Chamber
Plenary, 02 Apr 2009
02 Apr 2009 · S3 · Plenary
Item of business
Hospital Waiting Times
Who could fail to welcome the tremendous progress made in recent years to reduce waiting times for patients? I join the cabinet secretary in congratulating the NHS staff who have worked so hard to help make that possible, and the previous Administration, which laid some of the foundations for the advance.
There are few more stressful occasions in life than waiting for necessary diagnosis or treatment, and anything that is done to shorten such waits must be applauded.
I am delighted that the Government has expanded the number of procedures that are covered by the 18-week guarantee and that it has the courage to turn its attention to mental health services, which are sometimes called the Cinderella of the NHS but, alas, were treated more often by previous Administrations as if they were the ugly sisters.
As I am well aware from my professional work in the past, there are specific problems with mental health services. Mental health treatment is often long term and time consuming—that is especially true of the talking therapies such as psychology or psychotherapy—but there is abundant evidence that the earlier the intervention, the greater the likelihood that treatment will be successful. Resources invested in reducing waiting times in mental health services is an investment that will cover its cost several times over as years go by.
Presiding Officer, I am sure that you will be pleased that I do not intend to recite a catalogue of targets that our Government has now reached and targets that will be achieved by 2011. No one can listen to either of the ministers in our health team without concluding that our health service is in safe hands. [Interruption.] Promotion, please!
I will take a small step back and look at the broader picture of health delivery in the context of the wait for treatment. It is often stated that the need for health services is infinite and that such services must be rationed in some way, either by making people pay—by price—or by increasing the length of waiting lists. For a lot of services, that is arrant nonsense. At any one time, there is a finite need for hip-joint replacements, hernia operations, heart bypasses and many other procedures—if someone does not have the complaint, they will not thank anyone for giving them the treatment. Those treatments should be amenable to one-off waiting time initiatives that shorten the waiting interval and allow it to be kept short simply by keeping pace with subsequent demand.
The situation is more complex for investigations that might or might not lead to a treatment need. Speeding up investigations will allow earlier interventions for those diagnosed as requiring them, which, in turn, might well prolong life and/or preserve health. Although that is almost entirely beneficial, it might incur a greater financial cost for the NHS than a situation in which investigation is prolonged for so long that curative treatment is impossible. A good example is testing blood cholesterol. A high cholesterol level in a person will cost the NHS a lot of money in treatment, but such treatment might save the person from a heart attack or stroke. In strictly financial terms, that treatment might be a more expensive option for the health service than not treating the population and allowing a few patients to die suddenly and prematurely. It is to our credit that we do not proceed along those lines whole-heartedly, but I am afraid that, in the past, we have sometimes succumbed to the temptation to ration investigations, if not by waiting list then by availability, to avoid the cost of treatment.
There are also new health needs—needs that either did not or could not exist some time ago. Many, such as certain cosmetic surgery procedures and unproven alternative treatment, are not even considered to be related to health at all. As Helen Eadie said, the new advances in the treatment of infertility are wildly expensive in time and resource terms and tend to be rationed either by waiting time or availability. Whether such treatment should be available on the NHS is a matter for society, not health workers or health boards, which I suspect would welcome further guidance from society on such matters. There is an opportunity cost with any initiative, and we must always consider whether it is worth it.
That all means that, although waiting time targets are highly desirable, the need to achieve and shorten them should not be the be-all and end-all of our concerns. I am glad that the Government accepts that. I do not always agree with the BMA, but it is right to emphasise that some important services are less amenable to measurement than others and that the quality of a service is usually more important than the speed with which it is delivered. Some conditions might not need immediate attention, while others demand it.
It is always important to look at health services in the round and to consider not only waiting times but readmission rates, health-acquired infection incidence and whether there is a satisfactory outcome. We usually debate those issues when we are discussing hospitals, but there is a huge and relatively untapped pool of experience in primary care, which, if utilised properly, could transform the way that we provide services to those in need.
There are few more stressful occasions in life than waiting for necessary diagnosis or treatment, and anything that is done to shorten such waits must be applauded.
I am delighted that the Government has expanded the number of procedures that are covered by the 18-week guarantee and that it has the courage to turn its attention to mental health services, which are sometimes called the Cinderella of the NHS but, alas, were treated more often by previous Administrations as if they were the ugly sisters.
As I am well aware from my professional work in the past, there are specific problems with mental health services. Mental health treatment is often long term and time consuming—that is especially true of the talking therapies such as psychology or psychotherapy—but there is abundant evidence that the earlier the intervention, the greater the likelihood that treatment will be successful. Resources invested in reducing waiting times in mental health services is an investment that will cover its cost several times over as years go by.
Presiding Officer, I am sure that you will be pleased that I do not intend to recite a catalogue of targets that our Government has now reached and targets that will be achieved by 2011. No one can listen to either of the ministers in our health team without concluding that our health service is in safe hands. [Interruption.] Promotion, please!
I will take a small step back and look at the broader picture of health delivery in the context of the wait for treatment. It is often stated that the need for health services is infinite and that such services must be rationed in some way, either by making people pay—by price—or by increasing the length of waiting lists. For a lot of services, that is arrant nonsense. At any one time, there is a finite need for hip-joint replacements, hernia operations, heart bypasses and many other procedures—if someone does not have the complaint, they will not thank anyone for giving them the treatment. Those treatments should be amenable to one-off waiting time initiatives that shorten the waiting interval and allow it to be kept short simply by keeping pace with subsequent demand.
The situation is more complex for investigations that might or might not lead to a treatment need. Speeding up investigations will allow earlier interventions for those diagnosed as requiring them, which, in turn, might well prolong life and/or preserve health. Although that is almost entirely beneficial, it might incur a greater financial cost for the NHS than a situation in which investigation is prolonged for so long that curative treatment is impossible. A good example is testing blood cholesterol. A high cholesterol level in a person will cost the NHS a lot of money in treatment, but such treatment might save the person from a heart attack or stroke. In strictly financial terms, that treatment might be a more expensive option for the health service than not treating the population and allowing a few patients to die suddenly and prematurely. It is to our credit that we do not proceed along those lines whole-heartedly, but I am afraid that, in the past, we have sometimes succumbed to the temptation to ration investigations, if not by waiting list then by availability, to avoid the cost of treatment.
There are also new health needs—needs that either did not or could not exist some time ago. Many, such as certain cosmetic surgery procedures and unproven alternative treatment, are not even considered to be related to health at all. As Helen Eadie said, the new advances in the treatment of infertility are wildly expensive in time and resource terms and tend to be rationed either by waiting time or availability. Whether such treatment should be available on the NHS is a matter for society, not health workers or health boards, which I suspect would welcome further guidance from society on such matters. There is an opportunity cost with any initiative, and we must always consider whether it is worth it.
That all means that, although waiting time targets are highly desirable, the need to achieve and shorten them should not be the be-all and end-all of our concerns. I am glad that the Government accepts that. I do not always agree with the BMA, but it is right to emphasise that some important services are less amenable to measurement than others and that the quality of a service is usually more important than the speed with which it is delivered. Some conditions might not need immediate attention, while others demand it.
It is always important to look at health services in the round and to consider not only waiting times but readmission rates, health-acquired infection incidence and whether there is a satisfactory outcome. We usually debate those issues when we are discussing hospitals, but there is a huge and relatively untapped pool of experience in primary care, which, if utilised properly, could transform the way that we provide services to those in need.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
The next item of business is a debate on motion S3M-3848, in the name of Nicola Sturgeon, on hospital waiting times. Cabinet secretary, you have around 11 mi...
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
Presiding Officer, I am sure that all our thoughts this morning are with the families of those who lost their lives yesterday in the North Sea, and with all ...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
We would all agree that availability status code waiting lists should be abolished. In fact, Labour set that abolition in train. However, will the cabinet se...
Nicola Sturgeon:
SNP
As a former First Minister used to say to me, the median waiting time is not the true measure of a patient's experience. However, I say to the member that th...
Mary Scanlon (Highlands and Islands) (Con):
Con
Breakthrough Breast Cancer said that it welcomed the 31-day target for first treatment for breast cancer. However, it pointed out that there were no such tar...
Nicola Sturgeon:
SNP
We have taken the decision that the next stage in our process around cancer waits should be to have that 31-day guaranteed target for the time between the de...
Cathy Jamieson (Carrick, Cumnock and Doon Valley) (Lab):
Lab
Like the cabinet secretary, I offer my condolences to the families who lost their loved ones in yesterday's tragedy, and associate myself with the remarks th...
Mary Scanlon (Highlands and Islands) (Con):
Con
On behalf of my party, I acknowledge the remarks of the two previous speakers about the tragedy in the North Sea last night.We welcome the Scottish Ambulance...
Nicola Sturgeon:
SNP
I agree with Mary Scanlon's general point that waiting times are not the only performance indicator. However, does she acknowledge that the range of HEAT tar...
Mary Scanlon:
Con
I do not think that that is the case. We have constantly raised concerns in the Parliament about all the issues that I have mentioned. I have never, for exam...
The Deputy Presiding Officer (Alasdair Morgan):
SNP
Will the member begin to wind up, please?
Mary Scanlon:
Con
Will do. That meeting will take place on 29 April.I trust that all MSPs will acknowledge the work of all health professionals who care for NHS patients and s...
Ross Finnie (West of Scotland) (LD):
LD
I, too, on behalf of the Liberal Democrats, associate myself with the remarks that have been made by the cabinet secretary, Cathy Jamieson and Mary Scanlon a...
Christine Grahame (South of Scotland) (SNP):
SNP
I am sure that all members acknowledge the value of all those who work in the NHS, particularly the front-line staff such as consultants, nurses and ancillar...
Helen Eadie (Dunfermline East) (Lab):
Lab
As other members have done, I record on behalf of my constituents how much I value the commitment and expertise of health workers and the service that they p...
Ian McKee (Lothians) (SNP):
SNP
Does the member accept that the patients who are referred back to their GP from the hospital are referred back for clinical conditions that need treatment an...
Helen Eadie:
Lab
I am not sure that all clinicians would agree with that. In the context of prioritising care, the BMA, which has made representations to us, said:"Doctors be...
The Minister for Public Health and Sport (Shona Robison):
SNP
Do I take it that the member does not support maximum waiting time targets?
Helen Eadie:
Lab
The minister and the Government should listen to what the BMA and other professional organisations—not me—are saying. The BMA said:"Doctors believe that NHS ...
Ian McKee (Lothians) (SNP):
SNP
Who could fail to welcome the tremendous progress made in recent years to reduce waiting times for patients? I join the cabinet secretary in congratulating t...
Dr Simpson:
Lab
The rate of referral for such things as computed tomography and magnetic resonance imaging scans by general practitioners is hugely lower in Scotland than it...
Ian McKee:
SNP
I agree with Dr Simpson to the extent that we need a total review of how primary care contributes to achieving waiting list targets and to general health. Fo...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
I am pleased to be back in a health debate. It is some time since I spoke in one, and such debates have become terribly consensual and friendly in my absence...
Alasdair Allan (Western Isles) (SNP):
SNP
I apologise that I cannot stay for the closing speeches because of a matter that has arisen in my constituency.The price of reducing waiting lists is constan...
Aileen Campbell (South of Scotland) (SNP):
SNP
I, too, welcome this Scottish Government debate on hospital waiting times. I know that the issue is important to many of the constituents who come to see me ...
Mary Scanlon:
Con
In Highland, it is for many people difficult to access podiatry on the NHS. Will the member commend those podiatrists who treat patients privately in order t...
Aileen Campbell:
SNP
My sister would not forgive me if I did not commend podiatrists on their work. I know first hand that they work incredibly hard throughout the country. The f...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
I associate myself with the remarks that have been made about the tragedy in the North Sea yesterday. I am sure that, like me, many members have flown by hel...
Christine Grahame:
SNP
I was making the point that the clinical decision is made by the GP or the consultant, so the clock starts ticking when there is a referral or decision. A pa...
Jamie Stone:
LD
Ross Finnie and I are saying that we want to maintain a balance between waiting time targets and other aspects of the service. As Ross Finnie said, clinical ...