Health Care

– in the Scottish Parliament at 9:15 am on 26th March 2009.

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Photo of Alex Fergusson Alex Fergusson None 9:15 am, 26th March 2009

Good morning. The first item of business is a debate on motion S3M-3796, in the name of Mary Scanlon, on the national health service and the independent health care sector.

Photo of Mary Scanlon Mary Scanlon Conservative

I welcome the undoubted success of the Scottish regional treatment centre at Stracathro and put on record our congratulations to the previous Liberal and Labour Scottish Executive on setting up that pilot and leading the way with a highly effective partnership between the NHS and the independent health care sector. It is not often that we congratulate, but there we are.

As the motion states, the Stracathro pilot has been rated as excellent by its patients; has reduced waiting times; has had no reported cases of hospital-acquired infection; and has saved more than £2 million for the NHS. For people living in the area, the pilot helped to keep Stracathro hospital open, following a petition to the Parliament with 48,000 signatures. In the past, politicians and others have talked about the NHS and the private sector as two separate entities, which of course they are. However, the difference at Stracathro is that an independent company leases NHS facilities to treat NHS patients at times when the theatres are not being utilised, including outwith normal working hours, during the evenings and weekends, which suits many patients.

The partnership brings money into the NHS through leasing. It has also helped several NHS boards to achieve waiting time targets, allowed better planning for service delivery and cut down on expensive last-minute ad hoc spot purchasing from the private sector. Of course, any failure to deliver surgery and treatments within the timescale results in the independent company, Netcare Healthcare UK, having to undertake the activity free of charge. In the two years from February 2007 to February 2009, almost 5,000 patients from the Forth Valley NHS Board, Grampian NHS Board, Fife NHS Board and Tayside NHS Board areas were treated by Netcare at Stracathro. The system is more efficient and is estimated to provide 11 per cent more value for money than undertaking similar activity in the NHS. A contract variation was agreed with Netcare to reduce treat-by dates from 12 weeks to eight weeks for all activity groups by 28 February this year.

We hear constantly that the NHS should not be in conflict or competition with the independent sector. However, the project illustrates conclusively how the independent sector can complement and work alongside the NHS to benefit NHS patients. No one pays for treatment at Stracathro—the facility is for NHS patients. Another criticism that is often made of the independent sector is that it takes resources from the NHS. However, it was a contractual requirement on Netcare not to recruit staff who had worked locally for the NHS in the previous three months. My colleague Murdo Fraser will expand on that issue of additionality. The contract addresses many of the criticisms that have been made of the independent sector.

Our motion calls on the Scottish Government

"to continue to work with the independent sector ... to deliver the best possible healthcare" in Scotland. The Scottish Conservatives want to put patients first. We want patients to receive the best-quality treatment in the shortest time that provides the quality of life that they seek. The approach of working with the independent sector includes the service that is provided by Medacs Healthcare, a private company that is based in Leeds and which is the largest supplier of locum doctors to the NHS. The company also provides a full service to the Scottish Prison Service as well as providing forensic medical examiners for detainees, police personnel and victims in Scotland. I made it my business to telephone one or two constabularies and the Scottish Prison Service, which confirmed that they receive an excellent service from Medacs. The good thing is that those organisations can examine their contracts every few years so that anything that is unsatisfactory can be negotiated and put right. The system has worked well to the benefit of people in Scotland.

Another independent company is Atos Healthcare, which operates 31 medical centres in Scotland and employs more than 170 clinical staff here, including doctors and nurses. The company makes recommendations on entitlement to benefits after carrying out medical examinations and reviewing cases. I appreciate that entitlement to benefits is a reserved issue, but I hope that the Scottish National Party will not use forthcoming legislation to ban commercial companies, such as those that provide an excellent service to benefit claimants, the constabulary, the prison service and other organisations throughout the public sector in Scotland.

It is sad—I could use other words, but I will be diplomatic—that the SNP Government undoubtedly puts ideology above patient care. The Government amendment congratulates NHS staff on the excellent work that they do. All members would congratulate all NHS staff on their excellent work, but the Government could find it in itself only to note the role of the private sector staff who treat NHS patients—how shameful. The Labour Party amendment would even delete our tribute to it. My goodness—we are in a consensual Parliament with a minority Government, but when we congratulate our partners in the Labour Party, they attempt to delete our congratulations. However, the Stracathro project is undoubtedly excellent.

The examples of the Scottish regional treatment centre; the medical work for the Scottish Prison Service and the police service; and Atos's work on determining medical fitness in relation to benefits or fitness to work give a taste of the range of excellent work that can be done through the NHS and other organisations working in partnership with the independent sector to deliver the best possible health care for the people of Scotland. That is what the Scottish Conservatives want.

I move,

That the Parliament welcomes the success of the Scottish Regional Treatment Centre at Stracathro and pays tribute to the previous Scottish administration for piloting the scheme; notes that the Stracathro pilot was rated as excellent by its patients and has reduced waiting times, that the centre has no reported healthcare associated infections and that it has saved several million pounds of taxpayers' money in the process of successfully treating NHS patients; further notes that since 1999 successive Scottish administrations have recognised the contribution that can be made by the independent sector to treating NHS patients, with a record 4,409 treatments performed in 2008, more than double the level in 1999 and a 38% increase since 2007, and accordingly urges the Scottish Government to continue to work with the independent sector in order to deliver the best possible healthcare for the people of Scotland.

Photo of Shona Robison Shona Robison Scottish National Party 9:23 am, 26th March 2009

I welcome the debate, which gives us the opportunity to restate our policy on the use of the independent sector and to correct the claims that NHS boards' use of the private sector has increased during our period in office. I will come to that in a minute.

Our primary objective is to have a world-class Scottish NHS. We certainly have no policy of investing in independent services at the expense of the NHS. The funds that were voted for by the Parliament for the NHS will be spent by the NHS for the benefit of NHS patients. However, neither do we have a policy of prohibiting NHS boards from using the capacity of the independent sector at the margins when that is demonstrably of benefit to NHS patients and represents value for money.

For example, NHS boards are perfectly free to continue to use the independent sector to help meet short-term pressures and to provide capacity from time to time when that is necessary to treat patients quickly. That will always be at the margins. We use the independent sector on a tactical basis, with long-term investment in the NHS. That is unlike the previous Administration, which made available £45 million over three years specifically to fund and encourage the use of the independent sector. That funding has now been repatriated to NHS boards, which has allowed investment in direct patient care. The investment that we make available will build sustainable services within the NHS. The independent sector will be used tactically, not strategically, on NHS terms and without central pump-priming where funds are used for acute activity in the independent sector.

Let me turn to the statistics. The assertion has been made that official data are showing more use of the independent sector by NHS boards. Members should be aware that only now are procedures that have been taking place in the independent sector being recorded properly. The Information Services Division acknowledges that the published data are incomplete. That is why, last summer, the Cabinet Secretary for Health and Wellbeing specifically required boards to ensure that returns are submitted to ISD Scotland for patients who have been treated in the independent sector.

The figures that have been referred to by the Tories as somehow showing an increased use of independent hospitals include private nursing homes, hospices and other independent providers, including homes run by local authorities and charities. In fact, half of the total figure that was cited in the motion—2,435 out of the 4,409 treatments for 2008—is for non-acute activities. The Tories have got their facts badly wrong, and they have interpreted figures incorrectly, despite the explanatory notes and the written answers that have been given to them, which make that point very clearly.

Photo of Shona Robison Shona Robison Scottish National Party

They are our figures—with a very clear explanatory note that members should have read. It would be a mistake to use the welcome increase in local care provision as a means to further the argument that the NHS is increasingly relying on the independent sector for acute activity. Rather, it is clearly consistent with our policy of shifting the balance of care.

A proper analysis of the data that were provided by ISD Scotland shows that NHS boards have recorded a significant downturn in the use of the independent sector for acute hospital activity. The figures show that independent sector acute activity fell by 37 per cent between 2006 and 2008—1,008 episodes in 2008 compared with 1,604 episodes in 2006—notwithstanding the lack of proper recording prior to 2008. It should also be noted that the joint NHS-independent sector facility at Stracathro showed activity of 966 episodes in 2008, compared with none in 2006, which skews the available figures for 2007 and 2008. Figures for core acute activity, leaving aside Stracathro, confirm that NHS boards are not making increased use of the independent hospital sector for acute services.

I acknowledge the contribution that diagnostic and treatment centres can make to reducing patient waiting times. However, that can equally well be done in the NHS. The Stracathro pilot is currently being reviewed by NHS Tayside and its partner boards, which are examining their future capacity needs and are considering the full range of options for Stracathro's use to deliver the best outcome for patient care and the public purse.

Despite the tightest financial settlement from the London Treasury since devolution—



Photo of Shona Robison Shona Robison Scottish National Party

It is true. Despite that, the Scottish Government has invested more money in the NHS than ever before. We have increased spending on health per head of population to record levels, and we have delivered record investment, which will exceed £11 billion by 2010-11. Capital investment totalling £1.676 billion was made available to NHS Scotland over the period 2008-09 to 2010-11. In 2009-10 and 2010-11, capital resources of £603 million and £548 million respectively have been made available to NHS Scotland. That is a record level of capital funding, which will ensure that the NHS is better equipped and resourced than ever before to improve the quality of the patient and staff environment.

With those words, I am happy to move amendment S3M-3796.3, to leave out from "success" to end and insert:

"Scottish Government's commitment to a mutual NHS in Scotland and its decision only to use the private sector for health provision at the margins where necessary; further welcomes the fact that there has been a 37% drop in private sector acute activity, excluding Stracathro, between 2006 and 2008 and congratulates NHS staff for achieving this reduction; notes the role of the private treatment centre pilot at Stracathro, established by the last administration, and awaits the final evaluation of this pilot, and commends the Scottish Government policy to direct investment into the NHS rather than divert scarce resources into private sector health provision."

Photo of Alex Fergusson Alex Fergusson None

The remaining speakers were advised that they would have about four minutes each. I can now advise them that we have a bit of flexibility available, so members should feel free to take interventions if they wish to do so.

Photo of Richard Simpson Richard Simpson Labour 9:30 am, 26th March 2009

I pay tribute to Mary Scanlon and the Conservative party for lodging this morning's motion, which does, indeed, pay tribute to the previous Administration for commissioning the pilot scheme at Stracathro. That is a rare accolade, and it led me to look a great deal more closely at the evaluation of the Stracathro project. My colleague Helen Eadie will address some of the critical points arising from that evaluation, which were rather skipped over by Mary Scanlon.

Photo of David McLetchie David McLetchie Conservative

Given that the member's amendment deletes our compliment and tribute to the previous Scottish Executive, can we take it that the new Labour Party is now officially ashamed of its record in Government?

Photo of Richard Simpson Richard Simpson Labour

It will become clear as my speech progresses that we are in no way ashamed of what we did in Government. We are very pragmatic in our approach.

The Scottish regional treatment centre has made a positive contribution for patients. It has reduced waiting times for many patients with painful and debilitating conditions. That success has been achieved by increasing the number of spaces that are available for elective surgery, ensuring that the treatment is efficient and convenient, while maintaining high levels of care. The SRTC allows us to keep open a valued resource at Stracathro hospital—that was a very important factor in the decision that we reached, in response to the campaign in the area to keep the local facility open.

It was Labour's aim over its term in office to utilise the skills and capacity of the private sector to overcome NHS capacity issues on a temporary basis, and I am pleased that the proposals have worked so well at Stracathro. Independent health care organisations can provide great flexibility, particularly by introducing new and innovative care—not that the NHS is bad at introducing that. However, on occasions, it is necessary for us to use the private sector to instigate changes and to ensure adaptation.

Photo of Brian Adam Brian Adam Scottish National Party

Would the member care to spell out a little more where he sees the independent sector's role as being innovative? Can he give us some other examples?

Photo of Richard Simpson Richard Simpson Labour

In a speech of four minutes, I do not have time to do that. There is no doubt, however, that there are areas where it can play a role. For example, the private sector has done work on breast cancer and on infertility. Innovative work has been done in the private sector. That is in no way to detract from the NHS, which has produced the preponderance of innovation, but using the private sector can be very helpful to the NHS when it comes to mass change.

We developed the SRTC to ensure a greater balance of facilities in the east. It was appropriate for people in the west to go to the Golden Jubilee national hospital, and the nationalisation of that establishment was an important factor in creating the necessary capacity.

Photo of Richard Simpson Richard Simpson Labour

I have taken enough interventions, and I have to get on—I am sorry.

The Golden Jubilee hospital provides a great resource and provides capacity that boards themselves are unable to provide.

Many patients are still waiting on long lists, with 18 weeks from treatment to the out-patient stage, and 18 weeks from out-patient to treatment. That will change, and there will be capacity needs in future. The Minister for Public Health and Sport has said that the Government will use the independent sector not strategically but tactically, and I understand that, but it will become necessary to ensure that there is adequate capacity to meet the new, very challenging, targets. The use of the private sector will need to continue.

The standards of those independent sector services that we use must be the same as those for the public sector and that is certainly the case at Stracathro. Patients get a choice about the date and time of their initial appointment, which is now usually within six weeks of referral. It is important that it has been possible to achieve that.

Satisfaction ratings exceed 90 per cent for the treatment centre, and the incidence of health care acquired infection is low. I was very impressed with the centre when I toured it, and Tayside NHS Board was pretty satisfied with the treatment available there. Nevertheless, patients still have to travel quite long distances. In the longer term, it will be important to build capacity within the NHS to ensure that that is where the overwhelming majority of procedures are carried out.

Mary Scanlon mentioned Medacs Healthcare, and I am pleased that the prison medical service is to be brought back into the NHS. That is important. A pragmatic decision was made because it was not possible for the NHS to undertake the service as we wanted it to be undertaken. However, it has now been agreed in principle that both nursing and medical services in the prison service will be brought back into the NHS. I hope that that will happen quickly.

Labour will continue to maintain a totally pragmatic approach in which the interests of patients are put first. When we undertake work with the private sector, it will be done entirely on that basis.

The Labour Party will certainly support the Liberal Democrat amendment.

I move amendment S3M-3796.1, to leave out from "and pays" to end and insert:

"with its high level of patient approval and welcomes the Scottish Regional Treatment Centre's contribution to maintaining Stracathro Hospital as both a local and regional resource; notes the success of the nationalisation of the HCI hospital in Clydebank, now the Golden Jubilee National Hospital, and recognises the contribution of both these units and their staff in achieving the continuing reduction in waiting times."

Photo of Ross Finnie Ross Finnie Liberal Democrat 9:35 am, 26th March 2009

I listened with great care to the opening speeches from colleagues, and last night I read the motion and the amendments carefully, and I am bound to say that we are conducting a rather artificial debate. If we interpret the English language in the ordinary way, the motion in the name of Mary Scanlon makes no plea at all for an extension or expansion of private medicine in Scotland. It simply acknowledges that a pragmatic approach—to paraphrase the words of Dr Simpson—should be taken to utilising the private sector when it might augment and complement the NHS.

In her opening speech, Mary Scanlon drew attention to three examples of where it has been helpful to take just such a pragmatic approach; and although I understand that we are to hear from Helen Eadie a litany of failures, the wording of Dr Simpson's amendment acknowledges the contribution that such an approach has made. I am sorry for Helen Eadie, because the amendment has put her in an awkward position. But there it is: we all know how difficult it can be when there are internal party difficulties.

The Minister for Public Health and Sport has explained that she does not want any expansion in private provision. The Government has made its position absolutely plain, and I have no qualms about that. The minister has said that services should, in every case in which it is possible, be provided by the national health service. However, she acknowledges that places such as Stracathro might, on the balance of the argument, be able to offer a pragmatic solution. As a result, trying to find differences between the views placed before us is extraordinarily difficult. I have no doubt that, during the rest of this debate, we will turn not so much to simple medicine as to forensic medicine, in order to discern the differences between our positions.

Unlike the Labour Party in its somewhat contorted amendment, the Liberal Democrats have chosen to leave untouched the Conservative motion's gracious tribute to the previous Administration. Such a tribute has happened only once before, so I would be reluctant to delete it from the record. That would be churlish in the extreme.

The position of the Liberal Democrats is clear. We sign up to a health service that is, in essence, run by the national health service. However, we also acknowledge that we are where we are: private providers exist and if the NHS cannot provide a service—as happened in the prison service some years ago, as Richard Simpson pointed out—we have no ideological objection to the use of the private sector for the benefit of patients. However, we say clearly that any use of the private sector must not involve the displacement of people who are involved in or work for the NHS.

In a country the size of Scotland, it can be somewhat false to talk of competition. The competition would have to take place within what is a limited resource—limited both in personnel and in buildings. Having full competition, with all the duplication involved, would not be a sensible way to make progress.

As long as it is understood that the NHS must remain the core of health provision, Liberal Democrats are content that the private sector can have a role. We would do nothing to encourage the expansion of the private sector, and we would certainly not encourage any increase in the capacity of the private sector; but if on occasion the private sector can usefully assist the NHS to the benefit of patients, we are content that that should happen—as long as there is no displacement of staff or resource from the NHS.

I move amendment S3M-3796.2, to insert at end:

", while ensuring that the use of the private sector does not destabilise local NHS provision or undermine the recruitment and retention of NHS staff."

Photo of Murdo Fraser Murdo Fraser Conservative 9:40 am, 26th March 2009

I welcome the opportunity to speak about the success of the Scottish regional treatment centre at Stracathro from a local perspective. Many of my constituents from Mid Scotland and Fife, particularly those from the Tayside and Fife areas, have benefited from the facility, which operates within the independent health care sector.

Stracathro hospital has always been valued by the community in north Angus and the Mearns. Like many local hospitals throughout the country, it developed into a general hospital providing a range of treatments. Situated on a large well-laid-out site at the foot of the Angus glens, it provides an attractive environment for patients and is easily accessible because of its proximity to the A90 dual carriageway. The hospital has also been an important part of the economy in north Angus, providing employment to doctors, nurses and ancillary workers—employment that was often well paid and secure in an area where the main employers were in the fields of tourism and agriculture, where jobs are often low paid.

Like others, I can remember around 10 years ago when there were serious doubts about the future of the hospital at Stracathro. At the time, Tayside NHS Board seemed intent on running down the hospital or even closing it altogether. That would have meant people from north Angus having to travel to Ninewells in Dundee for treatment. Closure would have been a serious loss to the area.

As we have heard, a long and energetic campaign was fought by local activists against the downgrading of Stracathro. In due course, NHS Tayside started to change its mind. An important milestone in the process was the establishment of the regional treatment centre in 2007. As we have heard, that was a decision of the previous Scottish Executive. It is a decision for which I must commend in particular the former Minister for Health and Community Care, Andy Kerr—a man of intelligence and vision. How disappointing it is that the Labour Party amendment seeks to delete our recognition of his success. Perhaps Iain Gray is nervous of praise for his erstwhile leadership challenger.

Understandably, there were some local reservations about a private company coming into Stracathro to provide services, but the creation of the SRTC was nevertheless widely welcomed as representing a substantial new investment in a popular local hospital. As we have already heard from Mary Scanlon, according to PricewaterhouseCoopers there will be a projected saving of £2 million in cash terms to the NHS over the lifetime of the contract. There has also been a positive impact on waiting lists and times; and there has not been a single case of a hospital-acquired infection at the SRTC. Patient satisfaction is very high, with an overall 84 per cent rating.

Photo of Shona Robison Shona Robison Scottish National Party

Murdo Fraser and I have been party to the detail of the financing of the pilot. Of course, it would not be appropriate for us to discuss that here, because the information was given in confidence, but does he acknowledge that the financing arrangements for a pilot are not necessarily what would be required for wider applications?

Photo of Murdo Fraser Murdo Fraser Conservative

When the contract goes out to tender, I dare say that we will find out whether the excellent deal secured by NHS Tayside for the pilot can be repeated. I hope that the SNP Government will not rule out, for ideological reasons, the opportunity to save the taxpayer millions of pounds that could be spent elsewhere in the NHS. The figures speak for themselves and they reflect the high quality of care and the excellent work of the staff at Stracathro.

Opponents of the independent health care sector will often argue that independent facilities will poach NHS staff. That point is covered in Ross Finnie's amendment. The technical term here is "additionality"—in other words, the principle that staff employed in the independent sector should bring additional capacity to the local health care system and should not be recruited at the expense of NHS staffing levels. In its report, PWC found that additionality had not been a significant problem at Stracathro. Part of the reason for that is that the hours operated in the SRTC tend to be outwith normal NHS working hours. As a result, staff are often happy to add to their existing part-time work by also working part-time in the Netcare project. There is therefore no negative impact on the work that people do for the NHS. People are able to enhance their earnings, which puts more money into the local economy. It is a win-win situation all round.

We should not threaten, for ideological reasons, the future of this very welcome project. It has secured the future of Stracathro hospital, and it should continue.

Photo of Ian McKee Ian McKee Scottish National Party 9:45 am, 26th March 2009

I am sad to say that the Conservative motion is misleading and premature. It is misleading for the reasons that the Minister for Public Health and Sport has already given, and it is premature because the Stracathro treatment centre has not been functioning long enough to allow its success or failure to be properly judged.

There is plenty of evidence from England about similar independent sector treatment centres, as Labour began the experiment there much earlier and it involves greater numbers. In 2007, a Department of Health report claimed that of the £1.4 billion-worth of contracts to English independent sector treatment centres, only £1.18 billion-worth of services and procedures were carried out, but the remaining £222 million still had to be paid to the private sector. Payment was made for nothing, because the contracts obliged payment whether or not any service was provided.

In 2006, English ISTCs were paid for 50,000 operations that never took place—one centre was working to only 5 per cent of capacity. As a result, the second wave of ISTCs in England was drastically pruned, which obliged the Government to pay up to £25 million in bid costs to unsuccessful contractors. That is another case in which NHS money has been spent on nothing.

Photo of Derek Brownlee Derek Brownlee Conservative

Would the member, as a former general practitioner, like to comment on whether the new GP contract is a case of providing money for nothing?

Photo of Ian McKee Ian McKee Scottish National Party

As a former GP, I think that the new GP contract was perhaps the most unsuccessful thing that the Labour Government has ever organised, and it should be completely renegotiated. It is an enormous waste of money.

The problems that have been generated by ISTCs in England are not only financial. The accusations that the centres creamed off the easy cases and left the health service to foot the bill for more complex cases could not be adequately investigated by the Healthcare Commission, as the data from the independent sector was so poor. Most ISTCs did not take part in schemes to train young NHS doctors, so medical education suffered; and there was poor communication between the centres, which meant that transmission of test results and patient notes became more difficult.

It is no wonder that Gwyn Bevan, professor of management science at the London School of Economics, stated last year that even after seven years, there was little hard evidence that any benefit had been derived from that expensive initiative. However, perhaps things are different at Stracathro, and perhaps we have learned those lessons. I hope that that is the case, but there is, as yet, no robust evidence.

The Conservative motion states that the Stracathro centre is

"rated as excellent by its patients", but it would be surprising if a new centre on which millions of pounds have been lavished—whoever it was provided by—was not welcomed by patients. The PricewaterhouseCoopers survey is very short on methodological detail, and replies were received from only 39 per cent of those who were surveyed. The provision of extra facilities is bound to reduce waiting times, whether those facilities are provided privately or on the NHS.

The motion states that the centre is saving the NHS millions of pounds. However, although the PricewaterhouseCoopers report states that there were 2,200 referrals to the Stracathro regional treatment centre in its first 10 months of operation, the Tayside delivery committee reported on 12 March 2008 that there had been only 1,720 procedures to January 2008 since work began in February 2007, which is a shortfall of 480. It is possible that those procedures were paid for but not carried out—there is certainly such a penalty clause in the Stracathro agreement—and we need to know.

I hope that, one day, the facility—which is paid for from public funds—will be restored to NHS ownership and play its role in serving local communities as an integrated part of the national health service. The truth is that, in England, Labour's flirtation with the independent sector has been nothing short of a disaster. Hospitals have been forced to tender for services that they already provide, but have been prohibited from reducing their charges below an amount that is set by the Government, so they automatically lose the contract. GP practices have been taken over by large private companies against the wishes of the communities that they serve. There are also, of course, the ruinous private finance initiative contracts that have made fortunes for United Kingdom and foreign companies.

I understand the Conservatives' support for that flirtation with the independent sector—it is what they do—but I do not understand the support from those Labour Party members who profess respect for the ideals of Nye Bevan, or from the Liberals who boast about William Beveridge as the true father of the national health service. Those worthy gentlemen must have birled in their graves when Labour and Lib Dem members in this chamber voted in 2004 to promote the private sector.

The NHS is a public service, and the SNP promises the people of Scotland that we will keep it that way. I support the SNP amendment.

Photo of Helen Eadie Helen Eadie Labour 9:50 am, 26th March 2009

It is wrong to rewrite history in any partnership, whether domestic or political. Ross Finnie said that it had been suggested that I would recite a "litany of failures", but Richard Simpson did not say that—he said that I would be "critical" of the failures. As Ross Finnie is always careful about detail, I remind him that that was exactly what was said.

With regard to the petition to keep the hospital open, we should not confuse Stracathro hospital with Netcare. Stracathro, which I have visited, is a very good hospital, but I am not happy with the report on the private company, Netcare Healthcare UK.

In response to Brian Adam's point about the private sector, I tell him—although I see that he has disappeared from the chamber—that as a caring socialist, I would not stand by and watch anyone suffer. To pick up on Ian McKee's point, Nye Bevan and the other pioneers in the movement would never have wanted us to do that—if the capacity was not available in the NHS, they would have wanted us to ensure that we built capacity by using the private sector if that was necessary. I do not have a problem with that.

I say in response to Ross Finnie's point that I always want to ensure that we try to build capacity in the NHS and use the private sector as little as possible. The private sector—if Brian Adam wants an idea of how best to use it—should be used for infertility services. According to one report, patients are waiting up to six years for infertility treatment—the situation is critical, and the Government must do something about it.

It is a revelation that, although the SNP Government claims to be committed to avoiding the use of the private sector, it has in its first 18 months in office delivered a massive expansion in that area. In Fife, only 17 cases were authorised for treatment in the private sector in 1999, but by the end of 2008, that number had risen to 270 patients. In Forth Valley, only three patients were treated by the private sector in 1999, but by the end of 2008, the number had reached 525. In Grampian, only 92 cases were treated in the private sector in 1999, but by the end of 2008 the figure had reached 969. In Tayside, no cases were treated in the private sector in 1999, but by the end of 2007, the sector was treating 426 cases.

Photo of Ian McKee Ian McKee Scottish National Party

Does that not indicate that the Government of the time, which the member supported, did not provide enough NHS facilities and therefore caused the shortfall that required private intervention, which she says should take place only when the NHS cannot provide the services itself?

Photo of Helen Eadie Helen Eadie Labour

I ask the member why his party's Government has continued to expand the use of the private sector with great haste and vigour. That just shows that the SNP uses the private sector when it suits, which is a case of duplicity and deceit on a grand scale.

I am sure that other members will be interested to note what is contained in the minute of NHS Tayside's board meeting on 26 June. It states clearly that the director of public health for NHS Tayside, Dr Walker, requested that his dissent be recorded in relation to the value-for-money report by PricewaterhouseCoopers—the 10-month contract review of Netcare's three-year contract. I believe that his dissent was well founded, and anyone who carefully reads the report will see that it raises important questions.

The more I read of the report, the more incredulous I became—it made me raise my eyebrows, sit up and take notice. The figures that are used in the value-for-money assessment are taken from unaudited data sets, and no attempt has been made to verify or audit data sources. Astonishingly—and worryingly for the Scottish taxpayer—the contract requires that the NHS pay "unavoidable costs" in respect of any underreferral below the agreed threshold of 90 per cent. The figures to September 2007 show £139,000-worth of underreferral charges for that period, of which £128,000 was for "unavoidable costs"—as stated in the contract—that are required to be paid to Netcare in respect of activity that has not been undertaken.

If we seek to analyse the structural reasons why the NHS is more expensive—a figure of £2 million has been mentioned by the Tories—we need only consider the following to see how the dice are, as ever, loaded against the NHS. The report states:

"the SRTC has acceptance criteria meaning that clinically unstable patients, or those with significant co-morbidities are unlikely to be referred. This gives an overall more efficient and safe service appropriate for its setting but would, on average, lead to a lower cost per activity than in the NHS."

The report also states:

"Post operative quality of major joints is unproven at this stage."

In addition, the report shows that the patient satisfaction survey response rate was low—39 per cent is not excellent—which Mary Scanlon should acknowledge.

Financial records—including audited and unaudited accounts for the service provider—and any related reports should be made available, but such records have not yet been provided, or even requested. Initial difficulties with Netcare's management systems for collecting, processing and delivering the required information have meant that a degree of prompting by the NHS has been necessary to obtain that information. The fact that Netcare has changed management teams three times since the start of the pilot has created instability.

As if all that was not bad enough, the report goes on to say:

"We have not reviewed and therefore do not make comment on the completeness of any legal documentation, in relation to health and safety, insurance and any necessary registrations, warranties and licences which are assumed to be in place."

Frankly, I would make no such assumptions—

Photo of Helen Eadie Helen Eadie Labour

I would make no such assumptions, most especially on health and safety and insurance. I would want to be absolutely certain.

Photo of Andrew Welsh Andrew Welsh Scottish National Party 9:56 am, 26th March 2009

Stracathro hospital is an ideal setting for patient treatment and recuperation, with an excellent and dedicated workforce. Historically, the hospital has treated NHS patients not only from Angus but from a much wider—indeed national—catchment area.

The hospital is important not only as an excellent medical facility but as an essential provider of employment in Angus and the Mearns that contributes to maintaining educational and other public services in the local area. That is why I fought to save Stracathro from threatened closure and why I have visited and welcomed the new Scottish regional treatment centre. The SRTC is part of the new growth of services at Stracathro—growth that is essential to ensure the hospital's future as part of the overall NHS hospitals system in Angus and Tayside.

Although the Tory motion is correct to state that the pilot project has added value to NHS services, any attempt to turn a specific, highly specialised, excellent but limited service into a whole new generalised national system would be a very different proposal. Such attempts elsewhere have led to public bail-outs of private facilities, which were not capable of dealing with wider workloads. Where justified by results, the two-year pilot project should rightly be praised for its contribution. However, to claim that the pilot should be extended to the whole NHS system or become the basis of our national system is simply dangerous dogma.

Photo of Mary Scanlon Mary Scanlon Conservative

Where do we propose to extend the SRTC pilot to the NHS across Scotland? Can the member provide a reference for that?

Photo of Andrew Welsh Andrew Welsh Scottish National Party

I refer the member to Mrs Thatcher—I had the misfortune of watching her in action—who tried that before. I remember the real consequences of her attitude: NHS cutbacks and closures. I remember the campaigns to save Arbroath infirmary and Stracathro hospital as well as other NHS services. The Tory philosophy leads to privatisation by stealth and should be opposed.

The real long-term answer to NHS improvement is the SNP Government's action in strengthening our national health service system. We need a system that is available to all and which is supported by its professionals and workers. The SNP rejects utterly any idea of an exclusive, cheque-book health care system that is based on profit rather than on need.

The challenge of providing better, faster, more local and more flexible access to health care is, by definition, on-going, but Scotland's greatest challenge is in tackling health inequalities nationwide. Private facilities are a useful addition where they can be proven to be effective, but they do not address that wider problem. The Tory motion certainly does not address that point either.

The primary objective should be to grow NHS capacity by building on the Scottish Government's increase in health spending of 13 per cent over three years, taking the total NHS budget to £11.5 billion. The objective should be to strengthen and build our national system rather than to privatise it. Such public investment in, and commitment to, our national health service is the way forward. We do not need any large-scale farming out of core services to the exclusive private health care industry. That is the underlying subtext of the Tories' attitude and of the motion. They might not state that, but we know their history and we should be wary of it. There are few things worse than unrepentant Tories, but we obviously have a few here this morning. Clearly, the Tories have failed to learn anything from their mistakes. I will most certainly support the SNP amendment.

Photo of James Kelly James Kelly Labour 10:01 am, 26th March 2009

I welcome the opportunity to speak in this morning's debate on the NHS and the independent sector. Before I turn to the substance of Mary Scanlon's motion, I pay tribute to her for the amount of work that she does on health and other issues in the Parliament. She really is a credit to the Conservative group.

The motion deals with the NHS and the independent sector by making specific reference to the success of the Scottish regional treatment centre at Stracathro hospital. When that centre was opened in 2006, it was welcomed by Shona Robison, who represents the SNP on the front bench today. At the time, the centre was put forward as a solution that would meet local needs. Stracathro has been successful in reducing waiting times and helping patients, so, from that point of view, it is to be complimented.

As well as that solution for the east of Scotland, the Labour amendment refers to a solution that was used in the west of Scotland, where the Golden Jubilee hospital was taken into NHS control. The Golden Jubilee is becoming a very modern hospital.

Photo of Nanette Milne Nanette Milne Conservative

Does the member acknowledge that the NHS could have used those facilities for its patients without buying the hospital from the private sector? Does he accept that it would have been better to use that money—I recollect that it was at least £35 million—for front-line services?

Photo of James Kelly James Kelly Labour

Given the Golden Jubilee hospital's development since that decision was taken, there is no doubt that patients feel that the decision was worth while. There have been practical benefits and improvements in health care for those who have attended the Golden Jubilee hospital in Clydebank. Indeed, given that one of the big issues in the west of Scotland is heart disease, the west of Scotland has benefited from having such a facility under public control.

On the challenges facing the NHS, given the importance of achieving what the Conservative motion refers to as

"the best possible healthcare for the people of Scotland", there is no doubt that the issues that the Parliament needs to face up to include not just health inequalities—that is, how we improve access for all—but the treatment of cancer patients. Along with clinicians, patients and other MSPs, I attended the Scotland against cancer conference in Glasgow last Friday. In a number of presentations and workshops, we heard people speak about the important issues of diagnosis, treatment and lifestyle choices. There is also no doubt that, in coming up with solutions to address the issues raised in those workshops, we need to remember the importance of retaining staff and expertise within the NHS. That point is acknowledged in the Liberal Democrats' amendment.

The fact that a third of the Scottish budget—more than £10 billion—is at the disposal of health and wellbeing shows the size not only of the resources at our disposal but of the issues that we face. In deploying that budget, the default position should be to retain a publicly funded NHS. However, given the challenges that we face, I acknowledge that we should not be completely inflexible. In instances such as the Scottish regional treatment centre, we should consider other mechanisms.

We must put patients first. The NHS—Nye Bevan's tremendous creation—was 60 last year. We must maintain it, consolidate it and build on it, ensuring that we give the NHS another successful 60 years.

Photo of Jamie Stone Jamie Stone Liberal Democrat 10:05 am, 26th March 2009

My colleague Ross Finnie referred to the debate as being "rather artificial". However, some of the main threads have become apparent. I associate myself with his remark that there is no plea in the Conservative motion for an increase in private medicine in Scotland. I back him when he says that there should be no displacement of NHS services. Full competition and duplication are simply not the way forward.

There is perhaps broad consensus among members on that.

Mary Scanlon was ably supported by a splendid backing chorus—the choreography and timing were impeccable. The Conservatives clearly have an excellent artistic director. I pay tribute to the number of Tories who managed to rise out of their beds in good time to join us.

Photo of Jamie Stone Jamie Stone Liberal Democrat

I will stick to the main subject of the debate.

Mary Scanlon wisely referred to benefit claimants. We sometimes forget, in our devolved Parliament, that the issue can affect Scotland's revenue stream. We should always keep an eye on that.

I liked Shona Robison's expression that we should use the private sector "tactically, not strategically". That is the right approach. She used the mantra "the tightest settlement", which her master has been using and which he has instructed all SNP members to use. I think that we will hear more of it. We might debate whether the settlement is the tightest yet or whether, in fact, it is the most generous yet. There would be some mileage in having that debate.

I admonish Andrew Welsh for frightening members by summoning up a ghost from the past—but the past it is. I believe that she was on television last night, and I am sure that we wish the grand old baroness the best of health.

Ian McKee and Helen Eadie gave us what was probably one of the more extreme views in the debate. However, it was a timely reminder—indeed a stark warning—of some of the possible problems. The missing figures—the difference between 2,200 procedures and 1,720—is a very curious issue. An audit is essential to find out where the money has gone. As long as such discrepancies exist, doubt is cast on any evaluation of what is being delivered at Stracathro.

Murdo Fraser and Andrew Welsh's point about employment is hugely important and should not be forgotten. In my and Mary Scanlon's part of the world, the delivery of quality jobs—for instance, at Caithness general hospital, where consultants deliver maternity and other services—brings cash into the local economy. That may be a side factor, but it is a factor that should not be forgotten during the current recession. I have no doubt that that is an important aspect of Stracathro.

Photo of Helen Eadie Helen Eadie Labour

Jamie Stone talked about my and Ian McKee's extreme views. Is he therefore saying that the views that I referred to, which were the views of PricewaterhouseCoopers, are extreme?

Photo of Jamie Stone Jamie Stone Liberal Democrat

Perhaps the word "extreme" was wrong, but there was a lot of colour in what the members said, and it may have been a reminder to them of a proper attitude that we would be unwise to forget. The challenge to us from Helen Eadie and Dr McKee to check and evaluate was entirely appropriate.

Photo of Jamie Stone Jamie Stone Liberal Democrat

No. I really must conclude now.

Dr Simpson was challenged in an intervention to give examples of where the private sector has delivered, and he was correct to mention the treatment of breast cancer and infertility. Although the private sector has a role, I go back to what Ross Finnie said, which is that my party does not seek to displace NHS services. I very much associate myself with the minister's language: the use of the private sector should be "tactical, not strategic".

I support the amendment in Mr Finnie's name.

Photo of Cathy Jamieson Cathy Jamieson Labour 10:10 am, 26th March 2009

Ross Finnie began his speech by saying that, given the wording in the motion, the debate was "rather artificial"; nonetheless, it has been interesting, not least because I do not think that I have, in recent times, heard so many tributes paid to the former Executive by the Conservatives. Forgive me if I feel ever so slightly suspicious of Tories bearing gifts.

Mary Scanlon was praised by my colleague James Kelly for all her work on health. I add my thanks to her for that. However, I am perhaps slightly more suspicious than James Kelly—Jamie Stone referred to a choreographed chorus line, and the Conservatives have indeed been pretty well choreographed so far this morning. However, we have not heard the wind-up speech yet, and it may well be a wind-up, depending on what the Conservative member who sums up has to say to us.

David McLetchie asked whether we deleted all reference to the previous Executive in our amendment because we were unhappy with its record. I shall be very clear on that. We have no difficulty with the record of the previous Executive; indeed, our amendment seeks to get on the record our pride in taking the former Health Care International hospital—now the Golden Jubilee—back into the NHS. That important step has been, as James Kelly outlined, of great benefit to patients. I put on record my thanks to Malcolm Chisholm for all his work on that.

Further, I recall a number of occasions on which we were accused of lodging self-congratulatory motions when we were in government. I hope that the Tories will accept that this morning we are being slightly modest by not only seeking to gain plaudits for what we did in the past but looking to the future.

It is a fundamental principle of the NHS that it should provide everyone with the best possible treatment, irrespective of ability to pay. That is why the Labour Party is so determined to ensure that the NHS's fundamental principles remain. That means that we should scrutinise everything in detail. We welcome the pilot and want to ensure that it goes ahead, not least to keep Stracathro hospital open, providing that local service. However, Helen Eadie and Ian McKee raised the issue of looking in more detail at the results of the pilot. That is a fair point.

Mary Scanlon referred to the position of other forms of independent health care provision in the NHS, such as locum doctors and work with the Scottish Prison Service. Like Richard Simpson, I am pleased that the health services that will in future be provided to the SPS will come back into NHS provision.

Photo of Mary Scanlon Mary Scanlon Conservative

They are not all coming back into the NHS. In fact, Northern Constabulary has just signed another contract with Medacs. I think that Atos, too, provides a good service. Helen Eadie and Ian McKee did not mention the fact that Netcare had to provide £112,000 of activity free of charge due to contracted waiting time breaches. The figures are not all one way.

Photo of Cathy Jamieson Cathy Jamieson Labour

I am sure that Helen Eadie and others will scrutinise that in detail.

I say to the minister that the trade union Unison is concerned about the continued use of agency and bank staff to fill shortages and vacancies in the NHS, especially as some of them are on zero-hours contracts. I hope that we can address that in the future.

I want to correct a misunderstanding—if such it was—by Mary Scanlon, who suggested that our amendment deletes all references to supporting or recognising the value of the staff at Stracathro. In fact, it does not do that; it ensures that we recognise the value of the staff at both Stracathro and the Golden Jubilee hospital. We have also said that we will support the Liberal Democrat amendment.

Photo of Mary Scanlon Mary Scanlon Conservative

It is important that I put on record the fact that I commented on the SNP's amendment, which "congratulates" NHS staff on their treatment of NHS patients but only "notes" the role of private sector staff in treating NHS patients. I made no reference to the Labour amendment in that context.

Photo of Cathy Jamieson Cathy Jamieson Labour

That is a helpful clarification. If there was no intention to criticise the Labour amendment, I hope that the Conservatives might consider supporting it.

Murdo Fraser suggested that ideology should not threaten Stracathro. I would argue that ideology should not threaten the national health service. It is the jewel in the crown and something of which the Labour Party is extremely proud, having developed it. Of course we want it to continue as the way in which we provide services for the vast majority of our patients.

Photo of Shona Robison Shona Robison Scottish National Party 10:16 am, 26th March 2009

This has been an interesting debate. The most revealing aspect of it has been the slightly confused and uncomfortable position of Labour members, as reflected in their speeches, some of which had a history-starts-today feel about them.

Our position is clear, as set out in "Better Health, Better Care: Action Plan", which stresses public ownership through a more mutual approach, distancing the NHS in Scotland still further from what we would describe as the divisive market-oriented models that are favoured by some members. That document confirms the NHS's place as a public service that is delivered in partnership with the public.

We have made it clear that we are committed to investing taxpayers' money in the NHS rather than in building up private sector capacity. However, we have no difficulty with NHS boards using existing independent sector capacity at the margins for the benefit of NHS patients, although any use of the private sector by boards will continue to be minimal.

I correct Helen Eadie, who clearly did not listen to a word that I said in my opening speech. The statistics that she cited were based on a false premise. She did not mention the fact that half the figures that she was using included the figures for private nursing homes and care homes that are run by local authorities, charities and hospices. I say to her that the figures for acute activity—leaving aside Stracathro, on which she clearly has her own views—show a 37 per cent reduction in the use of the private sector between 2006 and 2008.

We continue to provide increased resources to enable NHS boards to invest in their infrastructure, which supports the delivery of modern health care services. By allocating resources directly to NHS boards, we are ensuring both that local priorities can be addressed and that there is consistency with national and regional planning agendas. For example, in November 2007 and January 2008, the Golden Jubilee hospital successfully opened two new dedicated orthopaedic theatres. That has enabled the hospital to increase the number of major joint replacement operations by around 1,000, taking the total capacity to around 2,500 hip and knee replacement operations. In addition, a range of minor procedures is undertaken each year. That benefits patients from throughout Scotland. It is now one of the biggest such units in Scotland. Also, last April, we announced £550 million of additional funding towards the development of the new Southern hospitals project in Glasgow, which incorporates the new 240-bed children's hospital.

NHS boards are also making resources available to expand services from their capital and revenue allocations. Examples of that include the extension to Ayrshire community hospital out-patient department; the creation of a new endoscopy suite at Borders general hospital; and an upgrade of X-ray and computed tomography facilities and the creation of a new magnetic resonance imaging suite in Dumfries and Galloway. That move enabled the repatriation of a significant contract from the independent sector in July 2008. Those developments are all aimed at ensuring that NHS boards are expanding their services to meet their populations' needs.

However, the NHS is not about adding new capacity without making best use of existing resources. Initiatives such as lean in Lothian have released significant additional resources for investment in front-line services, which is reflected in increasing activity. The overall number of procedures undertaken in NHS acute hospitals increased by more than 27,000 in 2007-08 compared with the previous year. All of that is leading to the success of the NHS in delivering significant reductions in waiting times. No doubt, we will have a further opportunity to discuss that in next week's debate. I look forward to highlighting the achievements of the NHS in reducing waiting times in that debate.

We are very pleased that there are now more doctors, nurses and allied health professionals working in Scotland than ever before. The total number of staff who are employed by the NHS in Scotland has increased by more than 2 per cent, bringing the head count to more than 165,000 at September 2008. That figure includes a significant increase in the number of medical staff. The actions that are being taken by the Government and by NHS boards clearly show that the health service is well equipped to meet the needs and expectations of the people of Scotland.

Photo of Jackson Carlaw Jackson Carlaw Conservative 10:21 am, 26th March 2009

I thank all members for what has been a good-humoured debate. More than on any other issue relating to the future of health care in Scotland, we take a different view from the Government in our readiness to work enthusiastically with the independent sector to the benefit of the NHS.

Although the independent sector works at the margins in providing health care to a country that for 60 years has benefited from its NHS, we have never believed that those who work in the independent sector—whether as nurses, doctors or auxiliary workers—are any less committed to the care of their patients, any less hard working or any less deserving of our support, gratitude and praise. They are not second-class health workers but first-class health professionals, so the contempt of the rhetoric that has been thoughtlessly directed at them is unworthy and misplaced.

The inherent hostility of the SNP towards the independent sector is well documented. It is worn brazenly as a badge of honour, yet contradicted every day by the Government's actions. As the debate has illustrated, it is precisely because the SNP in government has recognised the opportunity that the independent sector presents to offer a better service to NHS patients that more NHS patients than at any time since devolution are being treated by the independent sector. The most dramatic increase has taken place since the SNP Government came into office.

Photo of Jackson Carlaw Jackson Carlaw Conservative

No, I will not give way on that point, because I know that the minister would repeat the same dull statistic that she gave us before, which selectively slices away all the patients to whom she does not care to refer.

No doubt, all of that explains the diplomatic absence of the Cabinet Secretary for Health and Wellbeing from the chamber this morning—blushes have been spared.

Andrew Welsh told us that, despite the Stracathro pilot being an undoubted success, we should dismiss it out of hand because, 19 years ago, the Conservative Party was led by Margaret Thatcher. I am sure that that will be a great comfort to the staff at Stracathro.

I recognise ministers' mealy-mouthed acceptance of the fact that the independent sector can be used almost as a disposable asset whose primary role is to improve treatment waiting times, not for the sake of patients but to add to the spin that polishes ministers' haloes when they take the credit for waiting time reductions. However, that is poor reward. Today offered ministers the opportunity to be a bit more fulsome in their thanks and tributes to those in the independent sector who work as hard as anyone else; yet, as Mary Scanlon observed, the most that they could find it within themselves to do was to note those people's contribution.

I find the Government's hostility to the independent sector perplexing. We are talking about a very practical partnership that was established at Stracathro by Andy Kerr under the previous Executive. It is a bold initiative from which Richard Simpson and Cathy Jamieson have sought to distance themselves this morning by deleting the fulsome tribute that we are prepared to offer. Perhaps in disavowing Andy Kerr's record as health minister they will also accept the mistake that he made in proposing to close accident and emergency facilities throughout Scotland.

The pilot had a clear intention, which was to consider the potential additional use to which NHS operating theatres could be put when they were not being used by the NHS. Dr Ian McKee advised us that two years was not long enough to judge the success of the pilot. I assume, therefore, that he is similarly unconvinced about the success of the SNP Government after just two years. On that, at least, I think that the chamber is agreed.

By any standard, the Stracathro pilot has been a success. We have heard how it has performed operations successfully at a cost of some £2 million less than the NHS. We have heard about the outstanding patient satisfaction. Those patients would probably also be concerned about any creeping privatisation of the NHS. However, having benefited from the treatment that they have received, they can also see that a practical partnership with the independent sector that is designed to benefit the NHS makes political sense.

We can celebrate, too, the record at Stracathro of no hospital-acquired infections. I imagine that a number of us have visited the hospital and have seen for ourselves the commitment of those involved.

The model has worked. Given that, why would any Government not wish to do for patients across Scotland what is being done for patients in Tayside, Grampian and Fife? This Government, however, positively sizzles at the very presence of the independent sector, as is witnessed elsewhere by its determination to end all contracted-out cleaning, allegedly to improve performance in tackling health care acquired infections, even though the worst example of deaths due to an outbreak of Clostridium difficile occurred at a hospital that had in-house cleaning and, in any event, the reasons for the outbreak were complicated and extensive and the outbreak was certainly not simply the responsibility of the in-house cleaning team.

We have a Government that has used the independent sector to provide more treatments to NHS patients than any other Government and has inherited a pilot that is supported by all of the other parties in the chamber and is proving to be a success.

We call on the Government to shelve its caustic rhetoric, to recognise the outstanding incremental contribution that the independent sector has made and to set aside its misplaced prejudice against anyone outside of the NHS who might have a contribution to make. We are not asking the Government to set aside for one moment its commitment to the NHS or to the many worthwhile improvements that it has embarked on; we are asking only that it bury its dogma and put the interests of patients first. Perhaps we are asking for too much, though. SNP dogma will disadvantage patients in Scotland, which is surely the most damning indictment of all.