Ken Macintosh MSP

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Ken Macintosh MSP

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Parliamentary Activities

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Meeting of the Parliament 09 October 2014 : 09 October 2014
Ken Macintosh (Eastwood) (Lab)

I was intrigued by the cabinet secretary’s line that he intends to

“maintain our plans to increase funding for further education”.

Last year, the Auditor General for Scotland identified a real-terms cut in college funding between 2012 and 2015. Can the cabinet secretary confirm that today’s flat cash settlement for colleges maintains that real-terms cut to colleges over the three years? If not, can he tell me exactly how many of the 140,000 Scots who would have been denied a place at college will be given that vital opportunity?



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh (Eastwood) (Lab)

Most of us were worried by the Audit Scotland report when we first saw it, because it shows that Scotland’s performance against the A and E targets has deteriorated over the past four years. We spent some time trying to work out the main reasons why that might be the case in order to ensure that the matter is being addressed.

Last week, we had a good and frank discussion with colleagues from the NHS in which we touched on staffing, delayed discharge, sustainability issues and other things. One particular issue emerged, starting with a comment by Professor Ferguson, who is an emergency consultant in NHS Grampian. He said:

“We still operate the way that we have always operated. We know that people are more likely to die if they go into hospital at the weekend—there is good evidence to suggest that”.

I followed the matter up with the Cabinet Secretary for Health and Wellbeing, Alex Neil, and he said that there is no evidence to suggest that. However, Dr Dijkhuizen, the medical director at NHS Grampian, said of the international studies that show that there is an issue at weekends:

“I agree with Ken Mackintosh that, because those studies show such a relationship, we should assume that the effects are the same in our country and our organisations. That is why we do studies: to learn in order to know what to focus on.”

When he was questioned again by the convener, Professor Ferguson later suggested:

“What I am saying is that there is international evidence that backs up that that happens. I would surmise from that that we have the same problem in Scotland—otherwise, why would we need the safety programme?” [Official Report, Public Audit Committee, 1 October 2014; c 19, 28, 32.]

What do you make of that, Mr Gray? Do we have a problem with excess mortality at weekends in our A and E departments or in our hospitals generally?



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

Thank you for that and for following up the issue. If there is no shared acceptance or identification of the problem—if people do not think it exists—it is very difficult to address.

I want to pick up on the points that you made. The figures that you published through the FOI were welcome. I have spoken to several people about this, but I was contacted by Professor Paul Aylin, who is professor of epidemiology and public health, and co-director of the Dr Foster unit at Imperial College London. The Dr Foster unit has been influential in changing health patterns in England and I imagine that that is why the issue matters to its staff. Professor Aylin gave me his views on the information that was published through the FOI:

“the document cited by Mr Neil, which claims to support the fact that there is no excess mortality at weekends in Scotland is inconclusive. The analysis as it stands breaks down the data into individual specialties by day of the week and as such the numbers are just too small to show an effect either way.”

Although you referred to one comment in the BMJ paper, which was authored by Dr Handel and many others, the paper’s conclusion was actually that

“There was a significantly increased probability of death associated with a weekend emergency admission compared with admission on a weekday”.

That is key. The paper did say that “further research should be undertaken”, but it also showed other factors. The study spanned 11 years and showed a decline in mortality over that time. It was quite a positive study; it was not unremittingly negative about what was happening in Scotland—far from it.

There have been other studies. Professor Aylin, along with others, published “Weekend mortality for emergency admissions. A large, multicentre study”, which also showed differences between weekend and weekday admissions. There have also been international studies showing that difference.

My point is that in England, the NHS is taking policy action to address weekend mortality and readmission rates—it recognises the issue and has changed its policy. I am not going so far as to say that we should do that; it could be that the patient safety programme is doing that. I am trying to work out whether we can conclude, as Mr Neil suggests, that we have no problem at all. The figures that you published in response to the FOI request suggest a marked improvement between 2009 and 2012.

The BMJ study and others showed quite a difference—a 40 per cent difference in excess deaths at the weekend, which is significant. If your figures show that there is now no difference, can you point to the policy initiatives that have made the difference? Can you show what is working? That is important to us. If a decrease has happened, we should welcome and celebrate it. We should also work out what caused the beneficial effect. I suggest that the figures that you have published do not prove anything; they do not demonstrate a problem one way or another.



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

I do not want to spend too long on the issue. I agree that we should not draw the wrong conclusions from the BMJ article. As you said in relation to evidence in Audit Scotland’s report, evidence reveals problems, but we do not want to draw the wrong conclusions.

I am trying to work out whether we accept that mortality at weekends differs from that on weekdays. Professor Ferguson—a consultant who works in NHS Grampian and who gave evidence last week—believes that there is a difference.



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

The study suggests that that is true. It says:

“Particularly influential to policies has been the report by Dr Foster on an increased hospital mortality in the UK at weekends, which has been linked to a reduced cover by senior doctors at weekends.”

That is a separate report.



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

That is exactly the case.



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

There are different reports, from which different conclusions might be drawn.



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

At this stage, I am not suggesting even that we draw conclusions. I am just trying to work out whether we accept or believe that there is a problem of increased mortality at weekends. In his answer to me, Alex Neil said that there is no problem at weekends. He accused me of scaremongering, but I was not scaremongering in the slightest; my questions arose from a constituent’s case and I was trying to work out whether that was an individual situation or typical of what happens at weekends. I was slightly worried by what struck me as complacency on his behalf. If he believes that there is no problem, based on a survey that is not peer reviewed and is statistically inconclusive, according to Professor Aylin, that worries me. It seems that this is the one study that proves to Alex Neil that there is no problem at weekends.

Would it be possible for you to provide exactly the same evidence as Professor Aylin, Dr Foster and other medics including Dr Handel and all the ones at the BMJ? They studied evidence over 11 years up to 2009. Would you be able to provide the same evidence, breaking down, for example, not just weekend and weekday admissions but elective admissions. Basically, could you provide something comparable with the BMJ paper so that we could actually make the comparison?



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

I am not being critical of the safety programme.



Public Audit Committee 08 October 2014 : 08 October 2014
Ken Macintosh

I do not think that anybody is—far from it. It is just a question of trying to work out whether the safety programme by itself is going to address the weekend issue and whether the issue at weekends is a lack of cover.

This is not a political issue. It is a reflection of society and the five-day week. It is not a reflection of the political Government of the day, but it has to be addressed by the Government of the day.

The patient safety programme addresses patient safety. It does not address the issue of weekend working and whether there is an problem or not.

Vote DetailMSP VoteResult

S4M-11123 Joe FitzPatrick on behalf of the Parliamentary Bureau: Business Motion—That the Parliament
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NoCarried

S4M-11114.2 Kenny MacAskill: Policing—As an amendment to motion S4M-11114 in the name of Graeme Pear
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NoCarried

S4M-11114 Graeme Pearson: Policing—That the Parliament acknowledges that policing in Scotland contin
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NoCarried

S4M-11116.1.1 Patrick Harvie: Scotland’s Future—As an amendment to amendment S4M-11116.1 in the name
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NoCarried

S4M-11116.1 Nicola Sturgeon: Scotland’s Future—As an amendment to motion S4M-11116 in the name of Jo
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NoCarried

S4M-11116 Johann Lamont: Scotland’s Future—That the Parliament recognises the result of the independ
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NoCarried

Amendment 61 moved by Elaine Murray on motion S4M-11101 Kenny MacAskill: Courts Reform (Scotland) Bi
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YesDefeated

Amendment 62 moved by Margaret Mitchell on motion S4M-11101 Kenny MacAskill: Courts Reform (Scotland
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YesDefeated

Amendment 63 moved by Margaret Mitchell on motion S4M-11101 Kenny MacAskill: Courts Reform (Scotland
>> Show more
YesDefeated

Amendment 64 moved by Margaret Mitchell on motion S4M-11101 Kenny MacAskill: Courts Reform (Scotland
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NoDefeated

Search for other Motions lodged by Ken Macintosh
EventIdTypeSub TypeMSP NameParty NameConstituencyRegionTitleItemTextFormattedAnswer DateAnswerStatusIdExpectedAnswerDateAnsweredByMspApprovedDateSubmissionDateMeetingDateProductionStatusIdRecordStatusIdStatus DateOnBehalfOfConsideredForMembersBusinessCrossPartySupportRegisteredInterestSupportCountSupportDateIsEventLinkCurrentMinister
Motion S4M-11273: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 22/10/2014 Show Full Motion >>
Motion S4M-10819: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 15/08/2014 Show Full Motion >>
Motion S4M-10766: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 10/08/2014 Show Full Motion >>
Motion S4M-10023: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 12/05/2014 Show Full Motion >>
Motion S4M-09878: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 30/04/2014 Show Full Motion >>
Motion S4M-09633: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 04/04/2014 Show Full Motion >>
Motion S4M-08406: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 25/11/2013 Show Full Motion >>
Motion S4M-07580: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 04/09/2013 Show Full Motion >>
Motion S4M-07566: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 02/09/2013 Show Full Motion >>
Motion S4M-07032: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 17/06/2013 Show Full Motion >>
Search for other Questions asked by Ken Macintosh
EventIdTypeSub TypeMSP NameParty NameConstituencyRegionTitleItemTextFormattedAnswer DateAnswerStatusIdExpectedAnswerDateAnsweredByMspApprovedDateSubmissionDateMeetingDateProductionStatusIdRecordStatusIdStatus DateOnBehalfOfConsideredForMembersBusinessCrossPartySupportRegisteredInterestSupportCountSupportDateIsEventLinkCurrentMinister
Question S4O-03619: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22900: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22899: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22898: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22901: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22897: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22893: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22894: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22895: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>
Question S4W-22896: Ken Macintosh, Eastwood, Scottish Labour, Date Lodged: 20/10/2014 Show Full Question >>

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