National Health Service 2020 Vision

Part of the debate – in the Scottish Parliament at on 22 January 2015.

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Photo of Nanette Milne Nanette Milne Conservative

This has been a worthwhile debate. It is a good time to take stock of progress as we are just about halfway between the Government’s announcement of its 2020 vision for the NHS in Scotland and the year when it is hoped that that goal will be achieved, with everyone able to live longer, healthier lives at home or in a homely setting.

We echo the cabinet secretary’s praise of our hard-working NHS staff who, at times, work under great pressure to look after the patients in their care.

I am pleased that there is political consensus around the aspirations of the 2020 vision and cross-party commitment to a publicly owned, funded and managed Scottish health service that is free at the point of need. The overarching agreement between political parties—quite well hidden in parts of the debate—is extremely important, not least because it sends out a clear signal to all stakeholders that, to achieve the best outcome for patients and to achieve a sustainable health and social care system, there must be an end to silo thinking and professional barriers, and a framework of co-operation between healthcare providers at all levels and local authorities and organisations in the third and independent sectors that provide social care, with the recipients of care and their carers at the very heart of planning their care pathway.

Joan McAlpine dealt in depth with the important contribution that is made by the third sector to caring for and supporting people in our communities. I agree that that is a crucial part of a successful integrated system.

Yesterday, Richard Simpson, Jackson Carlaw and I attended a very interesting seminar on the next steps for primary care in Scotland. There was a broad spectrum of speakers, including GPs from affluent and deep-end practices, nurses, care sector providers and the Government. Although significant progress was acknowledged towards the 2020 vision, there is undoubtedly a great deal to be done to cope with the growing demands of an ageing population with increasing levels of comorbidity and to achieve people experiencing seamless care from their earliest years right through to the end of life.

There was also an acknowledgement that primary care should be the hub of an integrated system of health and social care, at the heart of a network of readily available local services such as pharmacy, optometry, dentistry, physiotherapy, podiatry and other allied health professional provision. That concept is already seen in many of the newly built primary care centres in Scotland and is very much in the users’ interests. The ready availability in these centres of nurse practitioners and health visitors and the link to telehealth provision for housebound people can give very necessary local support to patients who are self-managing their complex and long-term health conditions and, in turn, prevent the need for hospital admission.

However, to attract doctors into primary care and retain them, as we have heard this afternoon, the RCGP and the BMA have rightly emphasised that the share of NHS funding for primary care has to be adequate and commensurate with the service that it provides, which is not yet the case. There is also strong feeling that GPs’ professional contribution to patients is being undermined by an excessive administrative and bureaucratic burden. Those are issues that the cabinet secretary will have to address in early course in her pursuit of the 2020 vision for health if general practice is again to become an attractive career option for young medical graduates.

The pressures that are currently facing the NHS have been well aired in the chamber since the start of the year, from the intractability of health inequalities to the enormous demands on GPs and on A and E services—the latter issue, of course, has been exacerbated by the barriers to patient flow through the hospital system caused by a lack of appropriate care within the community. That has occurred close to home for me as a North East Scotland member, as has been highlighted by several other members from the area that is covered by NHS Grampian.

The Government’s announcement this week of a three-year, £100 million funding package to help deal with delayed discharge is, of course, welcome. How that funding will be deployed is clearly very important. I note the cabinet secretary’s indication that it will go towards community support to allow patients to be discharged within 72 hours of being declared fit for return to the community, which would be a major improvement. However, I was struck yesterday by a comment from Ranald Mair of Scottish Care, who suggested that the funding should go towards community support to keep people out of hospital in the first place—that is the other side of the same coin and is worthy of consideration. Mr Mair also made the case for initiatives such as community paediatricians—sorry, I mean the other end: community geriatricians—and models such as hospital at home and virtual wards.

The RCN has been vociferous—not least in its briefing for today’s debate—about the increasing pressures on nurses, many of whom feel that they are too busy to provide the level of care that they would like. The need for more NHS nurses has been accepted, certainly by us and by the Labour Party. We are both committed to providing a further 1,000 nurses, although we totally disagree about how they should be funded, which absolutely precludes our support for the Labour amendment.

Scottish Conservatives have also long pressed for more general practice-based health visitors and we were pleased when the previous health secretary heeded our calls and announced provision for another 500 health visitors. In his opening speech, Jackson Carlaw proposed developing a universal health visitor service up to the age of seven, which of course I support, and flagged up for discussion several other radical ideas for improving health provision, going well beyond 2020. We are pleased that the cabinet secretary is of the same mind and we look forward to working with the Government’s health team and others in planning for the future well beyond the next five years.