S2M-3990 Waiting Times

Scottish Parliament

Thursday 23 February 2006

[THE PRESIDING OFFICER opened the meeting at 09:15]

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Waiting Times

The Deputy Presiding Officer (Murray Tosh): The next item of business is a debate on motion number S2M-3990, in the name of Andy Kerr, on "Fair to All, Personal to Each"—the progress on waiting.

14:57

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15:44

Stewart Stevenson (Banff and Buchan) (SNP): An interesting thing about the health service and the politics that have surrounded it from the outset is that there has been broad, all-inclusive consensus across political parties that we want a health service that is free at the point of delivery. That consensus has been almost unique to our islands, compared with what has happened elsewhere in the world. For most of their history since the health service was first discussed in the early 1940s—Beveridge was, of course, a Liberal; perhaps Helen Eadie has forgotten that—even the Tories have wanted such a health service.

Helen Eadie: I know that, but did not want to say it.

Stewart Stevenson: Even I am prepared to acknowledge the contributions of others, as I am doing in my introduction.

That consensus of objective is something that we must not forget when we agree—with vigour, with passion—about the details of the policy to deliver on the community-accepted, politicians-accepted consensus. Of course, we have some fundamental differences over the details, but it is remarkable that that consensus has stood up for more than 50 years. It may show signs of breaking down, from time to time, but it basically stands up.

I characterise the Executive's current approach to the health service as one that has merit but also presents future difficulty. It is somewhat reminiscent of the generals of the first world war: one last heave, some more resources, and by throwing bigger munitions at the target we move a mile or two forward. Then something happens in the health of our community—its aging profile, or new, expensive procedures—that moves us back. That is a real difficulty for any Executive of any party to consider. While we look at the issues that are before us today to do with the current and recent past operation of the health service, we must not blind ourselves to the need to look to the significantly distant future and see what we need to do today to help it.

One of the ways in which we might consider the subject is through the prism of the current state of our dental service. Dentists have not been mentioned so far in the debate, although the Auditor General quite properly includes

"Consultation with GP or dentist"

in exhibit 1 on page 5 of "Tackling waiting times in the NHS in Scotland". Of course, the Executive has not set any meaningful targets for and has not targeted the improvement of dental care in the same way as it has done for other parts of the health service.

Mr Kerr: Will the member give way?

Stewart Stevenson: I will let the minister in, but first I want to make an important point. We are where we are on dental care, with the very real difficulties that we have, not because of what has happened since 1999—I accept that, and I think that it is useful to say that before the minister rises to speak—but because of a long-term neglect of that part of the health service.

Mr Kerr: On Stewart Stevenson's substantive point about the future of the NHS, if he looks at the trajectory of the number of patients who are waiting more than six months, he will see that there has been a gradual decline. That suggests to me that substantial changes are taking place inside the NHS that are sustainable and will continue to deliver. It is not a one-off throwing of resource; it is a consistent, sustained effort.

Stewart Stevenson: I acknowledge the changes that have been achieved in both the processes and the delivery of service. Nevertheless, slipstream planning—looking over one's shoulder at the past—is not an adequate basis for planning for the future. That is my key point. Yes, we have got where we are by throwing huge resources at the problem. That was the only thing that we could do in the short term, but our aim is somewhat imperfect.

The problems with the dental service have occurred over a long time because of a lack of training and a lack of appreciation of what we need in dentists. Are we planning adequate provision for doctors, dentists and nurses in the future? People may decide today to become a doctor and start on that road, but it will be 10 years before they are doctors, and we have no material planning for the health service that goes that far ahead. For nurses, the period is probably six years. There are huge problems.

One initiative from which we have, as yet, seen little material contribution is the e-health strategy. Yes, things have happened. However, when we introduce, for example, new out-of-hours services—which bring not the GP but other people to the table—and NHS 24, which brings other people who are unfamiliar with and who do not generally have access to patients' records to the triage process, we reduce the operational efficiency of the health service. Albeit that those are things that we should do, we are doing them in the wrong sequence and we are not putting the resources in place before we move forward.

I think that, in England, much more substantial efforts are being made in the use of computer technology, which we might look to copy in Scotland. Much has been done, but there is a great deal still to do.

15:50