Meeting of the Parliament 10 June 2015
I would like to make a little more progress, but I will do so later.
Those are significant and considered interventions from experts who do not use such strong language lightly. When they do, it demands the attention of us all.
I was, therefore, heartened to read the cabinet secretary’s response in The Herald on Monday. She welcomed the report from the royal colleges and said that she would listen to their concerns, as the First Minister did last Thursday. In her “Agenda” article, the cabinet secretary said that she wants
“to look beyond short-term demands and foster a consensus around how we best manage our NHS to ensure it meets the considerable challenges of the future.”
Indeed, her amendment talks of fostering
“a mature debate, involving the public, health and care professionals and MSPs from all political parties”,
and states that
“this consensual approach to future changes to Scotland’s beloved NHS will help ensure that it evolves to meet the future needs of the people of Scotland.”
The cabinet secretary is right if she believes that she cannot do that without working with the public, the professionals and other political parties. I make it clear to the Government that we stand ready to have that debate and to work together to improve our NHS for everyone. Before I set out some ideas about how we can take forward that debate, I will touch on the issue of targets, which the cabinet secretary raised this week.
On Monday, the cabinet secretary said that it is important that we rethink targets and make sure that we have the right targets. Many people must have thought that the cabinet secretary had a crystal ball because, on Tuesday, the Government missed its target for accident and emergency waiting times of 98 per cent of all patients being seen within four hours. That is the 295th week in a row that that target has been missed. The 98 per cent target has been revised down by the Government to an interim target of 95 per cent, but this week the achieved figure was just 92.6 per cent. If we are still so far off the interim target in the middle of June, that suggests that we have a serious problem. In the new south Glasgow university hospital, the figure was as low as 83.2 per cent.
On Tuesday, one of the success stories was NHS Tayside, which met the A and E waiting time target in 99.1 per cent of cases. However, a question mark now hangs over that number in the light of the allegations that have been made by a whistleblower who has claimed that the figures are being manipulated and that patients’ safety is possibly being compromised. I expect the cabinet secretary to establish an immediate investigation into those claims in order to restore confidence. The cabinet secretary’s response this morning—that she has been assured by the health board in Tayside—is simply not good enough. Whistleblowers need to be confident that the Government will take them seriously, and it is in patients’ and the public’s interests that the claims be fully investigated, no matter what outcome is expected.
We believe that there is a place for targets in driving up standards and maintaining accountability for performance in our health service. However, when boards do not have the adequate resources, we cannot allow targets to drive perverse behaviours. I would support the cabinet secretary looking at revising the targets so that they are smarter and more sophisticated and drive the right behaviour. That should be part of our debate on the future of the NHS.
We should never lose sight of why we have targets in the first place. Early diagnosis and treatment can lead to improved results, and people should not expect to wait longer and longer when a health service should be improving. Therefore, looking at targets can be part of that genuine public debate.
I will now set out some ideas about how we can have that debate to ensure that it delivers the results that we all want it to deliver. I look forward to the cabinet secretary doing the same in her speech.
A summit should be held with all stakeholders, including the professional bodies and trade unions that spoke out last week, certainly the patient groups whose experiences are central to this and, of course, the political leaders from across the Parliament, in the interests of democracy and accountability. The consensus that exists among those groups on an NHS that is publicly run and free at the point of need can be built on to agree how to transform our NHS and to deliver our shared ambition of a healthier Scotland. Of course, there is one stakeholder who, above all others, we must involve in the process—the Scottish public. In doing so, I hope that we can learn lessons from the recent past on how we allow people to shape the debate.
In many ways, politics has undergone something of a resurgence in this country, with the referendum reviving the tradition of town hall meetings and bringing to life street politics and unprecedented levels of discussion on social media. Thousands of people stepped up to have their say in the referendum, because they knew that they had a stake in the decision and in the outcome. What other issue could provoke such universal feeling in our country than the future of the national health service? We can take this debate to every town in Scotland, as we set out the choices that must be taken and then listen to the views of patients and the public on those choices.
The BMA report says that the public need to be involved in what are considered to be the difficult decisions about future investment in Scotland’s NHS. Unless people are empowered to do that and apprised of the options and the consequences of decisions, we cannot expect to take them with us on any journey of change, and our efforts to bring about change will not be successful.