19 May 2004

S2M-1326 Health Services

Scottish Parliament

Wednesday 19 May 2004


[THE PRESIDING OFFICER opened the meeting at 09:30]

Health Services

... ... ...


Stewart Stevenson (Banff and Buchan) (SNP): Too much of today's debate has been a flight from reality, but at least it is on the record that the representatives of the Fourth International are for public confiscation rather than public ownership. There is more in the SSP amendment, which demands that contracting from public providers be stopped. So we will have NHS brickies, NHS equipment designers and builders and NHS farms on which to grow food. I am so glad that I was awake when I was listening to the Trots sitting behind me.

However, numbers are not something that the Trots are terribly good at. They would spend 157 years' worth of the Scottish health service's drugs expenditure to nationalise two companies alone. Is that a return on investment that anyone in the chamber would be comfortable with? No, of course it is not.

Let us return to principles. The 1942 Beveridge report, which was entitled "The Way to Freedom from Want", stated that the aim was to abolish want, squalor, ignorance, idleness and disease. I believe that the greatest of those aims was to achieve freedom from disease. Beveridge wrote:

"Proposals for the future ... should use to the full experience gathered in the past, not restricted by consideration of sectional interests."

He also wrote:

"The state should offer security for service and contribution"

but not

"stifle incentive, opportunity and responsibility."

A Gallup poll from 1943 shows that an overwhelming majority of the public endorsed a proposal to include everyone in a comprehensive scheme of medical services. That remains as true today as it was 61 years ago.

Vested interests that run against the grain of public opinion have to be confronted today as they were before the NHS started on 5 July 1948—not 1947, I point out to Mike Rumbles. On 19 February 1948, a BMA press release showed that 40,814 medical practitioners disapproved of the National Health Service Act 1946 and that a mere 4,900 of them—or just over 10 per cent—approved. The figure in Scotland was slightly higher at 12 per cent in favour. The objectors were largely, but not totally, faced down before the health service started.

The question is, what should the NHS credo be today? I make three suggestions. First, access to health care should be based solely on need. Secondly, there must be respect for the public service ideal and the contribution that public service makes to wider society. The third ideal should be value for money.

I will test the Tory plans against those ideals. The Tories want preferential access for those who can afford to pay; the passport needs to be topped up, so its operation would be denied to those who could not afford to top it up. The result would be a move away from access by health need towards access based on greed.

Respect for the public service ideal is not in great supply on the Tory benches. The Tories must accept that the private sector does not have a monopoly on succeeding and that failure is not the sole prerogative of the public service. For example, Capita Group plc and a number of its public service contracts can be considered. There is a history of failure and hardly a success in a contract in which it has been involved. One benefit of PFI—the only benefit that I have found so far—is that it shows that private companies can and do fail when they try to deliver public services.

On value for money, a number of members have referred to expensive operations. NHS surgeons moonlight at weekends and in the evenings—

Often, NHS hospitals charge more for operations simply to provide people who have money with early access to a system in which access should be provided on the basis of health, not on anything else.

The Tory motion refers to international examples. The most recent edition of The Economist examines the French health service, which is largely privately provided and largely publicly funded. The service is excellent, but it is not delivering value for money and is probably heading for bankruptcy very soon. David McLetchie should read page 40 of The Economist—he will see what I mean.

Almost every member supports choice for all, rather than merely for the few. I have a challenge for the Tories, whose motion mentions supporting and developing the private sector. Which hospital in Glasgow would they close in order to develop the private sector to replace what is provided by the public sector in Glasgow?

We should not let Labour escape. In 1969, the Socialist Medical Association provided a report to Richard Crossman, who was a secretary of state, which focused on the long hours and poor pay of junior hospital doctors. That was many years ago and the argument has hardly moved an inch. Hospital services and young doctors are overworked and underpaid.

The health service is a great ideal. By all means, the service needs to be revisited and refurbished, but the ideals continue as they did before. I am happy to support the amendment in my colleague's name.


18 May 2004

Subject Debate: Children's Hearings

Scottish Parliament

Tuesday 18 May 2004

[THE PRESIDING OFFICER opened the meeting at 09:30]

... ... ...

Children's Hearings

The Presiding Officer (Mr George Reid): The next item of business is a debate on the subject of the children's hearings review, "getting it right for every child". The debate will be concluded without any questions being put.

... ... ...


Stewart Stevenson (Banff and Buchan) (SNP): We should recall that those who know no history are condemned to repeat it, so I shall therefore be visiting some of the background to the debate. I shall start, however, by welcoming the preparedness on the Executive's part to listen and involve members at this early stage. Nonetheless, I shall make some criticisms at a later stage.

It is interesting that, in this debate—our longest subject debate since Parliament first sat five years ago—we have never had less than two dozen members in the chamber. I have counted them. That is far more than we would see in the much larger Parliament at Westminster, and perhaps that tells us a little bit about how we are different.

I was slightly surprised at the Tories' ignorance of their contribution to our current system. The "Children and Young Persons Scotland" report was delivered in April 1964, and was therefore commissioned under a Tory Government. I say that not to praise the Tories, but merely to point out their ignorance, and that is, of course, a subject to which I shall return. It is worth quoting from that report of April 1964—40 years ago—because its language and the clarity of the exposition of the arguments within it are a model for today's reports. The report states:

"Wherever possible the aim must be to strengthen and develop the natural influences for good within the home and family, and likewise"—

Rhona Brankin should listen carefully, as this is not a new idea—

"to assist the parents in overcoming factors adverse to the child's sound and normal up-bringing."

It did not even start there. The 1964 report drew on the experience of the Liverpool police's 1949 juvenile liaison scheme. That raises an important point about the need to look beyond the confines of Scotland and the usual suspects, among whom I include MSPs, in considering the way forward.

In the 1964 report, we also read:

"In our view, referral should be made to ... panels for one reason only, namely that prima facie the child is in need of special measures of education and training."

That focuses on the needs of the youngster over the deeds of the youngster. The report went on to say:

"Panels must have available to them the services ... statutory and voluntary agencies whose work is such as to bring them into frequent contact with the family."

Perhaps, 40 years on, we have still to meet the aspirations of the 1964 report.

However, things are not all doom and gloom. The report's appendix contains statistics on the charges brought against young people, and between 1950 and 1962 there is no year in which the number fell to anything like the 14,404 charges that there were in 2002-03. I accept that fewer children are around, but fewer children are being brought to the attention of the system for criminal acts than before the system was put in place.

In 1964, it was not imagined at any point that the panel would be a soft option; instead, it would be the chosen option. The hearings system is a hard option if it operates well, because part of it seeks to have youngsters and children accept that they are guilty of a transgression against society's norms. It is not easy to stand in front of strangers and say, "I'm guilty of something that I should not have done."

That is the historical perspective. However, a lot has changed in our society since 1971, when the panel system came into operation. Indeed, when one considers how short a distance ahead in respect of changes in our society can be seen in reality, it is remarkable that a system that was established then still stands in good regard.

Volunteers have a central role in the panel system. According to the article in the Aberdeen Evening Express on his campaign trail around Scotland that Euan Robson has kindly provided, there are just under 100 panel members in Aberdeenshire. It is important to say that professionalism, which we expect of panel members, is not—I repeat not—about pay; it is about attitude, training and approach. Margaret Ewing made the point that we should ensure that we properly compensate people. Our world-respected hearings system must be scrutinised and we welcome that. When the minister sums up, I want to hear him assure us in the strongest possible terms that there is a future for our hearings system; if he fails to do so, he will go around Scotland pleading with people to put themselves forward as panel members, but those pleas will result in nothing. People will, of course, wish to wait and see what the system's future is. I am not saying that the minister has said that the panel system is to end—of course he has not said that—but he must paint a clear way ahead.

We have a system in which most of us believe—we certainly have a system in which most of us want to believe—but we currently lack the figures that would enable us to justify that belief to others with the necessary conviction. Therefore, we must have more facts about outcomes and the constraints on possible success in the current system. For a start, we must be able to see the gulf between the proposals that panel members believe they should be able to utilise and those that, in practice, turn out to be available to them. We must also be able to see that timescales for youngsters who are waiting a dangerously long time for the right support and guidance are being brought down. We must have facts that help us to understand the difficulties that exist.

New services must be developed to meet new needs. We may be misleading ourselves when we talk about major drug problems. Of course, there is a major drug problem in our society, but there have been major substance abuse problems for a long time. My great-grandfather was born in 1824. T C Smout's social history of Scotland describes the many major substance abuse problems in the 19th century. In the 1950s, drink was a major problem that affected social cohesion. Therefore, drugs are a modern representation of a long-standing problem that has affected society and our children.

We must not forget the educational aspect of the panel system, which was adumbrated in the 1964 report. We see people leaving the care system with dramatically poorer educational outcomes. We do not know whether that is because people with less potential enter the system, or because people whom the system has already failed go in at the front end. We need to understand the reason better. Is the system failing? I do not think so, but it can be seen as a struggling system.

The consultation is fine as far as it goes, but it probably does not ask all the questions that should be answered. I hope that consultees will not feel that they should answer only the questions in the consultation. For example, how would family hearings fit in any updated and revised system? I am not sure that the consultation will draw that out from consultees. The consultation asks about the involvement of young people in the wider community, but it fails to ask whether resources to support needs are sufficient.

I have given a little of the historical background. Modern conditions will require modern solutions. In the 19th century, drink was a major problem and we looked abroad to the Gothenburg experiment—community-owned pubs that delivered value from the abuse of drink back into our societies. That helped a great deal. I do not say that that would help today, but we may find things if we look further afield.

Rhona Brankin asked for an informed debate. I think that we have had one today. It is a start, not an end. There is a conflict of interest in asking us for our views at this stage then asking us to make a decision later, but I hope that we are all mature enough, old enough and wise enough to resolve that conflict when the time comes.


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