S2M-5572 Making the National Health Service Local

Scottish Parliament

Wednesday 14 February 2007

[THE PRESIDING OFFICER opened the meeting at 14:30]

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Making the National Health Service Local

The Deputy Presiding Officer (Trish Godman): The next item of business is a debate on motion S2M-5572, in the name of Andy Kerr, on making the NHS local.

15:20

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16:42

Stewart Stevenson (Banff and Buchan) (SNP): The Minister for Health and Community Care started this useful debate with a reminder of where we are coming from. He used the phrase

"as local as possible, and as specialised as necessary."

I heard nothing in the debate from any political party that disagreed with that central tenet of what we are trying to do and that central summary of the Kerr report.

On that basis, I will start with one or two issues on which we agree with the minister. I commend him personally for leading by example in a variety of ways, some of which I will put on record. First, his involvement in the interest of Mr Rumbles and me in maternity services in Grampian was helpful and constructive. It served well the interests of the constituents whom each of us brought to see him. When they went away, they felt that they had been listened to. I hope that other ministers take a leaf out of his book; occasionally, they do not appear to.

I also commend the minister for his personal contribution by leading by example on fitness. If only I still had joints that allowed me to run the occasional half marathon—or was it a marathon? I do not quite remember. For me, a half marathon would have been a marathon, but perhaps not for him.

I thank the minister for his support on maternity services by intervening to correct what would have been a serious wrong for essential local delivery of services in Mr Rumbles's communities and in mine. Of course, I say to Mr Rumbles that had we listened to the clinicians, Aboyne maternity unit would have been closed. He will have to read carefully his contributions to the debate in the Official Report.

Mike Rumbles: Will the member take an intervention?

Stewart Stevenson: Very quickly—come on.

Mike Rumbles: My point was that the Conservative approach is that doctor always knows best. Stewart Stevenson knows well that my criticism of Grampian NHS Board was that it always listens to clinicians.

Stewart Stevenson: I hear what Mike Rumbles says. Understanding may follow, but probably will not.

There is a tension in the system that the debate may not have explored fully, which will continue to challenge health ministers of whatever complexion. That is the tension between the minister, on the one side, the health board, in the middle, and the community, on the other side. That tension is a difficulty for whoever fills the post that the minister holds. The health board is appointed by the minister and is therefore seen by local communities as largely a creature of the minister—whatever the reality, that is the perception. For that reason, health boards must be much more sensitive in approaching communities when they believe that there is a need to redesign the services that are delivered locally.

Helen Eadie: Can Stewart Stevenson tell me how the SNP will set up the trusts that it will have throughout Scotland to finance all the capital initiatives? Will they be elected or unelected? Will they be quangos?

Stewart Stevenson: I suspect that that question goes a little beyond local services. Helen Eadie can read our manifesto on the subject, and members have heard our finance spokesman talk about how the trusts will be engineered. As someone who held large budgets and was involved in banking, I know how the idea works and that it can work. The argument will be whether it should work, and that will be for the electorate to decide.

Euan Robson made an important point when he said that we must move from focusing on the inputs in health provision to focusing on the outputs. People see the money being spent, but that means nothing if they do not see the services being delivered.

Another tension that the debate has not focused on as much as it might have is the tension between the focus on prevention and keeping people healthy longer, which we are now moving to and which we all support, and the continuing need to drive down waiting lists. I suspect that that tension is something that we will continue to debate.

In his intervention, back bencher Duncan McNeil exhibited tensions that were perhaps political rather than health related. I seem to recall seeing a picture of Duncan McNeil on the campaign line, ensuring that his own local services were not downgraded.

Mr McNeil rose—

Stewart Stevenson: There ain't going to be time—I am sorry.

Community care units are an important part of future provision; indeed, we should have more of them. They may well even serve a useful purpose by being co-located with accident and emergency units, and we should not close our minds to that possibility.

I will briefly give a practical example of the nature of the challenges, some of which are basic stuff. I went to hospital with a constituent who had been savaged by a dog—not too seriously, but seriously enough to require six stitches. We went to the nurse-led local accident and emergency unit in Banff and received a good service. The wound was cleaned, stitched and bandaged and the woman was inoculated against tetanus. The nurse signed the card to say that that had been done, but there was then a 100-minute wait for a return telephone call from a doctor to allow the antibiotics that were required to be prescribed. We have not quite joined the whole thing up. I know that the minister recognises that and realises that we must do something about it.

In response to some of the issues that Helen Eadie raised, I note that the Health Committee did not come to the firm conclusion that centralisation was the right answer. Conflicting views were expressed by various health professionals, and we should tak tent on that.

In today's debate, members have illuminated many of the challenges that remain, talked about some of the successes and touched on areas in which further progress is essential. However, the bottom line is that the debate in the chamber is a lot less important than the debates that local communities are having about the health services that they require in their local areas. I support my colleague's amendment.

16:49