Hansard

I thought that it would be useful for us to have a fairly wide-ranging debate on health and social care in Scotland, given where we are—particularly as we are approaching the time of year when the pressures on the national health service are always at their greatest.

I will begin by summarising what I see as the three big strategic challenges facing the health service not only in Scotland but in other developed countries. The first and most obvious one is the financial challenge, not only as a result of the reductions in public spending overall that we have had inflicted on us but because costs in the NHS, particularly for new technology and new treatments, are continuing to rise.

Secondly, as the Auditor General for Scotland outlined some months ago, despite all the excellent efforts of successive Governments over the past 30 or 40 years we still have a problem of inequality of access to health in Scotland.

That is an issue that we must address. I do not think that the health service can address it by itself, but we have a part to play.

The third challenge is the ageing of the population. We know that over the next 20 years or so the number of people over 75 living in Scotland will nearly double. Indeed, statisticians reckon that a fifth of all children born in Scotland today will live until they are about 100 years old. The people who will prepare telegrams for King William or King George to send will not be out of a job for some time.

The key issue is how we respond to those challenges. I could probably spend three or four hours telling members about everything that we are doing in health and social care in Scotland. Members will be well aware of some aspects of what we are doing, such as the integration agenda, and there are other things that we are doing to innovate and take forward new ideas and ways of working.

Our vision for the national health and social care system in Scotland is that by 2020 everyone should be able to live longer, healthier lives at home or in a homely setting.

Moreover, our quality strategy delivers a high standard of healthcare through safe, effective and person-centred care.

Person-centred care looks different in every setting but, fundamentally, it is about asking a person not, “What’s the matter with you?” but “What matters to you?” Later this month, my colleague Michael Matheson, the Minister for Public Health, will address the third national learning event of the person-centred health and care collaborative, at which more than 500 delegates will come together to learn from each other, service users and world experts in person-centred care, in which Scotland is a leading nation.

The person-centred approach benefits our dedicated staff as well as the people for whom they care; after all, they came into healthcare to help people, not “the case in bed 7”. Over the past five years, we have invested almost £10 million directly in community-based projects across Scotland through the self-management fund. For example, Mr Matheson and I have on different occasions visited the Thistle Foundation in Craigmillar and both of us have met Brian Brown, an inspirational former soldier whose life had been wrecked by post-traumatic stress disorder but was turned around with the sort of person-centred care that we want to become the norm. On my recent visit, Mr Brown, who now supports others at the Thistle, told me:

“I’ve learned that what I needed was to be listened to, to be treated as a person not as a diagnosis, and to be supported to find my own way forward and deal with my own demons.”

Listening carefully to people and changing how we support them is not only right but necessary, as no nation can afford to continue with the healthcare model that we have pursued to date. It is right that we look at a person in totality rather than at a particular ailment that is giving them trouble at a particular time. We must transform our approach and the main focus of that transformation will be a shift towards primary care.

Last month in Musselburgh, I met a group of local general practitioners who were concerned about their workload, bureaucracy and, more important, the length of time that they get to spend—or, to be more accurate, do not get to spend—with their patients. Like, I am sure, fellow members, I get complaints in my constituency mailbag about problems with getting a GP appointment. However, there are not two sides to this story. Patients and GPs want the same thing: a proper relationship with each other that is based on trust, local knowledge and clear communication. That is the view not only of patients but of doctors, and I am determined to make it the norm.

Our 2020 vision sets out the urgent need for an expanded role for primary care and general practice in particular. We want to keep people healthy in the community for as long as possible, reducing health inequalities and unscheduled care; we will do everything possible to support our excellent primary care workers to deliver care, freed from avoidable bureaucratic paperwork; and we must further develop primary care teams, allowing them to work in partnership with patients and carers to deliver much more person-centred, safe and effective care. As a result, we intend to modernise the GP contract and transform our approach to primary care, and I want to talk about each of those aims in turn.

With regard to modernising the GP contract, I have already said that GPs and the people of Scotland want the same thing—more quality time with each other. We know that getting appointments can be an issue and that the 48-hour access target can cause problems, albeit well-intentioned ones. We have a great opportunity at this time to make things better for Scotland. Late last year, we negotiated for the first time ever—and not for constitutional but for health reasons—a more Scottish contract with the British Medical Association in Scotland, allowing us to reach a negotiated agreement that differs from that imposed on GPs by Westminster and which has paved the way for a new approach. We are currently carefully considering with the BMA in Scotland what next year’s contract should look like.

As part of that, I am today asking my officials to work with the BMA in undertaking a review of access across all GP practices in Scotland and to develop an action plan to address any issues that arise from that review. That is just the first stage. We need to move to a new contract for GPs to match our 2020 vision and to recognise that the direction of travel of the health service north of the border is entirely different from the direction of travel south of the border, particularly in primary care and how it is organised. That will take time, but my clear ambition is for a new Scottish GP contract that will ensure that GPs get the time to do what they need and want to do, which is to work with individuals to ensure that their medical care is right for them, for their family and carers and for the local environment.

GPs are, of course, only part of primary care, and we must develop a full approach to safe, effective and person-centred primary care.