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Plenary, 25 Apr 2002

25 Apr 2002 · S1 · Plenary

Item of business

Primary Health Care

Sturgeon, Nicola SNP Glasgow Watch on SPTV

That is how the Scottish Executive analyses the situation, but the British Medical Association analyses it differently. The BMA thinks that to give patients choice, LHCCs require commissioning power to provide the muscle. That is a difference of opinion, but in this case, the Scottish Executive is wrong and those who are in the front line of delivering primary care are right. The Scottish Executive would do well to listen to them.

If patients have genuine power to choose through primary care, they will become a powerful lever for change in the system. I do not agree with everything that Alan Milburn says and does—or even the majority of it—but he is right to seek to devolve 75 per cent of the NHS budget to primary care organisations and to put them in the driving seat of commissioning services. We should aim for that not—as the Tories want—in order to open up the health service to private providers to make profits from patients, but to ensure that patients have access to the best available care in the NHS, and to ensure that there are incentives for those who provide care to do so to the highest possible standards.

A move in that direction would have implications for primary care trusts and for LHCCs; primary care trusts would become redundant and should be abolished in order to reduce the bureaucracy to which the minister referred in his opening remarks.

At present, the structure of LHCCs is not prescribed. The diversity and ability of LHCCs to reflect local circumstances are thought by some people to be strengths. However, if LHCCs are to become budget-holding and commissioning organisations, they must be expected to meet certain standards. For example, they must include all professional interests in primary care—some groups, such as pharmacists, currently feel excluded—and they must represent patients' interests. LHCCs must become more accountable to the public and to patients. I believe that LHCCs have enormous potential to turn the power structure of the NHS on its head and to put power in the hands of the people who count—the patients.

Although the debate is about primary care, patient experience in the acute sector remains crucial. The shift of emphasis from acute care to primary care is right; I do not know of anyone who disagrees with that. However, as I have said repeatedly, that shift must not be used as an excuse to cut capacity in the acute sector to the point at which the sector cannot cope. The biggest frustration for many people who work in primary care is not the inadequacy of the service, but the delays and inconveniences that are experienced when a patient is referred to hospital. Waiting lists are up and waiting times are growing, which are sure signs that the acute sector is not coping, despite the best efforts of those who work in it. The reason is lack of capacity. There are 700 fewer acute beds now than there were in 1999 and staff shortages are crippling the service. Development and improvement of primary care are essential, but they must not be at the expense of the acute sector.

The debate is important. There are many challenges in primary care, but there might also be many exciting opportunities if we are all prepared to forget our hang-ups and to grasp those opportunities in the interests of patients.

I move amendment S1M-3022.2, to insert at end:

"including greater devolution of power and resources to local health care co-operatives to support and empower primary care teams."

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Plenary, 25 Apr 2002

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