Chamber
Plenary, 05 Jun 2008
05 Jun 2008 · S3 · Plenary
Item of business
Remote and Rural Health Care
On what I hope is a consensual note, I begin by saying that Labour feels that this is certainly a welcome debate on an important issue. Health care in remote and rural areas is, of course, an important part of health care in Scotland and any debate on our health services must take that vital element into account.
We, too, welcome the analysis and findings of the steering group's report. It represents a key step forward in the delivery of services. I associate myself with the cabinet secretary's thanks to the group for its work and for the substance of the report.
I would like to say a little about the broader context, in order to remind members of the issues with which we are grappling and of the world in which we find ourselves. While preparing for the debate and familiarising myself with the fundamental issues that affect health care in remote and rural areas, I have been doing a bit of reading. I was struck by comments that were made by Dr James Douglas, who is a general practitioner from Fort William. He recently wrote:
"The health of rural people remains a global challenge for the developed and developing world. In many poor countries, access to clean water and food by rural populations remains a basic challenge to health. While HIV, TB, Malaria, road trauma and warfare challenge rural health in developing countries, developed countries are challenged by equity of access to sophisticated healthcare."
That equity of access to sophisticated health care is undoubtedly what we will focus on this morning. Our discussions will cover issues of extreme need and, at times, extreme poverty. However, it is worth putting our debate in context and keeping in mind the broader considerations.
As I have said, the final report of the steering group is welcome; it sets the agenda for the Parliament's discussions of health care in remote and rural areas. However, in the article that I just quoted, Dr Douglas says that much of today's work in health care in remote and rural areas is based on the principles that were set out in the Dewar report of 1912. As the article says:
"Dewar's principal recommendations included better training for rural doctors, better use of transport and technology, and guaranteed minimal levels of service provision for rural populations, despite geography."
The aim was to overcome the problems that are caused by remoteness. The issues that we are discussing today are not at all new, and we should be reminded of the issues and challenges that have arisen along the way.
I would, of course, be the first person to acknowledge the progress that was made by the previous Executive. I would want to list the ways in which progress was made, and I am sure that my colleagues in the Liberal Democrats—who did so much work relating to rural Scotland—would agree with me. However, I also support much of the approach that has been outlined by the cabinet secretary. She has given details of some of the issues that we will need to tackle when developing services for our remote and rural communities. Despite some of her comments, I hope that we can use the experience of MSPs of all parties, who are acutely aware of issues in their constituencies and are finely tuned to the needs of their constituents. I hope that we can use that experience consensually to work with national health service staff—professionals and volunteers—to develop services. Obviously, we should also work with staff in the social care sector.
I have to say, however, that I was rather disappointed with the tone that the cabinet secretary struck when talking about what I regard as legitimate criticisms and legitimate points that have been raised. That tone has to be shifted. When we tell the Government that we think that serious issues have emerged from the model of funding that it is using, or when we raise points about any other issues and say that we are concerned and think that the issues need to be interrogated and tested, it is beneath the office of the cabinet secretary simply to dismiss—yet again—our concerns as "scaremongering". You have to pay attention to concerns that are raised in Parliament, be more courteous and deal with the substance of the concerns.
We, too, welcome the analysis and findings of the steering group's report. It represents a key step forward in the delivery of services. I associate myself with the cabinet secretary's thanks to the group for its work and for the substance of the report.
I would like to say a little about the broader context, in order to remind members of the issues with which we are grappling and of the world in which we find ourselves. While preparing for the debate and familiarising myself with the fundamental issues that affect health care in remote and rural areas, I have been doing a bit of reading. I was struck by comments that were made by Dr James Douglas, who is a general practitioner from Fort William. He recently wrote:
"The health of rural people remains a global challenge for the developed and developing world. In many poor countries, access to clean water and food by rural populations remains a basic challenge to health. While HIV, TB, Malaria, road trauma and warfare challenge rural health in developing countries, developed countries are challenged by equity of access to sophisticated healthcare."
That equity of access to sophisticated health care is undoubtedly what we will focus on this morning. Our discussions will cover issues of extreme need and, at times, extreme poverty. However, it is worth putting our debate in context and keeping in mind the broader considerations.
As I have said, the final report of the steering group is welcome; it sets the agenda for the Parliament's discussions of health care in remote and rural areas. However, in the article that I just quoted, Dr Douglas says that much of today's work in health care in remote and rural areas is based on the principles that were set out in the Dewar report of 1912. As the article says:
"Dewar's principal recommendations included better training for rural doctors, better use of transport and technology, and guaranteed minimal levels of service provision for rural populations, despite geography."
The aim was to overcome the problems that are caused by remoteness. The issues that we are discussing today are not at all new, and we should be reminded of the issues and challenges that have arisen along the way.
I would, of course, be the first person to acknowledge the progress that was made by the previous Executive. I would want to list the ways in which progress was made, and I am sure that my colleagues in the Liberal Democrats—who did so much work relating to rural Scotland—would agree with me. However, I also support much of the approach that has been outlined by the cabinet secretary. She has given details of some of the issues that we will need to tackle when developing services for our remote and rural communities. Despite some of her comments, I hope that we can use the experience of MSPs of all parties, who are acutely aware of issues in their constituencies and are finely tuned to the needs of their constituents. I hope that we can use that experience consensually to work with national health service staff—professionals and volunteers—to develop services. Obviously, we should also work with staff in the social care sector.
I have to say, however, that I was rather disappointed with the tone that the cabinet secretary struck when talking about what I regard as legitimate criticisms and legitimate points that have been raised. That tone has to be shifted. When we tell the Government that we think that serious issues have emerged from the model of funding that it is using, or when we raise points about any other issues and say that we are concerned and think that the issues need to be interrogated and tested, it is beneath the office of the cabinet secretary simply to dismiss—yet again—our concerns as "scaremongering". You have to pay attention to concerns that are raised in Parliament, be more courteous and deal with the substance of the concerns.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
Good morning. The first item of business is a debate on motion S3M-2056, in the name of Nicola Sturgeon, on remote and rural health care. I remind members th...
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am happy to open yet another health debate. I suspect that there are members here this morning who have not been home since last night's member's business ...
Jeremy Purvis (Tweeddale, Ettrick and Lauderdale) (LD):
LD
I have heard that mantra on many occasions. It is, however, disingenuous. Although the baseline grant has not been affected for this year, boards such as Bor...
Nicola Sturgeon:
SNP
Jeremy Purvis came in right on cue when I was talking about irresponsible members. What I said is not a mantra; it happens to be the truth. No health board w...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
Will the cabinet secretary take an intervention?
Nicola Sturgeon:
SNP
No—I have to move on and discuss the Liberal Democrat amendment. The amendment is sensible, because a funding formula should not be static. It should be kept...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
On what I hope is a consensual note, I begin by saying that Labour feels that this is certainly a welcome debate on an important issue. Health care in remote...
Nicola Sturgeon:
SNP
I am more than happy to engage in debate, but debate usually involves suggesting solutions as well as making criticisms. Does Margaret Curran agree that she ...
Margaret Curran:
Lab
I think you should pay attention to the exact details of what I said. My argument is not about the amount but about the share, and you know that full well, c...
The Minister for Public Health (Shona Robison):
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No. I did Nicola Sturgeon the courtesy of taking an intervention, but she did not do me the same courtesy. I would prefer it if you would allow me to pursue ...
Shona Robison:
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No, thank you.We are talking about the range of resources from funding for ambulance services to funding to ensure equal access to major Government commitmen...
Nicola Sturgeon:
SNP
Margaret Curran makes an important point, but will she acknowledge that the appointments in NHS Western Isles that have attracted much criticism were made un...
Margaret Curran:
Lab
I say with the greatest respect that the cabinet secretary has missed the point. The point is not party political. Laughter.
The Presiding Officer:
NPA
Order.
Margaret Curran:
Lab
The point is not political. It is about the NHS's management. The NHS's appointments procedures are governed not by politicians, but by its administration. W...
Mary Scanlon (Highlands and Islands) (Con):
Con
Margaret Curran talked about Western Isles NHS Board. On behalf of all of us and for the sake of NHS staff and patients in the Western Isles, I hope that peo...
Ross Finnie (West of Scotland) (LD):
LD
I am delighted that we are having a debate on rural health care, as this is the first occasion since the new Government was formed on which I have been able ...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
Will the member give way?
Ross Finnie:
LD
No—I will press on, because I want to make a point about the purpose of our amendment that I hope will be helpful to Mary Scanlon and other Conservative memb...
The Presiding Officer:
NPA
We move to the open debate. Speeches should be around six minutes, please.
Christine Grahame (South of Scotland) (SNP):
SNP
I welcome the temperate and considered speech that my colleague on the Health and Sport Committee, Ross Finnie, has just made.The foreword to "Delivering for...
Margaret Curran rose—
Lab
Christine Grahame:
SNP
I want to move on. I have only six minutes in total.On staff issues, we should consider the delays in implementing the agenda for change. That is not a Scott...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
I am pleased to take part in this debate on remote and rural health care and I welcome the report. The cabinet secretary is pleased to endorse its recommenda...
Shona Robison:
SNP
The member has just said that the report referred to the minimum level of service that we would expect. Where there are more comprehensive services, we would...
Rhoda Grant:
Lab
I am grateful to the minister for that reassurance. I am sure that the people of Caithness will be grateful for it, too.The report states that there has been...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
The Howard Doris centre is funded jointly by NHS Highland and Highland Council. Does Rhoda Grant agree that there is a question mark over Highland Council's ...
Rhoda Grant:
Lab
Indeed. However, my point is that if the community had not brought forward that initiative, there would be no joint funding. It was the community that raised...