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Plenary, 24 Feb 2005

Meeting date: Thursday, February 24, 2005

Official Report 804KB pdf

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First Minister's Question Time

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Prime Minister (Meetings)

To ask the First Minister when he will next meet the Prime Minister and what issues will be discussed. (S2F-1458)

I expect to meet the Prime Minister again soon and I am sure that we will have a wide range of issues to discuss.

Given the serious problems in the national health service that have again been highlighted this week—longer waiting times, staff shortages in NHS 24 and cancelled operations due to a lack of beds—does not the First Minister think that it is time that he gave the NHS more of his personal attention?

The national health service not only gets a lot of my personal attention, but it clearly gets the attention of the ministers responsible for health. This morning, the Minister for Health and Community Care has been outlining the dramatic reductions in the number of people who wait longest in the national health service and the significant improvements that are taking place in relation to out-patient appointments, which is an area that I have personally raised in this chamber on several occasions as one in which performance had to improve significantly. That workload, should Ms Sturgeon want to call it that, goes on, but it is not seen as a chore; it is an opportunity to ensure that the people of Scotland have and are seen to have better health care delivered to them.

I suggest to the First Minister that, in light of the experiences of real patients that rarely match up to his spin, he needs to take a bit of a look at his priorities. For example, is he aware that his diary for last year, which was published earlier this week, shows that he visited just one hospital in the course of the entire year? He managed to swan around at 10 major sporting events but went to just one hospital. Is that because, as the facts published today show, out-patient waiting times are up, in-patient waiting times show no sign of improvement and the waiting list is at an all-time high? He knows that he has no answers for the patients and staff who want to know why.

If the diary list that has been published includes only one entry, it is inaccurate and I will ensure that it is corrected. I assure Ms Sturgeon that in my constituency and throughout Scotland, I visit not just hospitals—the health service is about much more than hospitals—but a wide range of other health facilities. I treat all the staff throughout the health service with the respect that they deserve and listen to what they have to say, as well as listening to what patients have to say.

Patients say that it was wrong to concentrate several years ago only on bringing down in-patient waiting times and that it is also vitally important to bring down out-patient waiting times and to shorten out-patient waiting lists. After the considerable efforts that have been made, today's statistics show a reduction in out-patient waiting times and in the length of the waiting list; those results are long overdue and required to be addressed. We also see yet another significant reduction in the number of people who have been waiting the longest in our national health service.

Ms Sturgeon might want me to distort the figures to ensure that the so-called median comes down by concentrating on those who have not waited longest, but I am not prepared to leave behind those who have waited the longest in our national health service. They remain our highest priority. Those individuals' procedures might take longer, their operations might be more difficult and they might require more specialist treatment, but those who have been waiting the longest are still our highest priority. It is their waiting times that are coming down and that will continue until they are all waiting less than six months.

Is it not the truth that the First Minister finds it difficult to look Scottish patients in the eye because he knows that for all the spin and distortion, his Government is failing to deliver? Is it not the case that, compared to 1999 when the Labour and Liberal Government came into office, today's NHS is treating fewer patients and that waiting times are 10 days longer for out-patients and 13 days longer for in-patients—all at a time when Scottish taxpayers are stumping up more and more cash? Can he explain why the Scottish people are paying so much more to get so much less?

I am afraid that Ms Sturgeon is living in the past. The reality is that the national health service today delivers treatment in a variety of ways, using a variety of members of staff and a variety of procedures. It is right and proper that it should do so. Just to ensure that the statistics were in some way more impressive would not be a good enough reason for us to stay in the past and ensure that all treatment was still carried out by consultants or other professionals of that sort. It is right and proper that our health service today delivers treatment in a variety of ways. That means that activity must be measured in a variety of ways.

While it is right and proper that we should continue to concentrate on bringing down the longest waits—which have already been brought down dramatically—and on shortening the out-patient waiting list and the waiting times for out-patients, because the start of the journey is as important as the end, it is also right and proper that we should go to other sources in order to increase capacity in our NHS. It is Ms Sturgeon and her party who are totally opposed to the improvements in capacity that will ensure that thousands of people in Tayside, Glasgow and elsewhere in Scotland will be treated over the next few months. Not only will we see an improvement in the statistics but, much more important, patients will get looked after properly.

I say to the First Minister that I am talking not about the past, but about his statistics, which have been published today. Does he realise that real patients lie behind each of those statistics? The statistics show that the vast majority of patients are waiting longer for treatment now than they were in 1999. When will he face up to that fact and, more important, do something about it?

That is completely untrue. More than 50 per cent of the people who are seen by the NHS are treated immediately—they do not wait at all. About 70 per cent of people are treated within three months. The people who used to wait for more than 12 months to receive in-patient treatment no longer have to wait that long; those who used to wait for more than nine months to receive in-patient treatment no longer have to wait that long; and the number of people who wait for more than six months between their initial appointment and their operation or other in-patient activity is coming down at a dramatic rate. It is right that that is our priority.

I ask patients right across Scotland: who has their interests at heart? Is it those of us who are prepared to ensure that they receive treatment regardless of the source from which it comes or is it the Scottish National Party, which would deny them treatment from the independent sector, purely for ideological reasons?

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Cabinet (Meetings)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-1464)

I expect that at the next meeting of our Cabinet we will discuss in particular policies that will improve opportunities for Scotland's children and young people.

The First Minister will forgive me for thinking that the Cabinet might also discuss the situation in the health service. It might care to reflect on the comparison between the situation in Scotland and the situation south of the border. The Executive's own figures show that, per head of population, spending on health in Scotland is some 14 per cent higher than it is in the United Kingdom as a whole. Will he please explain why it is that the number of people on waiting lists has gone up by 23,550—which represents an increase of some 26 per cent—since 1999, when the number of people on waiting lists in England has fallen by 20 per cent over the same period?

That is partly because the two sets of waiting lists are not comparable. It is also the case that we have made a conscious decision to ensure that what is important in our NHS is what is important to the patient, which is not whether they are on a waiting list, but for how long they are on it. That is why the waiting times in our NHS are our top priority and why we in Scotland, rather than our colleagues south of the border, were the first in the UK to offer guarantees about the maximum waiting times for in-patient activity. That is why patient waiting times in Scotland are still lower than they are not just in England, but elsewhere in the UK. Waiting times will remain our priority until we drive them down, not just for in-patient treatment, but for out-patient treatment and for consultations.

That is all very well, except that the facts show that the waiting times to which the First Minister refers have lengthened considerably. In 1997, the median wait—of which the First Minister is fond—for out-patient treatment was 34 days; in December 2004, it was 56 days, which is a substantial increase by any standard. The Conservatives have never said that no improvements have taken place in our health service in the past five years—significant improvements have been made and I give fair credit for them.

However, as my first question clearly demonstrates, the health service down south is improving far faster than the health service up here is. The improvements down south have come about as a result of reforms that were designed to increase capacity by extending the use of the independent sector. Accordingly, will the First Minister say when we will see the introduction of independently run diagnostic and treatment centres, which have played a major role in reducing waiting times and lists in England, as I am sure he would acknowledge? How extensive will the programme be in Scotland?

As Mr McLetchie will be aware, we announced before Christmas a significant increase in independent activity. Discussions are continuing on permanent contracts for that and other activity is taking place, for example, in Aberdeen in the past fortnight, if what the Minister for Health and Community Care tells me is accurate—of course, I am absolutely certain that it is.

Comparisons must be made—of course the health service has improved in the past five years, because the years of underinvestment and neglect of our health service under the Conservatives had to be turned around. However, to use one of the phrases of the moment, it is also important that we move forward, not back, in relation to our national health service. We will continue to ensure that our national health service is free at the point of need in Scotland; that the longest waiting times come down; and that we use capacity for our health service, wherever it may come from. However, we will not use Mr McLetchie's solution, which is to ensure that those who can already afford to pay have a subsidy and to take money and capacity out of the health service. That would be the wrong direction for our national health service. We will ensure that the same level of health care is available for all, including those who need it most, not just those who can pay for it most readily.

Our proposal would take us in exactly the right direction, because only by expanding capacity will we have an independent sector that can treat national health service patients. That is what our proposal is all about. The half-hearted measures—they can be called only that—that the Minister for Health and Community Care and the First Minister announced are a classic case of too little, too late and are representative of a Scottish Executive that had its head in the sand for five years and got the whole issue fundamentally wrong.

If the First Minister accepts that we have a major problem in Scotland—as he must when he sees the statistics today—why are he and his Executive not prepared to be much bolder in their approach, to champion the interests of patients and to take on the vested interests and political prejudices that hold us back?

Many of us are suspicious of the strong support among Conservative members for the subsidies that Mr McLetchie wants to give to the private health care sector instead of for using the money inside the national health service to improve capacity there as well as in the independent sector, so that we ensure that we deliver through the health service, not through subsidising those who can already afford to pay, which is the Tory solution, as reaffirmed last week by Mr McLetchie and his colleagues.

Mr McLetchie's assertions about today's statistics are simply wrong and I am certain that they are motivated by political prejudice. For example, the statistics show that the number of people who are on a waiting list for an out-patient appointment in Scotland is down by 9 per cent, which is long overdue. The number of people who are on a waiting list for a first out-patient appointment and who waited more than 26 weeks is down 15 per cent on the previous quarter. The results are similar in a range of other areas, particularly in relation to people who suffer from the killer diseases in Scotland, including those who require heart treatment. Waiting times for those people continue to come down, quarter after quarter. That is right because we have chosen the right priorities: the longest waits; the killer diseases; and now out-patients, too. It is by concentrating on the key priorities that we will improve the whole of the health service in Scotland.

Is the First Minister content to accept the findings of the civil service commissioner in relation to the conduct of senior civil servants working on the Holyrood project in the light of the information contained in the report—which is now public—that was commissioned from Gardiner & Theobald by the Auditor General for Scotland? The report states unequivocally that

"guidelines, rules and procedures set by the Scottish Executive, the Treasury and the European Commission have been blatantly"

"broken" and "ignored".

The report by the civil service commissioner was not a report for me; it was a report for the permanent secretary and was commissioned by him as the head of the home civil service in Scotland. The permanent secretary will take whatever decisions he requires to take, not only in the light of that report but to ensure that we have a modern, efficient civil service in Scotland.

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Make Poverty History Demonstration

To ask the First Minister whether he will attend the make poverty history demonstration prior to the G8 summit. (S2F-1478)

As First Minister of this devolved Government, I would not normally intervene in matters reserved to the United Kingdom Government, just as I would not expect it to intervene in devolved affairs.

However, the G8 summit coming to Scotland is a unique event and a unique opportunity, and I am publicly supporting the make poverty history campaign. The people of Scotland want us to speak clearly with one voice to the leaders of the G8 and to ensure that they act not just on climate change but on poverty in Africa. My attendance at events in the week before the summit will need to be decided nearer the time.

I look forward to seeing the Prime Minister on the demonstration. I will be there, marching alongside the socialists.

Does the First Minister agree with the make poverty history campaign, which contests that the major cause of world poverty is

"the glaringly unjust global trade system",

or what we socialists know as capitalism? Will he acknowledge that the gap between the rich and poor has never been wider and that 30,000 children die each day from preventable diseases—a figure that throughout history has never been higher? If he accepts those facts, will he also accept that that barbarity is the direct consequence of the policies promoted by the very people who will be wining and dining at Gleneagles in July?

I certainly support fairer trade. I continue to give my full support to that campaign. I do not believe that the Scottish Socialist Party or planned economies around the world have the right solution, but I welcome at least the SSP's in-principle support for the make poverty history in Africa campaign. We have got a job to do over the next few months, not just to influence the G8 leaders but to raise awareness in Scotland. I intend tomorrow to launch a competition for Scottish schoolchildren that will ensure that they are involved in this work. I hope that one of them—or at least a group of them—will win a very special prize indeed.

I remind the First Minister that the make poverty history campaign believes that the G8 is responsible for the fact that more people around the world live in abject poverty now than at any time in history. Perhaps he can tell us who he believes is responsible, if not the G8. Unlike that other killer, the tsunami, poverty is no natural disaster. The G8 has been promising to eradicate poverty for more than 30 years. Whose side is the First Minister on? Is he on the side of the billions who suffer the misery and despair of poverty, or is he on the side of the elite who enjoy riches and luxury beyond the wildest dreams of the mass of humanity? Is he a champion of the poor or an accomplice of the rich?

I congratulate Colin Fox on his election to replace Tommy Sheridan as leader of the Scottish Socialist Party, not least because he clearly does not have Mr Sheridan's ability to change his supplementary questions when he hears my first answer. He will have to do an awful lot better than that. I said in answer to his first question that I fully support the make poverty history campaign. Its three objectives are crystal clear and they are right for our time. They deserve and demand our support, and they have mine. They have the full support of every Labour and Liberal Democrat MSP in the partnership parties and we intend to ensure that Scotland's voice is heard, but heard peacefully, in advance of the G8 summit.

I was delighted to hear what the First Minister said about involving young people and increasing their awareness of international development issues. Can he give us any more information about that? What steps is the Executive taking to involve the range of international development organisations in highlighting the needs of the developing world?

Members will be aware that the primary responsibility for external relations matters in the Executive lies with Mr McCabe, but that in the autumn last year we agreed, as part of the new ministerial responsibilities, to give Ms Ferguson a specific responsibility for dealing with international development issues. In that role, she has been liaising closely with a wide range of non-governmental organisations and other bodies, not just to support Scotland's efforts in relation to the tsunami disaster but on other areas of activity.

Tomorrow, at Holmlea Primary School in Glasgow, I intend to launch a nationwide competition—which will, I am glad to say, be supported by the Hunter Foundation—in which all young Scots in Scotland's secondary schools can take part. I hope that the special prize that the winners will receive will generate a lot of interest. In that way, we will get young people in Scotland interested in what is happening around the world. I hope that those young people, who are, of course, the future of our country and the rest of the world, will have an even stronger commitment than our generation has to aid and development in Africa and elsewhere.

The First Minister recently voiced a strong message of protest against George Bush over his inaction on climate change. I say to the First Minister that people throughout Scotland, the United Kingdom and Europe agree with him on the matter and want to protest at the G8 summit in Perthshire in July. Will he support the establishment of a safe location for the protesters who come to Perthshire, instead of allowing a free-for-all whereby thousands of people will arrive in the area with nowhere to go?

I am not personally involved in the detailed discussions, obviously, but it is my understanding that discussions are taking place, and that further discussions will take place, between those who are organising demonstrations, the security forces and Scotland's police forces. I believe that it is vitally important that the voices of Scots and others from around the world are heard at the G8 summit, but that they are heard peacefully and reasonably. I hope that people will have that opportunity, not just in Perthshire but in Edinburgh. It is important for us to prepare for all eventualities, but it is also important that we encourage peaceful protest and the expression of important views at that time.

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NHS 24

To ask the First Minister what action the Scottish Executive will take to improve staffing levels in NHS 24. (S2F-1469)

It is the responsibility of NHS 24 to recruit and deploy the right staff and ensure that members of the public receive a good service. NHS 24 is now an important part of our national health service. We should recognise the real progress that it has made and the high-quality service that has been enjoyed by the majority of people who have used it. We want the service to be enjoyed more consistently by an even larger majority. It is important to take stock and therefore the Minister for Health and Community Care will confirm this afternoon that an independent review group has been established to identify performance improvements that should be implemented by NHS 24.

I thank the First Minister for his reply and for his advice about the review group.

Only last week, I was advised that a parent who was worried that their young child might have meningitis had to wait several hours for a return call from NHS 24. I am sure that the First Minister will agree that that is quite unacceptable. Will the review group consider what steps can be taken to recruit nurses who are not currently employed in the NHS so that the staff shortage problem does not just shift from NHS 24 to the NHS? Will it also consider the recruitment of other specialists, such as psychiatric specialists? When I visited NHS 24 last summer, I was advised that about a quarter of calls relate to mental health problems rather than physical health problems and that those calls are time consuming.

I think that there are two issues there. First, it is important that individual complaints are addressed and properly followed through. Any complaints that have been raised with the Minister for Health and Community Care or with me in recent months have had such attention. I know that complaints are also taken seriously and treated properly by NHS 24 managers.

Secondly, the review group will address the issues that seem to arise in rural Scotland. Its remit, which will be published this afternoon, covers not only the responsiveness of NHS 24 and the linkages with other NHS partners, but services for callers from remote and rural areas, where the potential for problems will always exist, given the restricted access to a wide range of health care providers and staff.

It is important to ensure that the right staff are in place. I understand that recent figures have shown that NHS 24 recruitment is bringing people back into the service rather than transferring them out of it, and we want that trend to continue. That will be part of the review group's remit.

NHS 24 is a very important service, but it must deliver higher-quality performance more consistently than in the past. I am sure that all its staff are committed to that. The review group will help them to achieve that.

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Care Homes (Top-up Fees)

To ask the First Minister why top-up fees are being charged in care homes. (S2F-1480)

Three years ago, we set out the circumstances in which additional fees can be charged to residents who choose a more expensive care home place. If others are being asked to top up fees for standard care home services, that is wholly unacceptable.

I welcome the inquiry into top-up fees in care homes that the Deputy Minister for Health and Community Care announced, but does the First Minister think that we also need an inquiry into the reasons for top-up fees and the increasing financial pressures on care homes? Is he aware that the Church of Scotland has just increased its charge for residential care by £106 per week to try to cover the increasing costs of care? Does he agree that until the long-running dispute over funding levels between the care home sector and the Executive is resolved, older people will continue to be caught in the middle and will end up paying the price?

Before the SNP decides that it wants to throw more money at anybody who asks for it, I remind the chamber that the review group that established the cost of care homes and the fees that should be paid included representatives of the private care home sector, who took part in the decision making that led to the fees that were established. The Scottish Executive has fully funded those fee levels.

If the SNP ever wants to form an administration at any level anywhere, it must learn not just to say yes when anybody comes along to ask for more money. A process of negotiation and agreement needs to take place. About six or eight weeks ago, Ms Sturgeon proposed in the chamber a cut of about £400 million from council budgets by freezing the council tax. Cutting budgets does not make extra money available for care homes. The SNP cannot have it both ways. It cannot cut taxes and make more money available for care homes. What is needed is a proper, balanced budget in which the numbers add up and the sums can be delivered. That is what we have in Scotland today.

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Local Authority Boundaries

To ask the First Minister what plans the Scottish Executive has to redraw local authority boundaries. (S2F-1460)

The Scottish ministers have no plans to redraw local government boundaries. However, should local agencies bring a problem to the Executive that cannot be resolved through local discussion, we will of course consider the options that are available to us.

I am pleased to hear that the First Minister will consider options. Given that Edinburgh residents this week halted congestion charging through a referendum, does the First Minister agree that local residents should also be able to halt through a referendum a move of their area into a neighbouring council area?

I certainly do not remember the Conservatives in Scotland giving anybody any choice over local government reorganisation through referenda or anything else back in 1995 when they tried to gerrymander Scottish local government and forced through boundaries around the country. That attempt was seen for what it was: in the Scottish local government elections in 1995, the Conservatives had their worst result, because people knew what was going on, saw what was happening and ensured that they were ejected as a result.

Does the First Minister agree that it is absolutely vital that, if any boundary changes to local government areas are considered in the future, that should come about as a result of proper consultation with local communities? As he rightly said, such consultation was not carried out by the Conservatives when they were in Government.

The approach that the member suggests is entirely sensible and I wholly endorse it.

Meeting suspended until 14:00.

On resuming—