Hansard

I start, as some other members have, by thanking the staff who work in our health service. I speak as someone who represents fairly widely-flung communities throughout Angus North and the Mearns. I am conscious that the staff who work in my local facilities have transport difficulties when everybody else has a transport difficulty and that they, too, suffer health issues. Somehow or other, in their various communities, they make it all work, and we are very grateful.

I thank Jackson Carlaw for his approach. I entirely agree with the idea that we really should be able to agree, across the Parliament, on our strategic planning. If we cannot, we have got it wrong. The timescales are so long and the inertia in the system is so big that we have got to get this right in principle and understand each other’s position.

My communities contain a number of hospital facilities; sadly, even in the time available, I do not have time to discuss them. However, I bring it to the attention of members and, in particular, the cabinet secretary that folk like a local facility. The cabinet secretary will be well aware that Brechin infirmary is under some threat. The infirmary is next to a GP practice that, for its own reasons, is unable to sustain that local cottage hospital—or community hospital, if I may use that term.

Community hospitals are a necessary add-on to GP practices. I have five of them in my constituency. My folk like a local community hospital. They are used to local hospitals, they value them, and they recognise that they have a cost. The costs arise in two ways. First, because there is a relatively low occupancy—sometimes the facilities are not occupied at all—there is a significant unit cost, if I may use that term to describe how we look after a patient. Far more important, where staff are in effect underutilised they are also very rapidly deskilled. That is a point that health boards need to get across to communities. It is a problem that I first met a long time ago when we were looking at ambulances up the rivers, in particular up in Braemar and Ballater. We can have an ambulance at every stop, but the people do so little that they rapidly become deskilled. We need to ensure that folk understand that.

I will pick up one or two of the important points that Sir Lewis Ritchie raised in his review—I am sure that members will pick up many others. I see the huge potential for shared records as an opportunity, but I am also a bit concerned, because, given that I sit on the Public Audit Committee, I get the impression that records are not always as shareable as they should be. We recognise that the boundaries between health boards are artificial—in the middle of my constituency they are wholly arbitrary—and we must make sure that the IT systems work in such a way that records can be accessible.

Sir Lewis Ritchie’s report refers to video links and recognises that there are often cultural barriers to their use. It seems to me that if a doctor cannot come to someone’s bedside, it might be entirely reasonable for a nurse to do so, with the appropriate video link. We do not seem to be making as much use of that as we should.

I turn to what I see as the biggest risk. I commend the cabinet secretary and the Government for what they are trying to do. However, it seems to me that integration joint boards come with a risk. I am not alone in saying that; the Auditor General for Scotland took that view in one of her recent reports. I have absolutely no doubt that everybody concerned wants to make integration joint boards work. I am concerned, however, that the people at leadership and governance level, who will come from one or the other organisation that might well have primary responsibility for aspects of what we are trying to integrate, will find it very difficult to know which hat they are wearing at any point in time and for the integrated services to become the dominant factor in their thinking. The leadership of our integration joint boards will be absolutely crucial.

It is relatively easy to come up with a vision statement, but turning that vision into changed processes, changed expectations of both staff and patients and increased satisfaction levels as a result of those expectations having been absorbed, is a huge challenge.

I hope that we can find leaders who will make that work and that we can instil in them the idea that this has to be for the whole population, not just the small section whom they previously looked after. I am concerned that we get the governance right. I have no doubt that the Government’s intentions are entirely correct and that the legislation is right, but leadership is crucial.

The doctors, nurses, pharmacists, physiotherapists, advanced nurse practitioners in particular, district nurses and social service and care workers who will be part of the integrated services that we rely on in future come in well motivated. As Jackson Carlaw said, I am absolutely sure that people want to do a good job. I find it inconceivable that anybody who goes into those caring professions does not want to do a good job, develop their skills and provide care.