Scottish Grand Committee
Tuesday 7 April 1998
[Mrs. Ray Michie in the Chair]
Health in Scotland
10.30 am
The Chairman: Good morning everybody. We begin with the substantive motion for the adjournment of the Committee on health in Scotland. This sitting is due to finish at 1 o'clock and I ask hon. Members for brief contributions to enable me to call as many speakers as possible.
The Parliamentary Under-Secretary of State for Scotland (Mr. Sam Galbraith): I beg to move, That the Committee do now adjourn.
Since the general election the Government have made some of the most significant changes in the health service for a considerable time. Our aim is to develop a health service with effective policies that will take it into the new millennium, when it will play an enhanced role in transforming the health of our nation.
The Government have done much, but because I wish to speak for no more than 15 minutes I shall deal with only a few areas. I shall also emphasise the specific Scottish nature of what we have done.
Let me start with expenditure. In our manifesto, we pledged to increase it in real terms year on year. Next year a total of £4.625 billion will be available for health expenditure in Scotland. That is a cash increase of 5.7 per cent. and an increase in real terms of 2.7 per cent. over inflation; it is nearly £250 million more for the health service. We shall spend £898 per person on health in Scotland this year; that is almost £900 for each woman, man and child. That, let me emphasise, is 22 per cent. more than will be spent in England. We promised real-terms increases and we have delivered them.
I was interested in the remarks attributed to the hon. Member for Tweeddale, Ettrick and Lauderdale (Mr. Moore), who will speak for the Liberal Democrat party. He said that despite the spin the Government have to date provided only 2.3 per cent. extra for 1998-99. I suggest that he revisits those figures. The additional money that we have put into the health service is equivalent to the rise of 1p in the pound in income tax that was promised by his party. I have spent his 1p on income tax.
The Minister for Education and Industry, Scottish Office, my hon. Friend the Member for Cunninghame, North (Mr. Wilson) has also spent that 1p on income tax on education. He spent it twice on welfare to work. The Government have stretched one penny a long way.
Dr. Norman A. Godman (Greenock and Inverclyde): Can I assume from my hon. Friend's remarks that there will be an increase of 2.7 per cent. in the mental illness specific grant this year? That is only a fraction of the amount that he has just referred to, but, as he knows, that grant assists people with head injuries, in a sensible and practical way.
Mr. Galbraith: The mental illness specific grant is for a wide range of provisions within the community, and some of those deal with head injuries. I can assure my hon. Friend that that funding is guaranteed for at least another three years.
We have increased expenditure in real terms by 2.7 per cent. and we have continued the attack on wasteful bureaucracy, to redirect resources to patient care. We have announced the abolition of the inefficient, divisive, internal market. As a result of those changes, over the next three to four years, another £100 million will be redirected from bureaucracy into patient care. We have promised increased resources and we have delivered them.
The White Paper, "Designed to Care", and the replacement of the internal market are at the heart of what we are doing. The overall objective is a modern, patient-centred health service that will improve the reliability, effectiveness and responsiveness of patient care.
A key part of the modernisation of the health service is a simpler structure of trusts. From April next year we will establish primary care trusts across Scotland. They will be unique to Scotland and offer a new way to strengthen links between general practice and other parts of the NHS. The primary care trusts will emphasise team working, not competition. Nurses, general practitioners, psychiatrists, midwives, therapists, pharmacists and others will all contribute their expertise and skills. Bringing together the primary and community health services will help to overcome some of the unnecessary barriers that interfere with effective patient care.
Mrs. Margaret Ewing (Moray): As the Minister suggested in the relevant document that there would be no blueprint for the establishment of primary care trusts and acute trusts, will he consider the possibility that individual areas might want a combination?
Mr. Galbraith: The hon. Lady is right; there is no blueprint. We suffered in the past from the imposition of a blueprint throughout the country. With respect to the number of trusts which is what the hon. Lady is talking about, although that issue is linked to types also we shall wait for consultation. I hope to deal with that briefly, but I guarantee that there is no blueprint for the matters that I have mentioned.
The primary care trusts will have strong links with secondary care. Each health board will establish a joint investment fund, which will be another unique feature of the Scottish health service. Through that mechanism the new trusts will work with the hospital sector to redesign care from the patient's point of view. General practitioners, community nurses and other community professionals will all have a key part to play in the management of the trusts. That fact will support the development of cost-effective and clinically effective services that will be responsive to needs.
General practitioners and other primary care staff will also come together as local health care co-operatives which will be managed by them and charged to design and deliver local community services.
Trust reconfiguration is another aspect of the changes, and the question asked by the hon. Member for[Mr. Galbraith]
Moray (Mrs. Ewing) relates to that. As well as a change in the nature of trusts there will also be a reduction in their number. Each health board is currently consulting publicly on the trusts to operate in its area. The proposals taken together suggest that there will be between 25 and 29 trusts in Scotland, in place of the 46 hospital and community trusts at present. That is a significant reduction in trust numbers and will result in significant reductions in bureaucracy. Money will be saved and redirected from bureaucracy to patient care. That will be a marked improvement on the current position.
Subject to the outcome of public consultation, therefore, I expect to be able to take decisions about the new configurations in the summer. I expect the new trust configurations to be up and running from 1 April 1999.
Mr. John Swinney (North Tayside): Before the Minister moves on from his point about public consultation, will he comment on the concern that is felt, certainly in my constituency, that loss of trust status will lead to the concentration of health services particularly with respect to the threat to Stracathro hospital, in which the hon. Member for West Aberdeenshire and Kincardine (Sir R. Smith) and my hon. Friend the Member for Angus (Mr. Welsh) share an interest with me. It is thought that the concentration of health services will inevitably lead to cities such as Dundee providing more health care and the loss of health care in the peripheral areas of the health board regions. Will the Minister assure us that in the consultation process the need for local acute hospital services will be protected?
Mr. Galbraith: It is important to understand that the trust configurations and numbers are a management system. The clinical provision of services is a separate issue, being dealt with in the acute strategy review. Of course, a conflict in clinical services has been highlighted, between concentrating on critical mass to ensure that everyone gets the best possible treatment, and convenience. It is important to achieve the right balance. There will be no blueprint for that, but, although it is necessary to concentrate some services to ensure the best possible treatment, the Government are committed to local services and community hospitals.
We always opposed the changes that took place in the 1980s. As a mark of our commitment to community hospitals, we have already given the green light to two new hospitals in the short time that we have been in office. One will be in Uist and the other in Ayrshire. therefore, our commitment to community hospitals and local care is clear.
Reducing the time people wait for treatment is one of the main priorities I have set for the NHS in Scotland. As we know, there has been a reversal of the downward trend in the past few months. I have already publicly expressed concern about that.
I am determined to drive down both waiting lists and waiting times, for the benefit of patients. My right hon. Friend the Chancellor of the Exchequer announced on Tuesday 17 March that additional funds would be allocated to the national health service in Scotland including £44.5 million, which will be specifically aimed at tackling waiting lists.
That substantial frest injection of funds demonstrates a continuing commitment to driving down waiting lists and ensuring that they stay down.
Mr. Tam Dalyell (Linlithgow): Can my hon. Friend tell us anything about waiting lists for elective surgery? They cause considerable anxiety.
Mr. Galbraith: Waiting lists have increased from 84,000 to over 86,000 in the past few months. I intend to reduce those lists. That is why we have put £44.5 million extra into solving the problem.
£20 million has already been allocated to health boards this month, so that they can draw up plans for tackling waiting lists in their areas. The first priority will be to tackle the number of people waiting for in-patient and day case treatment, but I also expect them to look at out-patient referrals and waiting times.
I do not wish simply to throw money at the problem that has been tried in the past and it has failed. For that reason, a further £20 million will be distributed later this year to assist actions that will influence more strategic change in service delivery, and achieve long-term reductions in waiting lists.
In order to drive forward this work, I have appointed a high level professional and clinical support group under the chairmanship of Tom Divers, general manager of Lanarkshire health board. He will review the plans to be submitted by health boards, pursue particular problem areas, monitor the progress of health boards and trusts in reducing waiting lists, and identify good practice.
My aim, and my promise, is that by April 1999, waiting lists will be shorter than those we inherited, and that we will maintain the downward trend.
I have so far concentrated on acute and primary care. The needs of community care priority groups are equally important. Among those mental health is a key priority for the Government and the NHS.
"The Framework for Mental Health Services in Scotland", which we published last September, is entirely consistent with our broad aims for all NHS services. They should all promote: patient centred care; care services that respond to individually assessed needs, and the importance of partnership planning and shared working.
The framework will help staff in the health, housing and social work agencies to develop a partnership approach to providing care and integrated services for people with mental health problems. That is one of the themes of our policy.
The response to date has been positive, with each health board developing a comprehensive mental health strategy in line with the framework's principles, which will be progressively implemented for the benefit of patients.
I have so far talked about treating people. In the last minute or so, I want to examine the big picture. Sadly, although health is improving in Scotland, it is doing so at a slower pace than in many other countries. No Government with a social conscience could tolerate such a state of affairs. If cultural attitudes and lifestyle have a bearing on health, so do the circumstances in which people live. Poverty and unemployment, poor housing and a bad environment are all inextricably linked to health.
We need a fresh start with no more nannying and no more blame attached to people. That new start should build on an accepted fact denied by previous governments that poverty is the cause of much ill health. If we do not tackle poverty, we shall not tackle ill health.
We therefore need a public health strategy that addresses the root causes of our health problems deprivation, poverty, unemployment, poor housing and inadequate education. That is why we have promised to improve public health in Scotland with new initiatives and preventive medicine, which is exactly what we have done.
We have launched a Green Paper, which proposes action at three levels. First and most importantly, we must deal with life circumstances. Improving them by giving people jobs is probably the most important health measure that we could take. It would give people a future, a stake in society, the determination to look after themselves and the economic means to make the necessary choices. Together with a job, a good education and a safe and attractive environment in which to work are also important.
The second is to improve people's lifestyles not by nannying individuals but by providing them with information to ensure that they are not brought under undue commercial pressures. As long as they have a job, they have a future and the economic means to make the appropriate lifestyle choices. Thirdly, we shall take action on a number of health priorities such as coronary heart disease, strokes and cancer. Consultation on the Green Paper finishes on 30 April and it will be followed by a White Paper later in the year.
I know that there is much to be done to revitalise the health service and it is our strong intention to revitalise it. I am confident that the range of initiatives that we have announced and implemented will provide a firm foundation to achieve our common aim a health service that will provide people with what they need, when they want it and be of the highest possible quality.
10.47 am
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