Health Funding

– in the Scottish Parliament at 10:20 am on 13 November 2008.

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Photo of Alasdair Morgan Alasdair Morgan Scottish National Party 10:20, 13 November 2008

The next item of business is a debate on motion S3M-2863, in the name of Cathy Jamieson, on health funding.

Photo of Cathy Jamieson Cathy Jamieson Labour 10:27, 13 November 2008

All members say that they are proud of our national health service and that they want to see it not only survive but thrive. We know that the staff are the NHS's greatest asset. Every one of us has examples of staff members who have gone above and beyond the call of duty because they care passionately about patient care and the principles of the NHS. That loyalty and dedication was demonstrated time and again at last week's Daily Record health awards, which were attended by the ministers and many others, including me.

To do their jobs as they want to do them, NHS staff must be supported with the resources, time and working environment that enable them to put patient care first. However, the reality—in this year when we are celebrating the 60th anniversary of the NHS—is that the Scottish National Party's spending review has resulted in the lowest increase in health spending since devolution. Within that, individual health boards have received an even lower settlement. That would make things difficult enough, but the Scottish Government's additional demand for a 2 per cent efficiency saving means that, in reality, health boards are not just seeking efficiencies but are actively considering cuts. Let us be clear: no one is suggesting that we want any service to be inefficient. Of course we want resources to be focused on patient care. Indeed, NHS staff themselves are often the best people to offer suggestions on how the patient's experience could be improved and how waste could be cut out.

Although the SNP claims that it is providing record levels of health spending, in reality its spending review is providing significantly lower increases than were provided under the previous Administration, and than are currently being provided for the NHS by the United Kingdom Government in England and Wales. As a result, Scotland's historically higher spending per head, compared with England, is now due to narrow from £260 in 2007-08 to £89 by 2010-11. If that trend continues, we will be overtaken by expenditure south of the border by 2013.

Within that expenditure, the allocations to individual health boards have been given an average increase—

Photo of Cathy Jamieson Cathy Jamieson Labour

I will finish this point.

The allocation to individual health boards has on average increased by only 3.2 per cent in cash terms, which is the lowest percentage growth within the health budget, which is set to grow by 3.9 per cent overall. Given a 2.7 per cent provision for inflation, boards have only 0.5 per cent growth for dealing with national priorities. Of course, they face the same issues that confront other parts of the public sector in the current economic situation. Along with the requirement for 2 per cent efficiency savings, it is clear that we are seeing an effect on front-line care.

Before the cabinet secretary retreats behind her usual call of "scaremongering" whenever proper scrutiny reveals things that she does not want to hear, let me just put on record what health boards themselves are saying—

Photo of Cathy Jamieson Cathy Jamieson Labour

No. The cabinet secretary ought to listen to what health boards themselves are saying. An NHS Highland document states:

"There was an acknowledgement that efficiency savings alone would not be sufficient to address the deficit and as such this would mean consideration of issues that were previously thought to be scary or untouchable."

The cabinet secretary will have an opportunity to respond to that later.

Photo of Cathy Jamieson Cathy Jamieson Labour

The cabinet secretary really should hear this—then, I will give way.

NHS Dumfries and Galloway reported that savings are necessary to deal with costs that have risen beyond budget levels in order to "maintain long-term stability", rather than to reinvest in front-line services.

NHS Ayrshire and Arran told us that its external auditor has highlighted the deliverability of the 2 per cent saving each year as a high-risk assessment. Although the board has made some savings in administrative services, savings in front-line services are around 1 per cent. The strategy of relying on administrative savings in the future was described as "doubtful".

NHS Tayside reported a high risk of failure to achieve cost-reduction targets.

NHS Forth Valley is making savings of £30m over a three-year period that

"will impact on direct patient services and on staffing levels".

NHS Shetland reported that it is reviewing nurse numbers, cancer care services and mental health funding in order to try to generate budget savings.

Only this week, we have received reports from NHS Grampian that show that it faces a requirement to save £26.2 million this year and a further £24 million in efficiency savings over the next two years. The board describes those pressures as arising from

"a relatively low level of uplift in our core funding allocation, and at the same time absorbing increases in pay costs, capital charges, drugs costs, and providing funding to enable service re-design."

In order to implement that, NHS Grampian is now instructing every department to cut 5 per cent. Those are not backroom savings or administrative savings but savings that will have an impact on front-line services, which is unacceptable.

Perhaps the cabinet secretary will respond to those points.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I have a simple question for Cathy Jamieson. When Jack McConnell said before the election that every penny of additional resources would go to education and that health would have to "cut its cloth", what exactly did he mean?

Photo of Cathy Jamieson Cathy Jamieson Labour

I am surprised that the cabinet secretary has completely ignored the serious points that I have raised. She must understand that, if she wishes to be in government, she must take responsibility for what is happening on her watch rather than constantly hark back to the past. It is important that the cabinet secretary and the Scottish Government move away from what is becoming their hallmark—complacency. They do not listen to what people are saying, refuse to listen to how their policies are affecting people on the front line, refuse to accept that proper scrutiny involves highlighting concerns on which they must act and refuse to accept any responsibility for what is happening on their watch.

Other members will cover a wide range of issues about the impact on front-line services but, in summary, the reports that we have received from health boards make it clear that the efficiency savings will have an impact by cutting staff and services for our most vulnerable people.

I ask the cabinet secretary to agree to look at the situation urgently, to review the situation in all health board areas and to ensure that there are no cuts that will adversely affect the ability of our NHS staff to do their jobs. There must be no cuts that impact directly on patient care.

I move,

That the Parliament condemns the emerging cuts to frontline services in Scotland's health service as a direct result of the SNP's budget settlement, which provides the NHS with its lowest spending increase since devolution; notes with concern that NHS boards across Scotland are facing extreme financial pressure as evidenced by the comments of NHS Highland that it needs to find savings that "would mean consideration of issues that were previously thought to be scary or untouchable"; further notes that NHS Shetland is reviewing the number of nurses, cancer care services and mental health funding to generate budget savings and that the Director of Finance and Planning at NHS Forth Valley has reported that the size of the savings required "will impact on direct patient services and on staffing levels", and therefore calls on the Scottish Government to take urgent action to ensure that NHS boards receive sufficient funding in order that they are not forced to consider cuts to frontline services.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 10:35, 13 November 2008

Today I want to address the facts, the dishonesty of Labour's position, Labour's complete lack of credibility, and the fact that Labour spectacularly misses the point.

First—the facts. Fact number 1 is that the NHS has considerably more money to spend now than it ever did under Labour. Over this year, and over the next two years, health board allocations will increase by £1.5 billion, even before we take into account additional funding for cutting waiting times, for tackling alcohol misuse and for other key national priorities.

Fact number 2 is that within the tightest budget settlement since devolution, health gets its fair share. Average increases of 4.2 per cent over the next three years are in line with overall budget increases.

Fact number 3 is that health under this SNP Government has precisely the same share of total Government spending as it did under the previous Labour Government. The budget that I inherited from Labour gave health 33.7 per cent of the total. At the end of the current comprehensive spending review period, the health budget will be 33.7 per cent of the total. If Labour's point this morning was that the total cake is not big enough, we might have found a point of agreement. However, I suggest that Labour members direct their complaints to their friends in London who decide the size of the cake, and that they join this Government in demanding a fair deal for Scotland.

Fact number 4 is that efficiency savings that are reinvested in front-line patient care are not "cuts". They are, in the words of Jack McConnell when, as First Minister, he first set a public sector efficiency target,

"sensible" and

"for the good of public services."

Those were the hard facts.

Let us now consider the dishonesty of Labour's position. Perhaps unsurprisingly, it ignores two key facts that Labour desperately wants to forget but that everyone else clearly remembers. First, the 2 per cent efficiency savings that Labour complains about today, and derides as "cuts", would have been 3 per cent efficiency savings if Wendy Alexander, Labour's former leader, had had her way.

Photo of Richard Simpson Richard Simpson Labour

Will Ms Sturgeon give way on that point?

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

I am sorry, is this a point of order, Dr Simpson?

Photo of Richard Simpson Richard Simpson Labour

On a point of order. Is it appropriate for Nicola Sturgeon to say that Cathy Jamieson did not take an intervention when she did?

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Would Dr Simpson sit down? I am not responsible for what members say, by and large.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I made a mistake about Cathy Jamieson and was therefore allowing Richard Simpson to make an intervention. I am sorry that he refused to take the opportunity.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

No, I want to go on to the second key fact that Labour wants to ignore. The 4.2 per cent annual increases in the health budget that Labour now derides as being too small would have been 0 per cent if Labour had been in charge. Let us remind ourselves of what Jack McConnell said before the election. He said:

"The additional resources— including efficiency savings—

"will be committed to education. That will mean other budgets having to cut their cloth".

In other words, the health budget would have been cut under Labour.

What did Wendy Alexander and Jack McConnell have in common? Oh, yes—they both had Cathy Jamieson as their deputy leader.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

For Cathy Jamieson to stand here today and criticise the budget that has been set by this Scottish Government, when the policies that she supported would have led to swingeing cuts in the NHS, is rank hypocrisy.

Labour's position is wrong on the facts, it is dishonest and it lacks credibility. This Parliament has a fixed budget; that fact is not of our choosing, but of Labour's choosing. If Labour members want to argue now for more money for health, then they have some tough choices to make elsewhere. I will take Cathy Jamieson seriously when I hear her tell Rhona Brankin, who wants more money for education, not just that she cannot have it but that she will have to take a cut. I will take her seriously when she says that to all Labour members who ask for more money for this, that or the other every time they open their mouths. Until that happens, Cathy Jamieson and the Labour Party simply do not deserve a hearing on this issue.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

No.

Perhaps the worst thing about Labour's position is that it completely misses the point. What this Government puts into the NHS stands scrutiny by anyone. However, it is what comes out that matters; it is what the NHS delivers that counts.

I will close by reminding Parliament of just some of the improvements that we have seen in the NHS since the SNP took office—by reminding Parliament of what is happening on my watch, to use Cathy Jamieson's word: two major accident and emergency departments; four children's cancer hospitals; and four neurosurgery units. Maternity services at Vale of Leven hospital and Inverclyde royal hospital—which were facing the axe as a result of Labour cuts—are now safe with the SNP. A total of 5,000 more staff are working in our NHS, waiting times are at a record low and prescription charges are down and on the way out. The largest hospital in the history of the NHS has been built in the public sector without the use of the private finance initiative, and car parking charges, introduced by Labour, have been abolished by the SNP.

Those are but a few of the many achievements of this Government and the fantastic people who work in our NHS, and just a few of the reasons why Labour is no longer trusted on the NHS, and why the NHS is safe in the SNP's hands.

I move amendment S3M-2863.1, to leave out from "condemns" to end and insert:

"notes that the Scottish Government's spending plans are set against the background of the 2007 spending review settlement from the UK Treasury that represents the lowest increase for Scotland since devolution; recognises that the NHS has received a fair share of the financial settlement and that the Scottish Government is increasing spending on health in Scotland; further recognises that in this context it is right that the NHS should strive to make sure that resources are spent as efficiently as possible; commends the NHS's record in achieving efficiency savings linked to good quality care; welcomes the Scottish Government's decision to continue the practice whereby all efficiency savings generated by the NHS will be retained by the NHS for local reinvestment in frontline services, and condemns the Labour Party, which instituted efficiency savings while in government but has irresponsibly attacked them in opposition."

Photo of Cathie Craigie Cathie Craigie Labour

On a point of order. I understand that the Presiding Officer has no remit over the ministerial code of conduct, but I ask that the cabinet secretary carefully look at the Official Report of today's meeting and consider her position under the code of conduct.

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

That is not a point of order, and I strongly counsel other members against attempting to make similar interventions.

Photo of Mary Scanlon Mary Scanlon Conservative 10:42, 13 November 2008

Following the Punch and Judy show, we can now move to calm reflection from the Scottish Conservatives.

We welcome this debate on health spending, and I make no apology for focusing on NHS Highland. There is no single reason—or, indeed, excuse—for the financial pressures that the board faces. The reasons include NHS Scotland resource allocation committee funding, the inclusion of part of NHS Argyll and Clyde, pay rises, and increased fuel costs and other costs. I could go on. On current projections, the savings, or "cuts", of £36.6 million that are required over four years, have led the board to consider what were previously considered to be, as Cathy Jamieson said, "scary and untouchable" cuts.

Redundancies, freezing recruitment, and reductions in emergency admissions are but three of the 39 measures that have been suggested by NHS Highland in order to balance its budget. I would like to consider the background to that more closely.

When NHS Highland took over the Argyll part of the previous Argyll and Clyde NHS Board, the financial fault lines that had led to the previous board's large financial deficit were not fully known. What was known was that the funding per person in Argyll was £80 less per annum than the figure for Highland, despite Argyll's many remote islands. I want to ask the Cabinet Secretary for Health and Wellbeing whether she will examine the resources that are given to NHS Highland and consider whether the board has inherited responsibility for the provision of NHS services without being given sufficient resources.

NHS Highland is responsible for an area that covers 41 per cent of the Scottish land mass, including 30 islands. The restructuring that was brought about by the previous Government's intervention has led the board to conclude that

"the challenges and risks faced by NHS Highland were unprecedented", even by NHS standards. The travel and communication issues of island communities and areas of supersparsity link with fragile economies to produce particular challenges for delivery of NHS services. I remind the cabinet secretary that that point was often raised by the SNP MSP Duncan Hamilton in the first session of Parliament.

Highland also faces significant consultant travel time and costs: out-of-hours services in Highland are five times more costly than those in urban areas, and specialist peripheral outpatient clinics and other facilities are required to provide NHS services.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I acknowledge the points that Mary Scanlon makes, although I remind her that NHS Highland is represented on the NHS Scotland national resource allocation committee working group and the points can be raised there. In return, will she acknowledge that, during the current year and the next two years, NHS Highland will get an additional £86 million in its budget?

Photo of Mary Scanlon Mary Scanlon Conservative

It will get an additional £86 million, but it is certainly facing "scary" cuts. It is important that we reflect calmly on the matter and consider the background. I think I am doing that responsibly.

If it is fully implemented, the NRAC formula, which is the replacement for the Arbuthnott formula, will lead to £21 million of cuts. I understand and welcome the fact that the NRAC formula is constantly under review, as the cabinet secretary said, but the fact remains that NHS Highland is facing £21 million of cuts, and that will remain so until the formula changes. NRAC, which was set up by the previous Administration and is accepted by the SNP Government, has led to an excess cost adjustment based on changes around hospitals and not on community data. It fails to take into account the remote, rural and island issues in health provision.

We support the reallocation of efficiency savings to front-line services. On recent visits to Orkney and the Western Isles, I was impressed by the joint working on asset and estate management, human resource management, maintenance and payroll systems. However, I ask the Government to encourage boards to introduce more integrated working, because economies of scale have the benefits of leading to greater efficiencies and reducing the need to cut front-line services.

My final point would also lead to savings for the taxpayer, NHS staff and patients. I mentioned it last week and I do not apologise for mentioning it again. Personnel departments should do much more to manage staff who are sitting at home for months and years and get them back into work.

We are minded to support the Government's amendment, but we will reserve judgment until we have heard the SNP's contributions to the debate. We cannot support the Labour motion because the Labour Party must take some responsibility for the NRAC cuts, for the dissolution of NHS Argyll and Clyde, and for the closure of accident and emergency departments.

Photo of Ross Finnie Ross Finnie Liberal Democrat 10:47, 13 November 2008

I am sure that, even after the time for which we have been on our feet, there are patients out there somewhere whose care we must be concerned about.

The Liberal Democrats find this debate a slightly strange one in some ways. There are issues about where within the health budget one ensures that front-line services are secured, and there are points in the Labour motion that must be addressed, but I say to Cathy Jamieson that if we have learned anything in the past five weeks it is that growth has come to an end. Indeed, we were in error to believe that growth would go on for ever. The idea that, somehow, there is a pot of money that can be endlessly tapped for public expenditure is not one that I would wish to pursue. On the other hand, I say to Nicola Sturgeon that, although she is right to say that the Government is spending more money, the central issue is whether front-line services are being protected.

The Liberal Democrats fundamentally disagree with the simple statement that the principle of having an NHS Scotland resource allocation committee formula is wrong. Members are entitled to go to NRAC and have explained to them what the formula is and what it means. Under the NRAC formula, there will be winners and losers because it reflects the rurality of areas, deprivation, and other indices. We cannot simply have everyone getting the same. If one objects to the fact that those factors are taken into account, that is a matter of principle, but I do not think that criticising the NRAC or Arbuthnott formulas in principle is sustainable in dealing with front-line services.

Photo of Mary Scanlon Mary Scanlon Conservative

I do not object to the use of a formula, be it Arbuthnott's or NRAC's. What I object to is the fact that the NRAC formula does not take into account remoteness and rurality, community data, or supersparsity. That is reflected in lower settlements for certain areas.

Photo of Ross Finnie Ross Finnie Liberal Democrat

My point is exactly that that is not what NRAC said when it gave evidence to the Health and Sport Committee on the way in which the formula works.

The fundamental issue is the conundrum that is before us this morning. The Cabinet Secretary for Health and Wellbeing appeared before the Health and Sport Committee on 29 October. I refer to columns 1207 and 1209 of the Official Report. At that meeting, she was pressed—indeed, I was one of those who pressed her—on the rate of inflation that health boards are experiencing, but she did not provide a figure. Having narrated the various pressures and stated that some of them are difficult, she concluded that the health boards are managing them. She went on to deal with efficiency savings, reporting not just that the health boards are achieving the planned savings but that they are likely to exceed them by £60 million, taking the savings to £277.08 million. As she did this morning, she made the point that the efficiency savings are reallocated to front-line patient care. That is fair enough.

The clear inference to be drawn is that front-line services are not affected when boards make and apply the savings. If that is the case, however, the cabinet secretary or the Government must address at some point in the debate the fundamental points in the Labour motion about what NHS Highland, NHS Shetland and NHS Forth Valley are saying. With all due respect, their claims that they are being badly affected do not square with what the cabinet secretary says. I take what she says in good faith, but it is of concern that, in the current, difficult circumstances, health boards that are responsible for delivering care to individual patients are not satisfied.

The Parliament is entitled to ask the Government how it squares the two positions, because there is a clear gap between them. We need an answer. Like Mary Scanlon, I will be interested to hear how the Government squares the two positions, which at present seem irreconcilable.

Photo of Jackie Baillie Jackie Baillie Labour 10:52, 13 November 2008

In the short time that is available to me, I will deal with the assertions in the SNP amendment. The politics of assertion that is practised by the Cabinet Secretary for Health and Wellbeing is no match for facts and evidence. Her statements hide a very different picture.

The SNP's first assertion is:

"the NHS has received a fair share of the financial settlement and ... the Scottish Government is increasing spending on health in Scotland".

Now for the real facts as opposed to Nicola Sturgeon's spin. The Scottish budget is rising by 1.8 per cent in real terms, but the SNP's allocation to health boards is only 0.5 per cent, so the SNP has chosen to spend less. This, at a time when spending is rising at a higher rate south of the border. Allocations to individual health boards are also poor, at only 3.2 per cent, and with inflation outstripping the provision of 2.7 per cent, there are real pressures.

Indeed, the rate of increase in funding for the NHS in Scotland is so low that we need to go back to the days of Michael Forsyth in the Scottish Office to witness anything comparable. I seem to recall that his nickname was Scissorhands, because of the cuts over which he presided.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Overall spending is low as well, and responsibility for that lies elsewhere. I assume that Jackie Baillie does not really misunderstand health spending, so I have to conclude that she is being disingenuous. Will she confirm that, over and above the basic health board allocations that she mentioned, significant additional resources—from the money that is retained by the health department centrally—are allocated to health boards for key priorities? She should be accurate in what she says in the chamber.

Photo of Jackie Baillie Jackie Baillie Labour

That was more of a speech than an intervention. I point out to Nicola Sturgeon that I expect her, as the minister in office 18 months on, to reflect the circumstances and the economic climate that is causing the problems that health boards are experiencing.

I move on to SNP assertions two and three. The amendment proposes that we commend

"the NHS's record in achieving efficiency savings linked to good quality care".

On the face of it, who could disagree with that? However, freedom of information requests to health boards throughout the country show that cuts are being proposed to front-line services.

In my area, NHS Greater Glasgow and Clyde is making £42 million of cuts this year and £72 million next year. These real, tangible cuts are not just about reducing red tape; they will affect out-of-hours services, physical disability services and learning disability services. The board's finance director, Douglas Griffin, claims that drastic measures are needed because the funding provided by the SNP Government is "significantly lower" than it has been in previous years. Moreover, as Mary Scanlon pointed out, NHS Highland is talking about making painful spending cuts, including considering options that were once regarded as "scary or untouchable" because

"efficiency savings alone would not be sufficient to address the deficit".

We have to stop talking about efficiencies; these are cuts that will happen to services in my area. In order to deliver savings beyond their efficiency targets, boards are cutting front-line services. The SNP's assertion that giving the NHS the ability to retain its 2 per cent efficiency savings is somehow doing it a favour is on the one hand laughable and on the other stunningly complacent. These are real cuts to real services and they affect real people. I am also disturbed to find growing evidence that capital savings are being used to underpin revenue. Such an approach only stores up problems for the future.

Finally I want to nail the SNP's defence that, because the previous Government instituted efficiency savings, they are not necessarily a bad thing. A 1 per cent efficiency saving—half the amount demanded by the SNP—in the context of considerably higher year-on-year funding increases to health boards is simply not comparable to the current situation. At that time, services were growing; in the current economic climate, they are being cut. The cabinet secretary is in the driving seat. She cannot deflect blame on to others. She has the power to ease the problems faced by the NHS in Scotland and I ask her to consider suspending these efficiency savings. If she does not, one can conclude only that the legacy of Michael "Scissorhands" Forsyth is alive and well in the corridors of St Andrew's house.

Photo of Stuart McMillan Stuart McMillan Scottish National Party 10:56, 13 November 2008

The speeches so far have been, to say the least, interesting and robust. I did not expect anything less.

With its scaremongering and attempts to strike fear into the hearts of the Scottish public, new Labour's motion is a typical example of its negativity. If the public listen to its nonsense, they will think that Scotland is some third-world country, constantly in-fighting, and that we are too small, too stupid and too insignificant. I know that Scotland is not too small, stupid or insignificant to matter and that it is moving forward with an SNP Government.

Some of the SNP Government actions that deserve welcome include record health board funding, which will rise to £11.5 billion in this spending round; the approval of a new southern general hospital, which will be built not through public-private partnerships or PFI but with £842 million of public investment; an extra £40 million for free personal care, a policy that was short-funded by the previous new Labour and Liberal Democrat Executive; and the policy of reinvesting 2 per cent efficiency savings in the NHS and not, as new Labour promised during the 2007 election campaign, transferring them to other budgets.

Photo of Duncan McNeil Duncan McNeil Labour

Does the member not agree that the cuts being made by NHS Greater Glasgow and Clyde, which amount to £42 million this year and £72 million next year, will have a devastating effect on front-line services? Will he join me in making representations to the Cabinet Secretary for Health and Wellbeing for a review of the situation?

Photo of Stuart McMillan Stuart McMillan Scottish National Party

What I will say is that, compared with what happened under the previous Labour and Liberal Democrat Executive's cuts agenda, the NHS is moving forward under the SNP Government. I could highlight many more positives for the NHS in Scotland under this Government—indeed, the cabinet secretary did so earlier—and long may the situation continue.

If new Labour had been in power, its cuts agenda would have amounted to £771 million, which is 50 per cent higher than the sum that will be achieved by the SNP's efficiency savings. Although the SNP Government has been accused of being draconian in introducing 2 per cent efficiency savings, I point out that, in May 2007, Wendy Alexander criticised the SNP for lacking ambition in not insisting on the 3 per cent efficiency savings that she and new Labour wanted and that were in line with the United Kingdom Government's policy.

I commend the SNP Government on certain actions over the past 18 months. First, I say well done for scrapping car parking charges at NHS hospitals. That tax on the sick was introduced on the previous new Labour and Liberal Democrat Executive's watch. I also say well done for keeping open Monklands and Ayr hospitals' A and E units, which had been threatened with closure by the new Labour—

Photo of Pauline McNeill Pauline McNeill Labour

On a point of order, Presiding Officer. The member cannot continue to misname the Scottish Labour Party as new Labour. Surely we are entitled to our proper title in this chamber.

Photo of Trish Godman Trish Godman Labour

That is not a point of order.

Photo of Stuart McMillan Stuart McMillan Scottish National Party

Branding is everything.

Finally, I say well done to the Government for instigating the independent scrutiny panels that recommended that the community maternity units at Inverclyde Royal hospital and the Vale of Leven hospital be kept open. Consultant services that were cut on the watch of the previous new Labour and Liberal Democrat Executive have been secured under this SNP Government.

While we remain part of the union, Scottish Administrations will continue to receive the block grant. Last year was no different—apart from the fact that the money came a couple of months late, which had a knock-on effect for public services. When we received the grant, inflation stood at 2.7 per cent; it is now a massive 5.1 per cent. That will have an effect on public bodies and the best thing that they can do is to manage their resources as effectively and efficiently as possible to get through a financial mess that has been aided and abetted by the UK Government.

Given that the Scottish Government has limited financial powers and no power whatever to deal with inflation, any increase in spending in one department will mean taking resources from another budget. Until such time as Scotland gets the powers to deal with its economy and does not have to rely on the whims and mismanagement of London governments, we will always find ourselves in a restricted position.

As I said, the motion is typical scaremongering nonsense from the Opposition and I urge the chamber to reject it this afternoon.

Photo of Rhoda Grant Rhoda Grant Labour 11:01, 13 November 2008

This debate is extremely important. After all, we must remember that health cuts will affect every one of our constituents. We thought, for example, that we had seen the last of long waiting lists, but I fear that that is not the case. That is not scaremongering—it is fact.

What good is it for someone to have a free car parking place if they cannot get a hip replacement? Their free prescription might cover the cost of their pain-killers, but they will not get their life back. What good is being able to vote in health board elections if a person cannot access health services? I am not criticising those initiatives; they have been popular and, if they were affordable, I would welcome them whole-heartedly. However, it is difficult to welcome the icing when there is no cake.

Photo of Shona Robison Shona Robison Scottish National Party

Will the member explain why, despite her comments, NHS Highland's chairman Garry Coutts has said that the savings

"will not affect outcomes for patients. Patients might see the way that they get services is different, but waiting times are going to come down, cancer waits are going to come down, the length of time you wait for a consultant is going to come down"?

How does that comment square with Rhoda Grant's scaremongering?

Photo of Rhoda Grant Rhoda Grant Labour

Although I have some confidence in NHS Highland's attempts to mitigate the effects of these budget cuts, I do not think that it will be able to mitigate them in full. Indeed, that is why it is talking about looking at "scary or untouchable" areas. The minister should consider those comments as well.

Given that resources in this area are scarce—we have been told just how scarce they are—it seems ludicrous to spend valuable money on measures that deliver no health benefits. Since the implementation of the NRAC formula, rural health boards have lost out in the allocations that have been made. We are not criticising the need for a formula; however, when the Health and Sport Committee took evidence on the resource allocations, it became very clear that the formula being used was damaged, because the data on which it was based had no bearing in reality. For example, as Mary Scanlon pointed out, the cost of the out-of-hours GP contract shows that it is much more expensive to deliver rural health services, but the Government has ignored that information.

Health service staff are happy to be efficient, want to make changes and want to work hard to find savings. However, they want the savings that they are being asked to identify to be put back into patient care. If working harder and making savings do not improve such care and instead have a huge impact on morale, where is the greater good? NHS Highland is looking at having to make £36.6 million in savings, and it has said that it is not able to do so.

Photo of Rhoda Grant Rhoda Grant Labour

No—I am running out of time and have a lot to cover.

NHS Shetland has reported that it is reviewing the number of nurses, cancer care services and mental health funding to find savings. Patients in Shetland have to travel far enough to access specialist care and any cuts that their board has to make will only disadvantage them further.

In its election manifesto, the SNP promised a major expansion of the health service, which was to be funded by efficiency savings in bureaucracy and backroom functions. The released resources were to be invested in front-line services. However, that has not happened. Indeed, the Scottish Government has written to NHS Shetland to ask it to deliver the financial outcomes that are included in its plan by holding a clinical review assessment as opposed to a backroom review assessment. We are talking about clinical services and front-line patient care.

No matter how the Government tries to dress things up, NHS Highland has had to revise its budgets because it has less money than it expected to receive from the previous Executive. NHS Shetland is considering the services that it delivers and the number of nurses that it employs. So much for investing in front-line services. The Government needs to act now and give patients access to health services that they deserve.

Photo of Keith Brown Keith Brown Scottish National Party 11:05, 13 November 2008

It has become quite fashionable of late for certain politicians to talk about serious times requiring serious people and serious policies, but Labour's—or should I say new Labour's—motion for this debate, unlike its motion for the previous debate, is shot through with inconsistency, hypocrisy and doublethink. It is anything but a serious attempt to question health budgets. At its root, it seeks to put forward a case that health budgets are being cut and that the Labour Party would do something different if it were still in office. Neither proposition stands reasonable scrutiny.

The best antidote to cant and posturing is the application of hard facts, although I realise that for the new Labour Party at least, the facts are difficult. First, Cathy Jamieson's motion refers to the

"lowest spending increase since devolution", but it pointedly avoids referring to the fact that the health settlement was made in the context of the lowest spending increase to the Scottish Government under devolution. That is a relevant point. If new Labour is to treat the issue seriously, it should recognise that the massive cut in the Scottish budget's rate of growth has an impact on health funding. It cannot then reasonably complain that separate budget heads are not increasing enough; that is simply not a serious point to make.

Perhaps that awkward fact could be overcome if new Labour—which, I presume, would have received the same settlement if it had clung to power last May—said that it would have cut other budgets in order to grow the health budget by more than the cabinet secretary has done, but we know that Labour would have sacrificed all other budgets in order to boost education. That is a legitimate aspiration, but it is not legitimate to pretend that it would not have impacted on the health budget. Aside from favouring education over health, Labour would have increased the efficiency savings that the Scottish Government asked of health boards by 50 per cent—that is Wendy Alexander's position and no Labour member has yet acknowledged it—and then turned those savings into cuts by taking them from health budgets and putting them into education.

That takes us to the crucial issue of efficiency savings versus cuts. Anyone who had to contend with the Labour-Liberal efficiency savings that were imposed on Scottish local government during the long, dark years from 1997 to 2007 is well able to tell the difference between efficiency savings that are redirected into the services that produce them and new Labour cuts that involve taking money from those services—as it was taken from local government—and redirecting it to other priorities.

Photo of Cathy Jamieson Cathy Jamieson Labour

Does the member want to consider the facts as reported by Forth Valley NHS Board? It has said that, to balance the books, it must review children's and women's services in this financial year. It is talking about cutting resource transfers to councils in 2009-10, and schemes worth £48 million will be under review. Surely that is a fact and surely the member is concerned about it.

Photo of Keith Brown Keith Brown Scottish National Party

I met Forth Valley NHS Board recently. It has given no indication that the efficiency savings that it is currently making are any different from what Labour previously proposed. In fact, it will get an extra £17 million over the three-year period.

Arguments are reinforced by relevant examples. I cite as an example of a cut rather than an efficiency saving the Labour Party's recent scandalous decision in Clackmannanshire Council to cut school crossing patrols. That service will not come back; the money will not go back into it.

It is a depressing fact that Labour knows that it is not being serious. It knows that comparisons with England are false because of the fiddling with projections and actual spend to cut Scottish funding in the first place. It did not raise an ounce of protest about that. It was not concerned about the cut to the Scottish Government's budget. It knows that, given the choice, it would take money out of health budgets and it is well aware that the health budget was agreed following the stingiest-ever settlement from London. The fact that Labour did not oppose the Scottish Government's health budget is more depressing still. We all recall Labour's fantastically assertive and decisive leadership when it decided to boldly abstain—I am sorry for the split infinitive—on the budget last year.

It is apparent to everybody that there is no real principle, far less substance, in new Labour's motion. Such can be the stuff of opposition politics—that is fair enough—but the motion has nothing to do with a sincere and sustained commitment to higher health budgets.

I am not entirely sure what the Liberal Democrats' position is. However, if they want increased health funding, that will have to be added to the growing list of things for which they want to increase funding and must be seen in the light of the £800 million of savings that their tax-cutting programme would introduce.

In conclusion, Labour politicians should listen to one of their own. These are serious times that call for serious people making serious proposals. Labour politicians misread the public's willingness to put up with puerile posturing at a time of rising economic distress. I am sure that Labour will not withdraw its stupid motion, but perhaps Labour members will think a bit more seriously before they submit another one like it.

Photo of Malcolm Chisholm Malcolm Chisholm Labour 11:10, 13 November 2008

The cabinet secretary made a typically robust defence of her budget, and I am sure that her debating skills and other qualities will win her the top award tonight. I am equally sure that she would have argued for more money for health at the time of the spending review and that she would have been disappointed not to have received it.

Her main defence was that the percentage increase for health was the same as that for the Scottish budget as a whole and that the percentage of the total budget that is going to health will remain constant over the spending review period. However, at a time when the overall budget is not increasing as fast as it has done in the past, there is a strong argument for increasing the percentage of money that goes to health. I will give an example. A year or two ago, if there was a 6 per cent overall increase in the Scottish budget, a 6 per cent increase in health funding would have covered health inflation plus a bit more, but if the overall increase in the Scottish budget is roughly 4 per cent, a 4 per cent increase in health funding as a whole will not cover health inflation and a bit more.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Malcolm Chisholm makes the legitimate argument that in days of smaller increases, we could choose to increase a particular budget disproportionately. To follow the logic of his argument, I presume that he is saying that we should have done that for health. Will he complete his argument by saying which budgets under the Scottish Government's control he would have cut to pay for that increase?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I will talk about that. I am not arguing for a massive increase in health funding; rather, a small increase could be made by finding more money from somewhere else and perhaps also by postponing the abolition of prescription charges. I support the abolition of prescription charges, but the cabinet secretary should at least consider postponing that in a time in which there is pressure on the health budget.

Members probably know the general facts about health inflation and how drugs, demography and so on affect it, so I will not go into that. However, health inflation and other factors mean that a 3.2 per cent funding increase is presenting boards with great difficulties. The cabinet secretary was lucky to inherit a strong financial position for the health service and, indeed, a strong health service in other ways—for example, the problem of non-recurring budgets had almost been stripped out of the system. Therefore, she had a strong start, but seven months into the new spending review period, she must listen to what boards are saying and respond in some way. I am not saying that she is or would be able to find large sums of money, but she should, in deciding the budget for next year, argue with her colleagues that a little more or some more money should be found for health, perhaps from another budget or by postponing the abolition of prescription charges.

Photo of Alasdair Allan Alasdair Allan Scottish National Party

Will the member confirm to the many patients who have benefited from the reduction in prescription charges that the Labour group's policy is that the proposed measure should be postponed and they should wait longer? Is the member speaking in a personal capacity or for the Labour group?

Photo of Malcolm Chisholm Malcolm Chisholm Labour

I am a back bencher now, so everything that I say can be taken as being said in a personal capacity. I responded to the point that the cabinet secretary made. She should consider other budgets—I am not putting things any more strongly than that—because she must respond in some way to what health boards are saying. The whole point of the debate is to put on the record what various health boards in Scotland are saying about the difficulties that they are facing seven months into the spending review period. We have two years and five months more of similar increases. The problem must be addressed.

I will make two final points. The big picture is not the total amount of health spending, but how that money is being spent. The general direction of health policy is to spend more money on community-based services. We need to try to track that money and ensure that more money in the budget is going in that direction. I was concerned that Audit Scotland's "Overview of Scotland's health and NHS performance in 2006/07" stated that there is no evidence of that shift taking place.

Today, we are talking about health budgets, but we must also monitor closely what is happening in local authority budgets. I will not go back over the debate about ring fencing, although I have concerns about that, for example on the abolition of the mental-health-specific grant. We must monitor closely the single outcome agreements and what happens to health-related spend in local authority budgets.

Photo of Jamie Stone Jamie Stone Liberal Democrat 11:15, 13 November 2008

I usually start such speeches by saying that the debate has been consensual, but that would not be true today. Nice guy that I am, I find myself amidst the storms on either side of me.

Cathy Jamieson laid out her case pretty well. She rightly gave the NHS staff their proper place—they are our greatest asset. The fact is that we have one of the lowest increases in health spending since devolution. That is set against the fact that, as Ross Finnie pointed out, growth is no longer an option because of inflation and rising costs, to which Mary Scanlon referred, such as wages and fuel. The trouble is that the inflation graph may not even be a straight line—the increase could be accelerating. That would bedevil any Government's figures.

I am afraid that it is a fact that the health spending increase here is lower than that in the rest of the UK—we can substantiate that. Cathy Jamieson rightly referred to the situation in Highland NHS Board, which Mary Scanlon fleshed out. The chairman of the board has said that there is a £21 million cut and that the board may consider reducing emergency admissions. The fact that such comments have been put on the record by the chairman of the health board should surely concern each and every member who cares about front-line services. Mary Scanlon made two useful points. The first was about the Argyll pig in a poke. We do not know what price came with Argyll when it was added to Highland NHS Board, but that must be examined. I politely request the cabinet secretary to consider that, because it might be bedevilling the board's figures. Mary Scanlon's second important point was about people who are not working and staying in their houses when they could be put to work. That is an issue for personnel and it should be examined.

Nicola Sturgeon, who I am sure has a high chance of winning a prize at tonight's politician of the year dinner, put her case eloquently and well, as one would expect. Her rebuttal was about the increases in money and about Scotland not having a fair deal. We have allegation and counter-allegation. However, when anyone says that there is more money in the budget, that must be measured against inflation and rising costs. There might be an increase in pounds and pennies, but not in the trend of spending.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

My question is genuine and is not simply to make a party-political point, as I do not know the answer. Will the member explain what impact the Liberal proposal to take £800 million out of the budget to pay for tax cuts would have on NHS budgets?

Photo of Jamie Stone Jamie Stone Liberal Democrat

No, I will not, because I am not here to discuss that. I am here to try to get the Scottish Government to accept that health boards out there are saying those things and that there really is a threat to patients. That is what we are talking about—the debate is not about hypothetical spending; it is about patients getting the services that they deserve. The Scottish Government must acknowledge that the issue is very serious.

When Jackie Baillie mentioned Michael Forsyth, it was as if Banquo's ghost had entered the chamber. He is almost unmentionable. One of Jackie Baillie's points has not been dealt with by other members, so I ask the cabinet secretary to address it. Jackie Baillie said that capital savings might be used to underpin revenue, which is a chilling thought. The chairman of Highland NHS Board has written to the cabinet secretary asking for capital funding for a new four-surgery dental facility in Thurso but, if Jackie Baillie is correct, it begins to seem as if that could be scuppered. My colleague Jackie Baillie has made a hugely important financial allegation, which must be answered, because the issue is crucial.

Photo of Jamie Stone Jamie Stone Liberal Democrat

I do not think that I have time.

Photo of Richard Simpson Richard Simpson Labour

From the replies that we received to our freedom of information requests, we have found that £42 million of property sales have been included in efficiency savings. Property cannot be sold more than once.

Photo of Jamie Stone Jamie Stone Liberal Democrat

I accept that.

I am interested in who decides whether a member takes an intervention—the member or the Presiding Officer. However, I will give leeway to the Presiding Officer on that one.

Rhoda Grant mentioned car parking. That is not hugely pertinent to the debate, but it is fair to say that free car parking has been talked about in the Highland area as something that perhaps did not need to be given. However, that is a debate for another day.

We must remember that growth is not an option any more and that the pot of money is limited. The debate takes place against the background of inflation. We must therefore consider what has to be done to meet the threat of cuts or reductions in front-line services for patients in Scotland.

Photo of Jackson Carlaw Jackson Carlaw Conservative 11:20, 13 November 2008

In 18 months in the Parliament, I have not been called on to participate in a more bizarre or disingenuous debate, nor one that has conjured up such a profound sense of déjà vu. In opposition through the 1980s and 1990s, the weary and lazy refrain from Labour was, "Stop the cuts." In my first Westminster parliamentary election—a by-election in 1982—the Labour candidate challenged me to fight the cuts. When I asked to which cuts she was referring in particular, she replied, "I don't know about that, but what are you doing to fight them?" When the Labour candidate was finally confronted at a public meeting by a constituent who inquired why the local library closed early on a Wednesday night, she replied, "I have absolutely no idea, but I am sure it's Mrs Thatcher's cuts." Such childish rants did not win Labour power then, although, just as now, they may have helped it to retain a seat or two in by-elections. Finally, in the 1990s, Labour elected a new leader, who abandoned that shameless and lazy rhetoric and progressed an agenda that discarded almost everything that his party had fought for in the previous 18 years. Has Labour learned from that? Why, no. Battered in opposition, it falls back on the same old chants, as Pauline McNeill, no less, confirmed in an intervention. There is the same old opportunism and scare-and-smear tactics. What a shambles; what a sham.

Photo of Jackson Carlaw Jackson Carlaw Conservative

I am sorry, but I am too far gone on my hobby-horse to dismount.

How dispiriting that approach is when there are serious funding issues to discuss, as Mary Scanlon detailed at length on NRAC. Ross Finnie suggested what might have been a much more interesting debate. I excuse Malcolm Chisholm, too, as he made a typically intelligent and reasoned speech.

The irony of it all. At the top of the list of reasons why Labour was kicked unceremoniously out of office in Scotland last year was its contempt for the public mood on health. Labour championed the real health cuts—cuts in accident and emergency health services throughout Scotland—and the Government, with Conservative support, reversed even more damaging accident and emergency closures that were planned in Ayr and Monklands. When in government, Labour planned regressive cuts in the net take-home pay of nurses and health service workers through the introduction of its hospital car-parking tax, which, to paraphrase, was a tax under which even a consultant married to a duke paid the same as a nurse married to a binman. Annually, that tax was to be greater than the net increase in the average health worker's annual wage. The shame of it—the Labour shame of it. Again, the Government, with Conservative support, has abolished that disgraceful tax.

Labour is so desperate to find a strategy back from an emerging wilderness that out comes the old scattergun of scare and shame. I know that Labour, when confronted with today's reality check on its health record—which I freely admit is not entirely without merit—will react true to form. I can hear the familiar charge coming, so before Labour members gobble on their spittle, I remind them again of uncomfortable facts. Labour is the only party in history that, when in government, forced through real cuts in the health service. A generation ago, Labour cut nurses' pay by 3 per cent; doctors' pay by 16 per cent; surgeons' pay by 25 per cent; and overall health spending by 3 per cent.

The Labour chancellor, Scissorhands Darling, chose to change the health baseline for calculating the Barnett consequentials, resulting in a budget to the Scottish Government on health that is about £342 million less than it would otherwise have been. However, Labour has the brass neck to look in our direction when talking of threats to the Barnett formula. In the election last May, the Labour Party pledged that education would come first. The then First Minister said that other departments would have to "cut their cloth". I presume that that would have included health. That would have been on top of the efficiency savings that Labour advocated of 3 per cent, not 2 per cent, as we have now.

The time will come when the SNP Government has to account for its record. It has argued for a disastrous local income tax and has put the continuity of our electricity supplies at risk by dogmatic hostility to nuclear power as part of the future energy mix. However, on health, the cabinet secretary demonstrated in a magisterial performance why she is a shining beacon of hope in comparison with the tawdry arrogance of Scottish Labour. She is held in such regard that she may even rival Governor Sarah Palin in the esteem of Scots. That may seem like faint praise but, truly, it is not intended as such, for it was the Labour Government at Westminster that chose such a damaging basis for the calculation of Scotland's health service budget; a Labour Government in Scotland that proposed and partially implemented devastating cuts to accident and emergency services; and the Scottish Labour Party in government that forfeited the trust of the Scottish people. When the general election comes, Labour will get its just deserts. The most liberating cut of all will be the people's cut on the dead weight of the Labour Government at Westminster.

Labour's motion is shabby, opportunistic and shallow—indeed, it is contemptible. It is the motion of a small-minded party—from a front bench grey in spirit and character, led by a man grey in name. We will support the Government amendment at decision time, and be done with it.

Photo of Shona Robison Shona Robison Scottish National Party 11:25, 13 November 2008

How does one follow that? I do not think that I could be any nicer to the cabinet secretary.

I wish that the debate had been constructive, but it was based on a false premise and opportunism. I will start with a little list—actually, it is quite a big list—of spending commitments that the Labour Party has made during the first 18 months of this SNP Administration. The list, which amounts to just over £0.5 billion, covers areas such as buses, student funding, apprenticeships in the creative industries, Scotland's sports ambassadors fund—a proposal from Cathy Jamieson—and pledged support for higher bursary funding. All those things add up to a fair bit of money.

Labour members stood before the chamber this morning demanding more money for the health service, yet they did not, of course, specify where the money would come from. Labour member after Labour member, in every speech, failed to give an indication of which budget they would cut to fulfil the party's desire for higher health spending. That is not worthy of an Opposition party, let alone a party that wishes to be in government again. Labour members cannot come to the chamber and tell the Government what it should be doing without putting forward any solutions.

Photo of Cathy Jamieson Cathy Jamieson Labour

Does the minister accept that the health boards are saying that they face the pressures that we raised in the debate? Will the cabinet secretary and the minister, at the very least, take that seriously? Will they take away the information, look at it and report back to Parliament at a later date? The SNP has said that this side of the chamber is scaremongering, but we are not. The words that we used are those of the health boards—the boards are saying that patients will suffer.

Photo of Shona Robison Shona Robison Scottish National Party

Cathy Jamieson did not offer up any answer to the question: where is the money to come from?

Photo of Shona Robison Shona Robison Scottish National Party

No; when the Opposition calls for extra spending, it is the Opposition's job to tell us what budget cuts it will make to fund that spending.

I return to Cathy Jamieson's misinformation and selective quoting. She said that NHS Shetland is making cuts in cancer services, but the fact is that NHS Shetland said:

"One-off savings achieved by the Board include vacancy savings in a nursing post. No services have been withdrawn and these specific savings total £10k.

Absolutely no savings have been made in Mental Health."

Saying that savings would be made in mental health services was another piece of Opposition misinformation from Cathy Jamieson. That is only one example; there are many more that show the level of misinformation, opportunism and selective quoting that Cathy Jamieson used in introducing this shoddy debate.

Gary Coutts, the chair of NHS Highland made his position on the savings clear. I repeat:

"It will not affect the outcomes for patients. Patients might see the way that they get services is different, but waiting times are going to come down, cancer waits are going to come down, the length of time you wait for a consultant is going to come down."

What a different picture he paints from the scaremongering about people dying—I think that that was what Rhoda Grant said—because of what were described as cuts to the health service. That is unacceptable language for any member to use about our hard-working staff in the NHS. Such language would not be good enough for members on any side of the chamber, but especially not for a member of a party that has been in government. Labour members should know better; they know about managing budgets.

I need say nothing more on the misinformation in Cathy Jamieson's speech, other than to repeat that it was misinformation.

I turn to Mary Scanlon's speech. I reiterate the point that, given that NHS Highland is on NRAC, it will consider issues including the future funding formula, which Mary Scanlon raised. Of course, joint working with the island boards is very important in making more efficient use of the services that they provide.

Photo of Mary Scanlon Mary Scanlon Conservative

I remind the minister that the funding for someone who lives on Coll or Tiree is around £700 less than for someone who lives on Barra in the Western Isles. That is an example of the funding differences that Highland NHS Board faces.

Photo of Shona Robison Shona Robison Scottish National Party

That is one of the very issues that NRAC will look at in taking forward the important piece of work with which it is tasked.

Ross Finnie made an interesting speech, some of which was reflective. As always, he said some interesting things. However, he cannot get away from the fact that the efficiency savings that will be made will be reinvested in front-line services. We have made that very clear from the outset. If Ross Finnie does not want those efficiency savings to be made and if he does not believe that that is the best way to free up resources to reinvest, he has to answer the question: where will the £800 million of savings that his party advocates come from? It is not good enough for any member, on any side of the chamber, to demand more money from the Government without saying where the money should come from. It is also not good enough to advocate cuts but not to say where the cuts will fall.

I turn to Jackie Baillie. Frankly, she surpassed herself in opportunism today. She raised the issue of efficiency savings. Who was in charge in 2005-06? Oh, sorry—it was Jackie Baillie's Government; she might even have been a minister at the time. Efficiency savings under that Labour Government that year were £169,383. In 2008-09, under this Government, the savings are £158,129. Our efficiency savings are less than those that were expected or made under the Labour Government.

Photo of Shona Robison Shona Robison Scottish National Party

I am in my last minute.

Jackie Baillie said that we should scrap efficiency savings, but yet again she gave no indication of where that money would come from. That is not good enough. No Labour member other than Malcolm Chisholm had the guts to offer up suggestions. He suggested that the abolition of prescription charges should not go ahead. No other Labour member had the guts to tell us where alternative savings should be made. Labour is not worthy of opposition, never mind government.

Photo of Richard Simpson Richard Simpson Labour 11:33, 13 November 2008

Like Jamie Stone, I would have liked to welcome the debate as constructive, but this has been one of our least constructive debates. I say to our Conservative friends that I did not recognise the two Conservative speeches as coming from the same party. Mary Scanlon rightly talked about the problems that NHS Highland faces, but Jackson Carlaw mounted his hobby-horse and disappeared into the far distance.

Serious issues are involved; Ross Finnie, Malcolm Chisholm and other members raised them in their speeches. The Government—and the SNP is the Government—made the decision in the comprehensive spending review to cut revenues by £1 billion. I hope that the cabinet secretary and the minister accept that. The SNP Government decided to cut revenues in a variety of ways. As a result, it has £1 billion less to spend on public services. Our public services have to take the strain of that reduced revenue.

That would be fine if the settlement to health boards reflected the allocation that Scotland has been given, but it did not—it is the lowest uplift since devolution. The SNP Government also failed to recognise the new situation of increased inflation and the fact that health service inflation always outstrips ordinary inflation. Furthermore, it failed to lay out clearly what should be included as so-called efficiency savings and what should be proscribed as cuts.

There are some incontrovertible facts in the debate. The SNP Government's budget was increased by 1.8 per cent in real terms. However, based on headline inflation of 2.7 per cent, the real-terms uplift in the Government's general allocation to health boards was 0.5 per cent. The Wanless King's Fund report stated that the NHS needs an annual increase of 4 per cent in real terms just to stand still, and in England Labour has provided the necessary uplift to achieve that, even though it, too, is faced with the new situation of higher inflation.

It is true that, on the calculations that we have been given by economists, our per capita health expenditure is on a trajectory to go below that of England by 2012-13. Labour in England is giving more to health than the SNP Government is giving in Scotland—that is a fact.

The special NHS inflationary pressures are recognised, and the Audit Scotland report demonstrates them: an ageing population; agenda for change; the European working time directive; new and more drugs, including a 4 per cent uplift in drug expenditure predicted for Grampian; and new and expensive technology. I would also include the need to clean our hospitals, as demonstrated by the audit report this week.

That is health inflation, but we must also consider general inflation. General inflation is not 2.7 per cent, as the headline inflation was, but considerably higher. If we consider fuel and food, which the NHS has to deal with, the level is even higher than the headline inflation of 5.2 per cent. Those are all realities that the cabinet secretary will have to face in the next year or so. We may be lucky—inflation may drop to zero and there will not be the same pressures in later years. However, for this year and next, the pressures undoubtedly exist.

Another incontrovertible fact, which disappoints me, is that both the cabinet secretary and the Minister for Public Health have said repeatedly that Labour is scaremongering, when the reason for the debate—I see Keith Brown nodding as well, although I welcome Christine Grahame as no other SNP member of the Health and Sport Committee has been present, which is a shame—

Photo of Richard Simpson Richard Simpson Labour

Time is short; I must get on. Anyway, the cabinet secretary refused my intervention, decided to take it and then messed around.

The Labour Party made a freedom of information request to every health board in Scotland on the efficiency savings that they were making and the pressures that their budgets might be under. That is a responsible approach for the opposition to take, and everything that Labour members have said today has been lifted from the reports that we have received from health boards. Nicola Sturgeon and Shona Robison might sit there, shaking their heads yet again, but are they saying that the health boards are lying to us in response to freedom of information requests? If so, they are making a dangerous assertion.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

My central charge is about the deep dishonesty of the Labour Party. Will Dr Simpson answer the question that Cathy Jamieson failed to answer: what impact would there have been on NHS budgets under the Labour policy to put all resources into education and cut NHS funding? That is central to today's debate.

Photo of Richard Simpson Richard Simpson Labour

I will not answer that question, because this debate is about the SNP Government facing the reports that we have received from individual health boards about the cuts that they are having to make.

Let me go into that point in more detail. We have heard about NHS Highland, which is talking about £10 million of cuts in addition to the efficiency savings. NHS Forth Valley has spoken about cuts of 1 per cent across the board, while NHS Grampian is having to consider a 5 per cent cut to balance its budget.

What are the efficiency savings, and will they affect front-line services? Shona Robison referred to dealing with vacancies—

Photo of Richard Simpson Richard Simpson Labour

In Shetland, but I am talking about other areas. [ Interruption. ] Shona Robison may sit there and laugh, but the fact remains—

Photo of Richard Simpson Richard Simpson Labour

No, I will not take another intervention.

We have heard from a number of health boards that they will use a delay in filling vacancies to achieve efficiencies. Are the ministers really sitting there and saying, from a sedentary position

Photo of Richard Simpson Richard Simpson Labour

No, I will not. The minister is commenting enough from a sedentary position. Is she saying that the health boards are not delaying vacancies? [ Interruption. ]

Photo of Richard Simpson Richard Simpson Labour

Is the minister saying that delay in filling vacancies is a reasonable way of achieving efficiency savings? Such delay puts pressure on front-line staff who have to cope without the consultant or nurse who has not been appointed. That is not an efficiency saving.

Many of the savings that were noted in the responses to us were one-offs, which are not efficiency savings. I will list them: property sales of £42 million; cuts in supplies, not improvements in procurement; capital to revenue virement reductions; accountancy adjustments; and freezing uplifts to budgets.

In summary, it is not Labour members who are saying that there are problems with efficiency savings; we are repeating the reports that we have had from health boards. The higher levels of inflation and the reports from health boards are serious issues that, as Ross Finnie said, need to be addressed seriously.