Hansard

I start by referring to targets in the NHS, which was a theme in the opening speeches. The briefing that the royal colleges prepared for the debate specifically mentions targets, and I will quote from it—sparingly. Action point 2 states:

“The current approach to setting and reporting on national targets and measures, while having initially delivered some real improvements, is now creating an unsustainable culture that pervades the NHS.”

I might not agree entirely with that, but the royal colleges have a point in relation to how sustainable certain targets are. I will say more about that in a moment.

However, we should not be in denial about the huge transformational change that health improvement, efficiency and governance, access and treatment—HEAT—targets can deliver in the NHS. In that regard, I particularly think of access to psychological services. In NHS Greater Glasgow and Clyde, the waiting time was up to two years when I first became an MSP, but that has been slashed down to something like 20 weeks. I wish that I had dug out the exact figure, but the HEAT target has been transformational. There is a balance to be struck, and we should not throw the baby out with the bath water. That said, the royal colleges have a point that we should listen to carefully.

The point about targets is not new. I do not want to steal the thunder of my convener on the Health and Sport Committee, Duncan McNeil, who has been making it for a while, but I add that our committee has made it in relation to our scrutiny of the NHS budget.

We heard just yesterday about targets for certain surgical procedures that are not a clinical priority—let me be clear that they are a priority to the people who wish to have them, but they are not a clinical priority. We heard that it can cost three times as much to drive the change and get close to meeting the target—perhaps being 1 or 2 per cent away—as it would cost if people waited a few days or weeks longer. We should bear that in mind. I give the example of a success rate of 93 per cent where the target is 95 per cent. If people waited a few days longer, the NHS could save a huge amount of cash, but it would not meet the HEAT target.

Consensual tones have to be two way. As we heard in Jenny Marra’s opening speech, the Opposition will be terrier-like in exposing a Scottish Government does not meet its targets, but it will not nuance that by saying that a target was missed by just a handful of patients for a handful of days. We must have a two-way process in the debate if we are to work out which HEAT targets we should revise, where the cost savings are and how the money should be reinvested. The Health and Sport Committee has done a lot of good work on that in the past couple of years.

We have to look at the successes that there have been and admit problems where they exist. For example, there have undoubtedly been problems recently with delayed discharge and, quite rightly, the Scottish Government was chastised for the situation when it appeared before the committee. However, the data show that it is still down by two thirds compared with when we had a Scottish Executive. We have to give credit where it is due; at the same time, we have to challenge the problems that exist and change the structures as and when necessary.

Over lunch, I chaired a meeting of the cross-party group on rare diseases. I will make a couple of points that came out of that meeting. We spoke about the new medicines fund, which was recently doubled to £80 million for 2015-16. We heard at the meeting that 1,000 people have had medicines that they otherwise might not have got, had it not been for that fund. The Health and Sport Committee had something to do with driving Government policy on that. It is a real achievement.

We also heard about an additional £2.5 million for specialist nurses. I pay tribute to Gordon Aikman and the motor neurone disease specialist nurse campaign, as £700,000 will go towards MND specialist nurses. I refer to that because, although members of the cross-party group welcomed that funding, it only scratches the surface in terms of need and the demand that exists. There are 35 Huntington’s disease specialists, five for the single gene complex needs service and zero for sickle cell disease. The question is whether we set targets nationally or leave the matter to local health boards. It was drawn to my attention that the moneys to fund specialist nurses have been given to local boards to make priority decisions, but we might have to review that.

That leads me to my key point, which relates to workforce planning. Earlier today, I met representatives of speech and language therapists, who told me that they want a needs-led full care journey to be planned out with multidisciplinary workforce planning, involving not just those in the health or allied health professions sector but those in the social care sector. As we develop workforce and workload management tools for nurses, we must get a lot better and a lot cleverer at creating a matrix for doing such planning right across the health and social care sector. The royal colleges mentioned that as well. We might need dramatic change, although I do not think that it would need to be dramatic, because much of the work appears to be happening already and the royal colleges appear to be calling for things that, I hope, the Scottish Government is already considering.

In these debates, I always talk about raising the status of care staff, increasing the esteem in which they are held and developing their career pathways—I did so in the most recent debate on health and social care integration. Let us make care the profession of choice for many young people when they leave school and college. Perhaps they could go to college on a day-release basis and, after five years in the care sector, could go straight into second year of a nursing or AHP degree.