Hospital Waiting Times

– in the Scottish Parliament at 9:04 am on 2nd April 2009.

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Photo of Alex Fergusson Alex Fergusson None 9:04 am, 2nd April 2009

The next item of business is a debate on motion S3M-3848, in the name of Nicola Sturgeon, on hospital waiting times. Cabinet secretary, you have around 11 minutes, but we have a little flexibility.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 9:42 am, 2nd April 2009

Presiding Officer, I am sure that all our thoughts this morning are with the families of those who lost their lives yesterday in the North Sea, and with all those in the emergency services who are involved in the rescue operation. It was an appalling tragedy, and it puts so much else into perspective.

Before I address the wider issue of waiting times, I want to welcome the confirmation from the Scottish Ambulance Service that it has, for the first time, not only met but exceeded its target to reach 75 per cent of life-threatening emergency call-outs within eight minutes. Figures for March show that the service has reached more than 77 per cent of category A calls across mainland Scotland within eight minutes. I take this opportunity to congratulate the staff on their hard work. It is a significant achievement that will improve outcomes for patients. That said, neither I nor the Ambulance Service is complacent. It will be important for performance to be sustained in the coming year, and I look forward to working with the service to ensure that that happens.

I welcome this opportunity to re-emphasise the Government's commitment to driving down national health service waiting times. I commend the NHS for its excellent performance so far in meeting current national waiting time standards and for the progress that is being made towards meeting future targets. I want to give a personal thank you to everyone who works in the NHS. As we know, delivering swift, high-quality care for patients is a team effort, involving clinical and support staff. They all deserve great credit.

Let me also acknowledge—as our motion does—the progress that was made on waiting times by the previous Administration and its successful efforts to reduce maximum waiting times to six months for both first out-patient appointments and in-patient treatment. However, I know that everyone recognised that a 26-week wait to see a doctor, coupled with a further 26-week wait to access treatment, was not a record that we should be satisfied with. That is why I am pleased to say that, in the past two years, the NHS has achieved a level of performance on waiting times that would once have been totally inconceivable. It has achieved and sustained the maximum waiting time targets of 18 weeks for out-patient consultations, and in-patient and day case treatment, and of nine weeks for key diagnostic tests; and it has achieved and sustained the whole-journey standards of 16 weeks for heart treatment and 18 weeks for cataract surgery, as well as the 24-hour target for surgery for hip fracture.

Moreover, as members will be aware, all NHS boards were expected to meet, by the end of this March, the target that no patient should wait more than 15 weeks for an out-patient consultation or for in-patient and day case treatment. I was very encouraged that, at the end of December 2008, two thirds of the Scottish population were living in health board areas where their board had delivered the targets three months ahead of schedule. I look forward to confirmation that those targets will be achieved throughout Scotland when the next statistics are published at the end of May.

Improvements have also been made in the past few years on cancer waiting times, after some years of little or no progress. The most recent quarterly audit data showed 94.6 per cent compliance with the current target, which is a 10 per cent increase since the beginning of 2007.

Our accident and emergency departments are also continuing to see and treat patients quickly. Even with the considerable challenges of the severe weather that we experienced in December and the increase in the number of patients attending accident and emergency departments, the NHS delivered a performance in which more than 96 per cent of patients were seen and then discharged or transferred within the four-hour target. We should not underestimate the progress that has been made in that area. In March 2007, less than 92 per cent of patients were seen within four hours of arrival at accident and emergency. However, boards are now regularly recording full compliance with the target. That level of sustained performance improvement has been delivered through the application of a focused and systematic approach to quality improvement.

All in all, the past two years have seen the best ever overall performance on waiting times recorded by the NHS. That is impressive in itself, but in my view it is all the more impressive when we consider that hidden waiting lists have also been abolished during that period. We now have a situation in which many thousands of patients who were previously excluded from waiting time standards now have access to health care with the shortest waiting times that this country has ever experienced. The progress to date is impressive.

Photo of Richard Simpson Richard Simpson Labour

We would all agree that availability status code waiting lists should be abolished. In fact, Labour set that abolition in train. However, will the cabinet secretary acknowledge that the statistics on waiting times, median waiting times and so on used to take the ASC waiting lists into account but no longer do so? The statistics therefore need to be considered slightly differently, because 100,000 patients are now off the lists, and many of them would previously have been on the ASC lists.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

As a former First Minister used to say to me, the median waiting time is not the true measure of a patient's experience. However, I say to the member that there is now complete and utter transparency around waiting time figures. That did not exist under the previous Administration.

As I was saying, the progress to date is impressive. However, we should not rest on our laurels. We can do much more. That is why "Better Health, Better Care" sets out an ambitious action plan. It also describes our vision of a mutual NHS. I believe that more timely access to health care is an important step in developing that mutual NHS. The benefits of shorter waits for patients are clear: earlier diagnosis and the earlier reaching of a decision to start treatment lead to better outcomes. Moreover, there is less unnecessary worry and less postcode variation.

Shorter waits benefit the NHS too, because they reduce the need to manage large treatment backlogs, and because large sums that have been spent on short-term waiting list initiatives would be better invested in sustainable and timely services. The ambition to do much more is why we have set an ambitious target—that, from the end of December 2011, patients can expect to be seen and treated within 18 weeks of referral. I make that commitment neither lightly nor in isolation. I know that within the chamber there is widespread support for that pledge, and I know that that support also extends to patients and to the public.

Labour's amendment today notes that England is already meeting the 18-week target, ahead of Scotland. That is correct. However, I feel duty bound to point out the reason for that. Whereas the UK Labour Government started working towards the target in England in 2005, it was not until the election of this Government in May 2007 that we started doing so in Scotland. However, I am pleased to say that good progress is now being made on the national 18-week programme. I am also pleased to say that the guidance that sets out the principles and definitions for the 18-week target significantly increases the number of patients who will be included within the standard. It is estimated that more than 100,000 patients who are currently excluded from waiting time standards will be treated within the 18-week target. The additional patient groups include audiology and consultant-to-consultant referrals.

That is good news, but we also need to address waits that lie outside the acute hospital sector. That is why, for the first time, there is to be a target to reduce treatment waiting times for drug misusers to support their recovery.

We are also working to establish a waiting time target for referral to treatment for specialist child and adolescent mental health services in 2010-11—the first ever waiting time target for mental health in Scotland. To support that work, we have established a new health improvement, efficiency access and treatment target. Access to psychological therapies will also receive a similar focus, and I am happy to consider the practicalities of including, over time, adult mental health services as well, a point that the Labour amendment raises.

On cancer waiting times, I have already mentioned the progress that has been made towards meeting the current 62-day target, and work on that continues. However, in "Better Cancer Care, An Action Plan" we set out a next stage for cancer targets, extending the benefits of the urgent pathway to patients on screening programmes whose initial findings give rise to suspicions that they might have cancer. We also set out a new 31-day target from decision to treat to first treatment for all cancer patients. That provides a fairer and more equitable service for all cancer patients after diagnosis, whatever their route into cancer services.

Those targets have to be implemented and achieved by December 2011. The new cancer targets will have other quality benefits, as they will further accelerate diagnosis for routine patients and integrate use of resources across all access targets.

I do not underestimate the enormous task facing the NHS in delivering our ambitious vision for the future. However, the progress that the service has already made gives me confidence that that progress can be continued and accelerated. It will not be easy. It will require the NHS to be prudent in its management of resources and to develop greater capability in innovation, modernisation and service redesign.

Photo of Mary Scanlon Mary Scanlon Conservative

Breakthrough Breast Cancer said that it welcomed the 31-day target for first treatment for breast cancer. However, it pointed out that there were no such targets for subsequent treatments such as chemotherapy. Can the cabinet secretary explain why that is?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

We have taken the decision that the next stage in our process around cancer waits should be to have that 31-day guaranteed target for the time between the decision to treat and the first treatment. As Mary Scanlon said, Breakthrough Breast Cancer has welcomed that target, but it has also pointed out that we will need to be vigilant to ensure that waiting times for subsequent treatment do not become extended. I can give an assurance that we will be very much focused on that.

Progress to date has taken an investment of significant resources, and we cannot achieve our aims without the investment of still more resources. As I have said before in the chamber, the Government is backing up its ambition with the provision of extremely substantial resources and as much support as we can give the front line through the improvement and support team's 18-week service redesign and transformation programme.

I am confident that the combination of sustained resources, the skill and dedication of all NHS staff, strong leadership locally and nationally, and the drive and expertise of our clinicians and health professionals will ensure the on-going delivery of better access for patients and a health service that we can be proud of.

Ultimately, decisions about treatment are always for individual clinicians, but I believe that it is important that there is a maximum waiting time guarantee for patients. If they need to be treated more quickly, they should be treated more quickly. However, there should be a backstop on the length of time that they have to wait, and that is what is being delivered across the NHS. We should be proud of that and back the NHS 100 per cent in its on-going progress.

I move,

That the Parliament welcomes the most recent progress that has been made in reducing waiting times for patients; applauds the commitment, dedication and hard work of all NHS staff who have contributed to delivering these significant improvements for the people of Scotland; notes the progress made by the previous administration; acknowledges the substantial investment being made to increase NHSScotland capacity and the continuing work on integrating, modernising and redesigning services to speed access, diagnosis and treatment, and supports the Scottish Government's commitment to deliver a maximum "whole journey" waiting time of 18 weeks by 2011.

Photo of Cathy Jamieson Cathy Jamieson Labour 9:54 am, 2nd April 2009

Like the cabinet secretary, I offer my condolences to the families who lost their loved ones in yesterday's tragedy, and associate myself with the remarks that were made about the emergency services.

In last week's health debate, we heard support from across the chamber for the fundamental principles of the NHS, something that I am sure that we will hear again today. In that context, it is worth remembering just how far we have come since, for example, the run-up to the United Kingdom general election in 1997, when the future of the NHS was central to Labour's campaign because of the fact that, back then, the NHS itself was in need of intensive care. For the benefit of anyone who cannot remember what it was like, I point out that, in the 1990s, it was not uncommon for people to wait for two years or more for their operation, and that many people did not survive their time on that waiting list. In 1995, after 16 years in government, the Tories unveiled their patients charter, which promised that no one would have to wait more than 18 months for elective surgery, although even that commitment was not delivered.

There is no doubt that the last decade has seen a revolution in the approach of the service, with the result that we have ensured that patients are treated more quickly.

There has been a welcome shift in emphasis away from the length of the waiting list and towards reducing waiting times. It was right to set targets to drive down the waiting times and to back up those targets with sustained investment at the UK and Scottish levels. I am pleased that we have successfully increased the capacity in the NHS to reduce waiting times.

The cabinet secretary referred to the Scottish Ambulance Service's success in meeting its targets on the time that it takes to respond to emergencies, and I also welcome that progress and thank the staff who have worked hard to make that happen. It is also right that we thank the staff across the NHS who have worked hard to deliver improvements in waiting times. We all recognise the commitment that they have shown.

Of course, the improvements that we are recognising today raise expectations and bring fresh challenges. Nowadays, the public do not think back to those days of 18-month waiting lists. Instead, they now think of the average waiting time of around eight weeks as nothing particularly exceptional or out of the ordinary; rightly, they consider such a waiting time to be part of the provision of a decent level of service. As Nye Bevan said when the NHS was created,

"the service must always be changing, growing and improving—it must always appear inadequate."

It is with that ambition and in that spirit that I urge the Scottish Government to continue carefully to consider what further improvements can be made. Even in areas in which the most overwhelming progress has been made, we still have to consolidate our gains. It is also important that we continue to invest and build on the work that has gone before. We all welcome the progress that the cabinet secretary has referred to, but we also agree that there is more to do.

As the cabinet secretary mentioned, in December 2008, the UK Government achieved an 18-week referral-to-treatment target. The current target in Scotland covers only referral to being seen by a consultant. The whole-journey target is scheduled to be met in Scotland by December 2011, and we must focus continued effort on achieving that further improvement as soon as possible. We do not want to meet the target for the sake of a numbers game; it is an important issue for patients. We all recognise that the wait between confirmation of diagnosis and commencement of treatment can be an extremely stressful time for patients.

Our amendment makes particular reference to adult mental health services. We welcome the inclusion of child and adolescent mental health services in the waiting time targets, which the cabinet secretary outlined earlier. However, we are specifically calling for further consideration of the provision of adult mental health services. I think that the cabinet secretary said that she would consider the issue of introducing maximum waiting times for mental health service provision in order to bring that area into line with other areas of health care, and I hope that she will report back to Parliament on that matter at some stage. She will be aware that that proposal has support from a wide range of organisations, including the Royal College of Psychiatrists, the Scottish Association for Mental Health and the Depression Alliance Scotland. Given that one person in four in Scotland will face mental health problems at some stage in their life, the move would benefit a vast number of patients.

In tackling mental health problems, we also need to ensure that the full range of health professionals is available. South of the border, for example, there is a programme of 3,000 training placements for psychologists. We have a pilot programme, but I hope that we will ensure that we have the full range of people available to work on tackling problem areas.

On waiting times for alcohol and drug treatment, again, I welcome the fact that progress is being made and will continue to be made. Sadly, however, waits of six months or more are still too common for those who desperately need treatment for alcohol or drug misuse, and in the worst-case scenario there are waits of up to a year. Given that alcohol-related conditions are overtaking the other so-called big killers, and given what we know about the cost to individuals, families and communities as well as to our economy, it does not make sense to continue with that approach. We must make a real effort to drive down waiting times in order to reap the social as well as the financial dividends.

If we get adults into treatment as quickly as possible, we will also minimise the harmful impact on children who live with drug and alcohol misuse. On that point, I echo the plea that Duncan McNeil made last week for a concerted effort to identify every child who is affected by parental alcohol or drug misuse and to get those parents into treatment programmes.

Other areas where waiting time targets can benefit patients include audiology, which the cabinet secretary mentioned. Again, I welcome the progress in that area, because hearing problems affect the lives of large numbers of people. I hope that we will ensure that further progress is made in future.

On cancer waiting times, Mary Scanlon mentioned the concerns that Breakthrough Breast Cancer has expressed. We welcome the progress that has been made on cancer treatment. The newly revised 31-day waiting time target covers the period between the decision to treat and the first treatment. That will help patients to access treatment more quickly. However, as Breakthrough Breast Cancer has pointed out, subsequent treatments, including chemotherapy following surgery, are not included. We are trying to do the right thing, but if we focus only on the first treatment, there might be unintended consequences. I welcome the assurance that the cabinet secretary gave on that this morning. I am sure that Breakthrough Breast Cancer will continue to keep her and the rest of us in the Parliament up to date with progress on the matter.

While welcoming the improvements that are shown by the national waiting time statistics, we must recognise that there are some disparities between waiting times in different parts of the country. If members glance at the figures by health board, they will see that the waiting time for general medicine in Tayside can be as little as one week, while Lothian, Forth Valley and Grampian all have significantly higher waiting periods of up to 18 weeks. For general surgery, hospitals in Lanarkshire and Lothian have waiting periods of two weeks, but patients in the Borders wait for longer—up to 18 weeks.

As with all aspects of health care, it is also important to ensure that the necessary systems are in place to tackle inequalities. I often hear the cabinet secretary talking about the mutual health service that she wishes to develop. I do not disagree with the principle of ensuring that patients are involved in health care. Far from it—I very much support that approach. Initiatives that drive down the number of missed appointments—for example, by making sensible use of phone calls or text messages to remind people of appointments rather than relying on appointment letters—lead to more efficient use of time and therefore help to get people into treatment more quickly. They also ensure that we reach some patients in the hard-to-reach groups. Offering flexibility in the timing or location of treatments also leads to the sensible use of resources.

As I said earlier, the progress on waiting times during the eight years of the Labour-led Executive—which the cabinet secretary recognised—and more recently by the present Administration is to be commended. As I also said at the outset, however, patients will not regard the current 18-week waiting time as an achievement in itself. They will want progress on the 18-week referral-to-treatment target. I suspect that we will also hear time and again during this morning's debate that targets must not become an end in themselves and that we should not automatically press continuously to reduce waiting times yet further if that would cut across clinical judgment.

There are opportunities to extend waiting time guarantees to yet more areas of health care to ensure that the capacity that we have built in the NHS is fully utilised for the benefit of patients. Patients also want a quality service, and they judge the success of the NHS on their whole experience and not just on waiting times. We must now focus on that. I look forward to progress being made.

I move amendment S3M-3848.3, to leave out from "acknowledges" to end and insert:

"while welcoming the extension of the waiting times guarantee to include child and adolescent mental health services, calls on the Scottish Government to consider extending the range of specialties to include adult mental health services; further calls on the Scottish Government to ensure sufficient resources to bring NHSScotland in line as soon as possible with the NHS in England where a "whole journey" national waiting time standard of 18 weeks was delivered by December 2008, and notes that this compares to a target of 18 months introduced by the previous Conservative administration."

Photo of Mary Scanlon Mary Scanlon Conservative 10:05 am, 2nd April 2009

On behalf of my party, I acknowledge the remarks of the two previous speakers about the tragedy in the North Sea last night.

We welcome the Scottish Ambulance Service's improvement in reaching category A patients in eight minutes. My colleague Jackson Carlaw will speak further on that issue. We also welcome the earlier intervention for child and adolescent mental health services, but, as those of us on the Health and Sport Committee are finding out, not enough is being done to identify mental health problems at the earliest possible age.

We welcome this morning's debate, which is about not only waiting times but the way in which the NHS allocates resources to meet the targets.

Scottish Conservatives want all patients to be seen as soon as possible, whether they are waiting to see their general practitioner, for accident and emergency services, for surgery, or for other treatment. We welcome the progress that has been made by both the previous Administration and the current Government, and we trust that the previous Administration will not vote against this week's accolade.

However, the focus on waiting times undoubtedly has consequences for service delivery. Any condition that is not included in the waiting time targets becomes something of an afterthought in the priority list for resource allocation. Those conditions are often called Cinderella services, because conditions that are covered by the targets assume higher status. An example is mental health. In July last year, the longest wait to see a psychologist in Highland was four years and seven months. In Lanarkshire and Tayside, there were waits of up to a year. If a patient is referred to a psychologist on the basis of clear clinical judgment, it is difficult for any of us to imagine the effect of a four-and-a-half-year wait on that patient's mental health.

The report that Audit Scotland published last week on drug and alcohol services in Scotland confirms that 75 per cent of problem drug users have a mental health problem. In some cases, drug taking could be a form of self-medication. Depression need not be a lifelong chronic condition with no hope of recovery and a level of service that does little to make people feel valued. I thank the Scottish Association for Mental Health for reminding us this week of the promise that was made to me in 2000 by the then Minister for Health and Community Care, Susan Deacon. In response to a parliamentary question, she stated:

"the Mental Health and Well Being Support Group are working closely with the Health Service in Scotland on the development of national waiting times targets in the three national clinical priorities."—[Official Report, Written Answers, 6 November 2000; S1W-10476.]

Those priorities included, and they still include, mental health. Cathy Jamieson might be better to focus on her own record than to look back further than 12 years.

Women in Scotland can wait for up to five years for infertility treatment despite its being age barred. The Government constantly states its opposition to the independent sector, yet its actions force many couples to pay privately for that service.

When a drug addict or an alcoholic reaches the bottom of a chaotic existence, he or she may have lost touch with the world of work, their family and their friends. If they were to seek help at that point only to be told to come back a year later, none of us could accept that the system is working.

However, I appreciate the work that is being done on the issue.

Another example is physiotherapy. I welcome the move by some health boards to self-referral, but GPs in many areas simply tell patients that there is no point in their being referred to the NHS because the waiting lists are so long. Instead, they recommend private treatment.

I also want to mention chronic pain, given that, with Gil Paterson, I co-convene the cross-party group on the issue. Although there are excellent services in Glasgow, the services in other health board areas are very much less than excellent. Because of the long waiting list in the Highlands, only consultants can refer patients to the chronic pain service; referrals from GPs are no longer accepted. Of course, the situation is better than it was a few years ago, when there was no service at all. In fairness, I have received a response from the chairman of NHS Highland saying that the board intends to address the problem.

That list is not exhaustive, but those are all examples of services that lose out as a result of the target-driven waiting times for other conditions. Moreover, the waiting time target is simply that—there is no measurement of the quality of patient care or patient outcome. As the British Medical Association states in its briefing paper for this debate,

"Waiting times are not the only, or the most important indicator of performance—patient outcomes, readmission rates, HAI rates, etc. are also important indicators of the quality of care received."

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I agree with Mary Scanlon's general point that waiting times are not the only performance indicator. However, does she acknowledge that the range of HEAT targets that health boards work towards reflects the broader priorities?

Photo of Mary Scanlon Mary Scanlon Conservative

I do not think that that is the case. We have constantly raised concerns in the Parliament about all the issues that I have mentioned. I have never, for example, seen a HEAT target anywhere near chronic pain services.

The assumption behind the waiting time target culture is that every patient has the same clinical need and that despite the pain they might be in, or other conditions that they might have, they must all wait the same length of time. Surely we need to pursue a system that, in partnership with clinicians, delivers care on the basis of prioritised clinical need.

I will be interested to see the legal right set out in the proposed patients' rights bill, particularly the level of redress and perhaps the compensation that might have to be paid out if targets are not met. I fully commend all those in the NHS and the independent sector for their commitment to patient care throughout Scotland, but I must question whether, with the reduction of waiting time targets, the requirements of the working time directive, the further 2 per cent efficiency savings that have to be found and the NHS Scotland national resource allocation committee cuts to boards such as NHS Highland, the targets will be delivered with the quality that we all rightly expect.

Unfortunately, the waiting time target does not focus on innovative ways of managing patient care such as the greater utilisation of telehealth and e-health opportunities that could undoubtedly lead to better outcomes and management of care. Sometimes boards are so busy pursuing and achieving targets that they have no time to consider such different systems and types of provision. I welcome the fact that Richard Simpson will be holding a meeting in the garden lobby to raise awareness of the issue—

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Will the member begin to wind up, please?

Photo of Mary Scanlon Mary Scanlon Conservative

Will do. That meeting will take place on 29 April.

I trust that all MSPs will acknowledge the work of all health professionals who care for NHS patients and support my view that patient care and health outcomes should not be jeopardised to meet targets.

I move amendment S3M-3848.1, to leave out from "staff" to end and insert:

"and independent sector staff who have contributed to delivering these significant improvements for the people of Scotland; notes the progress made by the previous administration; acknowledges the substantial investment being made to increase NHSScotland capacity and the continuing work on integrating, modernising and redesigning services to speed access, diagnosis and treatment, but cautions that, while shorter waiting times are welcome, patient care and health outcomes should not be jeopardised by attempts to meet centrally determined targets."

Photo of Ross Finnie Ross Finnie Liberal Democrat 10:14 am, 2nd April 2009

I, too, on behalf of the Liberal Democrats, associate myself with the remarks that have been made by the cabinet secretary, Cathy Jamieson and Mary Scanlon about yesterday's tragic events. Our thoughts are with the families involved and the emergency services.

Such debates are always difficult. We are right to remind ourselves that this work started because patients were thoroughly dissatisfied—to put it politely—with inexplicably long waiting times. It is all very well to say, "Well, that's fine. Now we need to move on and put together the perfect solution to all these problems," but we should remember that patients wanted a great improvement in those times. However, as Mary Scanlon pointed out, the targets were and are being used to measure the health service's performance, which some have seen as a highly unfortunate move. Indeed, that is why I feel that we need to be careful in how we move forward. However, it would be churlish not to welcome the progress on waiting times, particularly, as the cabinet secretary pointed out, with regard to cancer treatment and A and E.

I very much welcome this morning's announcement of the Scottish Ambulance Service's improved performance, although I point out that response time was not necessarily the core issue in that respect. The Liberal Democrats also welcome the extension of the waiting time guarantee to child and adolescent mental health services and the acknowledgement that was made by the cabinet secretary—and indeed by Mary Scanlon—of the issue of adult mental health services, as raised in the Labour amendment. The fact that treatment for substance abuse will come within the ambit of the waiting time guarantee is very much to be welcomed. Indeed, the Liberal Democrats are keen to explore the possibility of extending appropriate guarantees to other specialised services.

I do not in any way want to give the impression that it is not important to continue to bear down on waiting times. However, although we are making excellent progress, we are in danger of shifting the benchmark of success from achieving satisfactory waiting times for any procedure to achieving waiting times for elective procedures, which after all account for a small proportion of health care expenditure. As we drive forward, we need not only to consolidate what has been achieved but to maintain a balance between directing our attention at waiting times and not losing sight of the other areas that must be considered. I do not suggest that the cabinet secretary's remarks did so, but we must not give the impression that the NHS's performance will be measured solely on whether it bears down on and meets its waiting time targets.

We need to maintain progress, but we also need to think about the areas on which we need to move forward. Although I have no objection to using the independent sector where necessary, I agree with the BMA—and disagree with Mary Scanlon—that it is not a long-term solution to the current problems. Moreover, as my amendment makes clear, we must not, in driving forward with waiting time targets, lose sight of the fact that clinical staff must still be able to exercise clinical judgment.

As Mary Scanlon said, waiting times are neither the only nor, at all times, the most important indicator of performance in the NHS in Scotland; indeed, the cabinet secretary rightly pointed out that HEAT targets have been put in place. However, although we welcome attempts to improve waiting times for a whole span of conditions, we would also welcome the extension of HEAT targets to all aspects of care to ensure that they receive the same level of response.

The cabinet secretary is right to say that this progress has come at a price. Getting us to this point has required very substantial investment, and we must ensure that as we move forward resources are directed not only at achieving waiting time targets. After all, if boards begin to focus too much on one target, that might have an extraordinary and perverse impact on our ability to address health inequalities.

As we progress, we must be cautious in relation to the Government's desire to give the process legal backing and to provide a form of legal redress. All health care staff have professional standards. Most, but not all, of them are regulated or are seeking to become regulated. They are therefore individually capable of providing redress, as a result of their own practice. I am not entirely clear that we need to go further. A Government-driven and publicly owned health sector is capable of delivering targets and it can be publicly held to account on that. People who work in the service have professional standards that they are personally responsible for adhering to.

I welcome all that has been achieved. It would not be right to be churlish about that. Significant achievements have been made in improving a service that had to be improved. However, we must be cautious and ensure that we achieve the right balance. We need to sustain and consolidate progress on waiting times, but we should not make that the sole benchmark against which the NHS is judged. Clinicians must not believe that their clinical judgment is in some way subjugated to targets that are to be met for the greater good.

I move amendment S3M-3848.2, to insert at end:

"but believes that the achievement of maximum waiting times should ultimately be at the discretion of clinicians to protect those with the greatest clinical need."

Photo of Christine Grahame Christine Grahame Scottish National Party 10:21 am, 2nd April 2009

I am sure that all members acknowledge the value of all those who work in the NHS, particularly the front-line staff such as consultants, nurses and ancillary staff. It is not so often acknowledged that they are always under the direction of good and responsible management. We should also acknowledge the achievements of the previous Liberal-Labour Administration in the early days of the Parliament, when we were all feeling our way. The NHS is like an ocean-going tanker that is seemingly set on a fixed route and carrying necessary life-saving cargo, but which, as we all know, is painfully slow to change direction or even set another course. I will not go over the history but, as Cathy Jamieson said, we have come a long way in 10 years. That is against the background that expectations of the NHS are rightly high, which is reflected in demand, while treatments and developments are becoming more complex and expensive. The environment in which the NHS works is very different from that in the early days after its establishment.

As the Labour amendment does, I welcome the extension of the waiting time guarantee to child and adolescent mental health services. I will discuss the issue of adult mental health services later, but I assure members that the Health and Sport Committee, which is conducting an inquiry into child and adolescent mental health services, will monitor the situation carefully—that is our job.

I turn to the Conservative amendment. The SNP is rightly set on reducing private activity in the NHS. In a perfect world, I would not have any such activity, as it would be redundant. However, it would be churlish not to recognise that good work can be done in the private sector. "Churlish" must be the word of the day, although I point out to Ross Finnie that I wrote it in my speech before he said it. The Conservative amendment acknowledges the good work that the Government is doing.

Concerns about waiting times becoming the be-all and end-all are expressed in the Conservative amendment and are the meat of the Liberal Democrat amendment. I agree that we should caution against a mantra on waiting times, but the discretion that the Liberal Democrats would introduce on waiting times would put a major hole below the waterline in the SS NHS. That would dispose of certainty and, at the extreme, would make a waiting time obligation almost not worth the paper that it was written on.

We all know that waiting times matter. They matter to those who are delivering, because they understand their obligations and the requirement to organise resources and apply them accordingly, but they matter most of all to the patient, once diagnosed, who wants direction and security in a troubling period of serious concern. The proposed patients' rights bill will add to security by giving a legally binding agreement on treatment within 12 weeks for in-patients and day care patients. The sooner treatment is instigated, the better for the physical, mental and emotional wellbeing of not only the patient, but the family and the wider community.

We all accept that substantial progress has been made. In particular, I point out the progress that has been made on audiology services, which I always felt were a bit of a Cinderella in our priorities. As I said, I have concerns about waiting times for adult mental health services, which are also a bit of a Cinderella. We should perhaps consider prioritising services for the elderly, although they are not easy to label. As my late mother said endlessly, Rome was not built in a day—I am full of metaphors today. That applies to the NHS. Even in 10 years, we cannot sort everything. It will take time, but we are moving the great tanker in the right direction.

Ross Finnie raised concerns that the focus on waiting times will distort clinical priorities. Those concerns are understandable and I am sure that the cabinet secretary and the minister are well aware of them and that they will take them into account and monitor the situation. However, it is for GPs or consultants who have a patient before them to consider whether a referral for treatment or examination is necessary. That is where the referral starts and where the clinical prioritisation takes place. It is also when the clock starts ticking. I know that that is a burden on those professionals, but that is their job.

Despite my comments about introducing waiting time guarantees for, inter alia, adult mental health services and, I hope, services for the elderly, I welcome the progress that the Government has made. Indeed, I welcome the progress that the Parliament has made, as we have learned to do our job. The improvements in delivery and accountability in the NHS are not only a result of the work of the staff, to whom we should pay tribute, but proof that devolution, which was long delayed in my lifetime as we should have had it in the 1970s, is doing its job. Just think what more we could do with independence.

Photo of Helen Eadie Helen Eadie Labour 10:27 am, 2nd April 2009

As other members have done, I record on behalf of my constituents how much I value the commitment and expertise of health workers and the service that they provide in the private and public sectors. I include in that all clinicians and allied health professionals, right through to the hospital porters, who serve to improve our health in Scotland. There is no doubt that progress is being made, but there are major concerns. As other members have said, it would be churlish not to give credit where it is due. In the most life-threatening cases, targets are being met, but there are many issues that must be addressed by the cabinet secretary and her colleague the minister. We agree that there is a great deal more to be done.

Many conditions simply do not have targets and are not the focus of attention. It is our job as politicians to say that there is much more to be done. Complacency is simply not acceptable.

Christine Grahame said that the NHS is a tanker. I once read that the NHS in the United Kingdom is bigger than the red army ever was. Therefore, to turn round the NHS is a mammoth feat. My key message for the Government in talking about what more needs to be done is to point out that an expert advisory group of clinicians has reported that couples still have to wait up to six years even to begin to access infertility treatment or assisted conception services. By the time couples realise that there is an issue, their biological clocks are ticking. However, the NHS is failing people, so the private sector is their only option. Couples sometimes have to bear costs of tens of thousands of pounds to access assisted conception services, if they have the money. That is simply not acceptable.

I am concerned about the newspaper reports and headlines that we had last November that 100,000 patients had been removed from hospital waiting lists in a bid to meet Government targets. We learned that about 100,000 Scots a year were referred back to their GPs, which meant that they went back to the start of the 18-week maximum waiting time for treatment. Figures that were released last November showed that 27,160 patients were taken off waiting lists in that way in October. My friend and colleague Dr Richard Simpson has pointed out that nearly 30,000 patients were removed from waiting lists; they were denied treatment, sent back to their GP and told to start again. Richard Simpson said:

"Nicola Sturgeon built her reputation by exposing hidden waiting lists".

Now that she is in government, she has to be honest and accept that people find the removal of patients from waiting lists deplorable. If she was one of the patients who had been moved, she would be angry for them. I am angry for them, too.

We have been contacted by a number of organisations such as Breakthrough Breast Cancer. I echo the concerns that have been raised. I will not reiterate them, because Mary Scanlon and Cathy Jamieson have expressed them amply.

In support of Labour's amendment, I have to say that mental health is an issue of profound concern for us all. The request that Mary Scanlon made under the Freedom of Information (Scotland) Act 2002 to NHS boards last year revealed that waiting times varied substantially from area to area throughout Scotland. In Lanarkshire, the maximum wait to see a psychologist was more than a year, while in Tayside, more than 120 people waited between 26 and 52 weeks. That is simply not acceptable, given the delivery plan commitment to reduce antidepressant use and the integrated clinical pathway guidance that people with clinically significant depression should be offered brief psychological therapies within six weeks.

Photo of Ian McKee Ian McKee Scottish National Party

Does the member accept that the patients who are referred back to their GP from the hospital are referred back for clinical conditions that need treatment and that in many cases it would be dangerous to go ahead with hospital treatment at that time?

Photo of Helen Eadie Helen Eadie Labour

I am not sure that all clinicians would agree with that. In the context of prioritising care, the BMA, which has made representations to us, said:

"Doctors believe that waiting list initiatives have distorted clinical priorities in the past resulting in patients with less serious complaints being treated before those with more complex medical problems. 98% of doctors who took part in the BMA survey said that patient waiting times should be based on the individual patient's clinical needs and not political targets."

Photo of Shona Robison Shona Robison Scottish National Party

Do I take it that the member does not support maximum waiting time targets?

Photo of Helen Eadie Helen Eadie Labour

The minister and the Government should listen to what the BMA and other professional organisations—not me—are saying. The BMA said:

"Doctors believe that NHS managers should encourage local innovations led by clinicians which would have a positive impact on waiting times. 84% would back a system where waiting times for services with outcomes that are not easily measured"— such as care of the elderly—

"are given equal if not greater, priority than current targets for certain types of elective surgery.

The BMA does recognise that targets are necessary to help governments demonstrate and measure progress. However, the BMA would call on the political parties to work in partnership with clinicians to develop targets that are meaningful, relevant and that deliver benefits to patients who are most in need of care."

The Scottish Government has recently consulted on the proposals for a patients' rights bill. Although we and the BMA welcome

"the commitment to articulate the rights and responsibilities of all those using and providing NHS services", we all agree that we do not necessarily

"believe that any political guarantee regarding specific waiting times should be placed in legislation."

That is controversial and we need to debate it further.

The BMA said:

"We believe that without a significant increase in resources, and the provision of extra capacity in the system for periods of unexpected activity, legally binding guarantees could be of detriment to those who may be most in need of urgent care."

It remains unclear what the legal redress would be under the proposed patients' rights bill if a minimum waiting time guarantee was not met.

Much has been done, but, as I have demonstrated, much more has to be done. We are simply not performing as well as we could.

Photo of Ian McKee Ian McKee Scottish National Party 10:33 am, 2nd April 2009

Who could fail to welcome the tremendous progress made in recent years to reduce waiting times for patients? I join the cabinet secretary in congratulating the NHS staff who have worked so hard to help make that possible and the previous Administration, which laid some of the foundations for the advance.

There are few more stressful occasions in life than waiting for necessary diagnosis or treatment, and anything that is done to shorten such waits must be applauded.

I am delighted that the Government has expanded the number of procedures that are covered by the 18-week guarantee and that it has the courage to turn its attention to mental health services, which are sometimes called the Cinderella of the NHS but, alas, were treated more often by previous Administrations as if they were the ugly sisters.

As I am well aware from my professional work in the past, there are specific problems with mental health services. Mental health treatment is often long term and time consuming—that is especially true of the talking therapies such as psychology or psychotherapy—but there is abundant evidence that the earlier the intervention, the greater the likelihood that treatment will be successful. Resources invested in reducing waiting times in mental health services is an investment that will cover its cost several times over as years go by.

Presiding Officer, I am sure that you will be pleased that I do not intend to recite a catalogue of targets that our Government has now reached and targets that will be achieved by 2011. No one can listen to either of the ministers in our health team without concluding that our health service is in safe hands. [Interruption.] Promotion, please!

I will take a small step back and look at the broader picture of health delivery in the context of the wait for treatment. It is often stated that the need for health services is infinite and that such services must be rationed in some way, either by making people pay—by price—or by increasing the length of waiting lists. For a lot of services, that is arrant nonsense. At any one time, there is a finite need for hip-joint replacements, hernia operations, heart bypasses and many other procedures—if someone does not have the complaint, they will not thank anyone for giving them the treatment. Those treatments should be amenable to one-off waiting time initiatives that shorten the waiting interval and allow it to be kept short simply by keeping pace with subsequent demand.

The situation is more complex for investigations that might or might not lead to a treatment need. Speeding up investigations will allow earlier interventions for those diagnosed as requiring them, which, in turn, might well prolong life and/or preserve health. Although that is almost entirely beneficial, it might incur a greater financial cost for the NHS than a situation in which investigation is prolonged for so long that curative treatment is impossible. A good example is testing blood cholesterol. A high cholesterol level in a person will cost the NHS a lot of money in treatment, but such treatment might save the person from a heart attack or stroke. In strictly financial terms, that treatment might be a more expensive option for the health service than not treating the population and allowing a few patients to die suddenly and prematurely. It is to our credit that we do not proceed along those lines whole-heartedly, but I am afraid that, in the past, we have sometimes succumbed to the temptation to ration investigations, if not by waiting list then by availability, to avoid the cost of treatment.

There are also new health needs—needs that either did not or could not exist some time ago. Many, such as certain cosmetic surgery procedures and unproven alternative treatment, are not even considered to be related to health at all. As Helen Eadie said, the new advances in the treatment of infertility are wildly expensive in time and resource terms and tend to be rationed either by waiting time or availability. Whether such treatment should be available on the NHS is a matter for society, not health workers or health boards, which I suspect would welcome further guidance from society on such matters. There is an opportunity cost with any initiative, and we must always consider whether it is worth it.

That all means that, although waiting time targets are highly desirable, the need to achieve and shorten them should not be the be-all and end-all of our concerns. I am glad that the Government accepts that. I do not always agree with the BMA, but it is right to emphasise that some important services are less amenable to measurement than others and that the quality of a service is usually more important than the speed with which it is delivered. Some conditions might not need immediate attention, while others demand it.

It is always important to look at health services in the round and to consider not only waiting times but readmission rates, health-acquired infection incidence and whether there is a satisfactory outcome. We usually debate those issues when we are discussing hospitals, but there is a huge and relatively untapped pool of experience in primary care, which, if utilised properly, could transform the way that we provide services to those in need.

Photo of Richard Simpson Richard Simpson Labour

The rate of referral for such things as computed tomography and magnetic resonance imaging scans by general practitioners is hugely lower in Scotland than it is in England. There seems to be a major barrier to such referrals. Does the member agree that, if we loosened that up, it would improve the effectiveness and throughput of the service?

Photo of Ian McKee Ian McKee Scottish National Party

I agree with Dr Simpson to the extent that we need a total review of how primary care contributes to achieving waiting list targets and to general health. For example, we used to do lots of minor operations in primary care, but they tend no longer to be done because of the provisions in the Glennie report to protect us against new variant CJD, which the risk of contracting is extraordinarily slight. That also means that some people have to go to hospital because those operations cannot be done in primary care. Such matters should be looked into.

Another example, which has been mentioned, is the early treatment of people with alcohol problems. A relatively small investment in training in primary care—for not just GPs but nurses and even receptionists—could revolutionise how we tackle alcohol problems in the community and shorten the waiting time from several months to a day or two. All that is needed is the drive and the investment in services. I know that the Government will consider how primary care can be used in that way.

I sincerely congratulate the Government on the success that it has achieved and look forward to further progress in years to come, as I am sure my Labour colleagues do—I see them all smiling at the prospect.

Photo of Margaret Curran Margaret Curran Labour 10:41 am, 2nd April 2009

I am pleased to be back in a health debate. It is some time since I spoke in one, and such debates have become terribly consensual and friendly in my absence. I will not take that personally.

As an issue in all of our constituency work, health never goes away. Over the years, the Parliament has debated many health priorities—from inequalities to long-term conditions and the general improvement of our population's health. It is common ground that we want all our responses to those challenges to deliver proper and fair access to the services that are available. That idea is wrapped around the debate and that is why we have a substantial commitment to waiting time guarantees as a driver of standards and change.

We must ensure that all people—irrespective of their background, their age and particularly their location—receive the treatment that they need in a clear and understandable framework. Access to treatment reduces worry and all that goes with that but, in the past 10 years, we have also tried to empower patients and to create a sense of entitlement in the Scottish population. That has meant that families do not have to worry or argue with a service about when treatment will be provided, and it has created the expectation that the best that the NHS offers will be delivered to everyone on a timescale that is laid out.

Significant progress has been made. As Ian McKee said, that has not been easy to achieve, but the focus, drive and resources have allowed that to happen. Sometimes, that has come from politicians, but—as the motion says—it has also come from the national health service's leadership, which should be acknowledged, and mostly from NHS staff, whom all of us recognise, as is proper.

As Cathy Jamieson said, we should remember that reducing the waiting time from 18 months to 18 weeks was a fundamental turnaround, which was not easy to achieve. That change has transformed people's lives, expectations and confidence in the NHS. That is important, and we should understand how that was achieved as we—properly—progress from that.

Mary Scanlon, Ross Finnie, Helen Eadie and Ian McKee referred to the BMA's substantial points about the waiting time guarantee, which we cannot easily dismiss. As Ian McKee said, we should give great consideration to that as we try to answer some of the questions.

Waiting time targets should not be used to distort or direct clinical priorities. In fact, they should be a tool to implement clinical priorities, not an end in themselves. We should never fall for the quality versus time argument: we should always strive to ensure quality, but we should never take our eye off the ball of the time guarantee, which matters much to people and has driven up standards in the national health service. Waiting time targets encourage patients throughout Scotland to have a proper level of expectation about the service that they will receive.

The Liberal Democrats led a previous debate on waiting times in which I spoke, when we discussed legally binding guarantees. They are perhaps a step too far and could prevent us from addressing some of the limits of waiting time guarantees, which have been mentioned. Legal enforcement could upset a system that has—broadly—worked, and it could encourage a compensation culture that involves more lawyers than doctors. None of us wants to go down that road. It might lead us to take our eye off the ball of the need to maintain the focus and momentum with which the service has met the challenges of waiting time guarantees. I re-emphasise what the motion says about the commitment of staff. Legally binding guarantees would not facilitate the continued empowerment of staff that has happened so far.

Of course, we need to go further. We must focus on the whole-journey waiting time guarantee. I accept the cabinet secretary's point that the 31-day target for cancer treatment is a first step towards a whole-journey waiting time guarantee, but we must take seriously the Breakthrough Breast Cancer campaign's point that we cannot take our eye off the ball of the second phase of treatment.

Labour's amendment makes a critically important point about access to adult mental health services, and I welcome what the cabinet secretary said about that. All of us are aware of the exploration of mental health, the need for appropriate services and the fact that we are not delivering the services that we should for people with mental health issues. We must make a step change in those services.

All of us received the briefing from the Scottish Association for Mental Health, which says that waiting times for mental health services are substantial and vary significantly between areas. We must fully recognise the human consequence of that, and I am sure that all members deal with constituency cases of people who are not receiving the services that they need. That must be fundamentally addressed, and I hope that the cabinet secretary will report to Parliament on how she has fulfilled her commitment to consider including adult mental health services in the guarantee and to lay out a plan for doing that. Having a waiting time target for such services is unavoidable if we are to deliver the quality and range of services that are desperately needed throughout Scotland.

Like Ian McKee, I make the plea that we consider the contribution of not only the acute sector but other health professionals to the general standard of health. We need to meet the challenge of delivering waiting time targets for access to allied health professionals. Such services are often neglected, but they make a vital difference to the quality of health services. I hope that we can rise to that challenge, too, as Scotland would be better served by that.

Photo of Alasdair Allan Alasdair Allan Scottish National Party 10:48 am, 2nd April 2009

I apologise that I cannot stay for the closing speeches because of a matter that has arisen in my constituency.

The price of reducing waiting lists is constant vigilance, but it is a price worth paying. There is now serious evidence that waiting lists in a range of key services are reducing, and the motion recognises the achievements of the previous and current Administrations in that.

Waiting times are important not just because punctuality is popular but because, as we all know from our respective constituency mailbags, every patient understands the clinical importance of speedy treatment, which is key to providing the best outcomes.

Reducing waiting lists is worth the effort because, in the long run, it saves time, energy and resources by cutting out the bureaucracy of managing and administering queues and backlogs for treatment. It reduces inequalities by addressing variations in waiting times between NHS boards and hospitals, and it wipes out the postcode lottery in health care that prevailed under the previous Executive's stewardship. More important is that decent waiting times have a clear human benefit. They reduce unnecessary uncertainty, concern and sleepless nights for patients and—most important—they lead to earlier diagnosis and treatment.

The Scottish Government has invested £270 million in Scotland's health boards to ensure that waiting times are at their lowest since the relevant records began. It is significant that the Government has abolished the availability status codes that were established simply to doctor the figures.

We are fostering a new relationship with patients by providing them with a legally binding waiting time guarantee. Although others have already alluded to the fact, it is worth mentioning again that, when the Government came into office, it inherited 30,000 patients who had been kept off waiting lists.

The vision is for a truly mutual NHS, in which patients have a say in how their health service is run and organised and a direct say in how they are treated. If we are serious about that, patients have a moral right to know exactly what treatment they will receive and when it will be carried out. Health care should not be something that is simply done to them.

In July last year, the NHS celebrated its 60th birthday. One of the many ways in which the event was marked was by a visit by the Cabinet Secretary for Health and Wellbeing to the Uist and Barra hospital in my constituency, where she initiated a variety of new services. The point was made then—and holds now—that the agenda to reduce waiting times is inseparable from the agenda to reduce, where possible, the distances that patients have to travel for treatment. I will not rehearse the distances that are involved for patients in the Western Isles. Suffice it to say that cancer patients in Uist and Barra were relieved to get a chemotherapy service up and running locally in recent weeks, to save them the exhaustion and distress of a regular two-day round trip for treatment.

I know that the Cabinet Secretary for Health and Wellbeing will be concerned that, in recent days, Highland Airways has unexpectedly refused to transfer the materials that are necessary for the chemotherapy service, citing a gap in its safety certification—despite the willingness of NHS Western Isles to pay at least part of the cost of certification and to provide necessary training. I know that NHS Western Isles is working actively to persuade the airline to adopt a more sensible position.

I hope that we now recognise more fully that, just as people have a right not to be subjected to unreasonable travelling times, they have a right to be treated within a reasonable time. With that in mind and with, I would like to think, at least some support across the chamber, the Government has published a consultation on a patients' rights bill. It is vital that patients should see themselves as active partners in life-changing decisions. We want to ensure that they are respected and have entitlements set in statute to ensure that their access, safety and participation are valued and delivered.

As other speakers have mentioned, from December 2011, 18 weeks will be the guaranteed maximum wait for treatment of non-urgent patients following referral by a GP, although most patients will be seen more quickly. The 18-week guarantee is distinct from previous waiting time targets in that, rather than focus on a single stage of care, it focuses on what will be termed an 18-week referral-to-treatment standard. Rather than there being a target time from the GP referral to the first out-patient appointment and then a time from someone being put on a waiting list until treatment is delivered, the RTT standard will address the whole patient care pathway, from receipt of a GP referral up to the point at which each patient is admitted to hospital for treatment. That approach has the advantage of introducing a uniform standard for access that is less complex and should, therefore, be better understood by patients and health professionals alike.

The referral-to-treatment standard will be delivered through a service transformation programme that will engage with NHS boards and look at best practice. The employees of NHS Scotland will play a crucial role and, thanks to the increased investment that we have provided, the overall number of staff who are employed by NHS Scotland has increased and the number of clinical nurse specialists is at an all-time high.

Although all the steps that I have described will make a real difference to reducing waiting times in the short term, Scotland is clearly taking a longer-term and more holistic view of health, of which waiting times are only a single but important part.

Photo of Aileen Campbell Aileen Campbell Scottish National Party 10:54 am, 2nd April 2009

I, too, welcome this Scottish Government debate on hospital waiting times. I know that the issue is important to many of the constituents who come to see me at my surgeries across the South of Scotland. The broadly consensual nature of this morning's debate, which acknowledged past achievements, shows just how important we all know that the NHS is for communities throughout Scotland and why it is important for us to work together in a positive way to make it the best that it can be.

Today's debate shows the Scottish Government's commitment to ensuring that our NHS works for the people and responds to their needs. The Government's commitment to delivering a maximum whole-journey waiting time of 18 weeks by 2011 is just one aspect of its work to ensure a healthier Scotland and an improved NHS. I am heartened by the moves that the Government is making to ensure that people are placed at the centre of the health service, because when people come to me with problems relating to the health service it is often because they do not understand what is going on, who has made decisions and why things are happening to them in a particular way. It is distressing for people to have all those emotions when they at their most vulnerable. I hope that equipping people with knowledge of their rights will go some way towards removing remoteness, be reassuring and re-engage them with a service that they love.

As the motion states, the improvement that we seek is partly about valuing the work of the thousands of dedicated staff throughout the country who believe in the principles of the NHS, as well as delivering commitments to reduce waiting times. I have seen first hand how hard my sister, who is a podiatrist in the south of Scotland, and her colleagues work and how important their role and that of other allied health professionals is; Margaret Curran made that point in her speech.

We are all aware of the huge health problems that Scotland faces: rising obesity levels, heart disease and our drinking culture. Our lifestyles put an enormous amount of pressure on the services that the NHS provides.

Photo of Mary Scanlon Mary Scanlon Conservative

In Highland, it is difficult for many people to access podiatry on the NHS. Will the member commend those podiatrists who treat patients privately in order to maintain their mobility?

Photo of Aileen Campbell Aileen Campbell Scottish National Party

My sister would not forgive me if I did not commend podiatrists on their work. I know first hand that they work incredibly hard throughout the country. The fact that there are lower waiting times is testament to the work that NHS staff do, and their achievement is even more incredible given the pressures that all of us place on them.

Reduced waiting times, more staff and the fact that people are being placed at the heart of the NHS suggest a healthy prognosis for the service's future. However, as with everything, improvements will always be necessary, and the Government will need to strike the correct balance on the challenges that lie ahead. The Cabinet Secretary for Health and Wellbeing made that point in her opening speech.

The most immediate and important benefit of shorter waiting times is for individual patients. Faster treatment helps them to return much more quickly to health and a full and productive life. That has a wider benefit for society as a whole, especially in these times of economic difficulty. If we can treat people quickly and enable them to return to work once they are ready to do so, that will have knock-on benefits for the economy and society.

We should also hope that less time spent on waiting lists will mean that there is less chance of people developing complications or of conditions deteriorating. In turn, that will mean that NHS resources are spent much more effectively and can benefit more people. We should see a virtuous circle, as waiting lists reduce and more people can be treated much more quickly. In that way, reducing waiting times helps us towards the badly needed goal of moving the NHS away from being a national sickness service to being a health service that promotes prevention and overall wellbeing, which is good not just for individual patients but for society as a whole.

Since the Government came to power in 2007, there has been a clear, strong commitment to improving the level of care that is provided to people in Scotland. As Alasdair Allan said, £270 million of funding has been provided to NHS health boards between 2008 and 2011 to help them to meet pledges on waiting times. That funding has helped the NHS to take great strides in tackling waiting times in important medical areas such as cancer, drug use and mental health. Figures show that those requiring access to mental health services already receive treatment well within 18 weeks and that 70 per cent of those who are offered an appointment for a drug use assessment are offered a date within 14 days. Those figures, and the abolition of availability status codes, which—as has been mentioned—kept people languishing for months or even years without treatment, demonstrate that the Government has provided the support that allows the NHS to operate in an even better way.

The task of creating an even better NHS will be made much easier if we ensure that the NHS has the appropriate number of staff. I was pleased to see that the total number of staff who are employed by NHS Scotland increased by 2.1 per cent in the previous year, that the number of clinical nurse specialists is at an all-time high—as has been mentioned—and that the number of allied health professionals has increased.

As we all strive for a healthier nation, it is imperative that we support the Government in its work to provide the health service with the capacity to treat patients within guaranteed timeframes and to provide wide-ranging services that meet the needs of the people of Scotland. Although the move to reduce further the cost of prescription charges, with a view to getting rid of them altogether by 2011, is not the sole topic of today's debate, it has caught the imagination of my constituents. The move, which will ensure that people are not financially penalised because they suffer ill health, is especially welcome during tough economic times. The approach reunites the NHS with its founding principles and makes the service fit the needs of the people. I hope that such moves, along with the reduction in hospital waiting times and increased staffing levels, will create a healthier and fairer Scotland.

Photo of Jamie Stone Jamie Stone Liberal Democrat 11:00 am, 2nd April 2009

I associate myself with the remarks that have been made about the tragedy in the North Sea yesterday. I am sure that, like me, many members have flown by helicopter to oil platforms. My first thought was that the tragedy will affect people from my constituency, but I think that we do not yet know who lost their lives. The tragedy could affect any of our constituencies, and the thought of what the families are going through is, I am sure, with us all. Our hearts and minds are with them.

The cabinet secretary talked about driving down NHS waiting times, and Liberal Democrats give credit where it is due. We are also grateful for the cabinet secretary's gracious acknowledgment of the previous Administration's contribution. She said that compliance with the cancer waiting time target has increased by 10 per cent since 2007. In an intervention during her speech, Mary Scanlon was right to flag up that despite such improvements we need to tackle waiting times for further cancer treatment, such as chemotherapy. We should be mindful of the issue, which other members mentioned.

Cathy Jamieson offered a timely reminder of the appalling situation in the past. I was a local councillor in those days—as I am sure that many members were—and I remember how desperate it was for people who had a long wait for treatment. It is important to remember how far we have come. Cathy Jamieson reminded us that we have raised expectations to a level that was never anticipated, given continuing health improvements. She also picked up on Mary Scanlon's point about on-going cancer treatment.

I like the language about a mutual health service that involves patients as well as health professionals in decisions. I am sure that the cabinet secretary's comments about appointment times struck a chord with many members, including Alasdair Allan. If we are to drive down waiting times, we must ensure that patients can take up appointments that are made for them—for that reason, members talked about how reminders could be sent to people's mobile phones. For patients in the Highlands who live on the north or west coast, early morning and late afternoon appointments at Raigmore hospital in Inverness can cause problems. Such appointments can also cause problems for patient transport services, and those problems might be a reason for some cancellations, despite the best efforts of the cabinet secretary and her team to drive down waiting times. I have written to the cabinet secretary in the past—I mean the recent past; I am not demanding an instant reply—to ask whether appointment times could be co-ordinated, to help to achieve the outcome that she is working hard to secure.

Mary Scanlon's example of a Highland patient's four-and-a-half-year wait to see a psychologist was a horror story that showed how bad the situation can be. In my experience as a constituency member, there is an issue about waiting lists for physiotherapy and the chronic pain service, so I can confirm what she said. She was right to flag up the potential in telehealth. The approach has got beyond trial stage in two Caithness hospitals, and I hope that it will be rolled out further.

I was intrigued by a comment that Christine Grahame made. If I understood her correctly, she said that the waiting time clock starts ticking when a GP decides to refer a patient. Did she mean that the decision cannot be changed? As Ross Finnie said, some decisions have to be revisited, and a blind adherence to waiting time targets could get in the way of clinical decisions.

Photo of Christine Grahame Christine Grahame Scottish National Party

I was making the point that the clinical decision is made by the GP or the consultant, so the clock starts ticking when there is a referral or decision. A patient does not say, "I want to be treated within 18 weeks." If someone does not require treatment, there is no reason to refer them and offer an 18-week waiting time guarantee. Of course, as Dr McKee said, if circumstances change there might be a referral back to the GP: a patient's health might change and a proposed operation or surgical procedure might no longer be the right approach. The area is quite technical, so I will leave it to the Minister for Public Health to address it in more detail.

Photo of Jamie Stone Jamie Stone Liberal Democrat

Ross Finnie and I are saying that we want to maintain a balance between waiting time targets and other aspects of the service. As Ross Finnie said, clinical experts make clinical judgments, which should not be in any way subordinate to waiting time targets. Perhaps Christine Grahame and I are not far apart on that, and we will listen to what the minister says. I think that Ian McKee perhaps agrees with the Liberal Democrats because he said that waiting times should not be the be-all and end-all.

Alasdair Allan talked about his constituency mailbag and issues that rural members such as Mary Scanlon and I will recognise. I liked what he said about the local delivery of services such as chemotherapy. The more that we conduct audits that consider what services can be taken out of Raigmore hospital and delivered locally in Caithness general hospital in my constituency and other hospitals in the Highlands, the more accessible we can make services for patients—that brings me back to my point about the timing of appointments. Local delivery of services will ensure greater and quicker throughput and thereby drive down waiting times.

The cabinet secretary congratulated the Scottish Ambulance Service on getting its response times down. I cannot resist the temptation to say that in the far north there remains an issue about double manning and so on, but in fairness to the cabinet secretary I should say that she is aware of that.

Photo of Mary Scanlon Mary Scanlon Conservative

Does the member share the concerns of many GPs in his home town, Tain in Ross-shire, and elsewhere in the Highlands, who have been told that the waiting list for GP referral to the chronic pain service is closed? Does he share my concern at that example of what can happen when resources are diverted so that targets can be met? I appreciate that the matter is being considered, but many of the member's constituents remain concerned, as do I.

Photo of Jamie Stone Jamie Stone Liberal Democrat

I associate myself with Mary Scanlon's remarks. I imagine that the issue has been brought to her attention as much as it has been brought to mine. Work is being done, but a solution has not quite yet been reached.

I conclude where Ross Finnie began. I repeat that the Liberal Democrats believe in maintaining a balance between waiting times and other service aspects, and it is crucial that we get the balance right. I whole-heartedly support the amendment in Ross Finnie's name, and I sincerely hope that other parties, including the party of the Government, will do so too.

Photo of Jackson Carlaw Jackson Carlaw Conservative 11:08 am, 2nd April 2009

This morning's debate takes place against a sombre background, but it is nonetheless an end-of-term occasion of sorts. In the tradition of ends of term, we are presented with a report card, in the form of the motion. That somewhat lavish tribute to the Government has been penned by the Government itself—would that we could all enjoy a lifetime of writing our own reports. If, after two years, the Government has to congratulate itself, in the absence of anyone else to do so, we are at a crossroads. We might have hoped that the new politics, about which members of all parties spoke so engagingly only two short years ago, would have seen an end to self-satisfied, Politburo-style statements—it is ironic that such motions resemble the motions that used to populate Scottish Conservative party conferences two or three decades ago.

However, if we are to take the motion at face value and judge the Government by its own lights, we must admit that welcome progress has been made, for which the Government is entitled to a share of the credit. The question is whether, ultimately, targets are more indicative of progress than outcomes are.

We welcome the commitment and dedication of all the people—I mean "all"—who have contributed to the reduction in waiting times. Last week, Mary Scanlon admonished Shona Robison for having no regard for the contribution of health workers in the independent sector, which has contributed—in however small a way—to the achievement of the Government's targets. As I noted last week, those health care professionals have helped to polish the self-awarded halos that adorn ministerial heads. Perhaps it was too much to expect that the Government would reflect on the shameful disregard that it showed only a week ago for the many workers in the independent sector who—in however small a way, as I said—have, together with all those who work in the NHS, achieved so much. It seems to be business as usual and, in the process, the work of thousands of professional health care workers goes unrecognised by the SNP—

Photo of Jackson Carlaw Jackson Carlaw Conservative

In a moment.

The work of those professionals goes unrecognised by the SNP, riddled as it is with dogma rather than generosity of spirit, with the magnanimous exception of the independently minded Christine Grahame who, like Helen Eadie on the other side of the chamber, made a measured and sympathetic contribution to the debate that was anything but self-congratulatory.

I give way to Christine Grahame.

Photo of Christine Grahame Christine Grahame Scottish National Party

It is not necessary for me to intervene now—I fear that I have been handed the black spot.

Photo of Jackson Carlaw Jackson Carlaw Conservative

The member should rejoice at that news.

Our amendment recognises the efforts and success of those who are overlooked by the Government. Indeed, it goes further by supporting the Government's acknowledgement of the progress that was made by the previous Administration, on which Cathy Jamieson lingered long in her opening speech.

During the 23 months of the current session of Parliament, Conservative members have regularly been challenged to pay tribute to the previous Executive. A week has not gone by, nor has a debate been held, in which members opposite have not stood up and demanded that we doff our caps to the earnest good works that they achieved before their rejection by the electorate. It was good to hear from Margaret Curran earlier, who has made that demand a speciality during her time on the health front bench. However, when we acknowledged that very thing last week, we were spurned. Therefore, as I am sure members opposite will agree, it is certainly big hearted of us to persist with yet another attempt in the 24th month of the session. We live in hope but, even so, we fully expect that the inclusion of our acknowledgement of their efforts will ensure that our amendment is defeated.

As I said a moment ago, we acknowledge the progress that has been made. However, I question whether progress towards the achievement of top-down targets is the progress that we ultimately need and that will revitalise the morale of dedicated health care workers in our NHS. We believe that far more emphasis should be placed on outcomes.

To illustrate my point, even as we celebrate this morning the success of the Ambulance Service in achieving its attendance targets, it is the case—I have confirmed this with the Scottish Parliament information centre—that if an ambulance achieves its eight-minute attendance target and the patient dies, that is considered to be a success in terms of meeting the target. However, it is deemed to be a failure if the ambulance arrives after nine minutes and the patient lives. That is a peculiar sort of success.

Driving targets ever higher can distort clinical priorities and potentially worsen patient outcomes, which helps to demoralise a workforce whose expertise is in delivering health care. Surprisingly, that point was made by Cathy Jamieson.

Photo of Richard Simpson Richard Simpson Labour

I am fascinated by the member's speech, but is he saying that we should allow ambulance arrival times to drift later and later? When someone has had a heart attack, for example, speed is of the essence, so the targets are entirely reasonable. They are also rational, as they are set at 75 per cent rather than 100 per cent. The Conservative party's ideological opposition to targets is ridiculous.

Photo of Jackson Carlaw Jackson Carlaw Conservative

I am not opposed to people being treated at the earliest possible point. We are, however, uncomfortable with how it is determined what is a success and what is a failure. The outcome, as well as the speed at which the ambulance attended, is critical to the patient.

Of course, no one advocates a long wait for any patient, but top-down targets can lead to unintended outcomes. Clinical necessities must be our priority—I am sure that the cabinet secretary would not disagree. Many members have spoken this morning about the long waiting times that we want to avoid for patients, and about areas in which much work remains to be done.

We believe that there should be far more emphasis on NHS outcomes. We should record the result of the care that a patient experienced: whether they lived or died, and for how long they survived a cancer. We believe that health care professionals see value in a system that measures results rather than just processes and in which that information is used to drive up standards. It is the result that matters, rather than how it is achieved. We support the emphasis that Ross Finnie and Ian McKee placed on the need to achieve balance.

As for the rest of the Government's report-card motion, in addition to congratulating all health care workers on the outstanding job that they do, we acknowledge the further investment that the Government is making. We support that, as we supported the reversal of the deeply damaging accident and emergency cuts throughout Scotland that were planned by the previous Executive and championed by Scottish Labour. We welcome the investment in new health care facilities; in the treatment of cancer—to which Alasdair Allan referred—in both adults and children; in tackling health inequalities; and, hopefully, in tackling health care associated infections through the use of electronic bed and infection tracking technology.

On the Government's report card, we note, "Well done. Ministers are making progress and showing a determination in their application. They are brightish pupils, and we wish them well, but we caution against being narrow minded and dogmatic in their dealings with others, or self-congratulatory. Pride, after all, comes before a fall. Stick to it—try to be imaginative and flexible, and the rewards may speak for themselves."

Photo of Richard Simpson Richard Simpson Labour 11:15 am, 2nd April 2009

I associate myself with some of the sombre remarks that members have made about yesterday's accident.

The debate is serious and it must reflect where we have come from. Although she did not linger on it, Cathy Jamieson mentioned that we have moved a considerable way, not only in terms of what has been achieved in our health service, and what is continuing to be achieved under the present Administration, but in terms of the aspirations that we all have for the quality and timely delivery of the service.

I join the cabinet secretary and the other members who have praised NHS staff for their achievements during the past 10 or 12 years in moving the health service forward. When I entered practice in 1970, I referred my first patient to an orthopaedic surgeon and received a note back that said that there was no doubt that the patient needed an operative procedure, but it was not urgent and would not be done before the surgeon retired. I inquired when the surgeon would be retiring, and was told that his retirement was about five years away. We have moved a long way from those rather dark days, when the health service's waiting lists were appalling.

As I think the Liberals mentioned, NHS staff have not always found targets comfortable but, to be frank, I will not apologise to them for that. If clinical priorities are being distorted in a way that would put patients at risk, we need to take that seriously, but I do not believe that that is happening. I will return to that point later in my speech.

When I carried out a word search on the draft of my speech, I found that the word "welcome" was used on about seven occasions. I thought, "My goodness—this will be a hard speech to deliver," so I will get the welcomes over quickly.

I welcome the addition of the target on child and adolescent mental health, on which the Health and Sport Committee is currently carrying out an inquiry. There is a long way to go on that issue, but the target is welcome. I welcome the cabinet secretary's assurance in her opening speech that the Government will consider the situation with adult mental health.

Ian McKee, Mary Scanlon and Helen Eadie have referred to the enormous waiting lists for psychological treatment. There are workforce problems in relation to psychologists, which—although it will be difficult for the Parliament—need to be addressed. I am concerned that, in contrast with England, where 3,000 new therapists are being trained, we do not have the talking therapists who will be required to deliver on the joint targets on driving down the levels of antidepressant prescriptions. Those targets will not be met unless the therapists are in place. I hope that the NHS pilot on cognitive behavioural therapy by phone is successful, but I do not believe that it will be enough.

I welcome the decision to have a HEAT target on drug waiting times, although—as I said yesterday—I have some concerns about exactly how the new drug and alcohol partnerships will deliver on that. It is an NHS target, and the local authorities will now be put in a more central spot through the community planning partnerships.

Photo of Mary Scanlon Mary Scanlon Conservative

With his extensive expertise, does the member agree that it is not only the treatment that is important for drug addicts but the support that is provided over time through the recovery services?

Photo of Richard Simpson Richard Simpson Labour

Mary Scanlon is right. The support has to be sustainable. I am sure that no member feels that waiting more than six months for assessment is good for the 872 patients who have had to do that, or for their families or children—we have debated that aspect; nor is it good for the public safety of the patients' communities, because some of the patients will commit crimes. It will be interesting to see the targets that the Government brings in for those areas, as it has announced that it will.

Labour's 2007 manifesto promised that, if returned to power, we would tackle a number of issues—I am glad to say that most of them are being taken forward by the present Administration—including the use of availability status codes, which were always referred to as hidden waiting lists. I know that the press were persuaded to use that term; reporters had to ask me what the ASC actually meant. The availability status code was a simple system whereby people were put on a separate waiting list if they could not make themselves available or if their doctor decided that they were not available. The fact that the system was abused by management to deal with waiting lists was both unfortunate and regrettable, but we all agreed that the ASCs should be got rid of and they have been got rid of.

Therefore, we developed the new ways waiting times, which were then carried on by the current Administration.

However, there are problems with the new ways waiting times. As Helen Eadie mentioned, I have pointed out some of those problems on previous occasions. The fact is that 100,000 people have been put off the lists for one of the 14 reasons. I welcome—that is another welcome—the fact that the reasons listed as items 50 and 51 in the index to the new ways waiting times document, which relate to interconsultant referrals, will now be cancelled. At least we will now have two fewer reasons why people should be put off the list.

I remain concerned about the effect of the new system on some groups of people, including those with learning difficulties; those with communication difficulties, such as the deafblind; elderly people, especially those who are unsupported or have early dementia; the homeless; travelling people; prisoners; new immigrants; asylum seekers; some from black and minority ethnic communities who might have language problems; and some with mental health problems. We have a small amount of evidence so far that suggests that those groups might be squeezed by the new bureaucracy, but we do not have enough evidence to make a case or to have a debate on the matter. Nevertheless, I ask the cabinet secretary to ensure that the Audit Scotland review looks closely at whether those vulnerable groups are being squeezed by the new bureaucracy that has been created.

Another target on which we are all agreed is that no one attending accident and emergency should wait for more than four hours. More than any other, the four-hour A and E target has been the subject of protests from clinicians about false decisions being made in order to squeeze inside the target. We should send out the clear message from the Parliament that such targets are designed not to force clinicians into inappropriate decisions but to ensure that management supplies the resources that are necessary for the clinicians to undertake their work. I still hear from A and E consultants who are angry that, at three hours and 50 minutes, clinically unqualified managers almost bully them into sending patients home so that the target can be met. If a patient can be moved to a clinical decision unit to await the results of tests rather than be sent home just to meet a target, we need to find some more sophisticated way to allow that process because it is in the patient's interests. The interests of the patient should always be borne in mind. In that regard, I urge the cabinet secretary to look again at the emergency department information system—EDIS—which several reports suggest is not user friendly and might need to be reviewed.

As many members have mentioned, people are also waiting for appointments with allied health professionals. Last year, a census showed that 94,000 patients are on that waiting list. Is that the new hidden waiting list? We will see. As other members have mentioned, people are waiting to see podiatrists and physiotherapists as well as—I would add—orthoptists. Many groups of people are experiencing serious problems of waiting. Labour's manifesto committed us to delivering a nine-week waiting time guarantee for AHPs. I urge the cabinet secretary to consider that issue closely. In that regard, I understand that referrals from consultants to allied health professionals or from allied health professionals to consultants do not come within the current waiting time guarantee. That needs to be sorted.

Photo of Mary Scanlon Mary Scanlon Conservative

I remind the member that the most recent survey on the waiting list to see physiotherapists—of course, details are not held centrally—was carried out in 2005. At that time, 28,000 patients were on that waiting list.

Photo of Richard Simpson Richard Simpson Labour

As I understand it from my discussions with allied health professionals and from my reading of the census that was carried out last year, there are 2,600 separate waiting lists. This is not a criticism of the Government—we did not tackle the issue because we had other priorities, which the Government now shares—but I believe that the issue now needs further attention. I hope that Shona Robison will refer to that when she sums up the debate.

The Labour amendment draws a comparison with waiting times in England. I do not suggest that we emulate England's approach, which was taken to tackle the particular problems that it faced. Over the past 10 years, the Scottish health service has adopted a collaborative and co-operative approach that does not seek—this is one reason why we will not vote for the Tory amendment this evening—to build capacity within the private sector. Nevertheless, the fact that 93 per cent of in-patients and 97 per cent of out-patients in England now have a whole-journey wait of less than 18 weeks for treatment is a significant achievement. We are now falling behind, so we need to redouble our efforts if we are to maintain things. The cabinet secretary said that median waiting times do not reflect the individual patient's experience. That is of course correct, but the median waiting time in England for the whole journey for in-patient treatment is now 62 days compared with our 79 days. We need to be realistic about the fact that we are falling behind and we need to ensure that pressure is maintained.

Finally, we need to look ahead. We need to begin now a process of debating a more sophisticated system that goes beyond the target that has been set for 2011. We need to begin the discussion with the public, with professionals and within the Parliament on how we can achieve individual waiting time guarantees for conditions to reflect the needs of patients more appropriately. That discussion could begin now.

I ask members to support our amendment.

Photo of Shona Robison Shona Robison Scottish National Party 11:26 am, 2nd April 2009

Like others, I associate myself with the remarks that were made about the tragedy in the North Sea. Our thoughts are with the family and friends of those who have been affected.

This has been an interesting, worthwhile and quite consensual debate. Members have made a wide range of points that demonstrate the high level of interest in patient waiting times and how vital health care services are to us all in Scotland. I am encouraged that we appear to have general cross-party support on a number of issues, including the need to improve on the current waiting times standards by giving patients a clear indication of the maximum time that they will need to wait from referral to hospital treatment.

Delivering on the 18-week target will be challenging and will require an enormous shift in how hospital services are provided. Although Richard Simpson suggested that England was in some ways ahead of us in doing that, I should point out that England started on that process in 2005, whereas the previous Scottish Executive decided not to do so in 2005. Therefore, rather than falling behind, we are now catching up because of the efforts that were taken two years ago to move towards the 18-week target. As I said, the target is challenging, but it can be achieved by building on the changes that are already taking place and by continuing to develop the NHS as an integrated service in which the patient's experience is smooth, swift and seamless.

Mary Scanlon and Jamie Stone suggested that targets somehow distort clinical priority. I strongly disagree with that. As we have stated on a number of occasions, patients whose clinical need requires that they be treated quicker than the maximum waiting time should indeed be treated much more quickly. That is the very essence of a clinically driven system and we will always support and defend that. The maximum waiting time is a backstop, as the cabinet secretary said in her opening speech.

Photo of Mary Scanlon Mary Scanlon Conservative

If the waiting time is based on clinical need, does that apply to the waiting time for mental health services, physiotherapy and fertility treatment? As Jamie Stone will know, many people in the Highlands have been unable to wait for a psychologist and—I am sorry to say—have taken their lives with their own hands due to the long wait.

Photo of Shona Robison Shona Robison Scottish National Party

I am very aware of some of the challenges that exist with mental health services. That is why, for the first time, we have moved to bring some of those treatments within the waiting time target. Clinical priority is still very important in those areas and most people are treated within the 18 weeks, but there are still too many people who wait too long. That is an issue that we are determined to address.

Mary Scanlon and others mentioned the issue of long waits for patient groups that are currently outside waiting time standards. I assure those members that the Scottish Government is committed to ensuring that patients have swift and safe access to the full range of services that they need from the NHS. Already, an increase of more than 100,000 patients to whom the standards will apply has been brought within the waiting time target for 2011.

The development of the mental health waiting time target for children and adolescent mental health services has been welcomed by many members, as has the work that we are taking forward on access to psychological therapies. I note the workforce challenges that were highlighted by Richard Simpson. We are considering that area. However, it is to be welcomed that, for the first time ever, we have waiting time targets for mental health services.

We continue to focus on other services. We are well advanced on the drug treatment HEAT target. Alcohol-related problems were mentioned by some members. Work has begun on the development of the alcohol HEAT target. However, it is important to recognise that, although it is important that we develop a HEAT target, we have not rested on our laurels when it comes to alcohol-related problems. That is why we have invested a huge resource—up to £120 million—in alcohol-related services, many of which are directed at brief interventions. That perhaps answers Ian McKee's point. It is very important that the staff who are delivering those brief interventions, whether it is a GP or a nurse working in A and E, have received the training to do so. That is an important development, which members should welcome.

Helen Eadie talked about infertility services. I recognise the challenges, in that some of the waits are longer than we would want them to be. That is a long-standing issue, which goes back many years. Progress has been made, though, and those waits are not as long as they were. However, we recognise that there is more work to be done. We want to work in partnership with members to broaden our focus and ensure that all patients get a service that is continuously improving. I hope that other members share the same objective and will work with us in that positive spirit.

Although the debate has focused on waiting time performance, sustained delivery of that performance depends on having a workforce in place to deliver the highest level of care to the people of Scotland. I am pleased that more doctors, nurses and allied health professionals are working in Scotland's hospitals and community settings. Richard Simpson raised the issue of allied health professionals. If we are going to meet the 18-week referral-to-treatment target, we require to reduce waiting times to see allied health professionals. In turn, meeting the target will drive down waiting times.

The latest figures show that, at September 2008, the total number of staff employed in the NHS in Scotland was 165,551—an increase of 2.1 per cent. While I am on the subject of staff, I assure Jackson Carlaw that I appreciate the efforts of all health workers, no matter which setting they work in. I hope that he will welcome the improvement in staffing levels within the NHS, which will deliver for patients throughout Scotland.

As the cabinet secretary said in her opening remarks, we are investing more money in the NHS than ever before. We have increased spending on health in Scotland per head of population to record levels and have delivered record investment, which will exceed £11 billion by 2010-11. Capital investment totalling £1.676 billion was made available to the NHS in Scotland over the period 2008-09 to 2010-11—delivering real change and real progress for the NHS so that it can be better equipped and resourced than ever before to improve the quality of the patient and staff environment.

As the cabinet secretary stated, we are committed to giving patients better access and to providing a health service of which the Scottish people can be proud. We believe that the maximum waiting time is an important element of that. It focuses the attention of those running the health service on what patients expect, which is quick and safe access to treatment in the NHS. That is what the SNP Government is determined to deliver for the people of Scotland.

Photo of Trish Godman Trish Godman Labour

As we have finished early, I suspend the meeting until 11.40, when we will have general questions to ministers.

Meeting suspended.

On resuming—