03 March 2004

S2M-215 National Health Service Reform (Scotland) Bill: Stage 1

Scottish Parliament
Wednesday 3 March 2004
[THE PRESIDING OFFICER opened the meeting at 14:30]
... ... ...
National Health Service Reform (Scotland) Bill: Stage 1
The Presiding Officer (Mr George Reid): The next item of business is a debate on motion S2M-215, in the name of Malcolm Chisholm, on the general principles of the National Health Service Reform (Scotland) Bill, and on one amendment to that motion.
... ... ...
Stewart Stevenson (Banff and Buchan) (SNP): We welcome the ending of the NHS trusts and the burden that they have placed on the organisation of the NHS over a period of time. We welcome the move towards integrated working and the assurance that goes with it that a single system does not imply a centralised system. Of course, those assurances will go for nought if the implementation drops short of that and we will remain alert and watch carefully as the implementation of the proposals evolves.
The minister, in his response to the various committees' investigations of the bill to date, has made encouraging signs of flexibility. For example, he has shown that he is prepared to amend the bill at stage 2 on local staff governance. I will return shortly to the apparent lack of flexibility on finance.
The Executive has turned its mind with great energy to consultation across many of its policy areas. There are clear signs—in the consultation on this bill, as in many others—that although the process allows the public and special interest groups to make their points, the Executive's specific responses are not always so clear. Not all points that are made in response to a consultation can be accepted, because consultations bring out points that conflict with each other; that is a fact of life. However, there is considerable scope for improving the feedback to consultees.
Bill Butler made a point about direct elections to health boards. I have enormous sympathy with that idea and I know that my colleagues feel the same.
I give the minister early warning that if he is not able to indicate, in his summing-up, a preparedness to take away and re-present the financial memorandum in the light of the comments that have been made today, it is likely that we will be unable to support the motion on the financial resolution come decision time. Nonetheless, we will support the substantive motion on the bill and I look forward to doing that.
Like Kate Maclean, I was extremely reassured to hear the Tories' concerns about the bill and similarly felt that we must be on the right track. Of course, the Tories have mentioned the money that will be required for the bill. However, I recall John Scott telling me in a previous debate that he did not care how much it would cost to decommission nuclear power stations, so the Tories' interest in money is somewhat selective. I will return to that issue. Kate Maclean also broke with tradition by putting Mike Rumbles in his place over some of his remarks.
Eleanor Scott made an excellent contribution to the debate by making the point about health improvement that the British Medical Association raised in its evidence to the Health Committee. The BMA wants the health improvement strategy to be taken further, so that all policy decisions take account of health. Rural areas in particular cannot be developed if they do not have health provision. Without health provision, the development policies simply will not work.
My colleague John Swinney made an important point about consultation. Tayside's three public partnership groups count for nought if local services are cut in the face of considered and considerable input from local communities. The minister might care to ponder whether there is any value in consultation that leads to no change.
Carolyn Leckie, quite rightly, echoed Unison's point about the need to ensure that the trade unions and staff are fully involved in the process. Indeed, Unison's written submission incorporated the Munich declaration, which highlighted the need for authorities across Europe to strengthen nursing and midwifery by
"Ensuring a nursing and midwifery contribution to decision-making at all levels of policy development and implementation".
Let us hope that there is considerable scope for that in the way forward that the Executive has chosen.
If we do not get the staff on board, we will not be able to deliver for patients or for the public purse. Staff must end up in a position in which they are given individual freedom to make decisions that are in the interests of the service and in the interests of patients. Health service staff want to help patients. That is the fuel in their tank. That is the engine that drives them.
Let me turn to finance—I see that the Tories nearly woke up at the mention of that word. Paragraph 33 of the stage 1 report states:
"The Health Committee shares the concerns of the Finance Committee insofar as we believe the cost of intervention has been considerably underestimated".
We should hear more about that. Paragraph 62 states:
"The Committee would not wish to see the initial phase of change compromised in any way due to a lack of funding ... The Committee seeks further reassurance from the Minister".
I hope that the minister will be able to give us that reassurance.
I also highlight paragraph 65. Mr Rumbles signed up to that paragraph in its entirety, so I note his comments about the Tory member of the committee. Paragraph 65 states:
"The Health Committee endorses the view of the Finance Committee. We are not convinced that no additional funding will be required to increase public involvement."
The financial memorandum, which was considered by the Finance Committee, sums up the many changes that the bill will make to the NHS. The Finance Committee's report on the financial memorandum stated that
"it was regrettable that further information could not be provided"
about the costs of the bill, so there is clearly an issue about costs. On the costs of using the powers of intervention, Argyll and Clyde NHS Board thought that the cost per intervention would be £200,000, whereas the Executive says that it would be £85,000. Quite a lot of work is obviously needed on the costs associated with the bill. That is why the Finance Committee said that the work that the Executive had done did not provide adequate information about costs.
Even the Subordinate Legislation Committee, from which we seldom hear very much, had quite a lot to say about the powers that the Scottish ministers will retain for themselves. That committee expressed some concern and unease about the four significant powers that ministers will retain.
I must respond to Brian Monteith, who referred to Eric Blair. Brian Monteith is certainly not a Winston Smith, but far less is he a Winston Churchill. He has neither the gravitas, the dedication or the insight.
It is 40 years since I worked in the health service. I do not want a health service that is driven by an economic model in which the purchase of health care by money, however obtained, delivers dividends to people who provide it. All of us, apart from the Tories, want a health service that is driven by people's health needs and which delivers a dividend of good health and protection from illness to all people in our society, whatever their condition.

Stewart Stevenson
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