Meeting of the Parliament 03 December 2014
I will begin, in the short time that is allotted to me, by endorsing the opening statement of Labour’s motion and by paying tribute to the staff of NHS Scotland. The vast majority of those people work in the NHS because they want to help patients, and they work tirelessly to that end. That applies right across the board, within the community and in our hospitals, from the most senior consultants to the most junior medical staff, from nurses and AHPs to the cooks, cleaners, porters and secretaries, who all play their parts in running the vast organisation that is NHS Scotland in the 21st century. Compared with many people in the private sector they are not well paid, but by and large they derive immense satisfaction from the work that they do, and they deserve our gratitude and our support.
When I think back over the near half century since I qualified in medicine, the achievements of the present-day NHS are incredible and are growing, due to the many advances in technology and medical research and the development of more and more sophisticated medicines and procedures. In 1965, hip replacements were a dream, transplants unheard of, and cancer unmentionable and virtually incurable.
The flip side of that is that more and more people are living much longer and with complex medical conditions, and of course the NHS is under pressure to provide the expected—and, sadly, often taken for granted—services. There has to be new thinking about how demand is to be met, and the silo mentality and professional empires that I grew up with have to change. That is not easy when none of us really likes to change our habits and get out of our comfort zone.
The pressures are evident in the difficulty in meeting waiting time targets, in increasing attendances at accident and emergency departments, in delayed discharges from hospitals, in maintaining the NHS estate and infrastructure and developing it for future needs, and in attracting sufficient members of staff at all levels to deal with patient demand. Those pressures are not just within the NHS in Scotland; they are present across all modern systems of healthcare. We have to learn how to cope with them.
The pinch points are well known and we all have to work together to address them. That is why I do not particularly like the inflammatory language in Labour’s motion about a “race to the bottom”, because the aim of people who are associated with the NHS is to maintain and improve quality and to do that, it is imperative that patient wellbeing is our focus and that we move forward with that in mind, using the increasing—but finite—resources that are at our disposal to try to achieve the laudable 2020 vision that is the Scottish Government’s target.
We are fortunate that the NHS budget has been protected in recent years, not least due to the Barnett consequentials from the UK Government’s health policy, which have given Scotland an extra £3 billion since 2010, with more to come every year following today’s autumn statement. However, there will always be a demand for more money, and how it is spent is clearly a matter of political choice. For example, Scottish Conservatives would pledge an extra 1,000 nurses and midwives, paid for by restoring the prescription charge—except for the young, pensioners, pregnant woman and people on low incomes, who would remain exempt, as they always have been.
I believe that new ways need to be found to make the best use of resource, rather than spending valuable time and money on a wholesale review of the NHS. To do that, our total focus must be on the best outcomes for patients who want where possible to live at home or in homely community settings. To that end, we must involve people early in their lives and instil in them the importance of taking responsibility for their own health by making appropriate lifestyle choices that help them to keep well and active for as long as possible, thereby reducing their demands on the NHS.
It is also vital that integration of health and social care moves forward apace, which will mean more emphasis being placed on primary care—