I welcome the opportunity to lead this debate.
In recent years, the NHS has made impressive progress in improving the quality of health care. Undoubtedly, the most impressive achievement has been the slashing of waiting times. Like many MSPs, when I was first elected, it was not uncommon to get letters from people who had waited a year or more for treatment. Thankfully, that is a thing of the past. Waiting times for both out-patient and in-patient treatment are now at record lows and we are on track to meet the 18-weeks referral-to-treatment target next year. Both this Administration and the previous one can justifiably take some credit for that achievement, but the real praise should go to the NHS staff who have delivered it. However, important though that progress on waiting times is, we should not rest on our laurels. We must be—and this Government is—committed to making further improvements.
Patients want speedy treatment and quick access to care, but they want more than that. They also want a health service that is compassionate and treats them with dignity; they want to see real partnership between clinicians, patients and others; they want services to be provided in a clean and safe environment; they want hospital food to be good; they want continuity right though their journey of care; and, of course, they want to have confidence in the quality and effectiveness of any treatment.
Achieving all that for every patient, every time that they use the NHS, is what the quality strategy is all about. At its heart is a simple but very ambitious aim: to make the NHS in Scotland a world leader in the quality of health care services that it delivers.
That aim is not just good for patients, it is also right for staff. There is real enthusiasm across the NHS for the quality strategy—something that I would be the first to accept cannot always be said about Government initiatives. The reason for that enthusiasm is fourfold.
First, delivering compassionate care is at the very heart of clinical values. For staff in the NHS,
Secondly, the quality strategy is not just another Government initiative. Although we are calling it a strategy, it is, in reality, much more than that. It is a whole new ethos and one that I believe will position us more effectively to build on the strong foundations that we already have in place and on the impressive progress made to date and which will enable us to meet the challenges that we all know lie ahead.
Thirdly, it is about not reinventing the wheel but building on what already works and spreading good practice to every ward, surgery and clinic. For example, I have been hugely impressed by the results of the Scottish patient safety programme in reducing adverse incidents for patients and by the results of the releasing time to care initiative, which examines the systems and processes in place in a ward to cut down the time that nurses are forced to waste and free them up to do what they do best—care directly for patients Fourthly, it has been developed through extensive discussion with people working in and with the NHS, representatives from patient groups, the third sector and colleagues across the wider public sector.
So, what does the quality strategy do? Principally, it sets out three quality ambitions. First, we will create beneficial partnerships between patients, their families and those delivering health care services. Those partnerships will respect individual needs and values and will demonstrate compassion, continuity, clear communication and shared decision making. Secondly, we will ensure that people experience no avoidable injury or harm from the health care that they receive and that they are cared for in an appropriate, clean and safe environment at all times. Thirdly, the most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit from them, with no wasteful or harmful variation.
When I talk about the quality strategy, I am well aware that there are always sceptics—healthy sceptics, I have to say—thinking, "Surely all of that is what the NHS should do anyway." The answer to that question is, "Yes, it should" and, in many, many cases, "Yes, it does." However, the truth—that we must face up to—is that it does not do so consistently for all the patients who use the NHS all the time.
Our ambition—the ambition of the quality strategy—is that, in future, it will. So, from now on, everything that we do in the NHS will seek to contribute to those ambitions, and the delivery and performance management arrangements,
The other question that will be asked is, "How will we know that the quality strategy is succeeding?" The answer is that we will systematically measure progress. Quality—with its inevitable element of subjectivity—is, of course, harder to measure than, for example, waiting times, but it can and will be done.
We are developing a quality measurement framework that supports our vision of health care quality as described by the three quality ambitions. Progress towards those ambitions will be assessed by reference to quality outcome measures. Those will be based on a combination of patient and staff-reported experiences and outcomes as well as measures of patient safety and clinical effectiveness. The detail of the measures is still being developed, but pages 37 and 38 of the strategy give some examples of measures that are being considered.
The quality outcome measures will also contribute to a quality scorecard, which is a key tool for NHS boards to use to assess quality of care and to provide early warning of any potential quality issues. In light of the situation that arose in Mid Staffordshire in England and, indeed, in the Vale of Leven here, I believe that that is an important tool for boards to use, in addition to the governance systems that they already have in place.
As I have said, the HEAT targets will in future be aligned to the quality ambitions.
At the very heart of the quality strategy and the measurement framework is the determination to listen to patients' views. Ultimately the success of the quality strategy will be determined by the perceptions and experiences of those who use the NHS and of their loved ones and by the views of those who work in the NHS. That is why it is so important to gather those views both in a way in which they have never been gathered before and to more of an extent than ever before and to ensure that they are used to drive further improvement.
In my remaining time, I will make a number of points about NHS resources, as raised in two of the amendments. First, I have heard some suggest—not necessarily anyone in the chamber—that with the tightening of public sector budgets now is the wrong time to embark on something as undoubtedly ambitious as the quality strategy. I could not disagree more strongly. When a patient gets care or treatment on the NHS that is not of the highest quality, it is not only a disservice
I have a question not about the global amount of funding, but about its distribution. The cabinet secretary will recall that we met to discuss the difficulties that rural health boards are facing as a result of the move to the national resource allocation committee distribution formula. When will she be able to come back to Parliament with the results of the look-again at the rural element of health funding distribution, given its impact on the services that are necessary in such areas?
Jeremy Purvis has certainly raised that issue with me before. In fact, Malcolm Chisholm raised NRAC issues in Parliament earlier this morning and Christine Grahame, too, has highlighted the same issues. As Mr Purvis knows, the technical advisory group on resource allocation is looking at certain issues around the NRAC formula, and I am more than happy to consider where it would be appropriate to update Parliament on the outcome of that work. In the meantime, however, I am also more than happy to keep Mr Purvis updated. Whatever funding allocation formula is in place should be fair and should keep pace with some of the changes that happen in the NHS.
On the Labour amendment, I point out that this year's NHS budget is £264 million higher than last year's as a result of our action to protect the NHS from the impact of a Westminster-imposed £500 million cut in our budget. We will continue to protect the NHS. However, it is also right that the service makes efficiency savings to maximise the resources that it can spend on front-line care. Those savings are robustly scrutinised to ensure that they do not damage the quality of front-line care—indeed, that will continue to be the case—but it is vital that we do everything possible to ensure that every pound is spent wisely for the benefit of patients, to meet the population's changing needs and expectations and to reflect the different ways in which health care is delivered.
I am going to be charitable about the Liberal Democrat amendment, which I assume was lodged before the Lib Dems went into coalition with a Tory party intent on cutting £6 billion from public spending this year. I suggest that if the Lib
To all the Opposition parties I say that, although it is absolutely appropriate for all of us to make our various points in the debate, I hope that when it comes to tonight's vote we can unite behind the quality strategy and show those tasked with delivering it that we are all behind them in their efforts. I also hope that we can unite to ensure that over the next few challenging years we protect to the best of our ability the health service that is so highly cherished in our country.
I believe that the quality strategy's implementation will strengthen confidence in our NHS and will give confidence not only to patients and carers but to staff in the job that they are doing. I believe that it will help us to build an even greater sense of national pride in an NHS that I believe is amongst the best in the world.
I am happy to move, That the Parliament commends The Healthcare Quality Strategy for NHSScotland as the right approach, at the right time, to delivering the highest quality healthcare to everybody in Scotland, responding to what they want, need and deserve and, through this, to ensuring that the quality of healthcare services across NHS Scotland becomes recognised as among the best in the world.
I welcome the opportunity to discuss the NHS quality strategy and I congratulate the Scottish Government on introducing it. I find little to disagree with in the document and I am sure that that view will be shared among members across the chamber. We all want safe, clinically effective and person-centred treatment, which is at the heart of the quality strategy. We all want Scotland to become a world leader in the delivery of health care. It is right that we should continually strive to improve our delivery of services and the outcomes that we achieve for people throughout the country.
The ambition is right, and I am sure that the cabinet secretary will acknowledge that achieving that ambition will be dependent on leadership at all levels of the NHS, shared ownership of the objectives and, of course, partnership with staff, patients and carers. All that will be critical if we are to achieve change on the scale that is required and to begin to meet the objectives and take the direction of travel that the strategy sets out.
If any of the sentiments in the document is to become real, measuring progress matters. I am therefore interested in the quality framework, underpinned by HEAT targets, that will serve to monitor and drive progress. I have no disagreement with the 12 overarching outcome measures that are proposed and I am pleased that there is an outcome on hospital-acquired infections. However, there is a suggestion that there will be a reduction in HEAT targets. I ask the cabinet secretary which ones will be dropped and whether new ones will be developed.
That is an important issue and one on which I am happy to keep the Parliament updated. It is not a question of dropping HEAT targets; the aim is to ensure that the HEAT targets that we choose are aligned with the ambitions in the quality strategy to ensure that boards and those who work in the NHS are clear about the objectives that they are working towards. As always, I will ensure that Parliament is kept updated as that work develops.
I am sure that we all look forward to scrutinising that work as it is produced.
As the cabinet secretary did, I pay tribute to all staff in the NHS. Their contribution is simply beyond measure. So whether somebody is a consultant, a doctor, a nurse, a member of catering staff or a porter, we appreciate their commitment and service to the NHS and we thank them for it.
I am worried about the cuts that are being implemented now in various parts of the NHS. The cabinet secretary will say that the amount of money that the Scottish National Party Government has provided to the NHS has gone up by £264 million, but she will not tell us that that is the lowest settlement in real terms made to the NHS in Scotland since the days of Michael Scissorhands Forsyth—it is a mere 0.1 per cent increase in real terms. That is why, when representatives of health boards appeared before the Health and Sport Committee yesterday, their evidence revealed £270 million of cuts in the present financial year. For example, NHS Lanarkshire acknowledges its increase of £16.7 million for this year, but its increased costs are £40 million. The board says that it needs to make £17 million of savings. What about NHS Lothian? It has had a £31 million uplift, but it has increased costs of £60 million, with savings of £29 million to be found. NHS Tayside has had a £12 million uplift, but it has increased costs of £42 million and savings of £30 million have to be found.
I ask the cabinet secretary please not to tell me that those are efficiency savings. The so-called efficiency savings that health boards are having to find have to be achieved because, frankly, she has assumed them in their budget allocation and they
In my area, the replacement for the Alexandria medical centre, which was promised by the cabinet secretary and which is in the vision for the Vale of Leven, is on hold and under review. The community maternity unit has now moved from a 24/7 service to a daytime service, with women having to locate an on-call midwife before the doors are unlocked and the light is switched on in the unit. But guess what? The majority of babies are born at night. Is that efficient, or even sensible? I do not think so.
What about the 500 cleaning hours that are to be cut from Glasgow royal infirmary? Have we learned nothing about hospital-acquired infections?
What about NHS Lothian, which has been forced to reduce its workforce by 700? How many are front-line staff?
NHS Lanarkshire does not seem to understand the importance that the cabinet secretary ascribes to prevention. Smoking cessation staff numbers are being cut in half. The Braveheart programme is being reduced, if not cancelled. We heard earlier today from Cathie Craigie about the removal of podiatry services from an 80-year-old constituent. Sticking with NHS Lanarkshire, what about the cancellation of the 130-bed acute mental health unit and the likely reduction in community psychiatric services?
I know that the cabinet secretary will tell us that she has kept open Monklands accident and emergency unit, but she has not invested one single penny in the fabric of the rest of the hospital building, which is falling down. On her watch, she has allowed 16 surgical beds to be mothballed and there is no new mental health facility and no new cancer centre, which was promised.
How will we achieve the NHS quality strategy if those front-line services are being cut? In NHS Ayrshire and Arran, the new kidney unit is being cancelled. In NHS Borders, there is a review of £180,000 of spending on medical staff. In NHS Tayside, there have been £3 million savings from not filling vacancies. Our already hard-pressed front-line staff are being asked to do even more as their colleagues face a future on the dole queue.
NHS Dumfries and Galloway has taken almost £3 million off its acute services. NHS Forth Valley
No. Indeed I will not.
It is not often that I agree with Annabel Goldie, but she is right that the style of the SNP Government is based on grudge and grievance. However, the Government cannot blame somebody else, as it will inevitably try to do; it must take the responsibility. If it does not, it will be engaging in the politics of the school playground. The promise that the SNP made to the Scottish people was that it would protect front-line services. The litany of cuts that I have outlined today expose that as being a hollow promise indeed.
The First Minister talked about the Tory cuts to come. We have not even got there yet. I am sure that we will watch the budget, which is due in 50 days, with considerable interest, but the cuts that I am describing are SNP cuts—the SNP's alone. The SNP cannot say that it is putting £264 million extra into the budget to protect front-line services when we discover today that NHS Greater Glasgow and Clyde is cutting 1,252 jobs in its area this year alone. It is clear—to me, at least—that if 1,252 members of staff are removed, there will be a direct impact on patient care and quality.
Let us look at who those 1,252 members of staff are. They include: 21 doctors in training at the Queen Mother's hospital; 669 nursing and midwifery staff; reductions in elderly mental health services at Parkhead hospital; reductions in occupational health services; a redesign of Clyde mental health services with 45 fewer nursing staff; 60 fewer allied health professionals in podiatry, physiotherapy and speech and language therapy; and—get this—41 fewer pharmacists, who are being replaced by three automated dispensing machines. Did the cabinet secretary know? Did she agree to any of that?
NHS Greater Glasgow and Clyde has commented that towards the end of 2009, the Scottish Government health department announced a review of NHS workforce planning processes and advised that it would not require workforce projections by the end of April, as with previous years. However, on 9 April 2010, the Scottish Government health department wrote again to the human resources directors to request a workforce narrative for 2010-11 from all health
Is she aware of the projections for all health boards, given that they were submitted by 30 April?
Is Glasgow just the tip of the iceberg? In the interests of transparency, will the cabinet secretary release the projections today to SPICe, or does she have something to hide? I fear that the cabinet secretary is not just letting the cuts happen but demanding them.
I am conscious of time.
I fear that the NHS quality strategy will be strangled at birth. Quality is about people—staff and patients—working together to improve our service. The strategy is essential and I share the cabinet secretary's view about its importance. I will take an intervention from her if she will tell me how the cuts will have no impact on quality.
I will answer Jackie Baillie's questions. If she knew anything about the process, she would know that every board's local delivery plan is published once it is finalised.
I return to the point about the health department writing to boards. Does not Jackie Baillie think that it is a good idea for the health department to ask for boards' plans, so that we can scrutinise them? That is exactly what we are doing with NHS Greater Glasgow and Clyde's plans. If she were standing where I am standing, would she not do that? Would she allow things to happen without her scrutiny?
Absolutely not. However, my question was about whether the cabinet secretary was aware of what has happened. If she is, she stands accused of not protecting the health service from cuts and of demanding that such cuts happen throughout the health service. In the interests of transparency, I invite her to place the information with SPICe.
The First Minister and his deputy, the cabinet secretary, stand accused of the worst kind of hypocrisy. They say one thing but do something entirely different. They show no compassion, no sympathy and not one iota of concern for the staff who will lose their jobs and their hard-working families. What about patients? Will the cabinet
SNP members promised to protect front-line services. On the evidence so far, they have failed. What is even worse is that they do not even appear to have tried.
I move amendment S3M-6295.3, to insert at end:
"; therefore notes with concern submissions by NHS boards to the Health and Sport Committee identifying cuts to frontline services, and believes that these risk undermining the NHS Quality Strategy."
"The Healthcare Quality Strategy for NHSScotland" is interesting in that it sets out priorities, foundations and strategies. As Jackie Baillie said, no one doubts the need to focus on the quality of health care and—particularly in the current circumstances—on the best value for the public pound.
I say before making positive and constructive points that I will probably come under the category of healthy sceptic. I must ask why it is necessary to state the three aims of
"putting people at the heart of our NHS ... providing the best possible care and advice compassionately and reliably" and
"making measurable improvement in the ... quality of care".
As the cabinet secretary said, surely that is already happening. Do NHS staff really need to be told that? As for person-centred, safe and effective health care, is it really necessary to publish a document to state such key drivers and ambitions to staff who provide a first-class and excellent service day by day, as the cabinet secretary has said?
Quality ambitions that the strategy has required to outline are that
"There will be no avoidable injury or harm to people from healthcare they receive ... an appropriate, clean and safe environment" and
"The most appropriate treatments, interventions, support and services ... provided at the right time to" all who will benefit. In all the time that I have taken an interest in the health service, particularly since 1999, I assumed that that was happening.
It is incredible that any Government in any country should have to outline the fundamental ethos of health care, as the Scottish Government does in its new strategy for the NHS. For many people who have years of service in our NHS,
The strategy lacks emphasis on joint working with partners, which could be the basis of a quality strategy in its own right. The recent Health and Sport Committee inquiry into out-of-hours NHS care in rural areas showed the lack of joint working and of communication between NHS 24, accident and emergency departments, general practitioners and the Scottish Ambulance Service. I say to the cabinet secretary that the patient experience can be enhanced only by the whole health service working seamlessly.
Also absent from the document is mention of the fact that although the NHS is our caring profession, the way in which it treats its staff is not always too caring. Grievance and disciplinary procedures, along with staff suspensions and gardening leave, can last for months or years. That has a devastating impact on individuals and their families, represents a loss of skills to the health service and costs money in salaries, while not allowing NHS professionals to practice or patients to benefit.
That takes me to the issue of whistleblowing. From many constituency cases in the Highlands, I know that there is no doubt that the NHS does not provide a positive and constructive environment for staff to suggest improvements. The British Medical Association report "Standing up For Doctors; Speaking Out For Patients", published today, found that only 5 per cent of doctors are aware of a whistleblowing policy, with junior doctors being significantly less likely to report concerns, stating that they were not confident that they would be listened to and were concerned that they might alienate themselves from their colleagues or that their career prospects could be harmed. Doctors' concerns relate to patient care—the behaviour of fellow staff members and NHS boards' targets and strategies—yet doctors do not work in an environment that allows issues of patient safety to be raised. Unless that changes, the patient cannot be at the heart of our health service. I am interested to know how the quality scorecard will address such issues.
I am not sure whether these days I am supposed to intervene during the speech of a Conservative spokesman. Mary Scanlon questioned the need for the strategy. I will not argue the cabinet secretary's case for her, but do not the problems that the member has outlined reinforce the view that the strategy is needed?
I have always had a good working relationship with my Lib Dem colleagues in the Highlands. I am highlighting what is absent from the strategy, which is important.
There could be more focus on partnership, based on NHS Scotland working with independent contractors. There is no doubt that one of the most improved and effective care partnerships is in optometry and pharmacy. As a result of previous Scottish Executive funding, people across Scotland can have their cataracts and other eye issues monitored in their local area. I trust that the SNP will continue its support for engaging health professionals across Scotland for patients' benefit. For example, more referrals to chiropractors would help to get people mobile, independent and back to work much sooner than if they have to wait for the target time to see a consultant. Despite the SNP manifesto pledge to increase access to alternative therapies to improve patients' quality of life, that does not appear to be happening.
My final points relate to yesterday's meeting of the Health and Sport Committee, to which Jackie Baillie referred. When NHS Lanarkshire can cut £1 million from its public health budget, due to duplication, and give the committee a cast-iron assurance that that will not impact on the current or future health of its population, there is no doubt that a more efficient use of resources is necessary and possible. Indeed, Christine Grahame asked why the board has not been making such cuts for years, if it is so easy. We cannot support the Labour Party amendment, given that all members of the Health and Sport Committee, from all parties, robustly questioned witnesses from health boards about their budgets and were consistently told that they were reducing duplication, improving patient pathways, sharing premises and support services and collaborating on procurement and many other issues.
I do not have information on jobs in Glasgow. I did not mention Glasgow; I was talking about my line of questioning of the witness from NHS Lanarkshire at yesterday's meeting of the Health and Sport Committee, in relation to which I have access to the facts. I do not know what is happening in Glasgow. I am sure that Dr Simpson understands that I cannot comment on the matter.
My party supports the policy of making 2 per cent efficiency savings, so we cannot support the amendment in my Liberal Democrat colleague's name, which is unfortunate.
I thank the cabinet secretary for her commitment to report back to the Parliament on the protection of front-line services.
I move amendment S3M-6295.1, to insert at end:
"and calls on the Scottish Government to report back to the Parliament by the end of summer recess on how it intends to respond to the needs highlighted in the report, The Healthcare Quality Strategy for NHSScotland, in order to protect NHS frontline services."
The subject matter of this debate, "The Healthcare Quality Strategy for NHSScotland", is interesting. Like other members who have spoken, including the cabinet secretary, I do not think that anyone will object to the Government's main objectives. Mary Scanlon was concerned about whether it was necessary to repeat the three headline ambitions, but I tend to think that when we draw up strategies the inclusion of headline objectives might help to move the strategy in the right direction.
Liberal Democrat concern is that the report is part of a structure rather than simply to be taken on its own. It is inextricably linked with the Patient Rights (Scotland) Bill. The strategy document illustrates the difficulties that I have with the bill—not that the bill is the subject of this debate. It is clear to me that there is an absolute need for a clear view of the path that we are trying to take in relation to the quality of care that the patient should expect and have a right to receive. However, bits of the document are written very much in managementspeak. For example, on page 21 we find the following interesting concept:
"Patients' motivation to be involved in mutually beneficial partnerships with their families and carers and those delivering healthcare services".
It is unclear to me quite how someone can take my motivation and mix it with anyone else's—answers on a postcard, please.
I am sorry about the managementspeak, because its presence in what ought to be an important document is unhelpful. The cabinet secretary was right to direct us to pages 37 and 38, but that does not say much for the preceding pages. Only on pages 37 and 38 do we get to the nub of the matter, which is what we are trying to deliver, for whom and with what objective.
Breakthrough Breast Cancer's approach, which was published some time ago and is described in a briefing for today's debate, is instructive. In posing and answering questions about how the approach will work, Breakthrough Breast Cancer talks about each person having a set of rights and objectives, which will be delivered to them
We must ask what "underpinned by legislation" means in the context of the Patient Rights (Scotland) Bill, because as I read the bill, there is not a scintilla of enforceability in it. As a piece of proposed legislation, the bill is almost a contradiction in terms. The ordinary person in the street sees legislation as conferring on them a right of redress, but if there is no such redress, we are better off having just a strategy.
Let us return to the document before us, its aims, objectives and where we are trying to get to. The Liberal Democrats agree that that higher level of ambition, standard and rightful expectation for the citizen is perfectly correct, but we do not agree with the manner in which the Government seeks to introduce its aims. The cabinet secretary should look carefully at the sort of model that is used by Breakthrough Breast Cancer, although I understand that it is on a much smaller scale and not of the same order as the NHS quality strategy. That approach would also meet the criticism levelled by the BMA, which is deeply concerned that we drift in and out of managementspeak and are not clear that our aims and objectives are being determined by quality-based evidence. The BMA's points in that regard are extremely important.
I turn to the cabinet secretary's charitable introduction to our amendment. I assure Mary Scanlon that our concern is not to look at all forms of inefficiencies and ways in which the health service could operate better, more effectively and efficiently. Many of the questions that the member directed to NHS Lanarkshire yesterday concerned perfect examples of the very things that we all believe ought to take place, but which are wrapped up in general efficiency savings. Our concern now is the evidence that is emerging that there could be a blanket prescription for issues that might affect front-line services. I was genuinely taken aback when, as Mary Scanlon will recall, committee members asked one of the witnesses whether efficiencies were affecting front-line services and the reply was, "That depends on how you define a front-line service." That did not convey to me a sense of confidence that front-line services were not being affected. If all we say is, "We are not to affect front-line services, so we will redefine them. Gosh, they are affected again, so we will redefine them", that does not fill me with confidence. We have to look carefully at what is being said and the sort of efficiency that will improve the quality and financial management of the national health service.
As a West of Scotland member, I too have received a lot of representations about potential
Liberal Democrats have no difficulty in agreeing with the broad thrust of the strategy and the prescription in the areas that it wishes to cover. We are profoundly uneasy that instead of concentrating on a list of standards of care that we can expect to be delivered in a similar way to the breast care strategy, the NHS quality strategy includes some nebulous reference to a bill that will have no enforceability. That means that the strategy is incomplete and requires further work.
Although we will support the Government's strategy at decision time, we believe that it is more of a work in progress. It needs to become something that patients—particularly those who have great difficulties with the delivery of care—can rely on and believe in, and to be, in its ultimate form, a useful document. Let us be careful that where we call for blanket budget cuts, we are clear about what affects front-line services and what does not. Given the evidence from health board chairmen and the actions of NHS Greater Glasgow and Clyde in particular, we are all left with great concern about what is happening on the ground.
I move amendment S3M-6295.2, to insert at end:
"but further notes that NHS boards, while accepting that there is scope for further efficiency savings, are concerned that the proposed efficiencies of 2%, 4% and 6% over the next three years will impact adversely on frontline services."
I welcome the strategy, as one who is known to recommend to any witnesses who come before the Health and Sport Committee that they should restrict their use of the word "strategy", to which I have an aversion. I also share Ross Finnie's sometime nausea about managementspeak and jargon, and I appreciated very much his speech, which was as thoughtful as usual.
With the greatest respect to Jackie Baillie, if she did not hector so much, I would not stop listening to her speeches. The way in which a speech is made is important and if it is made in the right way, people will listen to points, even if they do not always agree; sometimes they will find bits that they agree with.
I make my contribution against the background of the recent budget cuts from Westminster, and those that are coming down the track. Quite frankly, the recession has not hit us full-on yet. For any Opposition party to indict the Government for real or imagined cuts, as at this afternoon's First Minister's questions, is indefensible. With an emergency budget coming from Westminster in a few weeks, and without the funding to which the First Minister alluded in answer to Iain Gray, how can any Opposition party possibly say—in particular, how can the Liberal Democrats and Conservatives at Westminster say—that Scotland's front-line services, whatever they are, and its national health service, will be immune? It is a nonsense.
Even in the face of recent budget reductions from Westminster, the Government has put in additional funding, and the NHS boards that came to yesterday's meeting of the Health and Sport Committee acknowledged that. I will talk about their evidence later.
I make the distinction between the actual reduced budget from Westminster and efficiency savings. As we know, the latter are retained by the health boards to be reinvested in front-line services. I appreciate Ross Finnie's caveat about how we define those services, but in practical terms, we are talking about treatment, diagnosis, preventive measures, hygiene and so on. Of course, that list is not exhaustive. We must use our funding more carefully, while keeping in mind the watchword of quality of care; the committee referred to that, because it is concerned that care should not be the victim.
No one can disagree with the priorities of patients that are set out in the document: care and compassion; communication and collaboration between all who are involved in patient care, including the voluntary sector; continuity; and clinical excellence. For example, patients should not feel too inhibited to complain because they fear that they might get a diminished service by way of retribution. I am not saying that that happens, but there is a genuine perception, particularly among the vulnerable elderly, that if they speak up their tea will be brought to them cold, or something like that. I welcome the Patient Rights (Scotland) Bill, which will give people an opportunity to make complaints and more confidence about doing so.
In evidence taken by the committee yesterday, it was mentioned that the chief executives of Borders, Tayside and Orkney health boards, for example, are looking to make their money work more effectively by reducing the use of bank nurses, locums and agency staff, which is a costly practice, and transferring that money to investment in permanent staff, while saving at the same time to reinvest elsewhere. That ties in effectively with the communication and continuity priorities of patients. There is security for the patient in kent faces at their bedside, for the staff to see the patient as an individual, and for a relationship to be built between the patient and ward staff. Undoubtedly, that improves the quality of care.
The committee was told about demographic changes. Lothian NHS Board's director of finance emphasised how the elderly population is growing in the Lothians, so the pressure on that board's resources is skewed differently from those of other areas. For example, remote and rural areas, as Jeremy Purvis said, face different challenges. It is obvious that the delivery of quality health care will be different in different areas, and it will be different from the bulk of health care delivery. That said, much is shared between health board areas, so sharing good practice is also key. Indeed, the boards seem to be doing that, for example by making more effective use of theatres and consultants' time.
I return to my own patch—that issue was raised by the new chief executive of NHS Borders at yesterday's meeting. It is interesting that he is a former nurse, as is the newly appointed chief executive of NHS Orkney, who was also at yesterday's meeting. I was comforted by the fact that they had come up from the grass roots.
Another issue is the use of technology. The Government's strategy refers to NHS Lothian using technology in the home, which is another way of using resources better. The Health and Sport Committee has pursued greater use of telehealth and e-health, which we must make a move on. When I say "we", I mean the Parliament collectively.
When we examined the budget, we found that some of the money had moved—[ Interruption .] I do not know who is answering; I will leave the minister to deal with that, as she seems to want to.
Much good practice is shared by the boards. I return to early intervention—I cannot remember who mentioned the issue. At yesterday's meeting, a representative from NHS Borders talked about the treatment of ulcerated legs. Early intervention stops patients being confined to bed and prevents a great deal of expenditure. Mary Scanlon mentioned the example of optometrists, who can diagnose other illnesses in advance; the same can be done through a call to the pharmacy. The boards have embraced such practice.
Leadership is key, not only at Government level, but at board level. What came through from yesterday's meeting is that if we are to make real change, the chief executive and the director of finance must provide leadership at board level. During questioning, Ross Finnie made the important point that we must get the boards to help their chief executive and director of finance to see what their job is, which is to act in the interests of the public whom they represent, not just to put up defence walls. I hope that directly elected board members will assist with that.
Yesterday, Rhoda Grant made the interesting point that because belt tightening has had to happen, it has exposed wastage. The director of finance of NHS Tayside gave an example of how duplication—which had involved two depots and two sets of staff being used to deal with aids and adaptations across health and social care—had been ended. He announced that as if it was a wonderful achievement but, frankly—as I said at the time—if something is easy-peasy lemon-squeezy, you do not need to be a director of finance to come up with it. Michael Matheson said that such ideas were being talked about 20 years ago. There is wastage in the health service. The money from that could go into the front line.
An overview of progress will be provided by the quality alliance. It is most important that we have accountability. [Interruption.] I do not know what I have done. Shall I proceed, Presiding Officer? I have a chorus beside me.
Through the unions, we must speak to the staff. It is important that we do not make them concerned. We do not want to make the health service good only at ward or hospital level; we want to make staff pleased to be part of the health service and to let them know that, as Jackie Baillie rightly said—in an otherwise relatively negative speech—they are excellent staff who do an excellent job that is highly valued. I conclude.
I want to talk about the quality strategy because for many years I have believed that the quality agenda needs to be described in
Yesterday, Theresa Fyffe, who is the director of the Royal College of Nursing Scotland, said:
"Recruitment freezes, cutting support for frontline staff and replacing registered nurses with non-registered support staff are guaranteed ways to damage patient care."
It is clear that we face a funding challenge, but that means that there is all the more reason to ensure that genuine, high-impact efficiency and productivity approaches are implemented rather than cuts to front-line staff. We must take a hard and clear view of that distinction.
I will take the member's word for that. I am not here to rubbish that point; I am here to talk about what is happening now.
As I said at question time—so I will not spend a lot of time on the point—it is far more important now than in the high-growth past that we ensure that NHS boards get the funding share to which they are entitled. It is self-evident that when there were big increases in the past, it did not matter if a board was not getting its share. When the boards are getting smaller, and presumably even smaller increases, it will matter a great deal. The gap between what Lothian gets and what it is entitled to is £69 million this year, which is £5 million more than last year. It is by far the biggest gap in Scotland. If that is not addressed, we will have particular problems in Lothian. I should point out that 700 jobs are already going.
Turning to the quality strategy, I particularly like the phrase about not
"pulling the plant up by the roots", because the quality plant has been growing over a period of many years. I pay tribute to the whole health care team for all the work that the staff have done over the years and to NHS Quality Improvement Scotland. For many years I have been a great admirer of that body and I have followed the way in which its work has evolved. It is regrettable that most people in Scotland know very little of what it does. A good example was at the recent reception that I hosted for the Neurological Alliance, when the new neurological standards were introduced. The lead clinician described how the work of NHS QIS had evolved and now, as he pointed out, it was going to work with clinicians on an on-going basis to improve the standards. That is typical of the work that NHS QIS is doing and we should pay tribute to it.
I also like the quote from Don Berwick on page 17 of the document. As far as I am concerned, and
I could go on about continuity, but I want to give three other examples. First, there is the whole issue of patient experience, which others have referred to. There is an important patient experience programme called better together, which is mentioned and described in the document; it was started under the previous Administration, along with related work. Using the experience of patients in a meaningful way is absolutely central to quality improvement. I believe—I am sure that the Government believes, too—that it needs to go a great deal further. I was a little concerned that only one of the 12 quality outcome measures listed on pages 37 and 38 of the document is a patient measure. To be fair, the document says that a second one will be developed in due course.
Ross Finnie gave a very good example of patients feeding into quality improvement. Breakthrough Breast Cancer has had that service pledge over the past few months. As far as I know, it is an excellent and successful initiative whereby patients are central in forming an improvement pledge for each breast cancer unit in the country.
Since we are talking of cancer, I should also mention, as I have done before, the outstanding work of the cancer care research centre at the University of Stirling, which has done an enormous amount of work on patient experience and, in my view, has been the Scottish leader in that field. It was led by Professor Nora Kearney, who has now moved to Dundee.
The second example is the quality and outcomes framework of the, often and wrongly maligned, GP contract. That has led to enormous improvements in primary care, which many patients are probably not aware of. Issues such as heart disease and stroke have been greatly helped by the new requirements on GPs that are part of that framework. I was pleased to see in the document that the Government is committed to building on the principle of quality strategy to maximise quality and other service areas.
My last example is anticipatory care. That, too, was started by the previous Administration but the strategy document talks about introducing and sharing anticipatory care plans for the 5 per cent of the population who are most at risk of hospital admission. That seems a really important development. For many years, we have been talking about the need to reduce emergency
There are many positive features in the quality framework. It has to be seen in the light of the funding issues that many have described. In particular, we must emphasise the role and importance of front-line staff in delivering the quality improvements. At the end of the day, the front-line clinicians will do that and they must be at the centre of the quality agenda. We need to empower them to make the quality improvements that we all want. I hope that we can all be united in that objective.
We have heard various views from members, but the debate has been reasonably consensual thus far. I would not dare to expand on the comprehensive account that Ross Finnie gave of the Liberal Democrat position, but I will pick up a couple of issues. Members will have heard me bang on about them before.
Before I do that, however, I want to refer to something that Mary Scanlon said about Lanarkshire NHS Board. We are all aware—it is a cliché—that there is more than one way to skin a cat. Having dealt with Lanarkshire NHS Board for getting on for 14 years, I know that it does things in certain ways. For example, we are facing a situation as a result of reconfiguration and people in Cumbernauld are likely to be deprived of an out-of-hours service. The board claims that the change is a straightforward reconfiguration, but that appears not to be the case because, despite questioning, it has refused to answer questions about what will replace the service. I therefore hesitate to take what the board says without a degree of scepticism.
I am grateful to Mr O'Donnell for raising that. I have to say to him that the questioning from the Health and Sport Committee was robust. The board said that there was duplication in the service and that the duplication had been streamlined. I would like to think that it gave an honest contribution in evidence to the committee. I do not think that I have any right to disbelieve it, despite my being a healthy sceptic. It assured us that there were no cuts to public health.
I have been to a number of board meetings of the same organisation and I have had the same assurances. I take on board the point that Mary Scanlon makes.
As other members and, indeed, the cabinet secretary have said, we need to be clear that the
For the most part, people are not at their best when they engage with the health service. Understandably, the impression that they take is all too often a continuous one that colours not only their perception of the treatment but the perception that they give to other people when they recount their experiences. A perception that is not good will go beyond the individual patient and the individual case. We all know that individual cases are all different. The problem that I have is that we do not have a shared understanding. Like Ross Finnie, I am not convinced that the Patient Rights (Scotland) Bill will necessarily give us that.
I am particularly interested in people with disabilities, particularly learning disabilities, and their experience of engaging with our health services. Having been on the front line of that for a goodly number of years, I know that we need to ensure that we take account of disabilities, but I am not convinced that the strategy will necessarily achieve the outcomes that we seek. Happily, the "Does he take sugar?" approach is disappearing and we have a more person-centred and holistic approach to delivery of services. I am interested that we are to have a care measure from a patient's perspective, but I ask the Government, in taking that forward, to ensure that information for patients is available through communication methods that are appropriate for the whole range of patients with whom NHS services deal, because that is not always the case. All patients need to feel empowerment. Certainly from a social services perspective, empowerment has been key to making those parts of our society feel included in the normal approach.
On IT, which Duncan McNeil touched on in his intervention, I am sure that I am not unique in finding constantly that, when our committees take evidence from organisations such as health boards, we are told that the data are "patchy" or "not clear". I accept that particular challenges might exist in the health service given the differing requirements of its different aspects, but monitoring needs to be consistent if it is to be useful to all the agencies that will access those data. At the same time, we must not deliver a process of unmitigated form filling and box ticking just so that we can appear to have hit the targets. The information must be useful rather than just politically expedient. Therefore, I welcome the strategy's commitment to
"a programme of action to ensure that peoples' equality needs are gathered",
In conclusion, following my colleague Ross Finnie's clear statement of the Liberal Democrat position in his opening speech, I hope that my speech has raised some issues of relevance. I hope that all the points that have been raised can be brought together to allow the strategy to do what it says on the tin.
The NHS is one of those public institutions that is held dear by the vast majority of the public. Everyone would prefer not to have to use the NHS, but we are very grateful for it when need arises, as I found recently when I had to go to the A and E department at 2 o'clock in the morning with one of my sons. The vast majority who use the NHS have a positive experience of care provision.
However, what makes the NHS perhaps unique among public bodies is the way in which people simply place their trust in it. People place their trust in the doctors to make the right clinical decisions to ensure that, as patients, they receive the best treatment and the treatment that they require. People also trust that the staff will act in their best interests in their time of need. People trust that everyone in the NHS has the shared objective of doing the very best in caring for them.
That said, there are clearly times when our NHS does not get it right. Sometimes, the quality of treatment or quality of care that the staff provide to patients is not what it should be. There are clearly times when the very complex system that is our NHS does not work collectively in the best interests of the patient. Given that all members will have received complaints from constituents who have raised concerns about the failings of the NHS—some members might even have personal experience of that—it is important that we take the right measures to try to rectify those problems.
The cabinet secretary rightly pointed out that we no longer receive complaints from constituents about waiting times for particular procedures. That is certainly my experience, but I now receive more complaints about the quality of care that people receive from the NHS. I believe that it is important to ensure that the trust that people place in the NHS is returned in the quality of care that they receive from the service. That is why I think that the quality strategy is both timely and welcome.
In few public institutions do people place such trust in the organisation itself, quite literally on a daily basis. Patients place their lives in the hands of the NHS and rely on it to get things right for them. It is essential that the quality of our NHS is as high as possible throughout the patient journey
No doubt the debates around greater efficiency and productivity in the NHS will continue over the weeks and months ahead. Given the growing financial pressure that all of the public sector is under, there will be further debate about whether we can get more out of the existing financial envelope for public services to make them more effective in delivering the services that are required.
I say to Jackie Baillie that it is fantasy to think that we can have cuts by the UK Government to the Scottish Government's budget but not expect that to trickle down in some way and impact on our public services. The question is about the priorities that the Government chooses for any additional spend. I repeat: it is complete fantasy to think that cuts to the Scottish Government's budget will not impact on public services in Scotland.
It is remarkable that the cabinet secretary has managed to secure that increase in funding for the NHS here in Scotland in the face of a £500 million cut to the Scottish Government's grant, which was made by the previous Labour Government. We can clearly see where the Scottish Government's priorities lie: in protecting front-line public services such as those in the NHS.
I particularly welcome the recognition in the strategy document for staff and for the focus in the NHS on being caring and compassionate. Staff have a key role in delivering that care. We can have state-of-the-art hospitals and the best clinicians in the world—we have many of them in the NHS in Scotland—but we must ensure that the quality of NHS staff is as high as possible. That can be the tell-tale mark of the patient's experience of the NHS. Staff have a central role in delivering the strategy. It is through high-quality staff that we can deliver high-quality care for patients in the NHS.
As has already been said, we can share a great deal of pride in the achievements of the NHS and its staff in Scotland. They have created a system that has produced results for people with serious conditions such as heart disease, stroke and cancer. As a result of our work early in the life of the Parliament, when we focused on such
We introduced targets and we drove up standards so that unacceptable waiting times for surgery and treatment would no longer be commonplace—as has been referred to by the cabinet secretary and Michael Matheson. I agree with them. However, although the complaints at our surgeries have changed, the case load has not. I completely agree that those changes in complaints have concerned the quality of service, particularly for the elderly.
There are still areas where we have not achieved what we would have liked to achieve—in vitro fertilisation treatment, for instance. People who cannot pay still wait for two years or more for IVF, and that needs to be addressed.
Reductions in waiting times are seen as an achievement, but however successful and popular they are, they have come at a price. Hospital wards and staff are geared up for the production line. I do not treat that in a negative way, as it is very efficient when it runs smoothly and it ensures that people enjoy a positive and speedy experience. However, when we push people through the system, the consequence sometimes is that we push the caring out of the system.
I had my own experience recently as a day patient requiring surgery. I was in in the morning and out in the evening, and I had a good and positive experience at Inverclyde royal hospital. If people can walk in and walk out, the experience is great. However, I also have personal and casework experience of what happens to elderly and frail people who require extra treatment. A receiving ward in an acute hospital is not a good place for those people. They have extra demands, which in my experience and from my case load I know are not being addressed. While we celebrate the achievements and recognise the progress that we have made on waiting times, we need to have a balance.
I share the cabinet secretary's enthusiasm to deliver a patient-centred approach in our health service. I believe that it is possible to take the benefits of the targets system that we introduced and marry it with an approach to care and support that all patients require. Whether that is possible in the current climate is another question. Whether we like it or not, the strategy comes against a backdrop of falling investment, services being axed and hundreds of staff facing cuts.
In today's debate, we have heard several examples of the cuts that health boards have been forced to make. More than 1,250 jobs have gone in NHS Greater Glasgow and Clyde, and I am fearful of what that will mean in Greenock and
None of that bodes well, and it undermines our shared ambition of delivering a world-leading health service. It is easy to say that we will deliver the type of health service that we all hope for, in which quality of care is premium, but it is much more difficult to put it into action.
To demonstrate that, I will cite the example of the Ardgowan hospice in my constituency, which for nearly 30 years has provided an excellent transport service for patients who require cancer treatment outwith the area. As members will appreciate, it is more than just a pick-up and drop-off service. It spares people who are in a weakened condition an awkward journey, it spares them the inconvenience of waiting around before and after what can be a very arduous treatment, and it offers some much-required comfort after what is sometimes a harrowing experience. I have spoken to volunteer drivers and heard of the bond that they develop with patients during these difficult, and now shared, experiences.
NHS Greater Glasgow and Clyde, in its 2010 "Palliative Care Health Needs Assessment", stated that patients
"found this to be a very welcome support that reduced the added stress that the ambulance transport brought to an already stressful experience."
However, when budgets were reviewed at the health board, it was decided that it could no longer fund the service. It would seem that, from an annual budget of £2.6 billion, the health board is unable to find the £35,000 that is required to support the transport service. Is that an example of quality being considered over cost? Is it a decision that is likely to inspire confidence? Is it responsive to what, in the terms of the cabinet secretary's motion, users of the health service "want, need and deserve"?
I have not. I hope that it will tell me that I have wasted my time this afternoon, and that a cheque for £35,000 is on its way to those volunteers, to allow them to carry out the job that they have done for 30 years. If the letter contains anything less than that, the minister will be getting another letter. If we are serious about putting quality into the health service, we cannot allow decisions like that to stand. I urge the cabinet
In the NHS in Scotland, we have a comprehensive system of medical care, the significance of which we can sometimes overlook as we continue to strive to make it better. We cannot, however, let that constant striving for improvement blind us to the success that the NHS achieves day in and day out. To that end, I would like to begin my speech by giving my thanks—not just as an MSP but as a patient—to all health workers, who work incredibly hard. I have first-hand experience, having worked for a time as a nursing auxiliary. I also come from a nursing family, with nurses, health visitors, porters, cleaners and auxiliaries among us. Indeed, my aunt is part of the League of Hospital Friends Inverclyde who—as Ross Finnie, Duncan McNeil and Stuart McMillan will be aware, because they supported the campaign—last week won their fight with the health board to be able to continue to provide the café services whose profits they donate to the hospital. I congratulate the League of Hospital Friends and congratulate everyone—paid or voluntary—who is working to improve our NHS.
The quality strategy is a powerful new framework for our patients and our health care professionals. As it is evidence-based in its goals, interventions and objectives, I do not doubt that it will be warmly welcomed by the Scottish people and those in the health sector. The strategy aims high: we are to be world leaders in health care quality. That is the right approach. We would not do ourselves any favours by attempting anything else. In 2007, the people of Scotland voted for ambitious governance, so it is right that we continue to fight to deliver ambitious and achievable goals and strategies across the devolved responsibilities.
Health care professionals are among the most passionate workers one will come across, and I have no doubt that they share a burning desire to make our health care system the best in the world, not for the good of our ego but for the good of our people. Last year, when health care was being debated in the US and the NHS's anniversary was being celebrated, we rightly focused on the benefits of universal health care. It is right that we ask that our NHS renew its focus on what lies at its heart, which is delivery of patient-centred high-quality patient care.
I have no doubt that we have all heard tales of the person-centred approach being noticeable only by its absence. That can be traumatic for patients, particularly those who have no one to advocate for them or to ask questions on their behalf. Some patients or their families do not ask questions because of learning difficulties or a language barrier but, often, people simply do not do so because questioning doctors is something that is just not done, and because people do not like to trouble busy staff with their concerns. I am glad, therefore, to hear about the establishment of the patient advice and support service. I would be grateful if the minister could say something about how PAS staff will be able to support people with additional needs, such as language or learning difficulties.
On the other side of the equation, when we do not support our health care professionals enough to allow them to provide person-centred care, we limit their ability to get meaningful job satisfaction from their work, as the strategy points out on page 6. There is a clear correlation between staff wellness and patient outcomes; none of us will be surprised to hear that. One of the most exciting aspects of the strategy is its recognition of those fundamental connections in the health sector and its goal of utilising them for the benefit of all. Ask any fired-up health professional about their motivations and they will talk about their desire to provide high-quality treatment for patients. We therefore have a duty to ensure not only that we do not hinder their aspirations by hampering them with output-based bureaucracy, but that we provide the proper strategic support.
To give some balance to some of the amendments that are before us, I will quote a health board chief executive who recently gave evidence at the Public Audit Committee. With reference to the discussion about where efficiency savings will come from, Richard Carey from NHS Grampian stated that
"The levels of funding that we have enjoyed during the past few years have enabled us to grow the health service in a positive way".
He went on to say that
"The situation in the future is going to be much more challenging"
—we all appreciate that— "but we believe that we can deliver savings in the budget through effective management, good productivity and service redesign."—[Official Report, Public Audit Committee, 24 March 2010; c 1609].
There was no mention of front-line services, and we did ask him about that.
My speech today strikes a mainly consensual note with members on most sides of the chamber, because although we may have different
Besides, consensus is a good thing and it has certainly been the week for it, at least until today. So far this week, there has been consensus among the Tories that they have no mandate in Scotland and therefore have had to appoint a consul general from the Lib Dem ranks, there has been consensus in Labour that it would rather sit back on the opposition benches than form a coalition against Tory cuts and there has been consensus among the Liberal Democrats—yes, finally, a consensus among Liberal Democrats—that the faint whiff of power is enough to sweep them off their feet and into the chilling embrace of Osborne, Cameron and the rest of the Bullingdon Club in the corridors of Whitehall, so there has been consensus all round. I ask the Parliament to embrace that spirit of consensus by supporting the motion and commending the strategy.
I will take my cue from Anne McLaughlin, who started her speech on a personal note. At Christmas time, I had treatment from the NHS—a small operation on my eye. I say, for the record, that I had the best treatment and was highly impressed.
The cabinet secretary gave us a feel for "The Healthcare Quality Strategy for NHSScotland". She mentioned matters such as waiting times and was generous to the previous Administration. I acknowledge that and thank her for those comments. She touched on issues such as NHS resources and, in his intervention, Jeremy Purvis properly brought in the rural aspect, which is, of course, extremely important to me. Nicola Sturgeon also made the point that if someone goes in to hospital for a day but gets a hospital-acquired infection, they can end up staying for a week. That is precisely what we must zero in on.
Jackie Baillie talked about leadership and about NHS board savings. She also went through a list of accusations—I think that that is the word to describe it. I am sure that, when the cabinet secretary looks at the Official Report of the debate, there will be things that she will want to check against the claims that have been made to see what the actuality is and whether the claims have substance. I will return to that point in my conclusion.
I intervened on Mary Scanlon's well-considered speech to pose a question because I had got the impression, perhaps slightly wrongly, that she was
My colleague Ross Finnie is correct to say that there is a link to the Patient Rights (Scotland) Bill—I also see that link—and that the use of managementspeak, as wittily pointed out by Mr Finnie, is not useful in the strategy document, or ever, if we can possibly avoid it.
Ross Finnie made the point that the simple blanket prescription of going for, as outlined in our amendment, efficiencies of 2, 4 and 6 per cent is dangerous. I was interested in his comment that a witness said, in response to a question at the Health and Sport Committee about front-line services, "Ah well, it depends on how you define 'front-line'." That is a cogent point and it is an issue that we must look at very closely because, by the simple use of different terminology, people can change the boundaries completely and it can mean that money can flow from one budget to another in the health service, but it could be exceedingly dangerous.
It is worth remembering the point that Malcolm Chisholm made at the beginning of his speech, which is that he is not contesting the history of this Administration over the past few years but taking a snapshot of the situation now as he sees it. Other members have touched on that aspect, too. Again, I will return to that in my concluding remarks.
Hugh O'Donnell's comments on communication methods were absolutely appropriate. There is a link there, is there not, to the use of managementspeak? If people do not get the communication right, they start to miss their targets and they will not be directing their resources where they are most needed.
Michael Matheson made a thoughtful contribution about trust in the professionals, which we all have. My own treatment left me with an element of trust. However, if the wrong measures are taken, trust is fatally undermined and something that is really rather special is corroded, because patients and the public do trust the health professionals. We need to restore and maintain that trust at all times.
The cabinet secretary will be glad to know that I am not going to talk about patient transport or ambulances in my constituency, which I have covered enough in the past. However, the first bullet point on page 15 of the strategy document is about something that is mentioned repeatedly throughout, which is people having an equal right to health services no matter where they live. That has been behind my comments over the recent period about patient transport and ambulance
It would clearly be very worrying if there was any substance in what is claimed, because we want to keep as many services as local as possible. A linked issue is that, while we face decommissioning at Dounreay and the problems of trying to create alternative, high-quality economic developments, it is not helpful if health jobs are to be lost. As I said, the cabinet secretary will no doubt look at the claims that have been made about cuts or possible cuts—I do not necessarily agree with the claims. My personal plea is that she will look at what NHS Highland may or may not be proposing for Dunbar hospital. The position is a bit more under wraps than I would like—I see Mary Scanlon nodding to that. She, as a Highland member, and I, as the local member, wish we were slightly better informed about those matters. In their letter to me, the trade unions said that they had not been kept fully in the picture. There is an issue to do with communication there. Like Duncan McNeil, I would love to be proved wrong on this one. If there is nothing in it, that is fine and I withdraw my remarks. However, on a personal level, I ask the cabinet secretary to check the situation.
I ask members to support the amendment in my colleague Ross Finnie's name. I think that it is an important one and pertinent to the issue.
I was interested to see whether this would be an informative debate. By and large, it has turned out to be exactly that, with the exception, I am afraid, of one rather ugly contribution.
I have an early confession to make: I am afraid that I loathe reports such as the Scottish Government's "Healthcare Quality Strategy for NHSScotland". It is a particular turgid example of such reports, with poor use of grammar and high-blown, nonsensical rhetoric, which is the antithesis of the objective stated in its very first page to provide "Clear communication and explanation". Indeed, I was struck by the thought that we could easily dispense with anaesthetists by giving patients this report to read instead. I had an overpowering sense of its being the collective work of a brainstorming seminar, with breakout groups all contributing their thoughts to be collated into meaningless corporate speak by a drafting team of the underemployed. I agree entirely with
Finally, having negotiated the seemingly endless pages, I was somewhat dismayed to find that by far the longest stretch of the text about final steps in the "Implementation" section was devoted to the proposal to spend money on a widespread communications programme, which is in essence a marketing exercise that will no doubt be costly and divert money yet further away from front-line services.
In the foreword to the report, we are introduced to the key ambitions that the people of Scotland have for their NHS, which are caring and compassionate staff and services; clear communication and explanation about conditions and treatment; effective collaboration between clinicians, patients and others; a clean and safe environment; continuity of care and good access to care; and clinical excellence. We agree with those aims. We agree with and applaud the progress towards achieving the objectives that is being made, often on the basis of natural common sense, by a dedicated NHS staff. I therefore return to Mary Scanlon's point about whether NHS staff really need to be trained in those notions and objectives by absorbing such a complicated document. She was right to suggest that, to dedicated staff who have worked hard for many years, the report will seem fairly condescending.
In Nicola Sturgeon's favour, we can say that the Government has further facilitated progress towards several of the objectives in the report. Earlier, for the first time in three years in the Parliament, I found myself in agreement with Michael Matheson—I have no doubt that that will be enormously discomfiting to him—as he explained the relationship between public trust and clinical quality. That is an issue on which we receive many complaints from the public. Those often relate not to big operations but to small or minor ones. Somebody goes in for something relatively trivial, trusting that the process will work, yet the quality process breaks down and they end up with a much more serious issue.
We must face the enormous financial black hole that Labour has created and which we face as a nation. In different ways, various parties—at least, those that are now in power—have made commitments to the NHS. The new coalition Government, which I and my very new and very dear friends Ross Finnie and Jamie Stone wish every success, has committed that
"funding for the NHS should increase in real terms in each year of the Parliament".
I am happy to do that. In fact, I am more than surprised that Jackson Carlaw was not watching the First Minister in the BBC leaders debate during the election campaign, when I believe he did the very thing that the member seeks. Even if Jackson Carlaw does not listen to the First Minister, I know that he always listens to me and I am therefore happy to give him that pledge.
Sadly, I was campaigning, completely in vain, elsewhere.
In the face of that financial pressure, we must note that the cabinet secretary has chosen to spend front-line cash on free prescriptions for herself and the First Minister and for all those people who will not now benefit from increases in inheritance tax thresholds. Indeed, the only tax cut that is being offered on a plate to millionaires—an issue on which the cabinet secretary and her colleagues expressed profound consternation only a week ago—is the one that she is awarding to them.
The refrain that Jackie Baillie rehearsed of cuts, cuts and more cuts is inherently untrue. There is no surprise there, although we all expect to hear the refrain become a mantra. Jackie Baillie did not mention that, had Labour been re-elected last week, the national health service in Scotland would have had to fund £36 million of increased national insurance employer contributions, as was confirmed by the Scottish Government. Jackie Baillie, who said that she was looking forward greatly to the budget in 50 days, can do so in the certain knowledge that it will not have Labour's £36 million tax hike on the NHS in Scotland, the money for which would no doubt have had to be found from front-line services.
It is self-evident that more money will not in itself be enough, and that is acknowledged by the report. The report's summary of future challenges illustrates again the problems with which we will be confronted as a result of an ageing population, a continuing shift in the pattern of disease towards long-term conditions and growing numbers of old people with multiple conditions and complex needs. Even with the guarantee of additional real-terms increases in funding, we must be smarter in the use of cash. We have to say to health boards that we do not expect that cuts to front-line services are in any way inevitable, as Jackie Baillie's amendment postures. Nor must we accept
Not just now.
I turn to something that a former secretary of state did when asked to find efficiencies within his department. He would turn to his civil servants and find the most sensationally unacceptable recommendations, so that those could be publicly postured and become completely unacceptable to the public. He could then go to the Prime Minister and say, "We simply can't do this." I hope that, in seeking to find efficiencies, health boards do not try to undermine the exercise by simply trying to identify efficiencies that are completely unacceptable to the public. It is necessary to find efficiencies to redeploy resources towards front-line services in the face of the demographic changes that are coming. The health and wellbeing of the people of Scotland cannot become a game of poker. The challenges presented by those demographic changes and the treatment of avoidable conditions will inevitably lead to even greater pressures on the NHS.
The aims of the report are sound enough but, if they are not to be undermined, we will need to achieve the efficiency targets that have been established. Our amendment invites the cabinet secretary to report back to Parliament by the end of the summer recess on how the Government intends to respond to the needs that are highlighted in the report while protecting vital front-line services.
Quality improvement is about the effective implementation of Scottish intercollegiate guidelines network guidelines, which we have had since 1997. We are not in a new situation. Quality improvement has not just suddenly landed on the table. As the cabinet secretary said, it is about building on what has been done before.
The patient experience, to which Malcolm Chisholm referred, is crucial. That partnership is the new element that has come in over the past few years, although the patient's journey, care and outcomes have long been the NHS's focus. As the cabinet secretary, Duncan McNeil and Michael Matheson said, the initial problems that we as a Parliament faced in 1999—of unacceptable waiting times in accident and emergency, long delays in getting appointments, difficulties in obtaining diagnostic tests and longer delays in getting treatment—have largely been addressed, although there are some exceptions, which a
However, we have many examples of improved quality of care and improved efficiency. One of the best examples is in renal dialysis. Over the past 13 to 15 years, a trend has developed of providing satellite units for home dialysis, which has transformed the lives of many renal failure patients. It is just a pity that the proposed NHS Ayrshire and Arran unit is now on hold. We must recognise that it will be difficult to address some of the quality issues that we face if new money is required to do so.
There are other successes, such as the patient safety programme, the better together programme and developments in anticipatory care, which Malcolm Chisholm mentioned.
Iatrogenic problems—problems caused by the very treatment that is being instigated—can sometimes be fatal. Regrettably, those problems have not always been given a high enough priority. In 2008, only one medical undergraduate course in Scotland was teaching patient safety. To embed a strategy in the health service, we have to start with undergraduate training. How many Scottish universities include quality improvement and patient safety in their undergraduate curriculum for medical, dental, nursing and allied health professional students?
The Tayside pilot that commenced as part of a UK-wide patient safety initiative in 2004—Tayside was the Scottish representative—has massively reduced problems in Ninewells. Which health boards or hospitals were part of the extension of the original four pilot sites to 20 sites throughout Scotland, and what were the results?
We have a lot further to go. For example, there has been a collective failure by all Administrations since devolution to implement electronic prescribing. There is excellent research to show that the reduction in errors that can be achieved by electronic prescribing is substantial. It would also save a considerable amount of funding in a number of clerical jobs, which could be diverted elsewhere.
Quality and efficiency should be synonymous, but, unfortunately, they have not been so. Indeed, too often in the past the way to make savings was through cuts, which impaired quality.
There have been two streams in existence since 1997: clinical governance and quality improvement, which are not the same thing. Clinical governance is about quality assurance—examining results and deciding whether they were
We know the risk to the quality improvement agenda of efficiencies and cash-releasing savings—evidence of the dangers of such an approach has begun to emerge. Warnings from the BMA and the RCN herald the renewal of across-the-board cuts, and skill mixes are being used that involve applying specialist nurse skills inappropriately. For example, in Glasgow, specialist nurses are being put back on wards, so their skills are not being fully used. At the other end is the risky deployment of staff beyond their skill level. If that happens, we will be in difficulty.
Boards are failing to replace staff who are on maternity leave or long-term sick leave. That places burdens on the remaining staff and increases stress, which leads to additional sickness. The Health and Sport Committee learned yesterday that vacancy management is expected to produce savings of £4 million for one health board that appeared before us and £1 million for another health board that was represented, so that will be important. However, if it simply means stopping the filling of vital posts, it will reduce front-line services. We therefore need to understand what vacancy management is about.
My experience of vacancy management was not good. To save money, the posts of people who gave due notice of retiral were not advertised, even when those posts were critical. The consequent delay in appointment—and, sometimes, the necessary appointment of locums when the system was at breaking point—was more costly in the end, so what was intended was not achieved. Substantial stress was also created for the rest of the team.
It is clear that we need to consider the skill mix and that reviewing the workforce is important. How we do that is also important—it must be done sensitively.
Audit Scotland's report "Day surgery in Scotland" showed that Scotland still lags behind England on the number of day-surgery procedures that are undertaken. At yesterday's Health and Sport Committee meeting, I did not question NHS Tayside's representative on day surgery, but the report says that NHS Tayside is in a low category for several procedures and that it is a long way from achieving the targets on 16 procedures. If we reached the targets, that would save money and improve the experience for patients, as Duncan McNeil said. When patients enter hospital just for the day, they are much less likely to develop hospital-acquired infection.
My colleague Jackie Baillie talked about cuts, to which our amendment refers. It is a fact that the NHS in Scotland has received lower increases than has the NHS in England since the current Government took office. Of the £900 million of additional money that was put into this year's Scottish budget, £274 million will go to health. I welcome that, but SNP members cannot have it both ways. A funding increase should protect front-line jobs. The cuts that my colleague Jackie Baillie outlined of 1,250 staff in Glasgow and 700 staff in Lothian—and other cuts—show that the situation will have to be examined carefully. Cutting cleaning hours at Glasgow royal infirmary is incomprehensible. On cutting volunteer drivers, the Minister for Public Health might confirm in summing up that Duncan McNeil represented his constituents successfully. However, to be frank, the cabinet secretary and the minister do not have enough fingers to stick into the holes that are beginning to appear in the dykes. They cannot resolve such problems one by one—a global strategy must deal with them.
We must consider several issues. As Ross Finnie said, we must define front-line care. The response yesterday—"It depends what you mean by 'front-line care'"—was disappointing.
I concur with Mary Scanlon and Jackson Carlaw's analysis of the strategy. It is apple pie—it contains nice fluffy aspirations, but it is not even as cunning as a cunning plan by Blackadder's Baldrick. No one could speak against it, but it fails on almost every count. Some counts on which it fails are astonishing. It fails to examine closely the quality improvement actions of the past 20 years. It fails to analyse the hugely successful Scottish pilot in Tayside, to which I referred. It does not talk about the successful lean in Lothian programme. It does not mention quality improvement techniques and tools such as lean, total quality management, continuous quality improvement, the Institute for Healthcare Improvement's plan-do-study-act system, business process re-engineering or six sigma. There is no indication of what is being done. It does not refer to the work, sponsored by the health department and published in 2009, by Powell, Rushmer and Davies, involving Dr Twaddle, which is an excellent summary and review of quality improvement and how it needs to be embedded. It does not tell us whether the health department is supporting the embedding of quality improvement in every board or has a role in facilitating boards' efforts to tackle the barriers that the strategy indicates are present in a number of areas.
The strategy makes no reference to training of board members, executive and non-executive, or lead clinicians. It does not talk about the co-ordinators of the managed care networks that underpin the developing collaborative system in
The strategy mentions quality ambitions, quality outcome measures and a quality measurement framework that will be produced. It also refers to a number of committees: a quality alliance, a quality improvement hub and an NHS strategic oversight group. I detect a growing confusion of the sort that we had with HAI. I am very disappointed by the strategy, which is light and weak and lacks the focus that is present in the department. One member referred to it as a "work in progress"—that is exactly what it is.
We all want quality. It is vital that we have efficiency, but it is also vital that we do not return to the situation that existed in the 1980s, when efficiency savings meant cuts. Such cuts were made repeatedly across the board, with management presenting clinicians such as me with statements requiring us to cut 3 per cent from our budgets for the year, even if we had made substantial savings in the previous year and had improved efficiency. We must be far more sophisticated than that. Regrettably, the strategy does not provide the basis for such an approach.
I am grateful to all members for their participation in and contribution to the debate. We are implementing the health care quality strategy for the NHS in Scotland to support our NHS in delivering the best health care services to the people of Scotland, in a way that responds to what people have told us that they want and need. We are confident that, by doing that, we can make Scotland a world leader in health care quality. We are also confident that, through that shared approach, the NHS will not only be able to deliver the highest-quality health care, but be better placed to respond to the economic and social challenges that lie ahead. Our confidence in our ability in Scotland to achieve those aims for the NHS is built on a strong foundation.
I say to Jackie Baillie that it is not good enough for the spokesperson for the major Opposition party in the Parliament to come to an important debate and offer absolutely nothing by way of
I will let the member in later.
Let me put some facts on the record. First, there will be no compulsory redundancies in the NHS. That is a real achievement, given the squeeze on the Scottish Government budget as a result of the £500 million of cuts from Westminster.
Secondly, although there might be changes in how the community maternity unit in the Vale of Leven hospital operates, as Jackie Baillie said, at least the unit is still there. That would not have been the case under Labour, which was absolutely intent on closing it. Only the action of the Cabinet Secretary for Health and Wellbeing overturned the proposals to close the unit that were on the table. Let us have facts, not fiction.
Another fact is that there are 10,000 more staff working in the NHS than there were before the SNP Government came to power in 2007. Those 10,000 extra staff are delivering improvement in the quality of patient care. I do not mind debating points in the Parliament, but debates must be based on fact and not scaremongering, which was the whole basis of Jackie Baillie's speech. The staff in the NHS and the patients who receive NHS services deserve better from the political leaders in the Parliament.
Speaking of facts, is the minister denying NHS Greater Glasgow and Clyde's workforce projections, in which 1,252 staff are cut? Is she denying that NHS Lothian said that 700 jobs would be lost? Is she denying NHS Tayside's reduction of £30 million? Is she guaranteeing that that will have no impact on front-line services? She cannot have it both ways.
The Labour Party cannot have it both ways, either. The Labour Party cannot make cuts of £500 million in the Scottish Budget and then assert that somehow those cuts have no impact on how public services are delivered.
We expect our health boards to leave no stone unturned in ensuring that in delivering the health service with their budget, including the extra £264 million that they have, they protect front-line services. I would have thought that all members would get behind health boards in doing that.
I pick up Jackie Baillie on another point. In her litany of accusations, she criticised changes to hospital-based mental health services for the elderly. However, only a few weeks ago Jackie Baillie stood up at the Convention of Scottish
More constructive speeches were made. Mary Scanlon asked why it was necessary in the strategy document to restate the key aims of the NHS. I think that the cabinet secretary explained well why it was important to do so. Ross Finnie and Jamie Stone talked about managementspeak. In a spirit of consensus, we concede that there is some managementspeak in the document. That does not detract from the important substance of the document. Any Government document might contain similar language—Liberal Democrats might find that some of their UK Government documents contain managementspeak.
Christine Grahame, in her considered speech, referred to the useful evidence that was put on the record at the Health and Sport Committee.
Duncan McNeil's speech was very constructive, in the main. However, in his intervention, he talked about reducing the IT budget for health. I remind him that Labour's proposal last year to cut the e-health budget would have really damaged the IT budget of the health service. He asked me specifically about the health service in his constituency and I asked him about a letter that is winging its way to him. He can read for himself the detail of that letter, but the last line says:
"I understand that further discussions between representatives of the Ardgowan Hospice and NHS Greater Glasgow and Clyde regarding funding have now taken place and that a funding arrangement agreeable to both sides, has been reached."
I hope that Duncan McNeil will welcome that in the spirit in which it is intended.
A press release from Lorraine Dick, senior press officer for NHS Greater Glasgow and Clyde, this week stated that there is clearly an issue:
"the hospice is actively pursuing new sources of funding to help us continue the much appreciated transport service."
I advise Duncan McNeil that the service is continuing and that an arrangement has been reached that is agreeable to both sides. He does the people at Ardgowan hospice no service when they have reached an agreement with the health board that is to their satisfaction. I
Malcolm Chisholm made a constructive, if at times challenging, speech. He showed that he understands well the issues behind what is involved and could perhaps teach his front-bench colleagues a thing or two about how to get a point across in a more effective way. He showed that he had read the document—so, full marks to him. We will reflect on the issues that he raised when we read the Official Report of the debate.
Anne McLaughlin talked about the patient advice and support service, which will be for every patient, recognising individual needs. Communication support and translation is a significant aspect of the proposed service. I hope that that answers her question.
Jackson Carlaw made some important points in his summing-up speech, not the least of which was the important point that the £36 million of resources that the NHS in Scotland would have had to find—it would have had to come from somewhere, perhaps putting pressure on front-line budgets—will no longer have to be found following the rejection of Labour's national insurance hike. That was an important point to make.
The strategy will not deliver change overnight, but it goes to the heart of what the NHS is all about. Staff in the NHS tell us that they chose to work in the NHS instead of working in other sectors because they wanted to deliver the best quality of care and treatment to patients. That is how the quality strategy came into being: it was driven by what the staff—and, equally important, the patients—were telling us that they wanted. We are absolutely committed to implementing the quality strategy and supporting everyone in Scotland to play their part in ensuring that our NHS delivers the health care that everyone wants and needs, now and into the future.
We have demonstrated why we believe that NHS Scotland can become a world leader. I am confident that everyone here supports that aim, which has been embraced by the NHS in Scotland. I hope that everyone will work with us to pursue the ambitions that we have set out in the quality strategy for our NHS.