Hansard

Thank you, Presiding Officer. I reiterate my congratulations to Shona Robison on her reappointment as health secretary, and I welcome the other members of her team.

I am delighted and humbled to have been appointed shadow Cabinet Secretary for Health and Sport. The portfolio comes with a huge responsibility that I and my colleagues in the Scottish Conservatives’ health team take seriously. We look forward to working with the cabinet secretary towards the healthier Scotland that everyone wants. Where we can find common ground with the Scottish Government, we will work together and do so consensually. I am happy to accept the invitation that the cabinet secretary just extended to meet her to discuss matters. However, we will not shy away from holding the SNP Government to account on all aspects of health, and I will set out concerns that need to be highlighted and addressed as soon as possible.

Our priorities are to ensure that our health service has the sustainable funding that it needs, that patients can tailor treatment to their preferences and that mental health achieves parity—in principle and in practice—with physical health. We welcome the Scottish Government’s commitment to mental health care, but we would like an extra £300 million to be committed to it.

The urgency of the issue is highlighted by the staggering statistic that one in four Scots will suffer from mental health problems at some point in his or her life. The Scottish Association for Mental Health has noted that one general practitioner appointment in three has a mental health component, and that that figure rises to one in two in Scotland’s most deprived areas—a real and stark example of true health inequality. Our young people in particular deserve improvement in mental health provision. There is much to do; my colleague Miles Briggs will elaborate on some of our plans.

On sport, we will continue to advocate the opening up of access to clubs and facilities, which delivers huge benefits in terms of health and opportunities. Preventative healthcare will be a key focus in the current session of Parliament; my colleague Brian Whittle will set out our priorities in that area later this afternoon.

On the key issue of funding for our health service, the first thing to do is to repeat my predecessor Jackson Carlaw’s clear conviction: the Scottish Conservatives are committed to a publicly funded health service that is free at the point of use. We are also committed to protecting NHS funding, which is why we want it to be protected by a health guarantee whereby funding increases each year by the highest of inflation, Barnett consequentials or 2 per cent—a triple lock, as it were. That would mean an extra £1.5 billion of funding by the end of the current session of Parliament, which would take the overall budget to £14.5 billion by 2021-22. We stand by that aim.

It is welcome that the Scottish Government has committed to increasing the NHS revenue budget by £500 million more than inflation by the end of the session, but will the cabinet secretary set out for the sake of clarity exactly how much the Scottish Government expects the overall budget to reach by the end of the session? In addition, will she commit the Scottish Government to matching the triple lock in our health guarantee? As we all know, NHS budgets in Scotland in the previous session did not rise by as much as they did in England.

On targets, the Scottish Government must recognise—I note, in the light of what has just been announced, that it has done so—that top-down targets that are imposed on the NHS may in some cases be putting pressure on staff. That will not be in patients’ best interests. We therefore believe that now is the time to review the top-down targets system in order to identify which targets effectively drive improvements for patients and which do not. That should be the acid test. A full review of NHS targets is needed so that staff always focus directly on patients’ needs. We sought such a review of targets in our manifesto. I am grateful that the cabinet secretary has announced a consultation, but I ask her to set out a definitive timetable for when it will occur and report.

As well as considering those arrangements, we must focus on the principal challenge that faces the NHS: its model of primary care. The advent of GP hubs is welcome, but I am aware of the huge pressure that is already facing GP surgeries across Scotland, not least in terms of GPs’ workloads. List sizes for practices have grown by 10 per cent since 2005, which has been exacerbated by the crisis in GP recruitment and retention. Although staffing levels across the NHS in general are seriously concerning, the situation relating to GPs in particular must be addressed urgently.

By 2020, according to the Royal College of General Practitioners, Scotland will be 740 GPs short of bringing coverage per head back to 2009 levels. That statistic has already been cited in debates in the chamber in the past few weeks, but it is an important one and it bears repeating. We should make no mistake—this is a crisis, and it is one that the SNP must have seen coming. If it did not, it should have done so—not least because it has been in power since 2007—but it has singularly failed to prepare for the desperate situation that we now find ourselves in. With a third of GPs being set to retire within 10 years, we need a lot more than the increase of seven GPs per year that the Government managed between 2009 and 2013. Can the cabinet secretary say how many more GPs she expects by 2020? I sincerely hope that the Scottish Government will produce a detailed and meaningful plan to deal with the crisis, and I look forward to hearing it. To start with, budget allocations to general practice should increase in both absolute and proportionate terms each year.

The scope to relieve pressure on hospitals can be further realised by putting pharmacies at the heart of primary care. As was set out clearly in the Scottish Conservatives’ manifesto—which the First Minister and her many acolytes apparently forgot to read before her speech a couple of weeks ago—we, too, propose that the minor ailments service be expanded in order to benefit primary care. I notice that the Scottish Government has already made some nods in that direction, so I hope that it will back those up with concrete commitment.

I move on to hospitals and health boards. New elective and diagnostic treatment centres are welcome, but we must not allow those schemes to detract from the many small community hospitals that are so important to the public across Scotland. I represent the Highlands and Islands and am acutely aware of the need for remote and rural areas to have access to the same health services as are available elsewhere. For example, a pregnant woman in Ardnamurchan who requires a scan needs to travel to Inverness, which is a round trip of approximately eight hours. Another example is that a parent who lives in Aberfeldy must drive to Dundee to access out-of-hours services if their child falls ill at the weekend. We Scottish Conservatives are determined to open up access for rural Scotland, so I look forward to working with stakeholders to make that a reality.

Another priority in the Scottish Conservatives’ plan for health is to put patients in charge of their own treatment and care. If the health service is to be sustainable in the face of demographic challenges while remaining responsive to each user’s need, it must combine flexibility with personal responsibility and self-management. We believe that the right way to approach that is using the principle, “No decision about me without me.” Patients will be consulted on treatment decisions and can express preferences on aspects including the location of appointments.

We also need to increase the availability of information for the public so that everyone is fully aware of the services that are available to them without having to navigate myriad phone numbers and websites. It is worth considering the idea of sending out to people’s homes annual statements that set out local health and social care services to people.

On the other hand, providing more flexibility should bring more responsibilities for patients themselves. There needs to be an injection of personal responsibility to ensure that the health service can serve everyone to the best of its ability. It is worth our while to consider allowing health boards and GPs in certain circumstances to fine patients who miss appointments three times without good reason.

The final area that I want to touch on is integration of health and social care. We have been, and remain, supportive of on-going integration, and we share the recognition by members across the chamber of the potential for more effective service delivery. However, we have concerns about the resourcing to support that. Is the Scottish Government confident that the allocated budgets are adequate and will they be spent efficiently? I will continue to provide constructive input as the partnerships develop, but we must ensure that we do not end up simply moving bureaucracy from one body to another. There is an overarching need to promote more joint working and information sharing between health and social care and the third sector so that organisations such as housing associations, pharmacies and voluntary bodies can bring their full weight to bear.

The Scottish Conservatives will work with the Scottish Government to secure the best approach to reform of the health service, but we are also here to ensure that every decision is made in the best interests of patients and the general public. That will always be our starting point. We will hold the Scottish Government to account on planned reforms and daily performance. The Government needs to think deeply and radically about long-term reform of the NHS. Will it be enough just to keep the NHS afloat in its present state by patching it up here and there with short-term solutions, or will the Scottish Government grasp the chance to make our whole health service sustainable in the long term? The debate is about not just the next five years but the next 25 years: it is about the health service that will exist then meeting the needs of our children and grandchildren, and it is about having the vision and courage to remodel that service for future generations in the face of huge demographic challenges. That is where the Scottish Conservative Party team has set its sights.

I move, as an amendment to motion S5M-00346, to leave out from “notes” to end and insert:

“believes that the time has come for a review of targets in the NHS to assess whether they are having a positive effect on patient care; aims to put patients at the centre of a flexible decision-making process across health and care services; approves of the UK Government’s decision to include protection for the NHS in the proposed Transatlantic Trade and Investment Partnership, and calls for a programme of government that will secure the sustainability of the health service for the next generation and beyond”.