Engagements to take forward the Government’s programme for Scotland.

It is clear that the Scottish national health service is in crisis. Audit Scotland said that there is “no evidence” of a clear long-term plan from the Government to put the NHS in order. The First Minister has been in charge of the Scottish NHS for nearly 10 years. Can she claim today to have such a plan?

The First Minister:

Presiding Officer,

“Over the last decade, there have been improvements in the way health services are delivered and reductions in the time that patients need to wait for hospital ... treatment. There have also been improvements in overall health, life expectancy, patient safety and survival rates for a number of conditions, such as heart disease.”

Those are not my words; that is the first paragraph of the Audit Scotland report that was published today. Context is important.

Notwithstanding all that, the NHS faces challenges. It faces rising demand, principally from an ageing population. The challenges are in no way unique to Scotland. They are common to health systems around the world, which is a point that the Auditor General for Scotland made on the radio this morning. She also said that Scotland’s performance stands up well against that of the rest of the UK. In the light of those challenges—in the light of that rise in demand—we are ensuring record levels of funding and will increase funding by more than the rate of inflation over the course of this parliamentary session. Those challenges are why we have ensured that, as Audit Scotland said,

“staff levels are at the highest level ever”.

Those challenges are why we are not just investing in the health service but reforming it, through integration of health and social care, shifting resources into social care and primary care and expanding elective capacity for routine operations.

There is nothing unique about the challenges that are faced by the health service in Scotland, but the Government is focused on meeting them and we will continue to do that.

The First Minister is the only person in Scotland reading today’s papers who thinks that her Government deserves a pat on the back for its performance on healthcare.

The reason why I asked my specific question, which the First Minister ducked, was that the Audit Scotland report that I quoted from was not from today. It was the one that came out in 2007, when the SNP first came to power. Nearly 10 years on, Audit Scotland reports with the exact same warning that it gave then about the lack of a clear plan and the failure of this Government to get a grip, which has inevitable costs: waiting time targets being missed, doctors and nurses under ever-greater pressure and health boards on the brink.

The Royal College of Nursing asks today:

“How many ... reports will be published by Audit Scotland before action is taken?”

That is a fair question, so what is the answer?

So, on my first question, there is no answer to the charges levelled by Audit Scotland and, on my second question, there is no answer to the charges levelled by the RCN and Scotland’s nurses.

We need to spell things out for what they are, and that is the failure of the Government to get to grips with our NHS. It is an outrage. Health boards are having to make huge savings in order to break even, to take out loans to keep going and to put off essential repairs to hospital buildings, yet we have also learned today that, because of the Government’s failure to manage staffing, there has been a 47 per cent increase in agency nursing and midwifery staff and—staggeringly—that individual agency doctors are being paid more than £400,000 each to provide cover for periods of less than a year. All that is happening while patient care suffers from cuts and hospital buildings are left to crumble. I call that a scandal. What does the First Minister call it?

The First Minister:

Health service funding is higher than it was when we took office; the number of people working in our health service is higher than it was when we took office; and waiting times are lower than they were when we took office.

The hypocrisy of Ruth Davidson is staggering. She talks about the financial performance of health boards in Scotland; that is, of course, challenging, but health boards in Scotland met all their financial targets, as narrated by Audit Scotland today. In the same year that Audit Scotland looked at, the NHS in England had a deficit of £2.5 billion, which was three times its deficit in the previous year. Agency spend for nurses is 0.4 per cent of the total budget, and that spend per head of population is less than a third of what it is in England, where the Tories run the health service.

The point that I am making is this: our NHS faces challenges, but those challenges are not unique to Scotland. They are being faced by health systems across the world. As the Auditor General herself said this morning, when it comes to facing up to the challenges, Scotland is performing well compared with other parts of the UK, and we will continue to focus on making sure that we do that.

The point is this: although there have been some improvements in some areas over the past 10 years—

Members:

Oh!

—which are welcome as far as they go, there is a big question about reforms that would give our NHS a sustainable future and allow health boards to budget for the long term. Successive Scottish National Party ministers, including this First Minister when she was in the role, have ducked the big challenges. When the SNP came to power, we had the opportunity to avoid that, but now we have an unavoidable crisis on our hands because the Government has preferred sticking-plaster solutions and, as we have heard today, a strategy of no clear framework, no milestones and no costings.

Audit Scotland and the Royal College of Nursing are recommending today that health boards be given more flexibility to plan by having three-year rolling budgets instead of annual financial targets. We will back that. Will the First Minister?

The First Minister:

That last question was a case of not waving, but drowning, with the grudging acceptance that there have been some improvements. There have been lots of improvements in the NHS in Scotland, unlike in England, where her party is in charge.

We will continue to focus on that. That is why we have integrated health and social care, why we have put in place a new national clinical strategy and why we have a range of work to improve population health. All that adds up to delivering our 2020 strategy and our broader strategy to 2030. Of course, Ruth Davidson should know that work is under way to combine all that work into a single delivery framework, which will be published before the end of this year.

I do not deny the challenges in our health service. There are challenges faced by health services right across the world, but the performance of our health service is good. Those who work in it deserve our thanks, and the Government will continue to work hard to support them.

1. I congratulate the Presiding Officer on his recent appointment to Her Majesty’s Privy Council.

To ask the First Minister what engagements she has planned for the rest of the day. (S5F-00361)

The First Minister:

I am very happy to compare the situation in the health service today with the situation in the health service in 2007, when this Government took office. There is now more than £3 billion more investment in the health service than there was when we took office. There are 11,000 more medical professionals, nurses and other healthcare professionals working in our health service, which is why Audit Scotland today says that s taffing levels are at an all-time high.

Of course there are challenges around waiting times in our health service, but let us look at the position when we took office. Back then, just 85 per cent of in-patients were seen within 18 weeks; today, more than 90 per cent of in-patients are seen within 12 weeks. The NHS is performing better against a tougher target.

Let us look at out-patients. When we took office, 70 per cent of out-patients were seen within 12 weeks; today, more than 85 per cent of out-patients are seen within 12 weeks.

The performance of our accident and emergency departments is 8 per cent higher than that of accident and emergency departments in England, where the Tories are in government.

Yes, there are challenges in our health service. That is why we have our vision 2020 strategy; why we have put in place our new clinical strategy; why we are planning increased investment in the health service; why we are determined to shift the balance of care into community, social and primary care; and why we will continue to focus on ensuring that we improve the health service so that it continues to have what it has today: high patient satisfaction levels.