Labour Party Business: Scotland’s Future

Presiding officer,

I am pleased to open this debate on the Labour’s motion and move the motion in my name. I should as usual draw attention of members to my declaration of interest.

Presiding officer this is a wide-ranging motion and amendments and hopefully will lead to a constructive debate.

It is inevitable that as opposition parties we need to fulfil our task of holding the government to account just I expect the government benches to defend their record.

However I hope that we can at least begin by agreeing that the funding provided through the Barnett formula valuable.

Including the current £125 million consequentials, a topic which Jenny Marra will address in her closing speech.

Labour increased health spend by 100% between 1997 and 2008 the largest increase in the 60 years of the NHS.

Decisions as to what to do with the funds provided is wholly a matter for this government and in that respect there are questions to be answered.

The independent Office for National statistics report from 2008 to 2013 showed England increasing  per capita spend in real terms whilst the SNP  reduced ours. Moreover expenditure in the North East of England a region often used for comparison with Scotland showed a greater increased ban the Rest of England. Are the SNP really comfortable that for the first time in the NHS Scotland has fewer GPs per capita than the North east of England.

I want to acknowledge that since the reopening of our parliament in 1999 Labour, Liberal Democrats and SNP have had common ground in seeking to sustain a public service model for our devolved NHS based on collaboration and cooperation and not competition. In June the Conservatives agreed  with the general approach.

Since 2007, demands on the Scottish NHS have increased.

Demands from the elderly numbers over seventy have risen from 400,000 to 500,000 since 2007, many with complex morbidity, new and advanced medical diagnostics, ever more expensive medicines and new treatments.

That is why the SNP often repeated defence of Comparing staffing levels in 2007 are irrelevant if not nonsensical.

More staff are critical to meeting greater demand. Malcolm Chisholm will also address this point.

The main two drivers for improvement in the patient experience since 2001 have been targets and the patient safety programme.

The Target for time from referral to treatment,

The Target for diagnostics,

The Target for accident and emergency,

The Targets for cancer diagnosis and treatment,

The Target for delayed discharges.

Each output began from a low base and progressed.

In many cases once the initial target was reached new and more demanding targets were set.

They have transformed the patient experience.

But again the comparison of the target levels Labour achieved by 2007 and what is now being achieved may make good sound bites but are infantile.

The comparisons should be whether there are year on year improvements and until 2012 this was the case under both administrations.

The problem is that in many instances apart from the new targets in CAHMS and psychological treatments we have been going backwards since 2012.

And then there is the scandal of the SNPs Patient Rights Act legal guarantee which has been breached every month since its introduction and breaches on a rising trend.

As the government amendment says most have been treated. But it wasn’t labour who promoted legislation which means anything less than 100% breeches the law.  This is a bad use of law. If Doctors are pressured into prioritising operations not on clinical priority but because they may breech this will be a scandal.

Every breech and every number for whom the target hasn’t been applied is not a number but a person whose experience is poorer.

One other crucial Labour decision was to initiate a move to a largely consultant led service. It takes ten years post-graduation to train a consultant so the maths are clear. Every new young consultant appointed under the NHS since 2007 began training under a Labour plan.

Workforce planning is never easy but it has to be for the medium to long term. Yet under the SNP plans were announced in 2011 to cut specialist training grades by 40% and FYO 1/2 by 20% at a time when implementation of  the European working time directive would require more junior and Middle grades.

The consequences are seen in three ways the largest number of consultant vacancies ever 339 or 6.5%, 20% in some specialities in some board.

Vacancies increasing year on year.

Expensive Locums being sought and flown in from all over the world.

Consultants being appointed largely on 9 clinical sessions to one other session  contracts which are not nationally agreed 7.5:2.5 contracts.

Nicola Sturgeon chose to ignore this issue in 2012 and when I raised it the other day as a concern I was accused of discouraging consultants coming to Scotland. Cabinet Secretary it is not me who is discouraging them it is your failure to order boards to follow the national contracts. It is at the very least a matter requiring examination to see if is deterring applications. Requiring new consultants to give up three sessions weekly sessions which would be devoted to teaching audit personal development and the crucial service redesign needed is counter productive and unsustainable.

As if these poor decisions on medical staffing was not bad enough this government cut nursing intake by more than 20% against the advice of the Royal college and Unison. In 2011 the SNP also allowed Boards to cut 2400 nursing posts a level at the time which was six times greater than cuts in England. They also cut midwifery intake by over 45% closing three midwifery schools with only a few months notice. This at a time when the birth rate had increased by 10% complex births had increased, conditions related to drugs and alcohol were being increasingly recognised and there was a UK shortage of midwives and when they were saying how important early years were including perinatal care.

This was another bad decision, a parochial decision increasing the stress for midwives in post

However, I welcome the fact that all these frankly extraordinary incomprehensible workforce decisions have been large reversed.

John Pentland will illustrate the damaging consequences in Lanarkshire

 

PO

We have been calling for an independent robust.     Integrated monitoring and inspection system this should happen now with an examination of the emergency systems in each Board and a more thorough inspection by HIS integrating the HEI, elderly care, boarding out and delayed discharges

The problems are across the whole NHS community and hospital. It is about demand with inadequate preventive measures or ablemant inadequate diversion to keep people out of hospital and then pressure on A/E partly due to a lack of a whole system approach to NHS. 24 GP out of hours, as well as delayed discharges. Rhoda Grant will talk more about care in the community and preventing admissions for example through good community palliative care

The problems were never seen more clearly than in the Christmas/New Year period. A/E was swamped. So patients lay on trollies for up to 24 hours and hospitals closed to new admissions Consultants seriously having to be dissuaded from leaving patients in ambulances at the door things we haven’t seen since 1997. And Cabinet secretary we haven’t even had the challenge of a bad winter.  Flu is at well below routine winter levels so far. Without the tremendous efforts of all our hard pressed staff maters would have been much worse.

 

PO, In 2008 Shona Robison proudly announced that the Labour’s  target of zero delayed discharges in hospital for more than six weeks had been met but her Hubris led her to say not only had they achieved this important target but delayed discharges would remain at zero. This was a claim too far. In 23/27 subsequent quarterly reports this zero level not been achieved. Despite this failure and despite the damaging and  unprecedented squeeze on local authority care  budgets Nicola Sturgeon set new targets of four weeks maximum delay from April 2013  and two weeks form this April 2015 this is another extraordinary decision .

The critical issue is that when beds are blocked admissions from A/E are delayed resulting in waits on trollies reported last week of up to 24 hours. The number of bed occupied days has risen by 25% since 2012 from 30,000 a month to 42,000 excluding code 9 patients. But once again this total masks huge variation with Renfrewshire reporting a rate of only 308 bed occupied days per 1000 people over 75 compared to Aberdeen city at 2212. On any given day around 1in 16 of all the acute beds are blocked. Staying in hospital is dangerous, made worse by boarding out. Labour’s recent FOI showed almost 1000 deaths of patients on the delayed discharge data base in the last two years and very few of these deaths being reviewed. But at least since our last FOI in 2010 when only Fife answered, every Board except Grampian is now collecting the data.

Will the Cabinet secretary invite HIS and the Care inspectorates to examine the reasons for the variation. Will she help local authorities with funds in particular   Will she commit to working with Aberdeen and Edinburgh cities which have the biggest problems?

In my remaining time I want to turn to the application of the UK Mansion tax a tax to be levied by Labour  to support the NHS in every area of the UK but paid for only by those with residences worth over £2 million some 895 in Scotland. This is a good example of sharing the benefits across the UK.  Scotland Wales and Northern Ireland benefit as will every region in England from the taxing Wealth accumulated in London to which we all contribute and should all benefit in redistribution. Will the SNP support Jim Murphy’s call for this to be used for 1000 extra nurses?

Presiding officer as I said at the beginning it is an oppositions duty to be critical. But I acknowledge that until 2011 progress was being made and I welcome the government’s acknowledgement to day of the pressures and challenges reflected in the worsening statistics

While we share common principles with the government we need to resolve the problems before our hard-working staff burn out.