Hansard

Of course I will not. I obviously cannot respond to every barking mad tendency in the United Kingdom, but I can confirm and underwrite the commitment that the Conservatives have given.

The less said about the Labour amendment the better. Quite why Jenny Marra should put to the sword again a proposal underwritten by funding mechanisms so discredited here only a week ago and so widely ridiculed elsewhere, not least by significant and senior figures in her own party, is a mystery.

Most recently, Lord Mandelson, the architect of Labour’s only UK election victories in the past 40 years, dismissed it out of hand. It is extraordinary and telling that Ed Miliband’s contribution to our debate is that London should step in. He is talking about the same London party that the Scottish Parliament, through its votes and approach, has deemed, over 13 years under Mr Blair and Mr Brown, to have embarked on health reforms that have so damaged the NHS in England. Labour’s solution is for Ed Miliband to act in some colonial potentate capacity, imposing reparations on the people of London to fund nurses in Scotland. After 16 years of devolved responsibility for health, no one other than Scottish Labour believes that responsibility for nursing in Scotland remains with the people of London.

At best, having correctly, if belatedly, identified the urgent need for 1,000 additional nurses in Scotland, Scottish Labour makes it conditional, not on the election of a Labour Administration in Scotland, to where the responsibility is devolved, but on the election of a Labour Government at Westminster, the prospect of which—I will be generous here—is, at least, doubtful. Let us be done with Mr Miliband’s nonsense, just as Britain will be done with him on 7 May.

Before the exigencies of the referendum campaign, the cabinet secretary’s predecessor embarked, albeit tentatively, on a collaborative journey with the other parties to seek understanding and agreement on the future for Scotland’s NHS that takes in its stride the 2020 vision and looks beyond. Scottish Conservatives have made it clear that we will support a courageous vision, with all the difficulties that that might entail, if the Government is prepared to be bold and direct in its purpose. The cabinet secretary has convened a meeting with health spokesmen next week, and I hope that she will demonstrate the same resolve and purpose. Whatever the merits of the 2020 vision—that is the thrust of the cabinet secretary’s speech today—it is clear from the testimony of so many that, although it is underpinned by general agreement, it is nonetheless being hampered by an NHS that is, for want of a better description, bursting at the seams. I do not mean that as a criticism, but the capacity issues are huge.

We, like Labour, accept the need for additional nurses, but I repeat that our preferred and deliverable funding method in Scotland is the reintroduction of prescription charges on an agreed model so that those who can afford to pay do pay. In so doing, they pay not just for their prescriptions but for the NHS to have 1,000 additional nurses. That is not conditional on anything other than the will of the Scottish Parliament.

Although we accept the thrust of the Government’s motion and the various achievements it identifies, I make the point that agreement between us on a publicly funded NHS that is free at the point of need is not a destination; it is a starting point. There is an urgent need for creative discussion, some of which might be uncomfortable but is no less urgent for that, on where Scotland’s NHS must head and how the more distant vision is achieved and made sustainable.

I will not rehearse the challenges again today, but it is surely time for us to speak of ideas. Scottish Conservatives will not shy away from contributing to the debate. We may not have settled on our views and we genuinely wish to work with others to achieve a plan that we can all support. However, strands of thinking are now emerging.

We cannot sustain the current NHS board structure. The new Southern General hospital is the model for the future but it suggests a structure that has, perhaps, four health boards. Such centres of health will still need a significant hospital structure and support, particularly given Scotland’s diverse landscape and all the challenges, such as that posed by dementia, that follow. That would in turn lead to a leaner pharmaceutical prescribing structure across Scotland, with more universal access to drugs for all Scots.

Scottish Conservatives have talked about the responsibility of Scots to an NHS that is guaranteed by health insurance. The conundrum remains that there is ultimately no appetite to deny those who are reckless with their own health access to health care. So what can we do to enhance individual responsibility? Perhaps when individuals reach their majority, a more deliberate insurance contract should be entered into. Perhaps just as households receive an annual council tax statement, they should receive an annual and personalised NHS statement that details their use of services, current key healthcare information and health statistics and advice, making it clear how they access the NHS and what they must consider as part of a responsible approach to their own healthcare.

At the heart of a sustainable future must be a rethink of primary care. It cannot be allowed to become marginalised, with the public routinely seeking out accident and emergency care ahead of their GP. It needs investment. Perhaps urban should follow rural and accept that small, underresourced GP practices will fall away and be replaced with larger practices that are capable of sustaining a 24-hour model locally, as the cabinet secretary suggested moments ago. We need to make general practice attractive to a new generation—and soon, as the ageing demographic of our current cohort of GPs is deeply worrying.

A model that is based on larger, well-resourced practices should be supported by an attached national and universal health visiting service. I welcome the announcement last year on more health visitor funding, but if our preventative agenda is to succeed, we need that universal service to reach beyond the earliest years and perhaps to offer support up to the age of seven to ensure that the changes that we all want are entrenched in individuals’ spirit as they become self-aware. We believe that such an approach will help to tackle persistent health inequalities at source.

Primary care offers the majority of healthcare but does not receive anything like the resource that that suggests, and some argue that it is commanding an ever-reducing share of the healthcare resource.

We have been too quiet in our deliberations on addictions, particularly to alcohol, since we passed minimum unit pricing nearly two years ago. That has yet to be implemented. However, the consequences of alcohol abuse remain a central and morale-sapping demand on accident and emergency services. Again, there is reluctance to introduce a system of fines for repeated alcohol admissions, but no alternative strategy has emerged. The Scottish Conservatives believe that an alternative approach is required—not an approach that is based on fines, but certainly one that seeks to reduce the reliance on A and E services and offers a more direct rehabilitation and recovery strategy.

The cabinet secretary has made quite a bit of the fact that Scotland’s healthcare budget is now some £12 billion. That is a staggering sum that is beyond the physical comprehension of many. That is why some find it all too easy to say that the solution is more money still. When we appreciate just how much of what the Government spends goes towards healthcare, it may seem hard but it is surely an inevitable conclusion that calls just for ever more spending are a fool’s gold healthcare strategy.

The challenges are understood. We may get lucky: breakthroughs in science and technology may come to our rescue. Think what a fundamental breakthrough in the treatment of dementia or type 2 diabetes would represent for all our fears, plans and calculations. In truth, such breakthroughs may yet be our best hope. However, we can hope for the best but we must plan otherwise, as they say.

We need to evolve a new platform for the structure and delivery of both primary and secondary care. Our preventative agenda must be dynamic, universal and sustained, and our approach to addictions has to become specialised and must not overwhelm the other mainstream services.

We support the motion—that is the easy, consensual bit. Last week, I urged the cabinet secretary to initiate the very discussion that she has announced this afternoon and to shape a plan that can achieve what we want. It is over to the cabinet secretary. We will work with her as she does that.