Chamber
Plenary, 05 Jun 2008
05 Jun 2008 · S3 · Plenary
Item of business
Remote and Rural Health Care
I am delighted that we are having a debate on rural health care, as this is the first occasion since the new Government was formed on which I have been able to talk about rural matters, with which I am somewhat familiar.
The Liberal Democrats welcome the thrust of the report "Delivering for Remote and Rural Healthcare". To refer back to my time as a minister, I well remember taking a close interest in the remote and rural areas resource initiative that was worked up by a team at Raigmore hospital in Inverness—although the team was based in Inverness, the work that it carried out covered the whole of rural Scotland, not just the Highlands and Islands. Therefore, I am pleased that the report builds on that work and adds substantially to that initial thinking. As the cabinet secretary made clear in her opening remarks, the principle is that everyone in Scotland has the right to expect the same standard of health care wherever they live, and we must recognise that; but, equally, as the initial work of RARARI pointed out and as the report makes explicit, profound differences exist in how we must model the delivery of health care services to meet the needs of rural communities.
I will not recite all those differences, as they are set out well in the report and because I see that almost all the members here represent rural areas, so that would be teaching grandmothers to suck eggs and would be a bit patronising. I will confine myself to measures in the report not only to which the Liberal Democrats want to give our clear support, but about which we feel passionate because they bear a close resemblance to measures in our most recent manifesto.
The general thrust of the report must chime with the approach to individual issues. The report suggests that we need to extend the community care model and acknowledge the differences, which the report brings out, between the primary care model that we need to develop and the current system, which uses an urban model. It is striking how different the suggested model is—it must improve the patient experience of primary care.
The report talks about an enhanced role and improved model for remote community hospitals, particularly in anticipatory care, and shifting the balance of care so that it is more locally based. That chimes with our view on the need to sustain small rural and community hospitals. Access to sustainable secondary care is a matter of considerable interest, as is the task of eliminating the disturbing variations in treatment in rural general hospitals. As the cabinet secretary pointed out, we need to develop the model so that it provides the hub for a range of services in rural communities. However, I caution those who talk about such developments that my colleagues Tavish Scott, Liam McArthur and Jamie Stone, who is here, believe that some of the services that are claimed as enhancements existed before. That is a minor point.
Some key aspects are particularly important in the rural context. The recruitment, development and retention of the workforce are perennial problems that threaten the quality of delivery in many rural areas. Therefore, the increase in specific remote and rural education through RRHEAL—I am grateful to the cabinet secretary for reducing that mouthful for us in her opening remarks—is an important development. It is difficult to attract people into the service but, when we do, they understand how important and rewarding it is. Getting them there in the first place and providing training is critical, so we must develop the infrastructure to support rural practices.
A further issue that is mentioned in the report is telemedicine. As was the case more than a year ago, we still need to do more work on that. In Scotland, we have failed to grasp the opportunities that telemedicine presents. We should consider the international experience. In Canada, telemedicine is developed in a much more determined way in huge areas. It is unfortunate that, in some parts of rural Scotland, telemedicine is seen as an alternative to a doctor visiting, rather than as an enhancement of the service. The technology is available, it works in other places and we need to develop it.
The Liberal Democrats welcome the thrust of the report "Delivering for Remote and Rural Healthcare". To refer back to my time as a minister, I well remember taking a close interest in the remote and rural areas resource initiative that was worked up by a team at Raigmore hospital in Inverness—although the team was based in Inverness, the work that it carried out covered the whole of rural Scotland, not just the Highlands and Islands. Therefore, I am pleased that the report builds on that work and adds substantially to that initial thinking. As the cabinet secretary made clear in her opening remarks, the principle is that everyone in Scotland has the right to expect the same standard of health care wherever they live, and we must recognise that; but, equally, as the initial work of RARARI pointed out and as the report makes explicit, profound differences exist in how we must model the delivery of health care services to meet the needs of rural communities.
I will not recite all those differences, as they are set out well in the report and because I see that almost all the members here represent rural areas, so that would be teaching grandmothers to suck eggs and would be a bit patronising. I will confine myself to measures in the report not only to which the Liberal Democrats want to give our clear support, but about which we feel passionate because they bear a close resemblance to measures in our most recent manifesto.
The general thrust of the report must chime with the approach to individual issues. The report suggests that we need to extend the community care model and acknowledge the differences, which the report brings out, between the primary care model that we need to develop and the current system, which uses an urban model. It is striking how different the suggested model is—it must improve the patient experience of primary care.
The report talks about an enhanced role and improved model for remote community hospitals, particularly in anticipatory care, and shifting the balance of care so that it is more locally based. That chimes with our view on the need to sustain small rural and community hospitals. Access to sustainable secondary care is a matter of considerable interest, as is the task of eliminating the disturbing variations in treatment in rural general hospitals. As the cabinet secretary pointed out, we need to develop the model so that it provides the hub for a range of services in rural communities. However, I caution those who talk about such developments that my colleagues Tavish Scott, Liam McArthur and Jamie Stone, who is here, believe that some of the services that are claimed as enhancements existed before. That is a minor point.
Some key aspects are particularly important in the rural context. The recruitment, development and retention of the workforce are perennial problems that threaten the quality of delivery in many rural areas. Therefore, the increase in specific remote and rural education through RRHEAL—I am grateful to the cabinet secretary for reducing that mouthful for us in her opening remarks—is an important development. It is difficult to attract people into the service but, when we do, they understand how important and rewarding it is. Getting them there in the first place and providing training is critical, so we must develop the infrastructure to support rural practices.
A further issue that is mentioned in the report is telemedicine. As was the case more than a year ago, we still need to do more work on that. In Scotland, we have failed to grasp the opportunities that telemedicine presents. We should consider the international experience. In Canada, telemedicine is developed in a much more determined way in huge areas. It is unfortunate that, in some parts of rural Scotland, telemedicine is seen as an alternative to a doctor visiting, rather than as an enhancement of the service. The technology is available, it works in other places and we need to develop it.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
Good morning. The first item of business is a debate on motion S3M-2056, in the name of Nicola Sturgeon, on remote and rural health care. I remind members th...
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am happy to open yet another health debate. I suspect that there are members here this morning who have not been home since last night's member's business ...
Jeremy Purvis (Tweeddale, Ettrick and Lauderdale) (LD):
LD
I have heard that mantra on many occasions. It is, however, disingenuous. Although the baseline grant has not been affected for this year, boards such as Bor...
Nicola Sturgeon:
SNP
Jeremy Purvis came in right on cue when I was talking about irresponsible members. What I said is not a mantra; it happens to be the truth. No health board w...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
Will the cabinet secretary take an intervention?
Nicola Sturgeon:
SNP
No—I have to move on and discuss the Liberal Democrat amendment. The amendment is sensible, because a funding formula should not be static. It should be kept...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
On what I hope is a consensual note, I begin by saying that Labour feels that this is certainly a welcome debate on an important issue. Health care in remote...
Nicola Sturgeon:
SNP
I am more than happy to engage in debate, but debate usually involves suggesting solutions as well as making criticisms. Does Margaret Curran agree that she ...
Margaret Curran:
Lab
I think you should pay attention to the exact details of what I said. My argument is not about the amount but about the share, and you know that full well, c...
The Minister for Public Health (Shona Robison):
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No. I did Nicola Sturgeon the courtesy of taking an intervention, but she did not do me the same courtesy. I would prefer it if you would allow me to pursue ...
Shona Robison:
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No, thank you.We are talking about the range of resources from funding for ambulance services to funding to ensure equal access to major Government commitmen...
Nicola Sturgeon:
SNP
Margaret Curran makes an important point, but will she acknowledge that the appointments in NHS Western Isles that have attracted much criticism were made un...
Margaret Curran:
Lab
I say with the greatest respect that the cabinet secretary has missed the point. The point is not party political. Laughter.
The Presiding Officer:
NPA
Order.
Margaret Curran:
Lab
The point is not political. It is about the NHS's management. The NHS's appointments procedures are governed not by politicians, but by its administration. W...
Mary Scanlon (Highlands and Islands) (Con):
Con
Margaret Curran talked about Western Isles NHS Board. On behalf of all of us and for the sake of NHS staff and patients in the Western Isles, I hope that peo...
Ross Finnie (West of Scotland) (LD):
LD
I am delighted that we are having a debate on rural health care, as this is the first occasion since the new Government was formed on which I have been able ...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
Will the member give way?
Ross Finnie:
LD
No—I will press on, because I want to make a point about the purpose of our amendment that I hope will be helpful to Mary Scanlon and other Conservative memb...
The Presiding Officer:
NPA
We move to the open debate. Speeches should be around six minutes, please.
Christine Grahame (South of Scotland) (SNP):
SNP
I welcome the temperate and considered speech that my colleague on the Health and Sport Committee, Ross Finnie, has just made.The foreword to "Delivering for...
Margaret Curran rose—
Lab
Christine Grahame:
SNP
I want to move on. I have only six minutes in total.On staff issues, we should consider the delays in implementing the agenda for change. That is not a Scott...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
I am pleased to take part in this debate on remote and rural health care and I welcome the report. The cabinet secretary is pleased to endorse its recommenda...
Shona Robison:
SNP
The member has just said that the report referred to the minimum level of service that we would expect. Where there are more comprehensive services, we would...
Rhoda Grant:
Lab
I am grateful to the minister for that reassurance. I am sure that the people of Caithness will be grateful for it, too.The report states that there has been...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
The Howard Doris centre is funded jointly by NHS Highland and Highland Council. Does Rhoda Grant agree that there is a question mark over Highland Council's ...
Rhoda Grant:
Lab
Indeed. However, my point is that if the community had not brought forward that initiative, there would be no joint funding. It was the community that raised...