Hansard

I speak as the health spokesperson for the Green group in the Parliament and as a former health professional. I make no apologies for saying that. Although Mr Davidson might think that I am a complete amateur in the Parliament and that I do not know anything about the workings of the civil service or government and so should not have been elected, the richness of those bodies comes from the fact that people bring experience—even baggage—from their previous employment.

No one would argue against the greater involvement of patients in the health service, whether at the individual level, with patients being involved in their treatment plan and interacting with health professionals, or wider public involvement in health services.

I will return for a moment to my baggage from my previous job. Last week's British Medical Journal was entitled "The patient issue". It was an experiment, in which all the main editorials and many of the articles were written from the patient's point of view. A lot of the articles were written by doctors who had also been patients, who recounted how the experience felt to them—doctors are human too.

One article, written by a managing editor of a consumers website in Australia, was entitled "Just how demanding can we get before we blow it?" She made the point that there is a risk because of the lack of inclusiveness of patient power. She wrote:

"It worries me that this trend is deepening inequalities in health care, as the better equipped patients corner more and more of their doctors' time."

She was talking about the middle-class patients who come with a list of questions, demands and so on. She continued:

"Yet, they may be the very people who could get their questions answered in other ways, while the people who need to rely most on the doctor"

get pushed aside because they are not so articulate. We must ensure that our patient consultation is not just consultation of articulate individual patients or groups of patients but reaches everybody.

Mike Stone, the director of the Patients Association, raised another point. He listed the things that patients want from their doctor, some of which the minister has talked about, such as communication skills, eye contact, partnership communication and getting an appointment. He wrote:

"However, if one wish could be granted for patients, it would be for more time with their doctor."

That is true. The one thing that patients want is more time with their doctor. Unfortunately, I do not think that the measures in the white paper will deliver that. In fact, I worry that staff—not just doctors, but all health professionals—who struggle to get the time off and the funding for study leave will have to undertake courses in communications and so on, meaning that we will be in a worse staffing situation that we are in now. People can engage with a doctor only if there is one there to engage with. In the Highlands and Islands, some areas are seriously under-doctored because of the recruitment problem. Frankly, someone would be quite happy to have an abrupt interaction with a doctor for three minutes now rather than wait a month to see somebody for eight minutes, if they are in pain or otherwise in need.

I hope that the idea of a culture of listening in the NHS is part of the idea of a culture of listening in government. Listening is meaningful only if what is heard during the listening exercise is acted on. If the Executive listens to communities but ignores what they say and does what it was going to do anyway, listening is a fairly sterile exercise, as other members have pointed out. We also need to listen to communities about other factors that can determine health. NHS provision is only one small factor in the determination of the health of a population. Other issues are equally important and, in some cases, more important. Those include the quality of the food that people eat and the air that they breathe; the green spaces that children can play in; children being able to get outside to play and exercise; and people not having a motorway going past their door. When communities are consulted on such issues, or when they are not consulted but make their views known anyway, they must be listened to. Listening in the NHS is of no use unless the Executive is listening across the board.

I give qualified support to Shona Robison's amendment, but I am not going to talk about Mr Davidson's amendment, as I do not agree with a word of it. I agree that there is a major democratic deficit in the NHS that needs to be addressed. I respectfully suggest that a way forward for a somewhat election-weary Scottish public would be for the NHS board function to be transferred to local government, which is what happens in other countries. That would make health boards democratically accountable, put health and community care under the same umbrella and reunite public health and environmental health. It would be of overall benefit and is worth considering. I hope that that idea will be considered in the consultation as a possible solution. The NHS boards would hate it, but that is their problem.

I will support the original motion, with reservations. I will also support the amendment, with reservations, as I see it as a prompt to remove the democratic deficit in the NHS. However, we must be clear that there is no point in promising to listen if there are not enough staff in the NHS to be there to listen.