity".
The NHS is a mighty animal, but it would be better controlled and developed by the light hand of professionals rather than the heavy hand of politicians.
I move amendment S2M-3990.1, to leave out from "welcomes" to end and insert:
"notes the progress in eliminating the longest waits; is concerned, however, at the corresponding rise in patients with Availability Status Codes who are not guaranteed treatment within the waiting times target; notes that the extra money going into the health service has not been matched by corresponding increases in productivity; further notes that, despite the efforts and hard work of the NHS staff, patients are not receiving the level of service they demand and deserve because of insufficient capacity to meet demand; is concerned by the stark health inequalities existing between each end of the social deprivation scale, local health service facilities being closed against the wishes of local communities and a slow adoption of new drugs and technologies, and believes that Scotland needs to move to a system with greater responsiveness to the needs of individual patients and communities, put power back in the hands of professionals to prioritise treatment by clinical need and increase the capacity available to treat NHS patients by extending the use of the independent sector."
All the speakers so far have thanked NHS staff. None of them has mentioned the fact that, disgracefully, the Chancellor of the Exchequer and the Scottish Executive think that they are worth a pay rise this year of only 2 per cent, which is below the rate of inflation. I do not share that view.
I want to concentrate on the Executive's flawed policy of increasing capacity in the health service by privatising it. I am interested in the debate that is going on in the UK-wide Labour Party. Harry Burns, the chief medical officer, is pleading with NHS staff to support the Executive in resisting privatisation. However, in the motion and in the minister's speech, it is clear that the Executive wants to encourage increased privatisation and use of the private sector. Obviously, Harry Burns has not caught up with Executive policy. I would be happy to support the Executive if it were happy to resist privatisation. It is a pity, however, that there is nothing to support.
Jim Murphy has popped up to encourage the Scottish Executive to carry out even more privatisation, but I think that that is more about pleasing Blair and getting a job in the Cabinet than it is about health policy.
Thankfully, I do not know Jim Murphy very well. Having read his article, however, I can tell that he is Blairite to the core.
I would be interested to be a fly on the wall at the Executive's discussions. Unfortunately, I am a bit cynical about the Executive and think that the battle is lost because the Executive too is Blairite to the core. Jim Murphy and Blair advocate a policy of privatising the health service come hell or high water. The example of the NHS Lanarkshire consultation demonstrates the problem. The plan for the future in that case includes no plans to increase capacity or improve staff ratios despite an increase in the dependent and ill population. It plans to plateau bed numbers and staff numbers and not to improve staff ratios even though there will be a greater demand on the service. That is happening in the context of a shortage of money—to the tune of £32 million—that is a result of the inadequate application of the Arbuthnott formula since 1999.
The idea that choice will address inequalities, which has been claimed by the Tories and the Executive, is nonsense. Poor people are less able to travel. The choice that is being offered is a false choice. There is no choice. People's first choice is to have local care in the local hospital in their local community. It is false to suggest that to ask them to travel greater distances gives them a choice. Indeed, the examples in England show that the existence and proliferation of the private sector undermine the local hospital and lead to its closure. That removes choice and creates a monopoly for the private sector. That is the road down which we are travelling.
Even though we are on that road, the Executive is not prepared even to audit its policies in relation to privatisation. However, the work of Unison and Allyson Pollock has substituted for a Government audit of the effects of the privatisation of the health service. Their work shows clearly that NHS facilities, which have the advantage of pooling the risk between complex care and lower-risk care, are undermined by the introduction of the private sector, which creams off the low-risk, low-complexity but high-profit cases, leaving the NHS unable to compete—to use the parlance. That creates a virtual monopoly for the private sector in the field of elective surgery, which further undermines the NHS.
The British Medical Association's deputy chairman, Sam Everington, recently said that the choice that is being presented is false and that people want more local core capacity. Unison clearly states that there has been no evaluation of independent treatment centres in England, yet the Executive is rolling ahead with the implementation of that policy in Scotland without any research to back it up.
The claims of increased efficiency, choice and value for money are simply not proven, as the Executive knows. Indeed, there is much evidence that privatisation compromises the safety and care of patients. Some 80 per cent of chief executives—no less—in England say that resources are being taken away from the NHS through privatisation policies and that patient care is being compromised as a result. We can cite many cases, for example that of Mrs Broderick in England, who waited in vain for oxygen for six hours, after the oxygen delivery service had been privatised, or the case that was reported in the press this week of Mrs Alma Murray, an NHS patient in a private bed that was contracted to BUPA. Mrs Murray's case demonstrates how the problem of privatisation rears its ugly head and creates situations in which there is no audit mechanism, no responsibility and no accountability.
When I asked the Executive recently to tell me what happens to patients who are moved to the private sector and perhaps receive inferior care, it could not answer my question, because it does not follow up cases or hold evidence or statistics on such matters. That is a disgrace. The truth is that the Executive, like Blair, is pushing policies while wearing ideological blinkers. The Executive is more interested in creating profits for private health care than it is in patients.
I move amendment S2M-3990.2, to leave out from "welcomes" to end and insert:
"applauds the dedication and hard work of all NHS staff who have helped meet the targets for patients; notes that the NHS has insufficient core capacity and insufficient core staffing of establishments resulting in increased overtime and locum costs; believes that resources that should be directly spent on patient care are being diverted to increasing the profits of private health providers; believes that NHS patients treated by the private sector have had their care standards compromised, for example patients treated by the Advanced Centre for Eye Care (ACE) and those in England with severe respiratory illnesses made reliant on oxygen supplied by the private sector; believes that all private healthcare providers in Scotland should be urgently audited by Audit Scotland to determine whether the standards of care provided are putting patients at risk or imposing additional care burdens on NHS staff; believes that the NHS is under threat as a public health care system and that urgent action is required to protect and improve it, including increased investment in training to provide more NHS doctors, dentists, clinicians, other professionals and support staff to increase the NHS's own capacity, and believes that Scotland's stark health inequalities will only be intensified by the increased involvement of the private sector."
I am grateful for the opportunity to set out the Liberal Democrat perspective on the "Fair to All, Personal to Each" agenda and the progress on waiting times. I start by putting on the record my party's thanks to all the people in the NHS who have worked so hard to deliver the improvements to waiting times in Scotland that have been achieved in the past year. It was good that all parties in the Parliament expressed their appreciation of the achievement of the targets to reduce maximum waits to six months for in-patients, day cases and out-patients by December 2005. I am sure that all members recognise that by seeking to ensure further improvements we rely on the hard work, enthusiasm and innovation of staff.
As the minister said, many people thought that it would be impossible to achieve the targets. However, not only have the targets been achieved, but the best performance ever in Scotland has been reported for in-patient, day-case and out-patient waiting. The out-patient waiting list has reduced by some 62,000 during the past year—that is more than 26 per cent. NHS Scotland has maintained the guarantees on targets for heart treatment whereby no patient waits more than eight weeks for heart investigation or eighteen weeks for heart bypass surgery or angioplasty.
The "Fair to All, Personal to Each" agenda envisaged further improvements for in-patients, out-patients and day cases by the end of 2007. The people who doubted that the 2005 targets could be achieved should at least acknowledge in the light of the evidence that the 2007 targets are achievable. In passing, I note that a key measure for the Liberal Democrats is that by the end of 2007 no one should wait more than nine weeks for key diagnostic tests. Such tests are crucial in ensuring that the right treatment is delivered for the patient.
The minister referred to a number of redesign projects, which he said had helped markedly to ensure the delivery of the targets. I ask him to ensure that health boards share their experiences. If a central mechanism is needed whereby best practice can be shared, I ask him to ensure that such a mechanism is developed soon.
My local health board, Borders NHS Board, has developed an orthopaedic multidisciplinary team, which has released appointments for orthopaedic consultants. I understand that the team comprises two specialist practitioner physiotherapists, a specialist practitioner podiatrist and a general practitioner who has a specialist interest in orthopaedics. Between April and September 2005, the team saw 310 patients, which released 264 patient appointments for the consultant to treat
The member mentioned two specialist physiotherapists and a multidisciplinary team. Does he know whether, when people are referred, they are given a block of physiotherapy appointments or they simply receive treatment for as long as they are under the multidisciplinary team's care?
I regret that I am unable to answer that question, but I will find out and tell the member informally.
Another notable success occurred in NHS Dumfries and Galloway, where general practices improved their waiting times by 75 per cent over the first 10 months of the programme. Such innovations and those that the minister outlined are making a significant difference for patients.
The Liberal Democrats also welcome private sector partners' contribution to the reduction in waiting times. There is no reason why the NHS should not work in partnership with the private sector if that work is carefully planned and is being done for a specific reason. That in no way implies that the NHS has any less of a commitment to delivering care and treatment that are free at the point of access. Instead, it is a sensible and practical way of using available resources to deliver what patients need in certain circumstances.
Similarly, the Golden Jubilee national hospital—otherwise known as the national waiting times centre—has made an impact on waiting lists. The minister pointed out that, since the hospital joined the NHS in June 2002, there has been a tenfold increase in the procedures that are being undertaken. Some criticism has been levelled at what has been described as the hospital's higher costs. However, as its chief executive Jill Young recently underlined on "Newsnight Scotland", the hospital delivers a range of more specialised services—not the general mix of services that other NHS hospitals offer—and does not deal with relatively low-cost injuries such as minor sprains, strains and fractures. Indeed, as she pointed out, the hospital has focused its orthopaedics on high-cost knee transplants. As those implants can cost as much as £8,000 each, we are indeed talking about a very high-cost procedure. As a result, it is not fair to compare the costs of the national waiting times centres with those of other NHS facilities.
However, I also agree with the deputy auditor general, Caroline Gardner, who said on the same programme that more information about what the national waiting times centre can deliver ought to be made available by boards to patients.
On behalf of my party, I welcome the progress that has been made thus far in reducing waiting times.
I rise to support my colleagues in the Scottish Executive.
This is a proud day for the Scottish Parliament, the minister, the Labour-led Executive, NHS staff and the people of Scotland. There can be no more significant challenge to the Parliament than maintaining and improving the health and well-being of Scotland's people. There has been much discussion about the state of the NHS and the direction of health care in Scotland. Increasing the NHS's efficiency and effectiveness is at the heart of Labour Party policy and ambition. We created the NHS, we uphold its values and we have ensured not only that it survives but that it thrives. The minister's announcement proves that commitment and proves that the NHS is being reformed for the 21st century.
What is crystal clear is that patients with life-threatening diseases are being put to the top of any waiting list. Opponents of the Labour Party and the NHS cannot complain that the Executive has not demonstrated the utmost commitment to the health service.
Mr Stevenson does not need to ask that question—he knows the answer to it very well.
Record amounts of funding have been pumped into the service. Opponents claim that the funding has been ineffective and that it has all disappeared down a black hole. No one should doubt for a second that the funding and running of a major service pose questions of efficiency, but the figures that have been released today show that great improvements are being made.
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We should consider the sheer number of people who now come forward. The more that is put into a system, the more efficient it should be. As medicine improves, people require more and better operations. In years gone by, people could not have hip replacement operations. The health service can now carry out many new procedures, which it has done.
The clinicians to whom I have spoken in hospitals and in my constituency have applauded the unprecedented finance that they have seen coming into the system. They have never had as much money. They tell me about problems, which undoubtedly exist—indeed, we would be dishonest if we said that there were no problems. However, the Labour Party profoundly thanks all the professionals from the top to the bottom of the NHS who have helped us to deliver objectives.
I have allowed enough interventions for the time being.
I return to today's news. The picture that the figures paint is that the Executive is succeeding in reducing waiting times. It has met and improved on waiting time targets, which went from a maximum of 12 months to a maximum of nine months in 2003 and to a maximum of six months by December 2005. Some 14 out of 15 health boards had no one waiting for more than six months for in-patient or day-case treatment or out-
I noted with interest Annabel Goldie's comments on health earlier today. She is in danger of exposing further the Tories' true agenda for the NHS in Scotland—I refer to their patient passport proposals. Patients would have to pay £6,000 to £8,000 for a hip replacement. I cannot imagine what people in my constituency would do if they were faced with a bill for £16,000 and were given a voucher for £8,000 by the Tories. How would that help the poorest in our land? The Tories' proposals defy belief.
An interesting thing about the health service and the politics that have surrounded it from the outset is that there has been broad, all-inclusive consensus across political parties that we want a health service that is free at the point of delivery. That consensus has been almost unique to our islands, compared with what has happened elsewhere in the world. For most of their history since the health service was first discussed in the early 1940s—Beveridge was, of course, a Liberal; perhaps Helen Eadie has forgotten that—even the Tories have wanted such a health service.
Even I am prepared to acknowledge the contributions of others, as I am doing in my introduction.
That consensus of objective is something that we must not forget when we agree—with vigour, with passion—about the details of the policy to deliver on the community-accepted, politicians-accepted consensus. Of course, we have some fundamental differences over the details, but it is remarkable that that consensus has stood up for
I characterise the Executive's current approach to the health service as one that has merit but also presents future difficulty. It is somewhat reminiscent of the generals of the first world war: one last heave, some more resources, and by throwing bigger munitions at the target we move a mile or two forward. Then something happens in the health of our community—its aging profile, or new, expensive procedures—that moves us back. That is a real difficulty for any Executive of any party to consider. While we look at the issues that are before us today to do with the current and recent past operation of the health service, we must not blind ourselves to the need to look to the significantly distant future and see what we need to do today to help it.
One of the ways in which we might consider the subject is through the prism of the current state of our dental service. Dentists have not been mentioned so far in the debate, although the Auditor General quite properly includes
"Consultation with GP or dentist" in exhibit 1 on page 5 of "Tackling waiting times in the NHS in Scotland". Of course, the Executive has not set any meaningful targets for and has not targeted the improvement of dental care in the same way as it has done for other parts of the health service.
I will let the minister in, but first I want to make an important point. We are where we are on dental care, with the very real difficulties that we have, not because of what has happened since 1999—I accept that, and I think that it is useful to say that before the minister rises to speak—but because of a long-term neglect of that part of the health service.
On Stewart Stevenson's substantive point about the future of the NHS, if he looks at the trajectory of the number of patients who are waiting more than six months, he will see that there has been a gradual decline. That suggests to me that substantial changes are taking place inside the NHS that are sustainable and will continue to deliver. It is not a one-off throwing of resource; it is a consistent, sustained effort.
I acknowledge the changes that have been achieved in both the processes and the delivery of service. Nevertheless, slipstream planning—looking over one's shoulder at the past—is not an adequate basis for planning for the future. That is my key point. Yes, we have got where we are by throwing huge resources at the problem. That was the only
The problems with the dental service have occurred over a long time because of a lack of training and a lack of appreciation of what we need in dentists. Are we planning adequate provision for doctors, dentists and nurses in the future? People may decide today to become a doctor and start on that road, but it will be 10 years before they are doctors, and we have no material planning for the health service that goes that far ahead. For nurses, the period is probably six years. There are huge problems.
One initiative from which we have, as yet, seen little material contribution is the e-health strategy. Yes, things have happened. However, when we introduce, for example, new out-of-hours services—which bring not the GP but other people to the table—and NHS 24, which brings other people who are unfamiliar with and who do not generally have access to patients' records to the triage process, we reduce the operational efficiency of the health service. Albeit that those are things that we should do, we are doing them in the wrong sequence and we are not putting the resources in place before we move forward.
I think that, in England, much more substantial efforts are being made in the use of computer technology, which we might look to copy in Scotland. Much has been done, but there is a great deal still to do.
As members know, I am not on the Health Committee, but I have the honour of serving on the Audit Committee, which this week considered the Audit Scotland report "Tackling waiting times in the NHS in Scotland". I acknowledge that, as the report recognised, the NHS in Scotland has made significant progress in meeting waiting time targets. I join other members in paying tribute to the NHS staff who have achieved that.
Part 1 of the report is headed "Factors that influence waiting times". I can remember from my own time in the NHS waiting list initiatives and boards getting clumps of money to tackle a particularly large waiting list. The report notes:
"Evidence suggests that short-term increases in activity at particular points in the system"— which are seen as bottlenecks—
"do not lead to sustained reductions in waiting times."
That makes sense. There is no point in shifting bottlenecks from one point in the system to another. There must be a holistic examination of the entire organism that is NHS Scotland. Whether
For the NHS as a whole, I believe that we must deal with overall capacity and plan for a future need for increased capacity, which will result from our aging population and all the illnesses of poor diet and no exercise that are becoming all too evident. We are getting older and we are not necessarily getting healthier.
Part 2 of the report deals with performance. It is interesting: it clearly shows that, despite the progress that has been made towards meeting the Executive's targets, the total number of people waiting for in-patient and day-case treatment has not changed much in two years. The Executive is focusing on waiting times because, as it might reasonably point out—and as I would agree—that is what matters to the patient. However, the total number of people on the waiting lists has stayed constant because of those who do not have waiting time guarantees and who are given an availability status code—others have already mentioned that issue. That will not happen after 2007; those patients will be on the list along with everybody else. The waiting time guarantee will be affected by availability, but there will still be targets. That will present a challenge for NHS Scotland.
I mention that not just because everybody else has, but because we often concentrate on waiting times in our debates. As I acknowledged, that is what is important to the patient, but waiting lists are actually more important for service planners. Waiting lists are the predictors of future demand, and we should not ignore them or the fact that they have not decreased.
Part 3 of the report is headed "Current approaches to reducing waiting times". Some of those approaches have been quite innovative, and they show potential. One example is the idea of reducing referrals to specialists by setting up a system under which a GP can get specialist advice and thereby manage the case herself. That is applicable to some specialties, but it will not be applicable to others.
Separating elective procedures from emergency procedures is also being considered, so that planned operations do not have to be cancelled to make way for emergencies. I can see some problems with that and I know that that concern has also been expressed by some of the professional bodies. For example, there could be training issues for people who see only elective cases and do not see emergency cases. That needs to be thought through and discussed extensively.
That is a valid point, and it comes back to the training issues that I mentioned, particularly for junior staff, who might work in units that either do not deal with emergency cases or do not deal with elective cases.
There is no getting away from the fact that, in some areas, there is a real capacity problem, which the report mentions on page 22. We would be doing the NHS a disservice if we failed to recognise that, in some areas and specialties, there is a real shortage of doctors, nurses and allied health professionals.
I also point out some inconsistencies in the system. We are supposed to be working towards a patient-centred service and we talk all the time about the patient journey. Sometimes, however, we see that journey in relation to only the time that is taken at each stage, not the whole patient experience. Patient choice is emphasised, yet there is a clear thrust towards encouraging patients from all over Scotland to be referred to the Golden Jubilee national hospital. The Audit Scotland report was critical of NHS boards with a low rate of sending patients there, yet those boards tend to be the furthest away from the hospital. Going to the Golden Jubilee hospital might be fine for someone from Glasgow; it is not so great for people from the north whose families cannot visit them.
There is also the issue of which consultant sees the patient. One practice that the report commends as helping to reduce waiting times is to have pooled referrals to a group of clinicians, rather than to one consultant; that is seen as more efficient. However, at the same time, the Executive is publishing league tables of surgeons' death rates.
I am sorry, but I am in my last minute. The minister can make his point at the end.
Will a patient who refuses to be treated by a particular surgeon be deemed to have unreasonably refused treatment and lose their waiting time guarantee, at least until next year, or will they be seen to be making reasonable use of the information that the Executive has decided that
Some of the patient choices are about politicians crossing their fingers and hoping that patients will elect to go where the capacity is, rather than demand that the capacity is developed or retained in their area.
I support many of the initiatives that are already taking place in the NHS. Many of the moves to deliver care more efficiently, such as increasing the number of procedures that are carried out as day-case treatments, are welcome, but there is a ceiling beyond which, in the search for efficiency, we sacrifice effectiveness.
We must review constantly the overall capacity of our health service and whether it meets the needs of our population. Above all, we must get serious about what is in the end the only meaningful form of demand reduction: a redesign of our communities so that it becomes possible to be healthy in a modern Scotland.
There was an indication recently that the number of problems with the Holyrood building had come down below 100, so we are clearing up the last few snags. I have to say that the persistent whine that we hear from the SNP benches does not seem to have been reduced in any shape or form. I do not know whether that can be resolved by de-snagging; it seems to be an endemic noise from that area of the chamber.
This is a debate about waiting lists, but we will not address waiting lists unless we achieve fundamental changes in the health service. There is a great deal to be proud of in the national health service, particularly in the west of Scotland. Nanette Milne said that the Conservatives had a programme of hospital building. I acknowledge that, but they did not do much hospital building in the west of Scotland; barely anything was done in greater Glasgow in the 20 years of the most recent Conservative Government. We have had to move forward in Glasgow and terrific things are being done. The new facilities at Stobhill and the Victoria are coming out of the ground. Plans for the Southern general are being implemented and new facilities, such as the new Beatson cancer facility, are coming into place.
I am particularly proud that the flagship is what the Executive is achieving with the Golden Jubilee, which is the national waiting times centre and the cancer centre for the west of Scotland. It is also becoming the centre of excellence for not just cancer care but orthopaedic care and the development of new technologies linked to medicine, such as that produced by AxSys
There are a number of important strands to what is taking place. The minister and his predecessor have expanded capacity to deliver improvements in waiting times by taking the Golden Jubilee hospital into the NHS, expanding massively the number of procedures and operations that are being carried out. Part of that process is about streamlining the delivery of care, so that the process of dealing with elective operations is being separated from emergency treatment; not doing that can often mean less efficient ways of working. When people go into the Golden Jubilee hospital, they know what time their operation is going to take place and they can have the strong expectation that there will be no interruption, disruption or delay in the procedure. The streamlining of treatment flows is being combined with improved technological and medical innovation, thanks to the excellence of the staff and the capacity to try out new things and make things better.
In cardiac care, cancer care at the Beatson and orthopaedic care at the Golden Jubilee and elsewhere, we are seeing a transformation: people are not only getting better operations, but getting them more quickly and within a more predictable timescale. I am sorry that Shona Robison has not stayed in the chamber to hear all the good news that is taking place in the NHS.
I will flag up one or two of the issues covered in the Audit Scotland report. We need to get more health boards to use the terrific facilities at the Golden Jubilee. I have raised that question with the minister in the past. When I go into the Golden Jubilee, I meet patient after patient who tell me what a terrific treatment experience they have had. The last time that I was there, I travelled to the hospital by bus with people from Dumfries and Galloway who were going there for cataract operations. They were getting their operations more quickly because the Golden Jubilee is able to progress operations systematically.
The minister will remember the gentleman whom we met on our recent visit to the hospital who had nothing but praise for his treatment. This is the human side of improving waiting lists; behind the statistics lie the human realities that represent significant improvement in the NHS. The minister and the Labour Party, and the Liberal Democrats who are part of the Executive, have a great deal to be proud of in the way that we have taken the issue forward.
This is a relatively low-key debate, which is a pity.
In the past, I have participated in some high-level health debates—some have been very rowdy. The rowdiness was based largely on the fact that there were serious problems in our health service.
Today is a big day and I would have liked to have seen more members present for the debate. Today is the day when we can see the light at the end of the tunnel for the first time. I find it strange to be saying that. Only a few short years ago, we believed that we were in a dire crisis in health terms because waiting lists and waiting times were getting longer. There was no end of ammunition for those on the opposition benches—including, occasionally, we Conservatives—to use. That happened because we had a health service that had been run since 1997 largely on the basis of political dogma that was being driven by the left. Our health service had money poured into it on the basis of the idea that all the money had to go into a nationalised health system.
Little recognition was given to the fact that much of the primary health care in this country has always been delivered by those who essentially work in the private sector. I refer to the general practitioners and dentists who put their life's work and resources into providing health care that is free at the point of delivery. That is NHS service at its very best. We then suffered a period during which the wrong people got into the ascendancy. Suddenly, health care was all about nationalisation.
I said that we have come to the light at the end of the tunnel today because, in Andy Kerr's opening speech, he said that he believed that health care must be free at the point of delivery—something in which I believe instinctively—but that we should be prepared to accept that it will be provided by whoever can provide it most efficiently, most effectively and, in relation to waiting times, most quickly. I believe that we have seen the end of the political dogma that so dogged the health service in recent years.
Of course, we did not have wait long to hear that dogma delivered once again. From members on the SNP benches, we heard that the use of the independent sector is somehow second best—we can use it just for now but, in an ideal world, it would not be our choice. We did not have to wait much longer to hear Carolyn Leckie reiterate, with greater vocal clarity than ever, her belief that wholesale nationalisation is the only way that the health service can survive in the long term.
Well, I think that we have had that experiment, on more than one occasion.
The minister's willingness to be more broad minded is not only a good precursor for the future; it is the reason why the figures are for the first time
The truth is that the Government has seen the light. The minister in his opening speech had the air of a condemned man who has suddenly had a reprieve. Compared with his predecessor in the darkest days, he seemed like a man who is ready for the fight. The Conservatives are prepared to support him if he is willing to accept that the future of health care in Scotland should not be based on political dogma or a nationalised industry and should not be about people owning the means of production—those days are long behind us.
We ought to be proud of the independent health care sector in Scotland and utilise it as effectively as possible. The minister has the levers under his control to ensure that the improvement continues, but we cannot afford backsliding: the dogma must be a thing of the past. We all support the mantra "free at the point of delivery", but we must be prepared to accept that the nationalisation of health care is a failed practice that has failed Scotland's people and the Executive. I am glad that change has happened and I look forward to it continuing in the future.
When we hear an offer of support from the Conservative party, I always detect what I term a Cameron gambit. One must be rather careful with such offers, but I nevertheless respect the spirit in which it was made.
As has been said, the NHS has made significant progress toward meeting the waiting time targets that were set in 2004 and has achieved, a year early, our target to cut waiting times for in-patient and day cases to below six months. Some members predicted that we would not hit the target, but as there is a magnanimous spirit abroad today, I accept the remarks that have been made from members of all parties on that.
The NHS achievements go beyond those on waiting times. The progress that we have made shows that one of the best methods of achieving waiting time reductions is sustained investment in new diagnostic technology and an increase in the number of diagnostic tests that can be carried out. Our national waiting times centre has 100 more beds, a new catheterisation laboratory, a new magnetic resonance imaging suite and state-of-the-art orthopaedic theatres that are the most modern in Britain and the envy of many. The centre has exceeded its activity targets in each year since its establishment and has contributed to the reduction in waiting times that we have witnessed. It is precisely through that kind of
I turn to the future. The Kerr report made a convincing case that we should make the NHS a service that creates health rather than one that just treats ill health. A simple approach to cutting waiting times in the NHS is to continue to invest in my party's policy of health promotion. A long-term approach to health care is necessary if we are to transform Scotland's health and shed our regrettable image as the sick man of Europe. By improving Scotland's diet and approach to exercise, we can tackle serious diseases before people get close to hospitals. The recent legislation to ban smoking in public places will make a definitive contribution to Scotland's health and will undoubtedly have a positive impact on waiting times for lung cancer patients as the numbers who suffer from that deplorable disease fall. The issue is close to my heart—as members know, I speak as the son of a much-loved father who died of lung cancer. The Executive commitment to cut waiting times in the NHS is to be commended, but my party and I believe that the long-term answer is to focus on improving people's health before they get to hospital. By targeting the roots of disease and reducing the number of people who require acute care, we will free up resources and cap waiting times for those who require treatment.
Although health promotion is a worthy long-term solution to the waiting times conundrum, we will still need sustained investment in diagnostic testing facilities, the training of staff and the creation of more beds in Scotland's hospitals. The early detection of disease is as important as the length of the wait from detection to treatment.
I shall quote two examples from my constituency. One has to be careful about using details in such matters and must use the most general terms. I have been contacted by a constituent who was concerned about the wait that she has had to endure between visiting her general practitioner upon discovery of a lump and her so-called urgent referral to hospital. She was, I am sad to say, horrified that despite the fact that we are constantly told that early diagnosis and prompt treatment are vital for beating chronic diseases such as breast cancer, she would have to wait six weeks for an appointment with a consultant. I have corresponded with the minister about that and he has explained that there was a vacancy for a consultant breast surgeon at the hospital, which resulted in a longer referral period than normal for urgent cases. Although I thank the minister for that response, the fact remains that I had that case. Another of my constituents contacted me regarding the waiting times for a MRI scan. He was informed last September that he would have to wait for more than seven months
I am sure that the minister would agree that those cases highlight the importance of recruiting and retaining staff in areas such as mine in the Highlands. That is a key factor in the process of cutting waiting times. The NHS needs sustained investment and although we are heading in the right direction, the new targets set by the Executive will be a challenge. It is therefore necessary to respond to the needs and circumstances of the regions of Scotland in their great variety and to deliver cuts to waiting times not just nationally but locally. If the minister cannot respond to the points that I have raised, I would be grateful if he would at least be mindful that, despite the good progress that we are making, we still have the odd blip. Those blips are of the greatest concern to my constituents.
The Scottish National Party believes that patients' rights are at the heart of the process of dealing with waiting times. As we indicate at the end of our amendment, we feel that patients' rights must be taken on board thoroughly and quickly. Our policy proposal to provide every patient with an individual waiting time guarantee, appropriate to them, within national waiting time targets, gets to the heart of the issues that have been raised. It is interesting that Jamie Stone and others have talked about waiting times in some of the more diverse parts of the country. We can congratulate ourselves on the general improvement in waiting times, but averages can be skewed enormously by the problems that people have in smaller health boards. It is on that area that I wish to spend a little time.
Key diagnostic tests are increasingly available and, as Euan Robson suggested, an ideal time of no more than about nine weeks is essential for such tests. Jamie Stone raised the case of the gentleman who was waiting for an MRI scan. If such a patient had waited six or seven months, only to be told that he would have to wait another nine months because of a recruitment problem, one has to ask how many places there are in Scotland where recruitment problems are one of the issues that affect waiting times. How many of the smaller boards that have a shortage of consultants and so on are affected by the problem even more than central Scotland is affected? That question bothers me considerably. When we are approached by constituents about such problems, we have to say, "You don't deserve to be treated any worse than people in larger communities." The
As many members have stated, waiting times are affected by the increasing aging population and the need for a good deal wider range of treatments than we have had in the past. However, they are also affected by the way in which health boards and health services have been reorganised almost every two years. Reorganisation affects staff morale, which affects how waiting times are dealt with.
Let us consider the 2004 figures for staff increases. The biggest increase of all—about 19 per cent since 1999—was in scientific and technical staff. Administrative staff and estate staff increased by 12 per cent, nurses and midwives by 5 per cent and general practitioners by 2.3 per cent. That demonstrates that, because of the way in which the NHS is now organised, there are more organisers than front-line staff. That suggests to me that the structures that we now have are not the best for morale or the best way in which to organise nursing.
The Arbuthnott cash settlements for various health boards were said to benefit those areas in most need. It was interesting that, when the First Minister visited the Western Isles last week, he said that there would be a huge increase in money for Western Isles NHS Board, but it turned out to be 6.7 per cent. That is lower than the increase for Highland NHS Board, which was more than 8 per cent—I think that it was 8.9 per cent, in fact. It is strange to me that Arbuthnott was unable to deal with the great problems of remoteness in areas in which there are increases in waiting time differentials.
Because this speech is short, I cannot go into more detail. I return to information. What would help us most is to ensure that information on MRI scans, for example, is available throughout the country. Certain health boards in the central belt can provide such information but, when NHS Highland was asked about its MRI scan record, it said that the information was too expensive to collect. That is completely unacceptable in this day and age and I wish that the minister would ensure that the information that we can gather to understand why people are waiting a long time is made much more transparent.
I congratulate the SNP members who were able to turn up today. The SNP is clinically averse to good news and I think that Shona Robison had to leave and get two large spoonfuls of bad news so that she could come back into the chamber.
The debate from the SNP has been predictable and pathetic. We heard insincere words of congratulation to the national health service, which quickly changed to sloganising about fiddled figures. However, despite all the challenges that we face—such as the SNP's daily diatribes against the national health service, the sensationalising of the reporting of issues in and around the health service, increase in demand on the service and the expectations of our constituents—some excellent figures on waiting times have been published today. All those who are responsible for them should be congratulated.
The minister made the point that waiting lists were not slashed by accident. That achievement is due, at least in part, to the record investment and modernisation programme that the Executive has delivered and that the SNP and others have opposed tooth and nail. However, there is a limit to what politicians can do. We can invest in the national health service and ensure that structures allow that investment to be put to best use, but results on the ground are delivered only by the determined efforts of national health service staff to provide the sort of service that their patients deserve.
I will pick one example. Mr John Morrice, a consultant surgeon at Inverclyde royal hospital, which is in my constituency, spoke in the Health Committee's public debate "Reshaping the NHS in Scotland?" in April last year, when he described himself as "one of those dinosaurs" who provides a general surgical service. Dinosaur or not, thanks to his efforts and the efforts of those who work with and around him, the waiting times for breast cancer patients at Inverclyde royal hospital are, as he recently pointed out in the local press, the lowest in Scotland, while the waiting times for colorectal cancer patients are the sixth lowest. People in my constituency are alive today because of the Executive's policies. It does not get any bigger than that.
That is not a frivolous point. In an area such as Inverclyde, which still suffers from poor public health, those are substantial achievements. They should be given the credit that they deserve and should not be sneered at by Opposition politicians who have never run much more than a bath. The results that were announced today are a testament to effective partnership working between the Executive and health service professionals.
There is no complacency about the challenges that we face in meeting the expectations of those whom we represent. I have been critical. I have pressed ministers and I will continue to press them on waiting times, digital hearing aids and other matters, but today of all days we have an opportunity to come together, unite and celebrate
I pick up from where Duncan McNeil left off. He is right: many more members should have been here today. I congratulate the minister. He is on top of his brief and I have found him easy to approach. I will say this for him—he does listen. The fact that he cannot always deliver as quickly as I would like is the fault not just of the minister but of a great number of things that I do not have time to go into.
Professor David Kerr's report stated:
"We need a health care system with an emphasis on providing continuous preventative care for people with long term conditions to balance our ability to react quickly and safely to medical emergencies ... Long term conditions require ongoing care ... They are common in the Scottish population, more common in people living in deprived circumstances, more common in older people and, because Scotland's population is ageing, they will become even more prevalent in the future."
Having talked to the minister, I know that work is being done to examine the situation in relation to long-term conditions. For example, work is already being done with people who approached the minister through the Public Petitions Committee, who have a condition that not many people know about—they are post-polio sufferers. I appreciate the fact that the minister took time to pay attention to a condition that has been neglected for a long time. Also, as a number of members said, Audit Scotland is studying the management of people with long-term conditions.
However, for many people who live with chronic conditions, the reduction in waiting times means little. I do not mean to whine; I am just stating a fact. The report from the NHS Scotland long-term conditions action team states:
"Our challenge is to provide the best quality of care within our finite resources for our citizens who may suffer from long term conditions now and in the future."
Obviously, its aim is to keep people as well as possible for as long as possible. It continues:
"Our staff will be well trained in patient centred approaches and will be working in strong multidisciplinary teams that span the current divides between primary and secondary care and health and social care."
Members might note the link between that and my intervention on the member who opened for the Liberal Democrats, when I asked about physiotherapy.
I turn the minister's attention to physiotherapy because it is an example of something that requires more of an emphasis now that he is getting on top of the surgery waiting times. We can
Many people who live with chronic conditions have a number of needs that cross several medical disciplines. At present, they have to be referred to each one individually by their GP. That concerns me, particularly in relation to physiotherapy. If we are talking about preventive medicine and about helping people to help themselves, physiotherapy should play a large part in the provision of care. Is the minister aware that, in Scotland, 64 per cent of physiotherapy graduates cannot get posts? That figure is shocking and I do not completely understand it; perhaps it takes us back to the question of finite resources. We also do not compare well with the United Kingdom figure, which is 53 per cent.
I have many examples to give to the minister later—I do not have time just now—to round out that bald figure and to show where paying more attention to physiotherapy and making better provision would help with hospital care and so on. I see that the minister is nodding. As I said, he is very approachable and I am happy to pay tribute to him for that, as long as he promises me that long-term conditions will not fall behind more dramatic illnesses in the priority scale.
Margo MacDonald will have to let me in on her secret; Andy Kerr has never been approachable as far as I am concerned. Perhaps she could give me some tips because he always sits with his back to me when I am speaking. Maybe he will look at me this time.
I go back to the issue of independent treatment centres and the separation of elective and emergency care, particularly the geographical separation and the policy that is allegedly being used to expand capacity, improve efficiency and all the other things that is being claimed for it. That is a serious question. The policy that is being promoted is quite dangerous, especially when health boards such as Lanarkshire NHS Board suggest the separation of elective and emergency care but acknowledge that there is no evidence, research or proof that it is safe for patients.
In Lanarkshire—which shared with me the research that has come out of England as a result of the policy—the surgeons opposed the geographical separation of elective and emergency care. They are the very surgeons who will be asked to carry out the procedures without the back-up of an intensive care unit or trauma facilities. Surely the minister should be concerned about that. When he is summing up today, will he tell me why the Executive does not already audit what happens to patients in those situations, and why it has no plans to do so? The Executive is prepared to promote a policy of privatisation and independent treatment centres but it does not take account of what happens to patients and it has no research to back up the policy. The question is a serious one and I hope that the minister will address it.
It has been demonstrated that the Golden Jubilee hospital has higher costs. It might have increased the turnover of tasks that it conducts, but costs are still higher and the hospital is still under capacity. There is also the anecdotal evidence of medical secretaries—which I trust implicitly because I know many medical secretaries—that patients are being phoned up and encouraged, or some might say put under pressure, to go to the Golden Jubilee hospital when they do not want to, and then find themselves on an availability status code. That is happening, and I will privately give the minister the evidence if he chooses to take it. I find that extremely worrying. It puts policy and propaganda ahead of what is right for patients.
I am concerned about people being bumped on to an availability status code because they did not attend for an appointment. The people who do not attend for appointments are the poorest, the most vulnerable and those who need the treatment. The policy of bumping such people on to availability status codes perpetuates inequalities.
The minister asked SNP members whether they think it appropriate for people who do not attend for appointments to be put on an availability status code. I do not think that it is appropriate because those are the very people whom we should ensure get the treatment they need when they need it. If they cannot attend for appointments, we should be asking why and giving them the ability to attend.
The member said that people do not attend for their appointments because they are poor and cannot afford to get there. Right across Scotland there is a system of volunteer drivers who take people to hospital if they have difficulties. Why are people not going to appointments when they can be driven to the hospital for free?
That is because there are complex social problems. Volunteer drivers are not the solution to poverty. I would have hoped that a
Where is the choice in what is happening at the Golden Jubilee national hospital? Propaganda and right-wing ideology are being put ahead of patients' interests.
Although he is not in the chamber, I suggest that Jamie Stone does not use medical terminology in his speeches as he cannot quite spit it out. He claimed that his party's policy was health promotion. That must be news to the thousands of health workers who have been involved in health promotion for years. "Lib Dems claim ownership of health promotion"—that stretches the bounds of imagination. It is even more brazen than their claims about council tax and road tolls. How much longer will Labour Party members put up with this from their coalition partners? The Lib Dems have some cheek.
Eleanor Scott's speech was helpful and considered, shedding more light on the debate than any of the other speeches. Alex Johnstone claimed that the Executive's announcements and policies were all about claiming that there is light at the end of the tunnel. There is nothing like a Tory when the Executive is desperately trying to pretend that it is not as in thrall to the private sector as Blair and Patricia Hewitt or that it bears a resemblance to the Labour Party of Bevan. It is great to have a Tory to confirm the socialist analysis of the right-wing trajectory of the Labour Party's health policy. The biggest problem for the Tories in Scotland is that the Labour Party has stolen all their clothes.
Will the SNP explain what it means by choice in its amendment—private or public? Until I know, I will not be able to decide on it.
This has been an interesting but low-key debate, as Alex Johnstone said. Even Opposition members have conceded that there have been significant improvements in waiting times, which is welcome. As Helen Eadie said, it is a proud day—perhaps these are proud times—and the improvement is a notable achievement. I reiterate the thanks that have been paid to the NHS staff for that.
In the previous session of Parliament, my party suggested that the emphasis should change from waiting lists to waiting times. It was important to make that change and it was a necessary precursor to the concentration on waiting times that is now delivering service improvements to patients.
I say in passing to Eleanor Scott, who is not here, that she must remember that waiting lists are
As I said in my opening speech, we welcome the primed direction in health policy for this and next year. The abolition of ASCs is important. The only difference between the parties is the matter of timing. Some members made comments about hidden waiting lists, but it is hard to understand how ASCs can be hidden when there is so much open discussion about them. Paragraph 42 of Audit Scotland's report on waiting times makes it clear that although there was an increase in the number of ASCs, the proportions have remained the same. It continues:
"For example, since December 2003, the proportion of patients assigned an ASC for medical reasons has remained at about one quarter and the proportion of patients who delayed admission for personal reasons or refused an offer of treatment remained at just over one half."
The position on ASCs is clear and is not being hidden in any way, shape or form. However, it is important to say that they are to be abolished in the near future.
Rob Gibson made some important points about the difficulties of delivering health services in rural areas, some of which I recognised from my constituency experience. Of course, behind any general assessment of the position across Scotland there will be exceptions that need to be dealt with. I believe that there are opportunities for better use of facilities, board by board, across the country. For example, I know that there is a possibility of increased use of maternity services at Borders general hospital by people from the southern end of the Lothian NHS Board area. As the minister is prompting me to say, better regional planning will help to deliver important changes that will improve the situation further.
Apart from some glancing references by Margo MacDonald, the question of workforce development has been missing from the debate. We need not only to ensure that there is a supply of skilled people in the future, but to do so in the face of an aging population and a smaller proportion of people in work. Investment in training and a broader career structure, probably across disciplines and in allied services and professions such as social care, will therefore be necessary. That will attract more people into the health
Waiting times are improving progressively and we look forward to the further improvements that are scheduled for 2007. Liberal Democrat members are confident that those will be delivered.
It is not fair to say that MSPs from all parties that are represented in the Parliament are not interested in health simply because they are not here. I imagine that many of them are following the debate intently on their monitors.
The Scottish Conservatives fully applaud the dedication and hard work throughout the NHS in treating more patients in the past 12 months. Many interpretations of selected figures for waiting times have been provided this afternoon, but I would like to quote from the Audit Scotland report, which states:
"The total number of people waiting for inpatient and day case treatment has changed little in the last two years. The number of people without waiting time guarantees has increased and most of these patients have been waiting over six months."
The report goes on to say that the number of patients who are without a guarantee has increased by 6,699 since June 2003, that just over two thirds of those patients have been waiting for more than six months and that 80 per cent have been waiting for more than 18 weeks. It adds that the NHS could get better value from resources that have been invested in tackling waiting times by making greater use of the Golden Jubilee national hospital, which was previously named the Health Care International hospital and—I say for Des McNulty—was built under the Tories to a standard to match that of the Mayo clinic in New York. I commend Des McNulty for his comments, because there is no doubt that the hospital is of great benefit to patients throughout Scotland.
More than 50 per cent of patients who were surveyed for the Audit Scotland report said that they would be willing to go to the Golden Jubilee, but fewer than 5 per cent were offered treatment, as I mentioned to the minister earlier. The minister said that he wanted to empower patients; we fully agree with that, but I say to the minister that instead of his having cosy chats with health board chiefs each month, more action needs to be taken on patient choice. If the minister is looking for a new target, he would do well to consider
I highlight to the minister the many patients whose care and treatment is not included in the waiting times statistics. I give the example of infertility treatment. In Scotland—in Grampian in particular—a person can wait up to four years for treatment. With a cut-off age of 38, many women are age-barred from that treatment while they are on the waiting list. I commend the Executive on its consultation on infertility treatment and care, which closed on 8 December 2005 and I hope that the ministers are positively considering the inclusion of infertility treatment in the waiting times directive. Although infertility is not a life-threatening condition, I am sure that members agree that the wait or the lack of treatment has a serious effect on relationships and individuals.
That is quite incredible because I am the convener of the cross-party group on fertility services and Mark Hamilton is a member of the group. That is a serious issue and I thank the member for bringing it to my attention.
I acknowledge Euan Robson's comment that compared the NHS to the private sector. It was an unusually professional and mature comment from a party that is better known for being critical of the independent sector, so I fully welcome the member's comment.
As Nanette Milne said, some progress has been made because the national figures on waiting times look very good.
Jamie Stone and Rob Gibson spoke about the drastic increase in waiting times when a consultant or key member of staff is off sick, and the time that is taken to fill vacancies. That is a serious issue in many smaller hospitals, particularly in rural areas, and can, as Jamie Stone said, lead to much longer waiting lists, albeit in the short term.
Although Rob Gibson mentioned the finances of the Western Isles NHS Board, I remind him that it is paid significantly higher amounts per person than is the case for Orkney and the Shetland Islands or Argyll and Bute, with its 25 islands.
Although today's debate is welcome, the real challenges in the future are to make quick diagnoses and to provide greater advice and support for self-managed conditions such as asthma and diabetes. More should and could be done in primary care in respect of there being greater emphasis on diabetes, given the predictions on incidence of diabetes.
As regards mental health, too many patients go to the doctor with mild or moderate depression, but whose wait to see a psychiatrist or psychologist often means that their condition is acute by the time they see a professional. I take this opportunity to commend the self-help group Depression Alliance, which supports people throughout Scotland. I say to Carolyn Leckie that that voluntary organisation is exceptional—it allows people to continue in employment while they gain greater understanding of their condition.
I support the Conservative amendment.
I welcome the achievements so far, which have been made possible through a great deal of effort by NHS staff; the minister mentioned a long list of those staff at the beginning of his speech. It would be churlish not to congratulate those staff and the Government on ensuring that it has priorities that we all share in this area. It is important that we achieve shorter waiting times for patients throughout Scotland, so I congratulate the Government on the work that has been done thus far.
On the point that Duncan McNeil made about people whining—I think that is the word he used—I must say that it is right and proper that the Opposition congratulate the people concerned when it is appropriate to do so but that it should also, as Audit Scotland did in its report, point out that, in relation to certain areas, there is a road still to travel to deal with problems and outstanding issues. It is quite right that we have done that. Duncan McNeil's attempt to castigate us for whining—his phrase—is nonsense. We expect nothing better of him, however. [Interruption.]
I have no mobile phone.
Earlier, the minister mentioned that it would be better, quicker and safer to use private providers. That is rather a serious charge and I hope that he will come back to it in his summing-up speech or now—I am happy to accept an intervention on the point. It might be quicker to use private providers, but I do not believe that it is better or safer, which is a serious charge to make against our NHS.
On so-called hidden waiting lists, yes—they are posted on a website. I am not sure that, as Euan Robson said, we would all talk about them if it were not for the fact that Opposition members raise the issue. I am sure that the Executive would not be so keen to talk about them if it was not for the fact that we had mentioned them in the first place. I do not recall a press release about waiting lists for people who do not have guarantees.
Perhaps there have been some press releases about the people on those hidden waiting lists, but I do not recall them.
Euan Robson also claimed that the maximum capacity at the Golden Jubilee national hospital is being used, but the Audit Scotland report says something quite different. It says that more procedures were carried out than were allocated but that, in cardiac surgery, the number of procedures that were carried out was 21 per cent less than the available capacity, in cardiology it was 16 per cent less and in orthopaedic joint surgery it was 13 per cent less. I am not quite sure what Euan Robson was trying to say, but I do not think that the full capacity of the Golden Jubilee is being used. It is dealing with more than its original allocated number of procedures, but capacity is far from being used.
Helen Eadie, who has unfortunately left the chamber, talked about huge increases in activity. That is rather odd, given that the total number of people waiting for inpatient and day-case treatment has changed little in the past two years. I mentioned that earlier in an intervention. Eleanor Scott also mentioned it, as did Audit Scotland's report. Helen Eadie said that extra people were waiting because many new treatments had come on board—the example that she used was hip replacements. I have to point out to Helen Eadie that hip replacements have been around a lot longer than two years and that, therefore, that was rather a strange example to use.
The reason for raising that point is that, although we welcome the extra investment to deliver lower figures, it has not reduced the overall number of people who are waiting. That must be a concern for the Government as well as for others. If we are not reducing the overall number of people who are waiting, we cannot continue to pump in more and more resources. As we know, all resources are finite. Stewart Stevenson's analogy about making a huge effort to move a short distance forward only to fall back again was good.
Alex Johnstone's speech was interesting but I am not sure what planet he is on. I do not know in which country the left-wing has had supremacy in terms of health care ideology since 1997, which Alex Johnstone suggested is the case, but I do not think that it was this country. I am sure that Tony Blair might find that rather offensive to himself and his politics.
Jamie Stone, who is also not here, unfortunately, made an interesting point. He said that, although it is important to improve treatment, it is more important to improve health. That is a fundamental point to keep in mind in all of our health debates. The idea of health inequalities is critical. Although the healthy life expectancy in many of our communities is good, in many other
Duncan McNeil has been barracking from the back of the chamber, as usual. During his speech—when he was supposed to speak—he made a rather bizarre point when he implied that the SNP is not interested in health because our benches were empty. His point would have been better made had there been anyone sitting on the Labour benches around him, but unfortunately the only thing near him was the tumbleweed rushing through the empty seats around him.
Duncan McNeil made a rather more interesting point on cancer care, which Nanette Milne also mentioned, when he gave figures for breast cancer and colorectal cancer waiting times in Inverclyde. We congratulate the staff in that area on their excellent work in ensuring that waiting times are so low—that is fantastic. Unfortunately the figures for colorectal cancer waiting times throughout the country are nowhere near as good as the figures to which Duncan McNeil referred. Just over 50 per cent—
Duncan McNeil does not like it when we point out that it is a fact that the target is being met for only just over 50 per cent of people. The member does not like the facts to come out because the truth spoils his attempts to create a good-news story. We have heard good news today, but we must keep it in proportion and talk about the context—[ Interruption. ]
If a patient has to wait three months in one health board area, but in the neighbouring area the wait is only two months, why cannot the patient be treated in the neighbouring area? That is patient choice.
I begin with the consensual and inclusive approach that I usually bring to debates, by acknowledging the remarks that every member who has spoken from every party has made in acknowledging the performance of our health service and thanking NHS staff.
I want to respond to some of the many issues that have been raised, although I will not be able to cover everything. First, patients want and expect better, safer and quicker access to health care whether it is provided by the private sector, the voluntary sector, the not-for-profit sector or the NHS. That is what we must deliver for patients.
A number of MSPs noted that the Audit Scotland report, "Tackling waiting times in the NHS in Scotland", comments that waiting lists have "changed little". The comment refers to older data; today's figures show that in-patient waiting lists are down by nine per cent and, as Euan Robson said, that out-patient waiting lists are down this year by a staggering 26 per cent—some 60,000 patients have come off the out-patient waiting list.
Stewart Maxwell mentioned the Golden Jubilee national hospital's performance. The purpose of that hospital is to allow us the flexibility that we need to carry out the treatment that patients need. Mr Maxwell quoted figures for orthopaedics and other specialties, but there has been an increase in general surgery. The Audit Scotland document also reports that the GJNH carried out 120 per cent of the ophthalmology procedures that were expected. The hospital allows us the flexibility to meet the patient targets that we set.
On a more substantive point, we need to examine closely the SNP's press release, which refers to
"The fact that almost 40,000 Scots waited more than six months in the year to December 31st 2005 for treatment".
However, at 31 December 2005 only two patients were waiting. Those are the facts, which demonstrate the success of the NHS and that we are delivering what we promised to deliver. Members should remain focused on how we use the numbers, because it is important to recognise the achievements of the NHS and the people who work in the service.
Stewart Stevenson mentioned dental patients. The data that we are discussing indicate that waits of more than 26 weeks for hospital treatment for dental patients were reduced from 5,031 in December 2004 to zero in December 2005.
On productivity and activity in the health service, angiography is up a staggering 12 per cent, angioplasty is up 107 per cent and cataract operations, hip replacements and knee
Of course, we are using the health service differently now. For example, the number of day-case operations and out-patient procedures has increased to the benefit of the patients who require such services.
On a point that was made by Carolyn Leckie, clinical governance arrangements with the private sector, the not-for-profit sector and the independent sector are set by NHS Quality Improvement Scotland to ensure that patients get the services that they desire.
During the debate, someone referred to an article that compared the performance of the NHS in Scotland with that in the rest of the UK. I have to say that I have not read that article, but I make it clear that I, and Parliament, will decide what is best for Scottish patients. We are targeting the three big killers—coronary heart disease, stroke and cancer—and our health service is making a real difference for the patients who suffer from those conditions. Because people are living longer, families are staying together longer. That is the purpose of the NHS in Scotland.
We need only consider some of the statistics. For example, the in-patient and day-case waiting list in Scotland is shorter per head of population than it is in England. Moreover, the number of patients who are waiting six months is lower in Scotland than it is in England. We must take those statistics as they are. We reflect the health policies that Scotland needs and, with the support of the Executive and Parliament, we will deliver the health service the way we want it to be delivered.
The Golden Jubilee national hospital has been mentioned many times. It is not underutilised; since it became part of NHS Scotland it has exceeded its targets year after year. As for the claim that the costs per case at the Golden Jubilee are higher than those at other hospitals, Euan Robson and other members made it clear that, for example, the Golden Jubilee has no emergency admissions and deals with a higher proportion of complex and high-cost procedures, such as hip and knee replacements. Moreover, when we establish the Scottish cardiothoracic centre at the Golden Jubilee, we will be able to bring down overheads and use the facility more effectively for the people of Scotland. With its state-of-the-art operating theatres, the hospital is an excellent facility that is flexible, works really well and provides for patients in our NHS. I advise members to stop having a go at it.
Stewart Stevenson raised e-health. I know that he is interested in that matter, but I do not have the time to go into it at the moment. However, I will be very happy to sit down and give him an insight into the effective policies that we are developing in that respect.
I say to the Green party that we are taking a whole-systems approach in Scotland. For example, the Scottish primary care collaborative is helping to make huge improvements in patient delivery and in working with patients to ensure that we tackle not only long waiting times but issues such as localisation of care and the provision of care as close to home as possible.
Alex Johnstone was right—I, too, wish that more members had been present for the debate. After all, this is a big day for the NHS in Scotland. I was disappointed to find that, on such a significant day for our health service, our own public service broadcaster, the BBC, was not present at the quarterly press conference that I hold. I suppose that, on some occasions, good news is no news.
I would like the Conservative party to clarify its position. In its 2005 manifesto, it said:
"We believe that making a contribution based on the cost of half the equivalent NHS operation both recognises the tax" that people
"have paid towards the NHS" and will further reduce waiting times.
However, the leader of the Conservatives has said that
"the right have spent too much time trying to get people out of the NHS and into the private sector. ... Margaret Thatcher's support for giving tax relief on private medical insurance, and our Patients Passport policy at the last election, were examples of" that. Such an approach is flawed. I am not sure where the Scottish Tories sit, so I would like them to clarify their position in due course.
Jamie Stone raised the key issue of diagnostics. We have set out a clear pathway for delivering on diagnostic wait times. For example, we are making £50 million of resources available and are addressing the training and skills agenda. Again, we are making effective use of the whole-systems approach.
Many members highlighted health improvement. I remind Parliament that the Executive—this Government—is at the cutting edge of world health-improvement strategies. The World Health Organisation and other organisations throughout the world are coming to see what Scotland is doing. Our hungry for success programme, our work in hard-pressed communities, our initiatives on diet and exercise and our mental health
Rob Gibson had a go at people whom he described as being more organisers than service providers. However, Stewart Stevenson then said that we need more information technology and e-health strategies. None of that adds up. We must support the NHS in many different ways. Of course, the e-health strategy and other aspects such as the patient records service do not rely exclusively on doctors and nurses; they also rely on skilled IT professionals. Moreover, as we invest resources in equipment for the NHS, we must remember that that equipment needs to be maintained, supported, installed and so on. All that work requires a labour force.
Rob Gibson also talked about bureaucracy and proposed his party's policy. There is the concept of an individual waiting time guarantee for each patient, which sounds very bureaucratic to me—indeed, it sounds more bureaucratic than any system that operates under the Executive. I am not sure that the patients' rights proposal would deliver any benefits, but it would certainly add to the bureaucratic burden on the NHS.
Margo MacDonald made salient points about chronic conditions. The Long-term Medical Conditions Alliance is working on those matters.
Carolyn Leckie did not provide any evidence to support any of her arguments. I point out to Mary Scanlon that we are working with patients and patient groups to ensure that they are involved in the development of the health service in Scotland.
I briefly return to where I began. This is a very good day for the NHS in Scotland. There has been the best performance ever recorded for in-patient, day-case and out-patient waiting. There are the lowest in-patient, day-case and out-patient waiting lists for many years. Well done to the NHS and to the staff who work in it.