18 September 2003

Subject debate: Improving Scotland's Health

The Deputy Presiding Officer (Murray Tosh): Good morning. The first item of business is a debate on rising to the challenge of improving Scotland's health. The debate will be concluded without any questions being put.
... ... ...
Stewart Stevenson (Banff and Buchan) (SNP): We have had two announcements from the minister today, and an announcement that there will be an announcement next week. Is that enough to justify an all-day debate without a motion? Well, yes, it certainly allowed a wide-ranging debate, which is excellent. It has enabled many points that would not have come out in any other way to be brought to the chamber. Have we, as members, learned how to use this form of debate to best effect? I suspect not. We still have to learn. The format is still on trial as far as I am concerned.
Across the chamber and across the parties, members have made many points of interest, some of which were local and some of which were of national concern. The challenge for the Executive is to show that it will respond to this form of debate. Of course, the Executive will not respond positively to everything that has been said, because it does not agree with everything, although there is much agreement round the chamber. I hope that ministers will reflect on those remarks, because, if they fail to respond, not just the Executive will suffer public opprobrium as a result of this debate format, but the chamber as a whole.
John Swinburne: On that point, I have sat here for 4 hours and 20 minutes but have had no opportunity to represent senior citizens in today's debate, which is shameful. It would not take rocket science for the Presiding Officer to curtail everyone's time slightly to give us all a chance to participate.
The Deputy Presiding Officer: Order. That is not a point for Mr Stevenson, but a point for me, which should have been raised as a point of order. This chair will not dispute in the chamber the choice of speakers or the allocation of time. I make the observation that we reduced the time for speakers in the afternoon. Seven members asked to speak and were not called—I forgot about Mr Sheridan earlier. No matter how we had handled the debate, there is no way that we could have shoehorned in an extra seven members.
Stewart Stevenson: I am sympathetic to John Swinburne's attempt to bring the issues associated with older people to the chamber. Members around the chamber have raised such issues. I am reaching a point where, not too long from now, I might be a pensioner as well.
We discussed money as part of today's debate. We keep hearing that there is more of it in the health service, and I believe that—money is going from the Executive's balance sheet and into the health service—but all of us have experienced meetings with health service professionals who say, "Well, that's fine, but where's the money? What's it doing? It doesn't seem to be reaching me."
At First Minister's question time today, my leader John Swinney raised the private finance initiative, which is only one of the clues to what is actually happening. The costs of PFI are considerable. There are many models for bringing the private sector to bear on public projects. The French in Napoleonic times had la concession, which was used to build the canals. The private sector built them, and the public sector committed to buy them after they were built. There are different models around the world.
The real point is that few schools are built by council brickies and few hospitals are built by NHS staff. The private sector is in there. It is not about who does the building of things, but about the diversion of NHS money into the banks' coffers and profits. My mortgage interest rate is about 4 per cent per annum. PFI projects borrow at around 8 per cent, with mezzanine finance at rates up to 14 per cent. Why is that so? My old boss, who was a bank chief executive from the local area, told me that with the SNP's trust model he would lend to trusts in the public sector at three sixteenths of a per cent over bank base rate, provided that the Government provided a guarantee. The cost of that guarantee would be approximately 5 per cent of the total project fund, which is more or less the difference between the first year's interest payment in the trust model and the interest payment in the PFI model. That is where some money is going. The Executive must open its mind on that issue.
I will deal with the operation of the NHS, because the debate is not all about money; it is really about patients. Some people appear to have suggested that NHS staff do not care about patients and do not put patients first. I do not meet such staff; I think that all NHS staff believe that they put patients first and want every opportunity to do so.
The public bring two subjects in particular—the health service and schools—to MSPs, because we have personal experience of them. I have a number of communications on school issues, but the public's view is increasingly that the health service is in poor health, like many people throughout Scotland.
We will not improve the health of people unless we improve the quality of our health service. The Minister for Health and Community Care courageously accepted that, in cancer services at the Beatson, we had to do more, and he addressed himself to doing so. I thank him for doing that, which is exactly what we want. That is some progress, and I say conditionally that we are moving in the right direction. However, it might be too little, too late. Consultants are resigning from the health service in areas that have particular pressures and shortages. When that happens, we are on a downward slope, because it becomes difficult to recruit more people.
I will focus on dentistry, about which one or two members talked and in which I have a special interest. Manchester has one dentist for approximately every 1,000 people and Edinburgh has one for every 2,000, but rural north-east Scotland and the Highlands and Islands have one dentist for approximately every 4,000. That shortage means that lists for NHS patients are all but closed in the dental service. In some towns, even private dentists cannot take new patients.
What does the Government know about the dental service? Does an NHS dental service exist at all?
Christine May: Will the member give way?
Stewart Stevenson: I do not have time; I have another eight pages of notes for my speech.
I have asked a series of parliamentary questions about the dental service. In question S2W-2355, I asked how much NHS dentists earn. The Government does not know. In question S2W-626, I asked how long people must wait to join a dentist's list. The Government does not know. In question S2W-625, I asked how many people are on a waiting list to join a dentist's list. The Government does not know. In question S2W-2356, I asked how many foreign dentists are working temporarily in the NHS. The Government does not know. In question S2W-2352, I asked how far patients must travel for NHS dental treatment. The Government does not know. The most astonishing answer is to question S2W-2353, which asked how many dentists are working in the NHS. The Government does not know.
The golden hello scheme was designed to bring more dentists into the health service and pays up to £10,000 for three years in some circumstances. The scheme has been such a success that six golden hellos have been approved. One golden hello has been given in Forth Valley NHS Board's area, two have been given in Lothian NHS Board's area, and the initiative has also been used in the Greater Glasgow NHS Board and Dumfries and Galloway NHS Board areas. However, no golden hellos have been received in Grampian NHS Board's area or Highland NHS Board's area, where the greatest pressure is felt. Do national dental services exist?
That situation affects not only dentistry. Scotland has 50 GP vacancies. Despite health board efforts and additional funding, will our remoter communities find themselves in a similar position in which we do not have the people to do the job and services cannot be delivered?
Ministers should think about social conditions. People who are captured by tobacco or other drug addictions will continue to suffer at the hands of those who exploit their compelling needs. Alcohol abusers will continue to suffer and to inflict suffering on others.
The Parliament has the power to empower patients and practitioners and to provide funds that can liberate our health service from the dead hand of overcontrol. Indeed, that is the consistent message that my colleagues and I constantly receive.
Although we can get better on the money that has been provided, we can get more for that money if we moved a little bit away from PFI. However, we need a successful economy in a successful country before we can solve the deep-seated problems that underlie the health service and so much else in Scotland. That means being a normal, independent country.

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