That particular aspect demonstrates what happens when the parties work together in the committee system.
I also highlight the reductions in stroke, cardiovascular disease and suicide. Gil Paterson and other members have mentioned other areas of improvement such as the reduction in smoking—especially in the number of adolescents starting—and in alcohol consumption.
However, in the rest of my speech I will present the problems on the other side. My central concern is that, although the SNP Government is very good at talking up the things that it does well, which is entirely appropriate, it fails to recognise quickly enough when things are not going right. Jackson Carlaw made a good point in summing up about the survey of NHS staff attitudes, because that reflects where we are. Morale in the health service is on a descending curve. If we, and those in the next session of Parliament, do not recognise that, we are in trouble.
Let us look at some of the areas in which we have not made progress. We have the highest number of drug deaths anywhere in Europe, yet the alcohol and drug partnership budgets are being cut by £16 million, unless the health boards provide that money. That amount is within the increase that has been announced, so there is not in fact an increase but a cut to the ADP budgets.
I highlight to the cabinet secretary that the conversations that I have had already with a number of ADPs indicate that boards are subjecting them to substantial cuts in staffing. There are big cuts in Edinburgh, for example.
What about obesity, which is the other big public health issue? The report card on the Government’s progress reads:
“Slow Progress; Limited Success; Requires More Effort”.
Those are not my words—they are from Obesity Action Scotland’s report card on the Government’s obesity route map. The level of obesity—the number of people who are overweight or obese—is 65 per cent in Scotland, and for children it is 68 per cent. That cannot continue. Life expectancy in Scotland will reverse if we do not tackle that problem, and I hope that Parliament will address that problem very seriously in the next session.
The SNP is very good on aspirations, and we share those aspirations, but it must admit when things are not going well. It came to power attacking Labour on hidden waiting lists, and introduced a highly complex new waiting times system. It was then faced with a gaming scandal in NHS Lothian in 2011.
I have raised as an issue the fact that, in Glasgow, social unavailability now applies to one in three patients. That means that one in three citizens of Glasgow, when they are presented with an appointment, says, “I can’t make it.” There is something wrong with an appointments system that produces that result. I am not saying that there is gaming, but there is something going on there. The rate of social unavailability is much higher in Glasgow than it is in Lanarkshire, despite the two health boards being fairly comparable.
The SNP’s second prong of attack when it came to power in 2007 was that it would not cut hospital beds, but 15 per cent of those beds have gone. We can debate whether that is appropriate but, nevertheless, the SNP made a manifesto promise not to cut beds.
The third prong of attack was on the closure of local hospitals. Much of Labour’s motion and many of the contributions from colleagues on my side of the chamber today have related to the uncertainties around the failure to make clear statements about some of those hospitals. We know that change is going to occur; without change, we cannot survive. On the other hand, delaying or prolonging the report on St John’s paediatric unit is not acceptable, because planning blight causes doctors not to apply for jobs in the unit, which makes it less safe and likely to be closed on safety grounds. It is interesting that the Government’s motion refers to the safety of such services.
Then we come to delayed discharges. Of course, the SNP members talked about the progress over the past year, and I got up and welcomed it. Nevertheless, the situation is twice as bad as it was in 2011 in terms of bed occupied days. We have to accept what Audit Scotland said, which was that seven out of nine targets were missed and that the situation was deteriorating. Unless we start with an honest debate, we cannot adopt the clinical strategy and try to drive it through.
I welcome the fact that we are talking about bed occupied days. If people stay in hospital for longer than six weeks, that is a very bad thing, but on the other hand the measure of bed occupied days strongly affects what is actually happening.
Let us look at another promise. One of the cabinet secretary’s predecessors, Nicola Sturgeon, promised that every health board would look at boarding out and that we would try to tackle that. However, 130,000 patients were boarded out in the past two years, and there are two boards that do not even have the capacity to report on boarding out. If they do not have that capacity, how are they even beginning to look at that issue?
Since 1999, we have been driven by targets. Targets have served the Parliament, the health service and our citizens extremely well, but I have to say to colleagues that they will need to be looked at and addressed. Some of the targets are now causing considerable clinical problems. It is perhaps at the margin to begin with, but they are part of the reason why staff morale is dropping, as Jackson Carlaw said.
The particular target that I want to draw attention to is the legal requirement that everybody have their in-patient and day-case treatment dealt with within 12 weeks. We passed the bill on that in 2011, and I warned at the time that it was not a good law.
As Paul Gray said to the Health and Sport Committee, a 100 per cent target is radically different from a 95 per cent target. The marginal costs of reaching a 100 per cent target are massive. If the boards cannot use the Golden Jubilee national hospital, which is expensive, they have to use the private sector. I have colleagues who are praising the Government for that target because, on the back of treating bunions and other small things, they are getting great holidays in the West Indies.
If you give somebody a legal guarantee, it is a guarantee in law. That legal guarantee has not been met for 32,000 patients since it was put into practice in December 2012, and the target has not been met once since the law was passed. That is a bad target, and it needs to be looked at again.
In the few minutes that I have left, I want to refer to a couple of other things. In relation to the increase in the number of staff and comparisons with 2007, I have to say to the cabinet secretary that we have 5 per cent more population than we had then. That is reflected, for example, in general practice. The number of patients per head of GP has gone up by 10 per cent; every GP is dealing with another 500 patients. That is a huge rise.
Jim Hume referred in his speech to the GP crisis. That was not recognised for a long time. I warned about it in 2010; I said then that we needed a new contract, but nothing happened. A new contract is now going to come in, but I have to say that it will not be a salvation.
The situation is that there are 500 empty GP posts. In Edinburgh, one in four practices has no patient choice—they have restricted access. Patients have to go to the patient allocation system to be allocated to a practice, and we have patients queueing at 8 am on a Tuesday morning to be the first 30 to be accepted by a practice. That is simply not acceptable. We have a crisis and, unless we admit that and accept it, we are not going to advance.
I will finish by mentioning two other things. One is dementia. When 50 per cent of patients with a diagnosis of dementia are admitted to hospital but the dementia is not recorded on their notes, how can we manage dementia in hospital? That is a huge challenge for the acute sector, but it is not happening. Those findings come from a Scottish research paper, based on Scotland.
We have all failed to tackle health inequalities, which have got worse since the Parliament was founded. That is the fault of all parties and all Governments, and it needs to be addressed after the election. Health is a fantastically challenging portfolio. We share a vision on 2020 and share a vision on the new clinical strategy but, as I have said, my one regret is that the SNP has too often denied problems over the past seven years. It has waited until they were inescapable and then thrown a little bit of money at them. That is no way to govern. We must have a common purpose and agreement on the way forward. If we have those things, this Parliament, which I will watch from afar with great interest, may begin to solve our problems. We have a world-leading NHS in Scotland but, unless we do that, we will not maintain it.