I thank Jenny Marra for securing this debate on what is one of the nation’s greatest assets. It is important to everyone who needs to use the services that are provided by the NHS across Scotland.
I also thank members for their varied contributions to today’s debate and, in particular, for the wide appreciation that has been expressed of the magnificent work and the dedication of those who work in our NHS. I, too, place on record my thanks to those who work in the health service.
I welcome the many constructive comments from the royal colleges but it is important that, as we engage in this process, we hear from everyone, including members of the Scottish Parliament and, crucially, members of the public and anyone who can contribute to our ability to progress issues around our NHS.
We have heard about the joint statement that was issued last week by the Royal College of Nursing and the Academy of Medical Royal Colleges and Faculties in Scotland, calling for a bold, visionary and collaborative approach between Government, public and professions to secure a better future for our health service.
The Scottish Government welcomes that contribution, but we should not lose sight of the considerable progress that the NHS has made in recent years, delivering high-quality care every day. It has record high funding, record high staffing, historically low waiting times, a world-leading patient safety programme and a clear 2020 vision. Nevertheless, we must be prepared to look beyond that horizon and consider the way forward for the NHS into the future.
To that end, the cabinet secretary set out in January this year the need for change to meet rising demand and the needs of an ageing population, and for a wider debate on the future of health and models of care, and explained our commitment to working with patients and families, health professionals and clinicians, the Health and Sport Committee and Opposition parties—indeed, everyone who wants to contribute—to help to shape the direction of our NHS and clinical strategy for the next 10 to 15 years. She reiterated that commitment today and, in a piece in today’s Herald that was welcomed by the royal colleges, she set out our desire to foster consensus on our way forward.
Planning for the future must include key elements such as determining what capacity is required where and what the workforce will need to look like to deliver the new services in a different way. The professional bodies and the royal colleges will be key to informing that work.
We agree that the NHS and social care services need to continually innovate and adapt to meet public expectations and the changing nature of demand. This Government legislated to bring forward health and social care integration, with full implementation to be in place by April 2016, in order to help underpin the shift from acute to community delivery of care. We support integration, committing over half a billion pounds of Government investment over the next three years to that end, including £300 million for the integrated care fund, £100 million for delayed discharge and £30 million for telehealth projects.
Sarah Boyack mentioned the issue of delayed discharges in Edinburgh. I know that she has a long-standing interest in that issue, as she has raised it with me in the chamber before. Tackling delayed discharge is, of course, part of the rationale for introducing the integration of health and social care, and I can report to the chamber that, across Scotland, the number of people whose discharge is delayed for more than three days is down from 947 in October to 646 in April, so it is clear that progress has been made.
The cabinet secretary also spoke about the work that is being undertaken with regard to primary care, the new GP contract and Professor Lewis Ritchie’s work on out-of-hours care. I know that many members take a great interest in that in particular. Indeed, John Pentland raised the issue of out-of-hours services in the Lanarkshire area. He will understand that I also take an interest in that matter, as I represent a constituency that is covered by NHS Lanarkshire.
John Pentland asked for a commitment from the cabinet secretary today that NHS Lanarkshire’s model for out-of-hours care must correlate to the outcome of Lewis Ritchie’s national review and the recommendations taken forward by the Scottish Government. The cabinet secretary made that clear commitment to him in her intervention, so I hope that that serves as an indication of the Scottish Government’s commitment.
Many members spoke about primary care. Mark McDonald and Kevin Stewart in particular spoke about the situation in the north-east and the meeting that the cabinet secretary went to up there. I say to Mr McDonald that I look forward to joining him on my visit to his constituency.
The new models of primary care that are being looked at are at an early implementation stage in primary care settings, mainly GP surgeries, across the country. What those projects will have in common is that they are bottom-up tests of change across a wide range of communities in Scotland, the learning from which will influence the future shape of primary care. They are a critical element of making our 2020 vision for integrated health and social care real, and they will inform work going beyond the 2020 vision.
We want a new emphasis on care being delivered in the community, which has been expressed as a desire by most members in the debate. We want that care to be delivered by multiprofessional teams to best meet patient needs, and we will be working with the professionals to deliver that. How that shift is better achieved will be a key element of the discussions with the professionals that the cabinet secretary will lead.
Bob Doris spoke about the opportunities for young people through the NHS. The NHS in Scotland benefits from a varied employee base, and the employment of young people represents a great investment in the future. Boards are asked to deliver a national target of 500 new modern apprenticeships by August 2017. Mr Doris also raised the issue of ensuring better career pathways through the NHS. I agree that that has to be part of our thinking.
Jim Hume, as to his credit he does regularly—although I do not always agree with every element—raised many issues around the future of mental health services, most of which I agree with. The need to tackle stigma is very important. That is why we continue to fund the see me campaign. He again referred to the parity between mental and physical health. I reiterate that that already exists legally through the National Health Service (Scotland) Act 1978. I also point out that we have recently announced an additional £85 million on top of the £15 million that was announced last year for mental health. That new funding will focus on a variety of areas, including further investment in child and adolescent mental health services to bring down waiting times, and improved access to services—in particular psychological services. There is a focus on community settings and better responses to mental health in community primary care settings, including promoting wellbeing through physical activity and improved patient rights.
Nanette Milne raised the issue of palliative care. The Scottish Government has committed to the development of a strategic action framework to provide a focus to support high-quality palliative and end-of-life care by the end of the year, and I will ensure that that is available to all members of the Parliament.
Lewis Macdonald raised the issue of NHS Grampian’s funding. In this year, NHS Grampian’s resource budget has increased by 6.7 per cent above inflation—the largest increase of any mainland board. However, this Government is willing to look at the issues that he has raised about the NRAC formula more generally.
Of course, it is sadly not possible to respond to every issue that has been raised, but I welcome the fact that we have had the debate and I welcome the fact that it has been consensual. We will continue to work with others in the chamber and, most crucially of all, with the professionals and the public, to ensure that we continue to enjoy a world-class national health service long into the future.
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