Hansard

We have made it very clear that we want explicit protection for the NHS in the TTIP agreement. We have been consistent about that and see it as the key priority for that trade deal and other trade deals.

We want to go further in this session of Parliament. We will enshrine safe staffing levels in law and put nursing and midwifery workforce planning tools on a statutory footing. We will create an additional 1,000 nursing and midwifery training places, retain the nursing and midwifery bursaries, and explore ways to support those in greatest need—including a discretionary fund of at least £1 million for nursing and midwifery students who face financial hardship. We will increase the number of general practitioners and nurses working in communities. We will increase the number of GP training places and medical school places—including by establishing a new graduate medical school—and we will train 500 additional advanced nurse practitioners. We will also train 1,000 paramedics to work in the community. We will improve recruitment and retention and—alongside the continuation of our no compulsory redundancy policy—we will enable the living wage to be paid to social care workers, who support some of the most vulnerable members of our society.

Despite the record of success and the priorities that I have laid out, I do not shy away from the difficult issues. There are considerable challenges ahead to improve population health; to tackle health inequalities; to ensure parity between mental and physical health; to shift the balance of care to people’s homes and communities; to ensure positive interventions for children; and to ensure that health and social care services are seamlessly responsive to local needs.

Those things matter to the people of Scotland—they told us so last year, as part of the national conversation on creating a healthier Scotland. That conversation reached around 9,000 people through 240 events, with more than 360,000 website and social media inputs. That fantastic response formed the basis of the report on the key outcomes of the conversation, which I published in March. The report focused on six key themes: preventing illness; the vital importance of mental health and wellbeing; person-centred care; the need for increased awareness of the range of social care services available; the need for more accessible and flexible services; and a real recognition of the challenges ahead and the need for clear priorities.

What is important here is the interrelationship between our priorities for health and wellbeing and those for increasing attainment and sustainable economic growth. In her press conference after her election victory, the First Minister referred to education, health and economic growth as the Government’s top priorities. The three are inextricably linked: improving the population’s health and addressing health inequalities cannot be tackled solely as a health issue. It needs, and will get, cross-portfolio working—for example, between health, education and social security. A healthy population and returning people to health are key to economic prosperity.

I am committed to taking forward our health and social care agenda in the context of public sector improvement and against the four pillars of public sector reform in our response to the Christie report: prevention; integration at a local level; workforce development; and a focus on performance, with outcomes-based targets.

In that context, as our delivery of health and social care changes, we will ensure that the structure of our NHS and its relationship with local government reflect those changes. That is why we have committed in this session of Parliament to review the number, structure and regulation of health boards and their relationship with local councils, with a view to reducing unnecessary backroom duplication and removing impediments to better care.

That is also a cornerstone of our national clinical strategy, which will be the blueprint for health and social care over the next 15 years. Its foundation is to provide care as locally as possible through a whole-team, community-based approach. That is vital to the future of the NHS and will allow the vast majority of people to continue to be treated close to home or in their home.

I want the best results for patients when hospital care is needed. Evidence shows that people who need very specialist treatment often get better outcomes by receiving it from teams who perform complex operations more frequently. The strategy therefore outlines how complex treatments may be delivered in specialist centres, with follow-up treatment available locally.

The strategy also outlines proposals to support smaller and rural hospitals to deliver for their communities, including having clinicians working in more than one hospital to allow specialist input to be delivered in remote and rural locations. There are good examples of that happening already, and we need to build on them to ensure equity of access to expert care for everyone.

The key commitments in our manifesto underpin this Government’s future focus for health and social care so that, by 2020, we will have secured our vision of people living longer, healthier lives at home or in homely settings and, over the period to 2030, we will have in place policies, systems and services that support people to begin their lives well, live well, age well and die well.

Our approach will continue to be underpinned by the quality strategy and the triple aim of better health, better care and better value. It will deliver transformational change in three key areas: shifting from a fix-and-treat approach to prevention and anticipation; shifting from doing things to people to working with them in active partnership; and shifting the balance further from hospital to community care. We will drive those changes through four interconnected key initiatives: the reform of public health services and a renewed emphasis on population health improvement; a renewed focus on getting it right for every child; the implementation of the national clinical strategy; and the continued roll-out of health and social care integration.

The national clinical strategy and continued integration, driven at local levels, will put clinicians—in consultation with the public—at the centre of redesigning care to deliver better patient outcomes, and they will support the transformational shift from hospital to community-based care, and from unplanned to planned care. That direction of travel reflects the approach in the chief medical officer for Scotland’s report, “Realistic Medicine”, which has been widely welcomed.

The key commitments in our manifesto will therefore be the building blocks for transformational change. We will support people to start their lives well through the development of a 10-year child and adolescent health and wellbeing strategy and the continued roll-out and extension of family nurse partnerships to provide support for young first-time mothers. We will support people to live well through the cancer strategy, which enjoyed widespread support in other parties’ manifestos and which will be supported by £100 million of investment, and through a range of commitments to expand primary care services by, for example, giving GP practices access to enhanced pharmacists and recruiting 250 community link workers. I want GP practices to become more of a community health service that involves teams of health professionals and others working together under the guidance of a GP, with people seeing the right professional at the right time. We are testing that approach already through new models of care, some of which are based around community hubs, and we will underpin it with the new GP contract in 2017.

In addition, we are developing a 10-year plan to transform mental health care. Mental health was a key theme to emerge from the national conversation. That commitment, along with the appointment of Maureen Watt as a dedicated Minister for Mental Health, shows that we have listened and acted. Maureen Watt will say more about mental health in her closing speech.

We will support people to age well through the protection of free nursing and personal care for the elderly; a new three-year dementia strategy; and investing £200 million in five new elective centres and expanding the Golden Jubilee hospital so that we can meet the increased demands of an ageing population, are better prepared for winter pressures, and can reduce cancellations, delayed discharge and the use of the private sector. We will also support people to die well by ensuring that everyone who needs it has access to palliative care that is designed with people and their families in mind, and we will ensure that there is parity between public funding for children’s and adult hospices.

I am also committed to ensuring that our approach to targets will be outcomes based to give people the best possible care according to need. Targets have served us well and have driven many demonstrable improvements over the past 10 years, such as lower waiting times and safer environments. Some targets continue to be, and will remain, vitally important to patients, such as speedy access to cancer treatment, swift progress through our emergency services in and out of hospital, and the sharp focus on tackling delayed discharge.

However, the time is now right to take stock of what we ask from the NHS, in conjunction with our partners in social care, to ensure that our approach is consistent with the outcomes-based focus of health and social care integration that is enshrined in statute and with the new integrated delivery landscape. I therefore announce that, over the summer, we will undertake a consultation, in conjunction with staff, stakeholders and social care and clinical partners, to review our approach to targets with a view to publishing a document on the way forward in 2016-17. An expert group will be set up to lead that review.

It is also important that we have systems in place that allow us to see how the NHS is performing, regardless of whether a specific target is in place, and to ensure more consistency across Scotland. I will therefore consider as part of the review how we monitor performance more generally, including performance in areas where there is no formal target.

All parties called for a review of targets during the election campaign, so I hope that that will have cross-party support today. I suggest to Labour members that they feed in their views on appropriate cancer targets through the review, rather than through their amendment, which is premature.

Delivering transformational change will involve extensive engagement with the public and professionals alike. People expect—rightly—to engage with us on health policy and delivery, and I am committed to having that engagement.

Last year, I announced the establishment of our voice, which is a framework to support people in getting involved at every level to improve health and social care services. We are recruiting 1,200 members of the public to a national citizens panel that will consider a range of important questions that relate to health and social care. We are supporting people to feed back on their day-to-day experiences of healthcare services through the independent website Patient Opinion, and we are supporting teams across Scotland to build a culture of continuous improvement that is founded on asking the people who use services what matters to them.

We move forward in the direction that I have outlined from solid foundations. Under this Government, we have a record-high health budget of £12.4 billion in 2016-17, and we will increase the NHS revenue budget by £500 million more than inflation by the end of the parliamentary session. We have record-high staffing levels, as confirmed in today’s official figures. We have high patient satisfaction ratings—86 per cent of people are fairly or very satisfied with local health services. We have cleaner hospitals—the number of MRSA cases was down by 93 per cent between March 2007 and December 2015. We have a 16.5 per cent reduction in hospital standardised mortality ratios since the implementation of the Scottish patient safety programme in 2008. That is about 20,000 fewer deaths than expected, which is an astonishing reflection of the hard work of thousands of dedicated staff.

Everyone who works in health and social care can—rightly—be proud of that record. However, I am aware that there are huge challenges ahead, difficult choices to make and priorities to set. I hope that we can unite across the chamber to rise to the challenges and to continue to build on the consensus that we secured in last year’s national conversation. As I did for that conversation, I invite the Opposition spokespeople to meet me to discuss how best to take the plan forward. I hope that that invitation will receive a positive response.

I am happy to move,

That the Parliament agrees that the NHS is the country’s most cherished public service and must remain free at the point of need and be publicly owned, funded and operated; further agrees that health and care services must continually evolve, including delivering the benefits of integration; recognises that meeting these challenges necessitates working in partnership across the health sector and the Parliament; believes that primary, community and social care and mental health should all receive an increasing share of the NHS budget each year to ensure that as many people as possible can lead fulfilling, independent lives; considers that health resource funding should increase above inflation every year, with the aim of being £500 million higher than real terms only increases by the end of this parliamentary session; supports a robust consultation process to help develop a new 10-year mental health strategy that cements the parity of status between mental and physical health; notes that the changes to the welfare system being put in place by the UK Government are exacerbating inequalities and putting more pressure on the NHS; considers that health inequalities will require an approach that looks beyond the NHS and that roots activity to address inequalities across government; agrees that the real living wage can help in addressing these inequalities; believes that it would be totally unacceptable if the proposed Transatlantic Trade and Investment Partnership, or any other trade agreement, were to go ahead without explicit protection for the NHS and public services on the face of the agreement, and calls on the UK Government to demand that this be included.