Hansard

That might be the case from a survey, but I tend rather to speak to people on a daily basis who come to my surgery, email me and talk to me. I am sure that members across the Parliament, irrespective of which party they are in, have the same experience as me.

Of course, we also have A and E waiting times, with targets that were missed for four years and then changed to try and help the Government to meet them, which mean that the goalposts were moved in the middle of the match. How does that sleight of hand fit with person-centred healthcare? The cabinet secretary mentioned GP practices, but there are some practices in which patients cannot get an appointment, staffing is stretched and GPs want to spend more time with patients with complex needs but are unable to do so.

It is those areas and the general state of the nation in Scotland’s NHS that should be debated. I suspect that the people of Scotland, the patients and their families, and the staff working heroically under enormous and growing pressure would prefer us to consider the nuts and bolts and day-to-day realities of the world as they face it rather than the woolly but worthy motion presented today.

In such a debate we could hear from the Government on basic questions. Do we have enough staff? Are they in the right places? How many patients should doctors be expected to look after? Is the level of financing right? How do we develop a long-term approach? What level of care do we as a nation want to see? Those fundamental questions have been highlighted very ably by The Herald in its NHS campaign, which reflects the concerns raised by people in our communities and in our mailbags day in, day out. One consultant I spoke to recently summed it up when she said:

“If I can appeal to you to raise one thing with the government it is the need to end crisis management in the NHS—at present we just lurch from one crisis to another, we cannot go on like this.”

How does person-centred healthcare sit with that view from a person in a front-line post in the NHS?

We as a society owe the vast majority of staff working in the NHS and other care services a huge debt of thanks for their tireless and unstinting efforts to ensure that our NHS continues to function and look after us. However, the reality is that they are being asked to do that while the Government makes decisions that make their lives much more difficult. Not only are they being asked to do more with less, but the very people expected to deliver the person-centred care to which we all aspire have seen their incomes cut as wages stagnate. What kind of message did it send out to them when the cabinet secretary awarded a miserly 1 per cent pay increase to the lowest-paid staff while giving a 4 per cent rise to senior managers? Is that redistribution Alex Neil style?

How will the healthcare system support people this winter? Will the cabinet secretary give us a sign of his confidence in winter planning by guaranteeing that the waiting times will be met? Will he guarantee that? I am happy to give way to the cabinet secretary if he wants to intervene. I see that he is not taking that opportunity, which is maybe telling.

The Government itself states in its 2020 vision that there are economic challenges ahead, but those challenges are undoubtedly having an impact on healthcare across the board. Scotland’s Auditor General expressed concerns about that, putting the NHS on a financial amber warning last year. The Auditor General raised similar concerns about long-term financial planning this year.

Audit Scotland noted that pressures increased in 2012-13 and that the focus is all too often on short-term measures. A senior nurse, speaking to the media, remembered the worst years of the Thatcher Government, when hospitals were desperately underfunded, and said:

“We are definitely getting back to that now.”

What about the critical role of social care in person-centred healthcare? As a society, not just as a Parliament, we have to address the morality of a system that has been driven down to the lowest common denominator by cuts to local government. At the moment, we have a system in which care providers compete for contracts that are ever more squeezed and care staff are often paid at the lowest level. Contracts are cut to the bone, followed by wages that are at or sometimes below the minimum wage, 15-minute care slots even if people need more than that, and elderly people being put to bed at 6 o’clock because that is when their care slot is. Where is the person-centred approach in that?

What is happening in social care in the community is being repeated in the care home sector. What is going on in social care is grossly unfair to the councils and the good providers who are doing their best with reducing budgets, immoral for the staff who are involved, and inhumane for the elderly and vulnerable people who need the person-centred care that we all aspire to.

We support the principle of person-centred care—healthcare has to be built around the individual. However, I fear that this winter will be one of the most difficult yet for the NHS in Scotland, and unfortunately it will be staff and, most important, the patients who will suffer.