Scottish Parliament, 18 November 2010

460 contributions from 74 members. The official report.

Care Home Costs

Alex Fergusson (None, Galloway and Upper Nithsdale)

Good morning. The first item of business this morning is a Conservative party debate on motion S3M-7422, in the name of Mary Scanlon, on care home costs.

Mary Scanlon (Conservative, Highlands and Islands)

There is no denying the changing demographics of Scotland. In the past 10 years, the number of people aged 75 and over has increased by 14 per cent and the number of people aged 60 to 74 has increased by 12 per cent. It is projected that, in the period up to 2031, the number of people aged over 75 will increase by about 80 per cent. The number of those aged 65 to 74 is projected to increase by 40 per cent in the same period. It is estimated that, in the next six years, the number of older people who need care and support will increase by 25 per cent. I hope that today’s debate will help us to plan services, as part of the Government’s reshaping care for older people process, to ensure that value for money is coupled with continuing high standards of care for our older people.

In March this year, there were 943 care homes for the elderly, providing 39,150 places, with more than 5,000 empty places. The independent and voluntary sector provides about 85 per cent of care home provision in Scotland, with the remaining 15 per cent in the council sector. All care homes must achieve equal quality standards, as set and regulated by the Scottish Commission for the Regulation of Care. Undoubtedly, there are excellent, good and not-so-good care standards in all sectors. We look to the care commission to take the necessary action against any home that is not performing to agreed standards of quality care; ultimately, that can lead to closure of a home.

Against that background, and in the current financial climate, questions need to be asked about the amount that councils pay for a placement in their homes, which is £800 a week on average, although the amount that is paid to the independent and voluntary sector for the same placement and standard of residential care is £480. I appreciate that local authorities pay higher wages and have significant pension provision for all employees, but some independent providers pay rates that are similar to those paid by local authorities. As an MSP who represents the Highlands and Islands, I am also acutely aware that in remote and rural areas, councils provide care in smaller homes, which are more costly to operate due to the absence of economies of scale and which would not be viable in the independent sector. However, although the cost of providing care is a matter for each local authority, section 22 of the National Assistance Act 1948 requires local authorities to set fees in their homes at the full cost of providing care. Therefore, if the cost of providing care is around £800 per person, surely that would be the cost for all sectors to provide the same level of care to the same standards.

That takes me to my next point: how do independent care homes stay in business when they are paid almost half the amount per placement that is paid for the same level of care for a person in a council home? The answer for many is that care home providers enter into contractual agreements with self-funding clients. The self-funding person in standard residential care tends to pay a considerably higher rate than the £480 that is paid for a council-funded placement. That means that there is significant variation in payments for the same level and quality of care.

I am not proposing that the fees that the independent sector receives should increase from £480 a week to the council level of £800 a week. However, the Government’s review provides us with an opportunity to look afresh at maintaining high-quality care, appropriate placements and value for money, especially given that £4.5 billion of the Parliament’s budget is spent on care for older people.

As I mentioned in a speech last week, independent and voluntary sector care homes could be used to prevent hospital admissions. That would ensure that patients receive the rehabilitation that they need to retain independence and go home, instead of waiting for six weeks in a hospital bed and becoming a statistic for delayed discharge. It would also help to utilise the 5,000-bed spare capacity to which I referred. The fee to care homes in the independent and voluntary sector is £480 and £550 per week, compared with costs of £800 a week for council residential care, around £1,400 a week for general hospital provision and upwards of £2,800 a week for acute hospital care. In these difficult financial times, that is a significant factor.

Care homes could also provide significant amounts of day care and respite care, as well as home care. That would enable elderly people to become familiar with the care home and its staff and lead to a more joined-up service, enabling people to have temporary stays in care homes before returning to their home.

More support could be given to unpaid carers, and our care home sector could be utilised more for respite care. Greater volunteering and community support could be developed by better integration. Telecare and telehealth developments have real potential to enhance quality of life and to create even more efficiencies, as well as better-quality care. The situation could be improved by extending telehealth links to care homes and using technology to provide direct connections to clinics and hospitals, which would help to prevent unnecessary out-patient and in-patient visits. I understand that West Lothian is working on a project of that type.

The independent care sector employs more than 100,000 staff, with an annual turnover of more than £1 billion. It is only right that we utilise that capacity and knowledge to enhance care for the elderly. Although the coalition Government at Westminster is considering a range of ideas through its Commission on the Funding of Care and Support, including a voluntary insurance scheme, it is up to the Parliament to ensure that older people get the care that they need and deserve, at the time when they need it, and in the place of their choice.

The motion in my name asks the Government to review

“existing models of funding and provision”

as part of the reshaping care for older people process,

“to ensure that value for money is coupled with continuing high standards of care.”

I hope that all members will support it.

I move,

That the Parliament recognises the changing demographics of Scotland and the increasing financial pressures on services providing care for older people; notes that independent and local authority-run care homes in Scotland are regulated in accordance with standards set by the Care Commission; further notes the wide disparities that exist between different service providers with regard to fees and costs and the disparities in the amounts paid by or on behalf of service users for the same service, and accordingly calls on the Scottish Government to ensure that its public engagement process, Reshaping Care for Older People, reviews existing models of funding and provision to ensure that value for money is coupled with continuing high standards of care.

Shona Robison (Scottish National Party, Dundee East)

I welcome the opportunity to debate care services for older people and the important programme of change on which we have embarked.

The current systems for delivering social care will not support increasing numbers of frail older people. That is why, as outlined in the spending plans and draft Scottish budget for 2011-12 that we announced yesterday, we are making available £70 million to be used in partnership across health and social care to focus on delivering improvements in older people’s services.

Residential care is just one of a complicated labyrinth of interrelated tough problems that we must tackle. We will tackle it, but we cannot do so in a disjointed, short-term way.

To help us to understand the complex issues that we are discussing today, l will touch on a few of the facts about care home provision for older people in Scotland. At the end of March this year, there were 943 care homes, providing 39,150 places. Almost 14 per cent of residents were in local authority homes, 75 per cent were in private homes and 11 per cent were in voluntary sector homes. However, the picture is changing. The number of residents in local authority homes has fallen by almost 15 per cent in the past 10 years, to just over 4,000. At the same time, more than 30 per cent of care home residents are self-funders, because they have capital in excess of £22,750. That number is increasing year on year.

Self-funders pay their own fees, over and above any entitlement to free personal and nursing care. Publicly funded residents have capital of less than £14,000, and the local authority pays for their care over and above the contribution that the individual makes from their pension, benefits and other income. It is clear from the statistics that local authorities depend to a very large extent on the independent sector for the provision of residential care to the older people in their areas—and I refer back to what I said about 14 per cent of residents being in local authority homes.

In response to long-running concerns about the stability of the care home sector and the quality of the care that is provided, the Convention of Scottish Local Authorities developed the national care home contract, in negotiation with Scottish Care, the body that represents the independent care home sector. The national contract was introduced in 2007-08, and the rationale for developing it was to standardise the terms, conditions and fees for publicly funded clients and to incentivise improvements in quality, through the grading system.

All the published research on care home costs shows that there is a wide variation in the weekly costs of residential care, regardless of who owns and manages the home. That is true for all sectors, drawing on comparisons within and across sectors. In spite of those wide variations, COSLA and the independent care home sector have successfully negotiated a standard national contract rate for publicly funded residents over the past few years, which has removed the need for costly and time-consuming negotiations between each of the 32 local authorities and the care home providers in their areas. Importantly, that has been linked to driving up quality.

I know at first hand from the recent Scottish Care conference, which Mary Scanlon attended, just how strongly the independent sector feels about the apparent inequity in the charges for local authority care home provision, compared with the amount that local authorities pay for a publicly funded care home place under the national care home contract. As with most things, the situation is not quite as black and white as it first appears. Given the clear interdependence of local authorities and independent providers, an adversarial approach to the single issue of the cost of a care home place is not helpful.

Faced with the dual pressures of diminishing public sector funding and increasing numbers of frail older people, we need to work together to develop new models of providing and paying for care. That has to mean much better joint commissioning, because only when partners in health sit down with their counterparts in councils and bring in expertise from the independent sector will we start to see real innovation, both in business models and in service development.

The £70 million change fund, which I have referred to already, is a significant milestone on the road to securing high-quality, person-centred care for the future. Our long-term proposals will be set out in our reshaping delivery plan, which is to be published at the end of this year.

We will not miss the opportunity to review current arrangements on funding and charging for care to ensure the development of long-term, fair and sustainable new models of care. In doing that, it would be wrong headed to focus on only one care sector and one care setting. Reshaping care requires us to take a far more fundamental look at the way in which care services are delivered across the board. That is what we have set out to do with the reshaping care process. A number of public sessions have been held across Scotland, and they have been very positive in bringing forward suggestions.

I am totally committed to keeping up the momentum on this important change agenda, and I hope that that finds support from across the Parliament.

I move amendment S3M-7422.1, to leave out from first “notes” to end and insert:

“recognises the need to shift the balance of care; notes that independent and local authority-run care homes in Scotland are regulated by the Care Commission in accordance with standards set by ministers, and further recognises the opportunity through the Reshaping Care programme public engagement process to examine existing models of provision and funding across all care sectors and care settings to ensure that value for money is coupled with continuing high standards of care.”

Jackie Baillie (Labour, Dumbarton)

I, too, welcome the opportunity to debate the provision of care. Mary Scanlon has focused her motion on care home costs, and I will deal with that issue first. I share her view, however, that the debate should be wider and should consider the rich and diverse continuum of care that is provided in communities throughout Scotland.

Mary Scanlon’s central point—and indeed that of the minister—is that the cost of public sector care homes can be much higher than the cost of provision by the private sector. All else being equal in terms of quality, why is there a disparity? I know from experience that Argyll and Bute Council, which covers part of my constituency, can charge up to three times as much for its care home provision than the private sector does, so the question is a valid one.

The situation is not quite as simple as many people would have us believe, however. As Mary Scanlon rightly suggested, there will be variations in staff terms and conditions, in whether pensions are provided for staff and in how much an employer will contribute to those pensions. Providing for older people in remote and rural areas can be less attractive for the private sector. Whatever is the case, I have no doubt that local authorities will be considering how they secure best value for their limited resources. I welcome the development of the national contract to ensure that a partnership approach to the care of the elderly is taken between local authorities and the private sector.

I am disappointed that the motion does not mention the voluntary sector, with its rich history of providing social care, including in care homes. I accept, however, that Mary Scanlon covered that in her speech.

That brings me to the point about the diversity of care provision. There are a variety of care providers, including local authorities, voluntary organisations and the private sector, and they are engaged in delivering a variety of different levels of care. Increasingly, providers are developing models of care that sustain people in their own communities and in their own homes. That is what older people say they want, and that is borne out by the trend that is emerging across local authorities of an increasing emphasis on home care.

We face the challenge of changing demographics and I understand that, 20 years from now, there will be about 75 per cent more 75-year-olds. As I look around the chamber, I see that to be true.

Members: Oh!

Karen Gillon (Labour, Clydesdale)

On the Tory benches, anyway.

Jackie Baillie (Labour, Dumbarton)

It is indeed the case on the Tory benches, Karen Gillon says.

We need to rethink how we do things. Doing more of the same in the face of those statistics will just not do. We should not view older people as a burden, who require to be cared for. The overwhelming majority of people—more than 80 per cent—do not come into contact with the care system at all.

We should be encouraging a healthy and active old age. Let us value the lunch club or the older persons’ club that is delivered in the local village hall. Let us value the yoga class taken by an 87-year-old pensioner—and in case members think I mean a participant, I am referring to my constituent Lily Kennedy, who leads a yoga class of people half her age.

Care at home is one possibility—it is a matter of ensuring that the right level of support is provided by home helps and specialist staff. There is also sheltered housing and very sheltered housing, much of which is provided by specialist housing associations such as Bield. Sheltered housing enables older people to maintain their independence, balanced with the appropriate support.

We must value and support our carers—the army of relatives and friends who provide care for loved ones every day. They need access to respite care, not just in emergency situations—although some councils are restricting eligibility to that. We should encourage diversity in provision and we must not lose sight of the value of prevention. That means funding the lunch club, the yoga class and the befriending project, because we know that they sustain people in their communities.

To meet the challenge of the future we need the creation of a national care service, bringing together primary health and social care in one organisation, with one budget and one focus—on the person being cared for. In too many areas of Scotland, agencies are not working together. They are guarding their own budgets or, worse, cutting budgets in the expectation that somebody else will pick up the work, and it is the person who needs the care who suffers.

It is often said that a society is judged by how well it treats its older and vulnerable people. Let us ensure that our society is well judged.

Ross Finnie (Liberal Democrat, West of Scotland)

The sight of Jackie Baillie holding a mirror in front of her while she tried to gauge the average age of the members in the chamber is not an experiment that I shall repeat.

The debate is timely, and I am glad that it has been secured. In reality, it is difficult to disagree with much that has been said so far in relation to both Mary Scanlon’s motion and the Scottish National Party amendment. The Parliament has placed an enormous emphasis on how we care for the elderly, and our policy in Scotland of free personal care for the elderly has not just been welcomed; it has had a radical effect on how care provision has been sustained. It has called on us all to examine critically exactly what goes on in the care sector. However, having put a spotlight on the sector in that way, we are finding out that, even 10 years on, there continues to be a huge disparity in costs. Mary Scanlon rightly pointed that out and, as Jackie Baillie said, there are not just differences in costs between local authorities and other providers; there are disparities within each group.

Each and every establishment is regulated by the Scottish Commission for the Regulation of Care, but there is quite a wide disparity in the range of services and standards of care in them, which is slightly worrying. That is not to say that they fall below the required standards—I am not accusing the care commission of being negligent—but a wide disparity exists. Of course, we are dealing with individual elderly people who require, demand and, rightly, should receive the highest quality of care.

I have some sympathy with the point that Jackie Baillie made at the conclusion of her speech. She spoke about integration of the model. We do not yet know what the outcome of the reshaping care for older people process will be, but there is a debate and we will not necessarily agree with the solution that is proposed. However, we understand that we must put the microscope on how care services are provided for all our elderly people.

There is a difficult interface. The intended purpose of free personal care was to ensure that more people would be able to stay in their home, but a burgeoning number are seeking places in care homes. There is also the unusual interface with the statistics, which show that the number of hospital admissions is still slightly increasing. We have to understand better the relationship between those three areas before we can be clear that our policy of providing adequately for the care of our older people is being properly directed.

That points to the issue that Jackie Baillie raised. There are concerns about care for the elderly in homes, there is care for the elderly in their own homes and people are still seeking hospital admission. Therefore, an holistic approach is needed to the question of how to shape care in communities. The Liberal Democrats are absolutely clear that, notwithstanding issues relating to the appropriate level and standard of care and the appropriate cost measurement, the structural issue of how we shape care in our communities is behind dealing with individuals’ needs. That means that we should try not to take a silo approach to care for elderly people; rather, we should look at the whole picture of care in the community. I am not sure whether that requires a new, separate organisation, which the Labour Party appears to posit—I look forward with interest to hearing more detail on its policy; instinctively, I feel that the creation of a separate institution is not necessarily attractive—but we must readdress how our elderly people and everyone else in our community are to be properly and financially dealt with. The efficacy of the approach that has been taken is quite worrying. Some statistics that Mary Scanlon has brought to our attention are not easily explicable. We are all aware of the different rates and costs, at different times, for no apparent difference in provision. Such an approach is not good value for the public purse.

We have no difficulty in supporting the general principle that we must consider reshaping care for older people and we hope that the Government will publish the results of the reshaping care for older people process fairly shortly so that we can have an intelligent debate about future provision and can consider the structure. The Government can be assured of Liberal Democrat support if that leads to far greater integration of services and far greater understanding of and openness and transparency about how we evaluate standards of care and how that relates to a more uniform level of costs. That would be much appreciated.

Sandra White (Scottish National Party, Glasgow)

As Mary Scanlon said in her opening speech, there are 943 care homes for older people in Scotland. Some 174 of them are run by local authorities, 637 are private and 132 are run by the voluntary sector.

Issues relating to care homes, their standards and costs have been raised with me as convener of the cross-party group on older people, age and ageing on numerous occasions. I attended the care conference that the minister mentioned with Mary Scanlon and Richard Simpson. Many issues pertaining to the care of older people were raised at it, and it was very good. I think that 450 providers attended it and they were very aware of the changing demographics, the need to consider different care models and the need to work in partnership with all providers, such as local authorities and health boards. I was impressed by the range of ideas that came forward. Some, such as on telecare, which Mary Scanlon mentioned, were innovative, and some were based on plain common sense. People knew exactly what they were talking about and wanted to provide good care for older people.

The issue of the disparity of costs rumbled about the hall while we sat in it. I am sure that Richard Simpson and Mary Scanlon will remember that the issue came alive during the question-and-answer session. At the time, I said that it was the elephant in the room that people did not particularly want to address. Mary Scanlon’s motion concentrates on the issue, and she spoke about it in her speech. I want to pick up on it.

We were asked questions at the conference and I offered to consider the comparisons between local authority and private provider costs. I have looked at some of the figures, and will refer to them. There is not so much disparity in the average gross weekly charges in care homes for older people figures as some people might think. The Aberdeen City Council charge has been £440 on average per week, whereas the independent figure in the area was £477. The Glasgow City Council charge has been £453 on average per week, whereas the independent figure in the area was £448. The City of Edinburgh Council charge has been £523, whereas the private provider figure in the area was £567. I have more figures and could go on, but I simply want to give members a taster. Things are not as clear-cut as they seem to be. We need to consider the figures. When I said that I would consider the comparisons, I was told that the Local Government and Communities Committee had taken evidence on the subject. Therefore, there is evidence. I hope that we can look at that evidence and that it can provide a basis for seeking further evidence.

It has been said that there is a lot more to the matter than simply providing care homes for older people. Homes can be used for things such as respite. As our population gets older and in need of care, it is our duty to provide it. I emphasise that we must work together to do that. Health boards, local authorities and others need to work in partnership. I am sorry that things have broken down in Glasgow City Council, but I hope that we can get back to working together. People cannot be admitted to hospital simply because there is no suitable accommodation for them with their family, in the community or in a care home. That is an example; I will not give a name. Admitting such people to hospital is not good for the person or the family, and it is certainly not good for the health service. Older people cannot be left to languish in a hospital because a local authority has quotas, as Glasgow City Council has, and they cannot get into a care home or even a house. I know that Jackie Baillie had such a situation in her area. We cannot have such situations, which is why we must ensure that we work together. Doing so is good for the older person, the community and, obviously, the health board. It is obvious that, if someone is languishing in a hospital, they could pick up an infectious disease; indeed, things could be worse for them.

I think that Jackie Baillie mentioned that this is not just about care homes; it is about other things that they can do. We must consider different models. Care homes can be used for respite and other things.

The debate has been consensual and very good. We have explored various avenues. If we explore such avenues and get together with providers, we can look for better care for older people and better care in care homes in future.

Helen Eadie (Labour, Dunfermline East)

Ensuring that there is good-quality provision of care for all of us in the future unites all members because we have a vested interest in it. We need to ensure that there is such provision for our constituents who require it at the moment, in particular.

Many of us had a variety of experiences in previous incarnations before we became MSPs. I was a full-time trade union organiser and negotiator for the GMB. I worked with care workers, private schools and many trade unionists in local authorities and the independent sector.

One the great things that we had at that time but do not have any more was the fair wages resolution. We also had the Employment Protection Act 1975, which established the Central Arbitration Committee. Schedule 11 of the act was also important. That all meant that a private sector worker could go to the Central Arbitration Committee—as I did on my members’ behalf—which could award pay and terms and set conditions that matched those in the local authority sector. For whatever reason—I do not know the reason—that system has gone. It also provided for equitable holiday pay, sick pay and pensions. It is a huge miss that that is no longer part of employment law. In one instance, when I used the Central Arbitration Committee and went up against Queen’s counsel, we won the case and our ladies from a private school were awarded a rate of pay similar to that of local authority cleaners. The Central Arbitration Committee could also be used in the care sector. However, I have to accept that we are where we are.

I have made great play of visiting the care homes in Fife. I was interested to hear what Sandra White said about the information that the Local Government and Communities Committee has gathered. I will have a look at that, because I am interested in it. In Fife, we have a bigger disparity than there is in the figures that she quoted. Figures have been quoted to me of the private sector cost per week being £585, as opposed to £785 in the local authority. I do not know whether Sandra White has information on Fife, but that is what I was told during my visits to the care homes.

Incidentally, I was hugely impressed by the care homes that I visited in Fife. Some of them are brand new homes and are places that I would not mind having to stay in. They struck me as providing quality care. That is equally the case for the local authority homes, which are very good.

There are cost issues that we need to address, but I am much more bothered by another issue: I know that the debate is not about delayed discharges, but Fife still has the highest number of delayed discharges in Scotland. That has happened before and it is happening again. That is not acceptable, because we now have to count every penny. Care must be top quality, but how can it be right to consider charging £300 per night—that is £2,100 a week—for a national health service hospital bed when the people in those beds want a care package and to be put into a home? That money should be taken from the local authorities, which are the bottlenecks that are holding up the system. It is the taxpayer’s money irrespective of which budget it comes from. The difference between £2,100 a week and £585 or £700 a week is huge. We all need to get our heads round that issue at a time of such financial constraint.

I welcome what the minister said about the £70 million change fund and I echo the points that other members have made about telehealth. My father-in-law is over 90 and I am pleased that he is still at home. God willing, he will stay at home. He may be one of the people who needs a care home, but I hope not—I hope that his family will always be able to care for him.

Jamie McGrigor (Conservative, Highlands and Islands)

I praise Mary Scanlon for lodging such an important motion.

I also put on record my praise for all the staff and managers of care homes in my region, who work hard day in, day out to provide excellent care for our elderly people. In my native Argyll and Bute, there are 24 care homes with more than 600 places for older people. Those homes fulfil a very important role.

I also welcome Scottish Care’s recently published manifesto “Making the case for care: A Manifesto for the future of care and support services for older people in Scotland”. It sets out clearly the extent and gravity of the challenges that face us as we try to reconcile increasing levels of demand and complexity of need, the rising costs of care and support delivery, and the continuing shift of the balance in care away from the acute health sector. Those challenges are set against a backdrop of very challenging public expenditure levels.

Because of all those factors and the need to ensure that available public resources achieve the most efficient results, the Scottish Conservatives will continue to speak out about the disparity that exists between the costs of local authority and independent sector care homes. Scottish Care indicates, as Mary Scanlon pointed out, that the average local authority cost per place per week for non-nursing care is around £800, while the equivalent cost for a place under the national care home contract is around £480. That is a massive difference. The cost per hour of care at home and housing support is estimated at £21 to £25 in the local authority, compared with £16 to £18 in the voluntary sector and £12 to £15 in the private sector.

Having spoken to the excellent Eventide care home in Oban, which is independent, I find that Argyll and Bute Council has done away with the enhanced rate, which added about £40 per week for clients who need extra care. However, the patients in that category still come to the home, which is paid the basic rate of £475, while a self-funding resident next door at the council’s Eadar Glinn care home pays £903. That is an enormous discrepancy and is unfair on those who provide a vital care service on which many of us depend. I do not know whether other councils have also abandoned that category, but it is obviously a cost-cutting exercise rather than a care improver.

Although I recognise the current mixed economy of care home supply in Scotland, we should still scrutinise the 15 per cent or so of care home places—and, indeed, the 50 per cent of care at home and housing support—that local authorities provide and ask why it is so much more expensive than the provision that is offered by the independent and voluntary sectors.

Shona Robison (Scottish National Party, Dundee East)

Will the member give way on that point?

Jamie McGrigor (Conservative, Highlands and Islands)

As Scottish Care’s manifesto suggests,

“it seems clear that”,

where the private and voluntary sector can provide a stable system of care homes,

“pursuing a phased process of outsourcing has to be the most sensible option, potentially delivering higher volumes of care and support for the same or possibly reduced levels of expenditure.”

Scottish Care also goes on to point out—rightly—that there is no evidence that, in general, local authority-delivered services are of higher quality, despite the higher cost. Why should they be?

That is not an attack on local authority provision for the sake of it; rather, it is about a genuine desire that as many of our senior citizens as possible benefit as much as possible while we ensure the most effective use of taxpayers’ money.

However, it is not only about money: placing a relative in a care home is often an emotional event for their family members. Therefore, it is essential that an esteemed relative or friend be looked after in the best possible way. Confidence in our care system is one of the marks of a truly secure and civilised society.

I will take an intervention.

Shona Robison (Scottish National Party, Dundee East)

It is about 10 minutes late.

Does Jamie McGrigor acknowledge that many local authorities, such as the City of Edinburgh Council, are looking closely at their care-at-home services? If they pay £21 an hour for their in-house services compared to £14 an hour for external services, for example, they are trying to work out what the added value is for the £21 an hour. The solution—I think this is the way those authorities are going—is that in-house care would be focused on more complex care, such as for people with dementia, for which the staff have a higher level of training, rather than some of the more routine tasks that other contracts may cover. Is that not a good way to proceed?

Alex Fergusson (None, Galloway and Upper Nithsdale)

You should close shortly, Mr McGrigor.

Jamie McGrigor (Conservative, Highlands and Islands)

Of course that is a good way to proceed, but we must prove that the local authorities get extra value for the extra money that they spend. That is the point. At the moment, there is nothing to show that.

Representatives of the independent care sector have also asked me to raise the issue of bed blocking.

Alex Fergusson (None, Galloway and Upper Nithsdale)

I am sorry, Mr McGrigor, but you must be very brief. Your time was up when you took the intervention.

Jamie McGrigor (Conservative, Highlands and Islands)

Okay.

Hospitals complained to me in 2007 about bed blocking. Why is it still a problem? The Scottish Government should act—

Alex Fergusson (None, Galloway and Upper Nithsdale)

Mr McGrigor.

Jamie McGrigor (Conservative, Highlands and Islands)

All right, Presiding Officer. Bed blocking is still a scandal.

Alex Fergusson (None, Galloway and Upper Nithsdale)

It is fortunate for all of us that we have a little time in hand.

Rob Gibson (Scottish National Party, Highlands and Islands)

How can I follow that?

The legacy of ill health and hard lives is partly why we have had care homes of the sort that we have had in the past. The idea of a differentiated service is one whose time has come, and when it comes to the ways in which it is applied across the country, there must be a mixture of providers. I represent small communities in areas of the Highlands and Islands in which there is great pressure on the public authorities to provide that care—it is noticeable that people can run private sector care homes only where there are large numbers of people to be their clients. However, let us put that to one side and recognise the important role of the local authorities in the provision of care.

In the Highland Council area, there has been a long-running saga about whether the existing care homes should be modernised. For various reasons, some of the buildings are no longer fit for purpose. However, it is worrying to see that the way in which the council has gone about doing that has called into question the ability of the council-run care homes to deal with key issues that the private sector is often unable to cope with. For example, the council-owned care homes have been well geared up to provide respite care.

One such care home, Duthac house, which is in Jamie Stone’s home town, has a section that was built in the 1980s and which has been given very nearly top marks by the care commission. If it were run properly and properly maintained, Duthac house would be able to cope with the general run of older people during the next four or five years, which will be a period of austerity. However, the Lib Dem-Labour led council has wasted quite a lot of money on trying to modernise: it has spent £2 million on plans for that, rather than on maintenance. The care commission has criticised some of the equipment, the kitchens and other areas of the care home. I wonder why that money could not have been spent on looking after the existing facilities in these rough, tough times.

I return to the question of disparity. The figures that Sandra White quoted, for which 2006 was the final year, are not completely up to date, but show a clear trend. The disparity in the figures for 2004-05 shows that that was the point at which the local authority’s expenditure increase was much greater than the expenditure increase—or, indeed, the costs—in the independent sector. In 2006, the average weekly cost of a place in a Highland Council care home was £612, whereas the cost of a place in the independent sector was £442—and we know that the disparity has since grown. We must ask ourselves what was going on at that time in the council-owned care homes that caused such an increase in costs. Were the extra costs due to the provision of pensions, better training and the higher quality of the staff in those care homes, compared with others? In private care homes not far from Tain, there are very poor standards that must be improved rapidly. Dingwall, in particular, has been in the news in our area. It bothers me that such examples seem to crop up again and again.

With the £70 million in the pooled budgets for service redesign and a shift in the balance of care, we must try to bring into play the parts of the health service that enable people to lead more healthy lives, just as much as provision for older people. That is worth considering as part of the debate.

Karen Gillon (Labour, Clydesdale)

I very much welcome the opportunity to participate in the debate this morning. As other members do, I recognise the complex picture of care and support that is available to older people throughout Scotland. Each of us will be aware of the wide variety of ways in which older people are supported.

Only last week, I was out with the Women’s Royal Voluntary Service in my constituency. The WRVS provides volunteer drivers to help older people to get about and take part in various activities. Last week, they were swimming and using the local gym at Coalburn. The service allows them to get out and about and to stay active. Another project that supports volunteering enables older people to go into schools to support children who may not have grandparents. They provide role models for the children and it enables the older people themselves to stay active.

The care at home that members have talked about is what many older people want; they want to be able to stay in their own homes. However, it is difficult for many local authorities to provide such a service when Tesco can offer potential carers better wages and better hours. It will be increasingly difficult for councils to compete with such employers when one can work 16 hours a week at Tesco, between 4 and 8, rather than work for two hours in the morning and two hours at night. The shifts at Tesco may be easier for someone who has a family to manage. It is, therefore, not always easy for local authorities to provide the care that is needed in rural communities, and it will become more and more difficult for them to find the staff.

Also, staff who have been trained and who have been in post for a few months or a few years sometimes get another job offer and move on. The council then has to go through that cycle again, which is particularly difficult in rural areas. Finding staff is becoming increasingly difficult for both the local authority sector and the private sector, and it will become a greater challenge as more people look for that kind of care. I acknowledge, too, the important role that cottage hospitals play in my constituency.

I represent a number of care homes that are run by the local authority or are in the private sector, and I very much welcome the invaluable role that they play. The decision to move into a care home is often not an easy one. It is often made after a long period of illness, either when the person has been in hospital or when they live at home but have come to the realisation that they cannot stay in their own home any longer. It can be a difficult decision to face.

Both the motion and the amendment talk about

“value for money ... coupled with continuing high standards of care.”

I do not have any difficulty with that. However, that is about best value, and the key to delivering best value in the sector is having well-trained, highly motivated and fairly paid staff. Of central importance is the whole health care team.

Today, we have seen the two faces of the Tory party. Mary Scanlon made a measured speech in which she talked about the whole range of issues. We also saw the real face of Jamie McGrigor, who talked about local authorities paying people too much. My mother, who worked in the private sector, got a pay rise only when the national minimum wage was introduced. That is wrong. I will not apologise for people who clean or do laundry in the private or public sectors being paid a proper wage. The reality is that, if we do not have cleaners doing a proper job, we will have infection in our hospitals, our care homes and elsewhere. It is right that they be properly paid for the job that they do.

Jamie McGrigor (Conservative, Highlands and Islands)

Will the member take an intervention?

Karen Gillon (Labour, Clydesdale)

I do not have time. I am sorry.

We should have catering staff providing people with well-balanced meals that are appropriate for their conditions. We should have care staff providing people with motivational programmes of activities, and we should have properly motivated nursing staff who are well trained and highly skilled. Yes, I will mention the level playing field, but I will not talk about the playing field being levelled at the expense of staff and their wages or terms and conditions. If we are going to do anything, we must do it fairly, across the board and in a way that treats everybody as equal citizens, whoever they are and wherever they come from. That includes the staff, whatever grade they are on and wherever they work.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

I compliment Mary Scanlon on lodging the motion, and on her contribution. She painted an accurate picture of the changing demographics and how we should plan, and she pointed out the variation in care standards and disparity in charging. As my colleague Ross Finnie said, facts are chiels that winna ding and those are solid facts that we have to look at to see what is happening. What Mary Scanlon said about support for unpaid carers was excellent and, as she also said, there are great opportunities to be realised from telehealth.

In her speech, the minister talked in detail about the independent sector, and acknowledged its contribution, which is important. Jackie Baillie mentioned a national care service, which is interesting to us all. Perhaps the minister will return to that idea in her summing up.

My colleague, Ross Finnie, talked about what I would describe as an holistic view of care, and about taking care for the elderly out of its silo. Opportunities could be realised in that area, and I will return to that topic shortly.

I was most interested to hear Helen Eadie’s ringing endorsement of what is happening in her constituency. I venture to suggest that it will be some time before she needs to be looking to the sector for her own care.

David McLetchie (Conservative, Edinburgh Pentlands)

Oh, you sook!

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

No—I am not a sook.

I return to Rob Gibson’s contribution, but not to take him up on what he said about Duthac house in my home town, which is a problem, although there are reasons for that. It was built in the early 19th century as Tain royal academy, and that was where I went to school. [Laughter.]

Ross Finnie (Liberal Democrat, West of Scotland)

That explains a lot.

Jamie Stone (Liberal Democrat, Caithness, Sutherland and Easter Ross)

I pay no attention to sedentary interventions and comments from the member sitting on my right.

The design of a 19th century school is completely inappropriate for a care home for the elderly. That is true of care homes the length and breadth of the Highlands in the public and private sectors. Some private sector care homes find the design of the buildings in which they operate very difficult indeed, and the alterations that the care commission requires, such as en suite bathrooms and so on, can prove to be too expensive within a Victorian or older building.

I was glad to hear Karen Gillon talk about the supply of carers, and I think that she was the first member in the debate to make that point. That is crucial, and we see the problem in all our constituencies. Where are the carers to come from? It is proving to be increasingly difficult to recruit and motivate people. Karen Gillon was entirely correct to flag up the point. Part of the answer is to recognise the contribution that such people make.

Mary Scanlon talked about care home provision in remote areas such as my constituency, which is a seriously important issue. Elderly people who hail from remote and close-knit communities wish to spend their later years amid the sounds and scenery that they know and love, but that is not easy to achieve, as Jackie Baillie and others said. However, by bolting on day and respite care, as Mary Scanlon suggested, economies of scale could be realised that would make local care home provision more attainable. Furthermore, by co-ordinating local services as varied as social work, the NHS and private volunteer-based care organisations, we could extend achievable economies of scale that could make local care homes more possible.

The bottom line, as far as I am concerned, and representing the constituency that I do, is that local delivery is a goal that all agencies, including national agencies and local government, should strive for. I am most interested to see whether the minister has something to say about that. If she has not, I look forward to talking about it after the debate.

Richard Simpson (Labour, Mid Scotland and Fife)

I will not go into the demographics because they are very clear. There will by 2016 be a rise of 23,000 people who require care. The only thing that I take issue with in the programme outline is the fact that it begins by saying that Scots are enjoying better health; they are not. They are enjoying longer life, but not better health.

At one time, I ran two care homes in England on behalf of a Scottish merchant bank, so I have experience of the problems of cost differentials and the care commission requiring adaptation of buildings. One home was excellent, but it was in an old building and the adaptations that the care commission required threatened its viability.

The Scottish Commission for the Regulation of Care is one of the best things that Parliament has created. It is driving up standards and, therefore, costs for the independent sector, but that is entirely appropriate. The debate is about costs, and in the social sector, they are approximately £4.5 billion, of which £1.4 billion is in the hospital sector. The debate is primarily about the variation in costs and whether local authority costs, when they are higher than those in the independent sector, add value, and it is about whether there are other reasons for those costs being higher. Mary Scanlon referred to remote and rural areas, where smaller homes can have higher costs.

Training provision with local authorities is statutory, and it is growing in the independent sector. The public sector provides occupational pensions, with contributions of 15 per cent to 18 per cent from the local authority, whereas the private sector sometimes does not provide pensions at all, although it will be required to do so in about 18 months.

Helen Eadie and Karen Gillon referred to pay levels, which are very important. The minimum wage is being paid in parts of the independent sector. Some of the differentials are accounted for and understandable, but Parliament’s job should be to drive up the minimum wage that is being paid in some places to equalise them with the wages that are paid in other areas.

I turn to delayed discharges, which were raised by Jamie McGrigor and Helen Eadie. In July 2010, we were back up to 62 delayed discharges. We are all agreed that the target was zero discharges by March 2008, and we have achieved that since 2008. Each year, we achieve zero discharges by March, but as the year progresses and we enter the worst time of the year for the hospital sector, the number of delayed discharges increases. In the July 2010 survey, the number of delayed discharges had increased to 708 from 634 in July of the previous year. Those delayed discharges are predominantly within six weeks.

When there are 5,000 empty beds, and 17,000 beds in the hospital sector are being occupied by people whose discharges have been delayed, we have to wonder what we are doing, especially in a period of austerity. The median time for delayed discharges has risen from 19 to 21 days, and the mean time is 24 days. If we could clear some of those hospital beds, we could reduce the £1.4 billion cost and provide better wages for those who work in the public sector.

Care must be all about partnership. Our care sector, whether it be private, independent, or local authority, must provide step-up and step-down care, palliative care, respite care, and enhanced care of the sort that Jamie McGrigor mentioned. The nursing homes that I ran did not have contracts with the local authority but with a hospital, in order to take people out of hospital quickly and provide them with enhanced care, which the nurses in the sector enjoyed providing. We must be able to share the risks, so that there are agreed levels of occupancy, and we do not have all those empty beds. We need joint commissioning.

We also need joint inspection. It is a disgrace that the local authority inspects a home on one day and the care commission inspects it a month later. I say to my Liberal colleagues that the Liberal member of the panel at the care conference in Glasgow actually tried to defend that particular piece of bureaucracy. We must get rid of it; it is a nonsense.

Karen Gillon and Jackie Baillie talked about lunch clubs, yoga classes, day care and social events. They should all be being provided across the sector, and it should not be purely a matter for the community or the care homes themselves.

I will finish by talking about the national care service. We believe that the time has come to enhance the excellent joint working that is being done in some areas by requiring that services be put together. We are not talking about creating a new superstructure at the top: we will work within the existing community health and care partnerships to enhance the excellent joint working that is already being done.

I welcome the opportunity to speak in the debate.

Shona Robison (Scottish National Party, Dundee East)

This has been a largely consensual debate, and a very useful one.

Jackie Baillie was quite right to talk about the voluntary sector and support to unpaid carers. To reassure the chamber in that regard, I say that we have made it clear that when local partnerships are discussing how they are going to spend the £70 million of new pooled budgets in their local development plans, the voluntary sector must be around the table at the very start of the discussions, to ensure that its interests are represented in those plans.

There has been a lot of talk about the integration of health and social care, which, as I have said on a number of occasions, I whole-heartedly support. Further, this chamber—following a debate on another Conservative motion, I believe—previously endorsed the principle of the integration of health and social care. However, we should think carefully about the model that we choose. I am pleased that Richard Simpson has clarified Labour’s position, because I think that it would be a mistake to set up a new bureaucracy. In this financial climate, we can ill afford to spend more money on financial bureaucracy and less on the front line. I also think that we have to think about, for example, the cost of transferring 60,000 people on to agenda for change conditions, which would come with a huge price tag. However, other models could achieve the same outcomes that people want but could do so more quickly and less bureaucratically. I am open to discussing what those models might be.

Mary Scanlon (Conservative, Highlands and Islands)

I remind the minister that Orkney has already set up a social care organisation that involves the NHS and the local authority working together. Would the minister like to consider how that model is working?

Shona Robison (Scottish National Party, Dundee East)

We are considering that model, and a number of others. Good commissioning models have been tried and tested down south, such as ones that involve the council commissioning the health service to provide adult social care. All that I am saying is that we should think carefully about which model best serves the needs of Scotland.

Ross Finnie—actually, it might not have been him; I think that it was Helen Eadie—

Members: Aw!

Ross Finnie made a number of good points, I have to say.

Sandra White talked about the other uses of the care home sector, such as respite and intermediate care. She was right to point out that the issue is not just permanent residential places; there are many other important uses.

Helen Eadie and Richard Simpson, as well as others, talked about delayed discharge. That is an important issue, and the Administration has given it some serious attention and has made it a priority. I point out to Richard Simpson that the previous Administration set the zero target but never achieved it—not once. We have achieved the zero target at the last three April census points. I accept, however, that there have been in-year challenges in certain areas, and I will be the first to say to those partnerships—

Richard Simpson (Labour, Mid Scotland and Fife)

The minister will remember that the situation that we started with in 2001 was one in which there were 2,000 blocked beds of more than six weeks. We set a target of zero blocked beds by 2008, which the current Administration achieved, and I give it plaudits for that. However, the Administration set a new policy that the figure would remain at zero, and it has not succeeded in that regard. It was the current Administration that set that policy, not us.

Shona Robison (Scottish National Party, Dundee East)

When we took over, 650 people in blocked beds were over the six-week limit. We have dealt with that. However, we must sustain it. Richard Simpson is right to point out that some partnerships face challenges. I assure members that I have made it clear to those partnerships that they need to get back on track. We have made it clear that the pooled budgets have to be used to redesign services to make that sustainable. That will be one of the top priorities for the use of the pooled budgets.

Rob Gibson made one of the most important points in the debate when he talked about unlocking some of the resources that are caught up in providing services for older people in those acute hospital beds. He is right that those resources need to be released, which is why we will ensure that the pooled budgets can be used to do that. In that way, we can release another resource that can be used to keep people safely in their homes, which is what many members have said they want to happen.

I thank everyone for their speeches, particularly Jamie Stone, who made an excellent contribution. I assure members that the contributions that have been made in this debate will feed into the reshaping care programme that we are taking forward.

David McLetchie (Conservative, Edinburgh Pentlands)

I, too, am grateful to all members for their thoughtful and informed contributions to the debate and for the local examples that they used to highlight some of their points. As Mary Scanlon said, this debate is not intended to be a matter of partisan political controversy; rather, it is intended to draw attention to the important issue of caring for our older citizens, having regard to the demographics of an ageing population and the demands on the public purse, of which we are all acutely aware.

In this case, we want specifically to focus on the situation of care providers in our care homes, whether the homes are run by councils, the private sector or the voluntary sector. Helpfully, the minister earlier set out some of the statistical background and talked about the fact that the overwhelming preponderance of homes are in the independent sector—three quarters of all care homes are in the private sector and 11 per cent are in the voluntary sector, compared with the 14 per cent of homes that are run by councils. In total, those 943 homes provide 39,000 places across Scotland. However, the number of homes has declined by more than 11 per cent over the past 10 years. For our older people who require to be looked after in a care home—notwithstanding our efforts to ensure that people can be looked after in their own homes, through care packages—the key questions to be addressed are how we fund and sustain care home provision and deal with some of the stark disparities and anomalies that exist today, which are neither fair nor equitable, between various categories of provider and between various residents. Those are the questions that we have posed in our motion.

As many have said, why is it that there is such a vast gulf between the amounts that are paid by councils when commissioning care from an independent sector provider, which is done in accordance with nationally determined rates and amounts to just more than £550, and the amount that is spent on care that is provided by a council in one of its own homes, which is funded on a full cost recovery basis and amounts to an average of more than £800 for every resident? Equally, someone who fully funds their own care out of their own savings may well ask why their care charges are significantly higher than those that the council pays on behalf of a fellow resident, in a neighbouring room, who is receiving exactly the same standard of care. Is one, in effect, cross-subsidising the other?

It appears that, at the recent care conference that was attended by the minister, Mary Scanlon, Sandra White, Richard Simpson and possibly other members, the matter that I have just discussed was, unsurprisingly, a hot controversy. Earlier, the minister talked about the controversy and said that we do not want to have an adversarial approach to the negotiation of rates between the providers and the councils, as that would not be helpful, and she is quite right. However, equally unhelpful would be an approach that led to care homes going out of business and the loss of places that we need for our older people, as that would serve only to put far more pressure on our national health service and on domiciliary care costs and would end up costing us more, not less, which is a point that Richard Simpson made effectively in his speech.

Some members tried to explain the disparities, but like Ross Finnie I did not find those explanations wholly convincing. Karen Gillon referred to rates of pay and made some valid points about the impact of the introduction of the minimum wage. She went so far as to suggest that somehow standards of cleanliness vary according to rates of pay and who the employer is. However, as we all know from the tragic instances that have been investigated in many hospitals throughout Scotland, it makes no difference who employs the people who clean the hospitals. We need to learn that sad lesson, rather than make assumptions that are not based on the facts and an analysis of the situation.

Karen Gillon (Labour, Clydesdale)

I was making the point that we should seek to raise rather than lower the standards of pay for members of staff, particularly those at the lowest level, and make them valued members of the health care team rather than trying to devalue their work.

David McLetchie (Conservative, Edinburgh Pentlands)

That is a fair point, but Karen Gillon also criticised the standard of work and said that there was a disparity in that regard, and I was correcting that point.

Helen Eadie (Labour, Dunfermline East)

Will the member give way?

David McLetchie (Conservative, Edinburgh Pentlands)

No. I am sorry, I must conclude.

In the consensual spirit in which the debate has been conducted—at least until the last 60 seconds—I am happy to accept on behalf of my colleagues the minister’s amendment to our motion. We look forward to the outcome of the reshaping care for older people consultation and review.

All members will have received in their mailbag this morning a copy of the Scottish Care manifesto “Making the case for care”, to which Jamie McGrigor referred. The manifesto draws attention to some of the problems in the independent care sector, which looks after 35,000 people and employs 100,000 people. We must address those problems and concerns, and ensure not only that those 100,000 people are properly paid but that they continue to work in a sector that is sustained and sustainable.

Prescription Charges

Trish Godman (Labour, West Renfrewshire)

The next item of business is a debate on motion S3M-7423, in the name of Derek Brownlee, on prescription charges.

Derek Brownlee (Conservative, South of Scotland)

The Scottish Conservatives make no apology for returning today to a subject that Parliament has debated on a number of occasions.

There is a clear issue of principle around the question of whether or not to charge some people for their prescriptions. Before I turn to that issue, which divides the Parliament, I will outline some areas in which I think we are united.

Although the Treasury and the Scottish Government use the gross domestic product deflator of 1.9 per cent as an inflation estimate, inflation in health care costs has traditionally been assumed to run ahead of general price inflation. The combination of an ageing population, medical advances and rising public expectations means that since the creation of the national health service in 1948, no Government of any party has managed to limit health-care costs to inflation.

“Of course, with the costs of healthcare rising fast, it would be wrong to say that the NHS doesn’t face any financial challenges. It does.”

Those were Nicola Sturgeon’s words when she addressed the Scottish National Party conference last month. She was not the only one to post a bleak warning on the NHS in October. Jackie Baillie told her conference:

“As the price of drugs rises and demand for services grows from an ageing population it will mean deep cuts in every hospital and every doctors surgery the length and breadth of Britain.”

I had thought, therefore, that the opening line of my motion, which merely asks Parliament to note the financial pressures on the NHS, would provide common ground. Equally, I thought that we might have found common ground on the figures from the independent budget review that the SNP Government established—although admittedly because we told it to do so. I hope that neither Labour nor the SNP disputes the £25 million figure. If they do not dispute it, nor the funding pressures on the NHS, why do the Labour and SNP amendments seek to remove any reference to funding pressures on the health service or the cost of abolishing prescription charges?

I return to Jackie Baillie’s doom-laden speech in Oban, which may well have been one of the lighter moments of the Labour Party conference. She said:

“the SNP are ... Cutting jobs and cutting nurses ... Well Labour won’t stand for it. We will protect our NHS.”

She is right. Labour will not stand for it—it will not stand up for the NHS and it will not stand up to the SNP. Labour members will carp and criticise, and then they will vote with Nicola Sturgeon anyway.

I wonder what has happened to the brave soul who pronounced on the issue of abolishing prescription charges only a month ago that

“At a time when Nicola Sturgeon is cutting 4,000 health workers in Scotland including 1,500 nurses, we need to seriously consider if this is the right priority at this time.”

That was, of course, one Jackie Baillie. She has obviously concluded that it is the right priority at this time to cut 1,500 nurses, because by not abolishing prescription charges she could fund more than 1,000 extra nursing staff. However, that would mean that she would not be able to complain about the SNP cutting them, and it would mean taking a position on prescription charges that might be unpopular—even if it is the same position that Labour supported in the dark days when it was in power. It would mean standing up for the NHS, and that would never do for the only party ever to have cut the NHS.

Our argument is simple: to take the revenue that is raised from prescription charges away from the NHS is the wrong choice. It is a cut that is imposed not by the coalition in London, but by the coalition in Edinburgh. Labour and the SNP, the so-called left-wing parties, are taking money from the NHS and putting it into the pockets of people who can afford to pay.

If the issue is, as the cabinet secretary said in the debate in January, simply that some people are just over the income threshold and not in an exempt group, there is an answer: we could raise the threshold. If the central issue is the principle that there should never be charges in the NHS, we will presumably hear the SNP and the Labour Party discussing the abolition of charges for dental and optical treatment. The truth is that the issue is about one principle only: the SNP is trying to get re-elected, and the Labour Party is helping it.

I turn to the concerns that the cabinet secretary raises in her amendment. Abolishing prescription charges will indeed benefit those who currently pay for them, at least to the extent that they save the money that they would otherwise pay for prescriptions. However, that money comes from elsewhere in the NHS, and that has consequences for the poor and the sick. We never hear about those consequences, but they are consequences nonetheless. If 1,000 nurses lose their jobs to pay for the abolition of prescription charges, does that help the poor or the sick? Abolishing prescription charges takes money from the NHS, and that is what the Government is intent on doing, with Labour Party support.

It is ironic. The Labour Party has spent the past three years condemning the SNP for breaking manifesto promises, and has been particularly vociferous in attacking the SNP for breaking those pledges that Labour did not support. It now appears, however, that Labour is prepared to vote with the SNP to deliver a manifesto promise with which, apparently, it does not even agree. The SNP has been lucky in the incompetence of its main opposition, but Labour’s failure to oppose the SNP when it is wrong will hurt the poor, the sick and the NHS.

That is why the Conservatives have brought this debate to the chamber today. We will oppose the plans because we want to stand up for the NHS, even if Labour and the SNP will not. All those members who are intent on abolishing prescription charges must tell us where that money will come from and which services will be cut, which otherwise would not happen. They must explain what the consequences will be for the poor, the sick and the national health service.

I move,

That the Parliament notes the financial pressures on the NHS and that the Independent Budget Review established by the Scottish Government has estimated that the full abolition of prescription charges would remove a further £25 million of income each year from the NHS and accordingly calls on the Scottish Government to reconsider its position on prescription charges.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I welcome the debate, although it was only in January that the Tories last brought the debate to the chamber and failed to persuade Parliament of their position.

This morning, I have the opportunity once more to set out the Government’s commitment to abolishing prescription charges and to remind members why that policy is so important to people throughout Scotland.

I believe that all of us in the chamber want to create a healthier country and tackle the health inequalities that blight Scotland. We want to support people to live longer and healthier lives, and to ensure that people have timely access to the health care that they need. Removing prescription charges is an important part of delivering all that.

The reality—whether the Tories choose to see it or not—is that prescription charges are a barrier to health for many people throughout the country. They can prevent patients from collecting their medication, and they even deter some people from visiting the doctor in the first place. I have spoken to patients who have found themselves in that position. If we believe in a fair and equitable society, that situation is simply not tolerable. The policy will ensure that patients with long-term conditions are not prevented from collecting their medicines. We are now only one step away from removing the barrier for all patients, without the invidious exercise of weighing up which of them are more deserving and more worthy than others.

We know from the information that we have on prescription prepayment certificates that patients with long-term conditions are benefiting the most from the policy. We brought the cost of PPCs down more quickly than the cost of single prescriptions. As a result, sales of PPCs are up by 165 per cent. That benefits people who need multiple medications.

I know that there are people, led by the Tories, who say that we should not abolish prescription charges for all and that we should simply extend the list of exempt conditions, but that approach is not simple in reality. The Parliament has previously recognised that it would be fraught with difficulty. When we were considering our approach in the early days of the current session of Parliament, many concerns were expressed to us about the difficulty and delay that would be associated with defining a list that was comprehensive and complete and—more important—which avoided simply creating new anomalies and a new set of invidious choices. That reality has been recognised not just in Scotland but in Wales and Northern Ireland.

In any case, abolishing prescription charges only for people with long-term conditions would also ignore the needs of people on low incomes who are not exempt. Many patients who are not eligible for exemption struggle to pay prescription charges. Again, I have spoken to many people in that position. The Tories suggest time and again that only those who can afford to pay are charged for prescriptions, but that is not the case.

Derek Brownlee (Conservative, South of Scotland)

Will the minister give way?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I will give way in a moment.

The Tories need to recognise that 600,000 adults living in Scotland right now earn around £16,000 a year and they struggle to pay for medication that they have been prescribed. However, it is perhaps not surprising that the Tories, yet again, seem oblivious to the reality of poverty. I also think—and on this point I will take an intervention—that it speaks volumes that it was the Tory party’s finance spokesperson and not its health spokesperson who moved the motion. The health spokesperson is not even in the chamber, which perhaps tells us what his view is.

Derek Brownlee (Conservative, South of Scotland)

The health spokesman is at a funeral, for the cabinet secretary’s information.

The point that I raised in my remarks is simply this: if there is an issue about people on low incomes, could it not be addressed by raising the threshold, rather than simply abolishing prescription charges for everyone, including people on £50,000 a year? Surely the rate of non-collection of prescriptions by people on £50,000 a year is negligible.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Before I respond to that point, I apologise to Murdo Fraser. I was not aware of his personal circumstances today.

I think that Derek Brownlee makes the point that I am trying to make. We could extend the list of people who are exempt, to include those with long-term conditions, or we could raise the threshold, but in doing so we would simply create a new host of anomalies. The United Kingdom British Medical Association said recently:

“changes to the system short of abolition would still be unfair on the reduced number of patients who do not qualify for exemption ... We really have to question whether the small financial benefit of retaining charges outweighs the many disadvantages of taxing the sick.”

That sums it up exceptionally well.

It has been suggested again today that, given that budgets are tight—and they are—we should spend the money in different ways. That is the very choice that we want to remove from patients, whose own budgets are ever tighter. As we know, the pressures on family budgets are increasing, principally because of some of the decisions that the UK Tory Government is taking. Prescription charges are one pressure that we do not want to impose on the tight budgets of families throughout Scotland.

For all those reasons, total abolition is not just right in principle but the fairest, most cost-effective and most sensible approach to take. That is why we remain committed to it. It is also important to point out that Scotland is not unique. We are not somehow in a stand-alone position on the issue. Wales and Northern Ireland are ahead of us. They have already abolished prescription charges, and I think that it is right that in April we will come into line with them. I hope that, today, the Parliament will reject the latest Tory attempt to play off one part of health funding against another. I hope that the Parliament will unite in supporting free health care for all.

I move amendment S3M-7423.1, to leave out from “notes” to end and insert:

“recognises that the abolition of prescription charges will benefit all those patients with long-term conditions and the 600,000 people on low incomes who are not entitled to exemption and further recognises that total abolition is in the best tradition of the NHS and that poor people and sick people should not be made to pay the cost of the economic and financial situation that Scotland faces.”

Jackie Baillie (Labour, Dumbarton)

I welcome the opportunity to debate prescription charges again. We last debated the issue in January, on the basis of a Tory motion. Not content with the response then, the Tories are back again today. They are nothing if not persistent.

I have to say that Derek Brownlee is at best confused and at worst deluded. Of course we recognise that there is a tough financial settlement. It is so tough that we have the smallest increase in the health budget since the creation of the health service way back in 1948, and it has been done by a Tory Government. We therefore need to ask what our priorities are and what can be afforded. However, I am flattered that Derek Brownlee listened so intently to all my conference speeches, and I look forward to his learning from them.

In January, we supported the introduction of free prescriptions, and today Labour members will support the ending of prescription charges. We previously favoured an incremental approach that would have meant extending free prescriptions to those with long-term chronic conditions and those on a range of top-up benefits as a result of low incomes. At present, 92 per cent of all prescriptions in Scotland are issued free. Wide categories of people are already eligible, including under-18s, the unemployed and pregnant women. However, there is an issue, because a substantial proportion of the remaining 8 per cent have chronic conditions and they might require substantial amounts of medication that some might struggle to afford. It is therefore not accurate to say that only people who can afford to pay for prescriptions are paying for them.

I repeat something that the cabinet secretary said, because it is valid: something like 600,000 adults in families in Scotland earn less than £16,000 a year, but that puts them slightly over the exemption level, so there are low-income families who are not exempt from paying prescription charges.

David McLetchie (Conservative, Edinburgh Pentlands)

Will Jackie Baillie explain why it is that, in the eight years of the Labour and Liberal Democrat Executive, when budgets were rising, Labour never once brought a proposition to reduce and abolish prescription charges, yet at a time when budgets, by her acknowledgement, are static or falling, all of a sudden Labour is in favour of free prescriptions? That makes no sense whatsoever.

Jackie Baillie (Labour, Dumbarton)

David McLetchie’s attempt to rewrite history is inaccurate. We did bring forward proposals to reduce prescriptions. If he had been listening—which is something that the Tories would do well to do—he would know that I described that incremental approach.

We could spend a lot of time today—as would suit David McLetchie—rehearsing old arguments, but that would not be valid. The cabinet secretary and the Scottish Government have reached a judgment about the value and affordability of prescription charges, and it is appropriate to question that policy robustly to ensure that it has been thought through. When we last debated the issue, the total recurring cost was set at £57 million from April 2011. I ask the cabinet secretary whether that figure remains accurate and whether it is in the budget.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Yes.

Jackie Baillie (Labour, Dumbarton)

That is helpful. Given that we witnessed a one-year election budget yesterday, can the cabinet secretary provide assurances that the policy is sustainable? She knows the figures for the next three years. Will she tell us what has been set aside for 2012-13 and 2013-14 and whether percentage growth has been allowed for? There is a possibility of a general increase in demand, which needs to be factored in. That would assure not just the Parliament but the country that the policy is properly costed and sustainable beyond the current year.

Derek Brownlee (Conservative, South of Scotland)

Will the member take an intervention?

Jackie Baillie (Labour, Dumbarton)

I do not have time.

Trish Godman (Labour, West Renfrewshire)

You have time to take an intervention if you wish.

Jackie Baillie (Labour, Dumbarton)

Do I? Fine. I am always delighted.

Derek Brownlee (Conservative, South of Scotland)

Is Jackie Baillie telling us that Labour members are going to vote for free prescriptions today but they have no idea whether the policy is sustainable?

Jackie Baillie (Labour, Dumbarton)

I do not know where Derek Brownlee was yesterday, but the problem is that the Parliament does not know the budgets for future years, in terms of the allocation of funds. On the basis of his question, he will not be voting for anything at all. We need to question the Government and ask it to come forward with those figures, so that the Parliament and the country can be reassured about the sustainability of the policy. I think that it is appropriate to ask for those figures.

Members will know that we encouraged the Scottish Government to introduce free prescriptions for cancer patients in Scotland, in line with the policy in England and Wales. Let us be clear: we are not asking for that to be done instead of addressing prescription charges for other chronic conditions, and it is wrong to suggest so.

The SNP’s manifesto pledge way back in 2007 was to

“immediately abolish prescription charges for people with chronic health conditions, people with cancer, and people in full time education or training.”

We agreed with the approach of prioritising people with long-term illnesses by widening the conditions that are eligible for free prescriptions. However, while I welcome the ending of all charges and have sympathy with the cabinet secretary’s reasoning, it remains the case that while charges for cancer patients were scrapped by the Labour UK Government in April 2009, cancer patients in Scotland were denied that benefit. It was absolutely right to abolish charges for cancer patients. It has transformed the lives of about 150,000 people, who have each benefited by saving up to £100 a year. We would have liked that to apply to Scotland, and it is a matter of regret that it does not.

Voting for the Tory motion will put in jeopardy free prescriptions not just for people with chronic illnesses but for all. We on this side of the chamber will not do that, because we support the abolition of prescription charges in Scotland.

I move amendment S3M-7423.1.1, to insert at end:

“, but regrets that free prescriptions for cancer patients in Scotland were not implemented by April 2009 in line with England.”

Ross Finnie (Liberal Democrat, West of Scotland)

There has been a tinge of unreality about the debate so far. It is almost as if we had huge amounts of as yet undreamed of funding available to us, there was no funding crisis, there were no cuts nor any prospect of cuts to our health service and everything was going on as before, so this is a rather narrow and silly debate.

Liberal Democrats began to wonder whether abolishing prescription charges was the right priority only because of the change in financial circumstances. That is why last year we opposed the move to reduce further the level of prescription charges. Today, strangely, we are told that prescription charges are the only threat to those who are sick and those who have long-term conditions. That is not the world in which I live. There are already serious threats to the condition of many people because—this might be news to some—health boards are making cuts. Perhaps they should not be—perhaps they are making a mistake—but they are making cuts. They are reconfiguring services. They use odd phraseology with nurses: “You will find another job but not necessarily 40 miles from where you live. You will be reconfigured and your grade 5 status will not be required.” That is affecting not only nurses, but patients. Things are also changing for those in our communities, particularly poorer people for whom health care, general practice and other health provision in the community is especially important. Services are being reduced and that is affecting the health of those people.

Another issue is the change in the allocation of specialist nurses. The large number of specialist nurses make a huge contribution to the efficacy of drugs prescribed for patients. It is nonsense to suggest that there is no connection between the reduction in the number of specialist nurses and the efficacy of our drug and prescription policy. As far as Liberal Democrats are concerned, we are not looking at a blank sheet of paper. We are looking at the reality, which is that we have to make choices and we have to be sure about those choices. The decisions that I have talked about are being made before this year’s allocations to health boards are taken into account. Liberal Democrats are very concerned that the claims that there may be adequate provision in the funding of our health service do not stand up to close examination.

We were interested in the proposal by the independent budget review panel that it was right and proper for us to look at the £25 million that would be used for the final step of abolishing prescription charges. In the present financial climate, we found that very difficult, indeed. There was some concern that linking prescription charges with the cost of providing drugs might stray outwith the competence of the motion, and I am grateful for your indulgence in the matter, Presiding Officer, because the independent budget review panel drew particular attention to the level of prescription charges and the fact that the total drugs bill is more than £1 billion. The two are inextricably linked in any consideration of ways in which to make more money available within the health service.

Richard Simpson (Labour, Mid Scotland and Fife)

It looks like the Liberal Democrat position is now changing. To quote Ross Finnie, who seemed to be fond of quoting me the other day:

“The Liberal Democrats would support proposals to give protection to those who have long-term conditions.”—[Official Report, 21 January 2010; c 22953.]

The overwhelming majority of the 8 per cent who pay prescription charges have long-term conditions.

Ross Finnie (Liberal Democrat, West of Scotland)

I am not sure of the date of that quote—

Richard Simpson (Labour, Mid Scotland and Fife)

It was January.

Ross Finnie (Liberal Democrat, West of Scotland)

I think that it has been quoted before and I am grateful for that second reading.

People with long-term conditions are the very people who have nurses assisting them with their drugs. Remove that assistance and we imperil how their health care is dealt with. These are not easy, choose one as against another, decisions. I know of many patients—Dr Simpson ought to know of many, too—for whom removing those nurses will not help them one jot to benefit from their prescribed drugs.

I was moving on to the issue—

Alasdair Morgan (Scottish National Party, South of Scotland)

The member should perhaps move on to sum up.

Ross Finnie (Liberal Democrat, West of Scotland)

That is exactly what I am doing, Presiding Officer.

We need to make savings on that £1 billion drugs bill if we are to preserve our position in relation to prescription charging. A 2.5 per cent reduction in that bill is imperative in the current financial circumstances. It is also a way of tackling misuse and abuse of the system. I know that the Government has addressed that, but we need to go further.

I move amendment S3M-7423.2 to insert at end:

“, prescribing practice, medicines management, adverse reactions to medicine and procurement and purchasing of drugs.”

Alasdair Morgan (Scottish National Party, South of Scotland)

We come to the open debate. Members have up to five minutes each.

Jackson Carlaw (Conservative, West of Scotland)

I acknowledge Nicola Sturgeon’s belligerent commitment to the principle of the abolition of prescription charges. She is misguided, but with the virtue of being consistently so. I know that she has been looking forward to the debate all year, probably with as much fervour as she did to her wedding in the summer, because it gives her the opportunity to dust down her Govan soapbox and paint the Conservative position yet again as being that of vampires rising from the grave to suck the last living blood out of the sick.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

While I welcome Jackson Carlaw back to the health debates, for the avoidance of doubt I wonder whether he will accept that I made no use whatsoever of my Govan soapbox during my wedding in the summer.

Jackson Carlaw (Conservative, West of Scotland)

Sadly, the invitation to witness the proceedings not having arrived, I can only take the cabinet secretary’s word for it.

I counter the cabinet secretary’s earlier argument by pointing out that the Scottish Conservatives supported the reduction of the prescription charge in 2008 from £6.85 to £5. We supported the reduction in cost of the prepayment certificate, which at that point was £98.70. We did so for a couple of reasons. First, we accepted that there had been a significant increase in the overall contribution to the health service through the rise in national health insurance contributions from the public. Secondly, we accepted that the accelerated rate of increase in prescription charges had got to a point at which a multiple prescription cost for many people was a considerable financial burden. We supported—and our manifesto committed us to supporting—a reduction in the costs to those with long-term conditions.

I want to challenge a point that the cabinet secretary made and explain the argument in slightly more detail. She said that the Conservative position is that those who can afford to pay for prescriptions should do so and that they are the people who currently pay for prescriptions. I do not believe that that is the case: it is a much more complicated position than that.

The basis on which people currently pay for prescriptions is nothing to do with whether they can afford to pay. My mother is a higher rate taxpayer. She is nearly 80 years old. She could well afford to pay for her prescriptions, but because she is a pensioner she does not. There are millionaires who could well afford to pay for prescriptions for their children, but because the prescriptions are for children they do not.

Jackie Baillie made the not unreasonable point that there are people among the 600,000 who still pay prescription charges who do not have masses of money to dispose of and for whom paying a prescription charge is a considerable matter. That is why we supported the original reduction in the overall prescription charge. In an ideal world in which there was no financial consequence facing the NHS—another issue that I will come to—it could be argued that abolishing prescription charges would be a priority for spending, but we are not in that position.

The cabinet secretary has never addressed an issue that has come up in many of the debates. It is a point that I will illustrate with an experience relating to my wife—who said she hoped that I would at least be discreet enough not to say what her prescription was for. I went along to the pharmacy to pick up a repeat prescription on her behalf. The pharmacist said to me, “Mr Carlaw, the cost of this medicine as a retail item is cheaper than what you pay for the prescription. It would be cheaper for you to buy it and tear up the prescription than to pay for the prescription.” That is what I did.

Between the ages of 14 and 40, I was a long-term migraine sufferer. I picked up across-the-counter medicine for migraine—Migraleve—which now costs between £7 and £10, depending on whether someone buys 16 or 32 tablets. I presume that, when I suffered from migraine, I was sick as in the terms of the cabinet secretary’s amendment. Once we have abolished prescription charges, what will be the incentive for people not to go to the doctor for a prescription so that they can get, free of charge, over-the-counter medicines that they currently routinely pay for? What is the cost to the NHS and to GP practices of individuals going to the doctor for a prescription for an over-the-counter medicine? To some extent, that practice has been experienced in Wales and Northern Ireland, and if the health secretary is determined to proceed she owes us at least an explanation of how she will deal with that point.

In the final analysis, I accept that, with all her customary grace, charm and intelligence, the cabinet secretary has been committed to the policy throughout. It was in her manifesto, the SNP supported it, and it intends to deliver it. That is the complete opposite to the position of the party that seeks to be in government next May. There is no principle in the Labour position; we have simply seen a politically expedient act on its part because it is frightened to stand up for what it stood for at the last election and for what Gordon Brown stood for in the rest of the United Kingdom. There is no principle underpinning Labour’s support for the cabinet secretary’s amendment, and it is a poor state of affairs to consider that it should ever be in charge of the nation’s Government if that is how it seeks to operate.

Ian McKee (Scottish National Party, Lothians)

I will say why I oppose the motion before us this morning. First, I and members of my party believe in a health service free at the point of need. Of course it has to be paid for, but we do that out of our taxes according to our means, and not according to our illness.

There are few health needs greater than the dispensing of a prescription recommended as needed by a highly trained and competent doctor, so why should we select such a prescription for a charge? Where will it end? How many more direct health charges have the Conservatives in mind? Would they charge for self-referral to physiotherapy, which is not assessed by a doctor?

David McLetchie (Conservative, Edinburgh Pentlands)

In that spirit, will the member tell us when his Government intends to abolish all the dental and optical charges on the NHS?

Ian McKee (Scottish National Party, Lothians)

It certainly is a long-term aim to do that. I know that Mr McLetchie has great confidence in the SNP Government, but it is a bit much, even for us, to expect us to undo in less than four years the damage that unionists have done in 57 years of running the health service.

Then there is the unfairness of the charges. Although there are many exemptions, I know that there are also many families for whom a prescription charge is a hefty financial burden. Who does not pay the charge? Jackson Carlaw is right: the answer includes well-paid people such as you, Presiding Officer, me, Annabel Goldie, Mary Scanlon, Nanette Milne, Jamie McGrigor, Bill Aitken, Ted Brocklebank, Richard Simpson and Ross Finnie, among others. The Conservatives argue for prescription charges, but the truth is that more than half of the Conservative group in this Parliament who are arguing for others to be charged either are now eligible for free prescriptions or soon will be. As Jackson Carlaw asked, what about the children of millionaires? Are the Conservatives now recommending charges for pensioners? If that is what they intend, they should come clean.

Derek Brownlee (Conservative, South of Scotland)

I will make it absolutely clear: we are saying that the Government should not proceed with the abolition of the prescription charges that exist; we are not suggesting that they be extended at all.

Ian McKee (Scottish National Party, Lothians)

I gather that Derek Brownlee says that in the motion, but Jackson Carlaw seemed to say that it is wrong that a lot of very rich people, including more than half of his party, do not pay prescription charges. If the Conservatives want to keep prescription charges, they will have to think of a system whereby people who earn large sums of money are not exempt from them just because of their age.

When there is a prescription charge, some people just cannot afford to have a prescription dispensed—ask any pharmacist working in a deprived area. Some critics even argue that if a prescription is not presented for dispensing it cannot be needed. Let us look at the ramifications of that argument in a little more detail.

The process of a medication being developed and prescribed is about as closely monitored as it is possible for it to be. No medicine is allowed to be used unless it meets the highest standards of safety, efficacy and affordability. Prescribers are highly trained in prescribing matters, and if treatment is prescribed inappropriately, the prescriber can be identified by the health board and counselled. Scrutiny is by expense and by comparison with peers, so that outliers can be identified individually and asked to account for an abnormal prescribing pattern. We can therefore assume that most prescriptions are given appropriately.

Nanette Milne (Conservative, North East Scotland)

Will the member give way?

Ian McKee (Scottish National Party, Lothians)

I am sorry: I need to get on.

What happens if, at the end of that sophisticated process, the prescription is not dispensed? The illness might take longer to get better; it might even get worse. The result may well be more time off work, more sickness benefits paid, more expensive treatment later on to effect a cure, or even costly hospital admission. Charging for the prescription can easily prove to be a false economy, and it makes no sense.

It also makes no sense to expect the patient to decide which medicine to take and which to refuse on the grounds of cost. If members really feel that some prescriptions are not needed, it is the prescriber who should be chased—and that happens already. What the Conservatives are proposing is as scientific as tearing up one in every 100 prescriptions and making prescribing savings that way. At least that would risk the health of all patients equally, not just those in low-income brackets.

I want finally to turn to Jackie Baillie’s amendment. I understand that she has to try to glean some comfort from the situation, but the fact is that, on analysis, absolving only cancer patients from prescription charges gives us the same problems as exempting other patients. Some people with cancer are not affected severely and have high incomes, while other people have conditions that are as debilitating as some forms of cancer. On those grounds, I support the cabinet secretary’s amendment as the one that encompasses the best for all sections of Scottish society.

Helen Eadie (Labour, Dunfermline East)

I rise to speak in support of Jackie Baillie’s amendment and all that she said.

I have a number of concerns. As the cabinet secretary said, health care should be free at the point of access for everyone. That is a founding principle of the NHS, but in Scotland today some patients are being denied any treatment whatsoever. In other words, we are seeing free prescriptions for all, but what is the price that some families have to pay? For some families and individuals, there is zero, nil, zilch treatment available if they happen to require certain NHS treatments. Two examples are infertility treatment and bariatric surgery. I would have thought that it was against the law to deny patients NHS treatment when a consultant says that the patient can be treated—

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Will the member give way?

Helen Eadie (Labour, Dunfermline East)

I will come back in a minute.

Politics is the language of priorities, and we have to examine that situation. I have a range of questions that I can write to the cabinet secretary about separately, because a lot of questions came up in my mind when I was preparing for today’s debate.

Some of Jackson Carlaw’s points were actually pertinent. When the cabinet secretary issued her first ministerial statement on the issue, on 5 December 2007, she responded to a question from Richard Simpson by saying that announcements about the minor ailments service would follow “in due course”. However, I know from speaking to pharmacists at a recent community pharmacists dinner in Edinburgh that that point has still not been addressed. If costs rise in relation to minor ailments, will that mean rationing of more expensive drugs?

It is vital that the cabinet secretary says, at long last, what is to happen to the minor ailments service. Since the introduction of the service, anyone who receives free prescriptions has been entitled to register with a pharmacist and have a prescription issued to them for minor illnesses. Although the system benefits those who are currently on free prescriptions, if it is extended to the whole population, more people will ask for prescriptions for minor illnesses.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Helen Eadie might have been absent from the chamber on all the previous occasions when I have answered that specific question, but will she accept that I have previously made it very clear that the minor ailments service will continue as it is now? The eligibility for it will continue to be the current eligibility, which is based on the prescription charge eligibility, even when prescription charges are abolished. As I have yet again answered that question, will Helen Eadie and her colleagues finally accept the point?

Helen Eadie (Labour, Dunfermline East)

It is not me who needs to accept the point; it is the community pharmacists’ representatives, with whom we have met and who say that the point is still not crystal clear to them. The cabinet secretary and her officials have a responsibility to pursue that.

I said earlier that politics is the language of priorities. How can it be right for well-off families to pay anything up to £30,000 for infertility treatment, but for some families, such as some of my constituents, to be denied completely any access to that treatment? How can it be right for the Parliament to make choices that deny treatments such as bariatric surgery and infertility services to NHS patients? We are talking about important decisions.

Earlier this year, the Western Mail, reported on the future of the Welsh Assembly Government’s flagship free prescriptions policy. It was once more called into question when it was shown that the number of items that were handed out to patients had reached an all-time high. The NHS in Wales is footing an increased bill for medicines following the abolition of prescription fees. The latest official figures show that the number of prescriptions that were issued last year hit 67.6 million items. GPs told the Western Mail that they probably see patients who would previously have bought medicines over the counter. So some of the points that Jackson Carlaw made are important.

Although the Labour Party can agree with the Government’s policy, we need to know how it can be right that millions of items will be prescribed, including Tesco own-brand ibuprofen caplets, which are priced at just 28p on the shelf, but cost the NHS £3.75 for each prescription. There are important questions. We cannot simply accept the policy without careful scrutiny and questioning. I absolutely support Jackie Baillie’s points, but I can see merit in some of the arguments that the Conservatives have made.

Christine Grahame (Scottish National Party, South of Scotland)

It will be difficult to bring something fresh to the debate, as we debated the issue in January and I am speaking late in this debate. However, I will try to bring a fresh angle.

I begin by laying it down that, as Ian McKee said, prescriptions are not free—they are paid for through general taxation, and the richer somebody is, thankfully, the more tax they pay. As I came into the chamber, I picked up a booklet from the Long Term Conditions Alliance Scotland, which has a display outside. There is an interesting section called, “Impact of the Economic Downturn on People with Long Term Conditions”. As Jackie Baillie said in the debate in January, 92 per cent of prescriptions are free and 8 per cent are charged for. Many of the people who are charged have long-term conditions. I will try to drift away from the ageing aspect and not take it personally.

About 600,000 people are not eligible for free prescriptions but have an income of less than £16,000. Several issues arise out of that. People with long-term conditions have not only the costs of multiple prescriptions, but higher transport and child care costs because of the need to access services. Interestingly, the booklet by the Long-Term Conditions Alliance states:

“Citizens’ Advice Scotland ... found that 41 per cent of their CAB debt clients listed sickness or disability as a reason for their debt. Furthermore, ‘sick or disabled’ CAB debt clients have greater financial problems and, on average ... Have six debts and owe an average of £20,588.”

So for somebody who is maybe on or just above £16,000, no account is taken of the liability that they already have for debts and other payments that must be made, which greatly reduce the income that they have to pay for prescriptions. That issue has been missed in the debate.

Against that background, it is important to consider the impact of recession on people’s health. There are all kinds of difficulties for people, such as job loss and marriage break-ups. It might be then that they need to go to their GP to access prescriptions. If they are earning above the threshold, they will have to pay for their prescriptions. As Ian McKee said, that might compound their illness and, at the end of the day, cost the NHS a great deal more.

Thresholds are fraught with difficulty. Derek Brownlee suggests raising the threshold, but to what level would he raise it? I invite him to respond.

Derek Brownlee (Conservative, South of Scotland)

The Government could consider what the appropriate level was. Yesterday, for example, the Government had no problem at all with imposing a threshold of £21,000 for its cut-off for the public sector pay freeze. If the Government can do that for one thing, why can it not do it for another?

Christine Grahame (Scottish National Party, South of Scotland)

Let us say that Derek Brownlee has suggested that £21,000 should be the threshold. So somebody who was on £21,500 could not access free prescriptions. They might have substantial debts, which would not be taken into account. Raising the threshold is not a simple matter. There are injustices with thresholds, which is why it is better not to have them at that point, but to have them at the point of taxation and to bring in general taxation to pay for the NHS. That is the way to remedy the issue and it is far more just.

Endeavouring to extend the list of exemptions for long-term conditions is also fraught with difficulty, as we well know. The BMA has examined the issue carefully. In the debate in January—I must now refer to it—I pointed out that the BMA has said:

“Moves have been made to exempt patients with cancer from prescription charges, but already this looks set to create a new set of winners and losers depending on which side of an arbitrary line you fall. If the current system is to continue to exist, then we believe that consideration of more radical proposals is needed rather than a simple extension of the list of medical exemptions.”

So that is not a solution and, for me, a threshold is not a solution.

The issue comes down to the question of why medication should be free for in-patients, when out-patients, who are taking it home, are charged. That seems unjust.

Rhoda Grant (Labour, Highlands and Islands)

Although I support the principle of free prescriptions, I, too, have one or two concerns that I want to highlight. The Labour Party in Scotland has long advocated that the Government should make prescriptions free for cancer sufferers prior to the measure being extended to the whole population. Cancer patients in England and Wales now get free prescriptions, so it is a shame that those in Scotland will have to wait until next year before they are on the same footing. Through rebalancing of the phasing process, it would have been possible to extend the measure to cancer sufferers before now.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I absolutely accept the sincerity of Rhoda Grant’s point and the suffering and anxiety that go with a cancer diagnosis, but why would it have been right to have an early exemption for cancer sufferers but not, say, for people with Parkinson’s disease? Is it not the heart of the matter that, if we start picking and choosing, all we do is create even more anomalies, which is why complete abolition is the fairest way?

Rhoda Grant (Labour, Highlands and Islands)

The evidence that we have received, certainly from cancer charities, tells us that cancer is a special case, because cancer patients tend to suffer from fuel poverty and, when they receive treatment for their disease, they have a lowered immune system, which makes them more susceptible to viruses and the like. Although I accept that people with many other conditions would benefit from having free treatment now, there is certainly a special case to be made for cancer.

The cabinet secretary said in an intervention on Helen Eadie that those who qualify for free prescriptions will continue to qualify for free treatment for minor ailments from a pharmacist. That statement means that those cancer patients who do not qualify for free medication now—as well as people with chronic illnesses who do not qualify for free prescriptions now—will not qualify for access to free minor ailments treatment through their pharmacist in the future. As I said, people who are undergoing chemotherapy have poor immune systems and are susceptible to minor ailments, as are many people with other chronic conditions. If they are to access free medicines for those minor ailments, they will need to go to their GPs to get prescriptions and that will lead to a delay in their being treated and, indeed, to a greater burden on GPs. Although I am sure that that is not the cabinet secretary’s intention, I ask her to consider amending the criteria for access to free minor ailments treatment now so that cancer patients and others with chronic diseases that lead to a predisposition to minor ailments will receive treatment free of charge.

Ross Finnie’s amendment raises a number of good points about prescribing. In yesterday’s health debate, Elaine Smith said that the prescription of thyroxine is problematic for people who require it because they need to be prescribed the same brand if they are to benefit properly. She told us that GPs and pharmacists are unaware of that and that people’s health is being compromised because they are receiving different types of treatment. That issue should be considered. We have the same problem with other generic drugs in that some people are sensitive to a small change in their drug treatment. Although we need to encourage GPs and others to use generic drugs as much as possible, it might be worth pulling together some guidance on the drugs to which people are more sensitive, so that GPs are allowed to prescribe an alternative in such cases while considering generic drugs to be the norm.

Another issue that has been raised before in the chamber, and certainly by Mary Scanlon, is the recycling of underused medicines. Back when Mary Scanlon started raising the subject, there was a problem with the idea because medicines tended to come loose in bottles and could be tampered with easily or become contaminated in some way. However, drugs are now mostly dispensed in blister packs. With a little care, it should be possible to recycle them, which would help to cut costs. Others have touched on the cost of drugs and the inflation in the cost of drug treatments. We need to try to encourage health boards to buy together and look at ways of saving on those costs in order to tackle the inflation in the cost of drug treatments and get value for money for our services.

I ask the cabinet secretary to reflect on the points that have been raised today in a genuine attempt to improve prescribing practice and help the most vulnerable in our society to benefit most from their health treatment.

Jeremy Purvis (Liberal Democrat, Tweeddale, Ettrick and Lauderdale)

I start with a point of clarification for Jackie Baillie, who referred to health spending across the United Kingdom. As there was some reference to rewriting history, I offer the fact that Alistair Darling’s plans on behalf of the Labour Party were to protect health spending in England and Wales for two years out of a four-year period, rather than for the whole period. I am sure that Jackie Baillie is aware of that, but it is worth getting it on the record.

Jackie Baillie (Labour, Dumbarton)

Rather than suggesting that what somebody planned did not come into effect, will the member address the fact that we have the lowest budget settlement ever since the creation of the NHS?

Jeremy Purvis (Liberal Democrat, Tweeddale, Ettrick and Lauderdale)

All I am saying is that, over the four years, health spending would have been lower because it would have been protected for only two years.

It is fair to look at the £25 million figure in the Scottish Government’s budget statement yesterday. The Government said that the pay freeze for public sector staff earning over £21,000—given that it does not apply to college or council staff, it is by and large an NHS pay policy—will save approximately £300 million and that that equates to protecting 10,000 jobs. On that basis, the cost of £25 million for the free prescriptions policy equates to around 1,000 jobs in the health service. Although I do not want to labour the point, the Government needs to be consistent in its public messaging when it equates funding figures with job numbers.

The health secretary’s principled argument is that free health care for all is her policy. Changing prescription charges from £3 to zero does not end the charging regime in dentistry other than for check-ups; it does not remove all other care charges; and it does not abolish other elements from the list of charges. Unless I am wrong about the current list of NHS charges, I would be grateful if the cabinet secretary would clarify that, of the items on that list that are charged for currently, only prescriptions will be set at zero.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

To build on Dr Ian McKee’s point, does Jeremy Purvis agree that, on this point, as in life generally, just because we cannot do everything, it does not mean that we should not take a significant and important step in the right direction?

Jeremy Purvis (Liberal Democrat, Tweeddale, Ettrick and Lauderdale)

I understand that point. Supplying surgical tights, surgical brassieres, abdominal or spinal supports, stock wigs, partial human hair wigs or full, bespoke human hair wigs, which bring dignity to out-patients, is within the bailiwick of this Government’s funding policy under the National Health Service (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2010, which the Parliament considers. We do not know what the Government’s proposals are for items B to H of the charging regime; we have a Government policy for item A only.

All that I am asking for is an understanding. We heard from Christine Grahame that the difference between an in-patient and an out-patient prescription is unjust if what we get free in hospital we have to pay for as an out-patient. That applies to elastic hosiery, including stockings, and it applies to tights if, like my granny, someone is an in-patient or older person. She was supplied with those for free because she is a pensioner, but if someone is not a pensioner or in the exempt category, surely that injustice continues. All I am asking for is to know the Government’s position. It is not a case of saying, “We would like to do it if we were independent”—

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

That is not what I said.

Jeremy Purvis (Liberal Democrat, Tweeddale, Ettrick and Lauderdale)

It was Ian McKee’s point. We are dealing with the charging regime that we have now and I just want to know what the Government’s position is.

Choices are being made. I have had casework involving patients who could not understand why provision of hyaluronan injections for their arthritis had been removed by NHS Borders. They can still get the drug if they pay for it, but they can get free painkillers to treat the symptoms, although that could be a long-term situation because of the pain that they are in. However, they are asked to pay for injections that could mean being pain free for three months. That is the point that Ross Finnie made, which I support entirely. Health care is not just about the prescription transaction in isolation from all other parts of care and prescribing. That is why we have raised unashamedly issues to do with prescribing practice, the overall drugs bill, which has grown, and the current health care regime. It is easy to look at one aspect of the whole in isolation, but we would prefer to look at it holistically.

Richard Simpson (Labour, Mid Scotland and Fife)

We have rehearsed the history of prescription charges on many occasions and I do not think that we should do so again, except to say that they have been in and they have been out. The basic principle is that charging for health care is not regarded as appropriate in this country. On practical grounds, charges have been introduced from time to time and co-payment systems have been used. The privatisation of dentistry by the Conservative party created a massive charging system, whose potential for being rolled back has been difficult to examine.

Derek Brownlee (Conservative, South of Scotland)

I wonder whether I have this wrong, but I thought that we still had NHS dentistry—I seem to be married to an NHS dentist. [Laughter.] Well, she tells me that she is an NHS dentist, but Richard Simpson tells me that she has been abolished. What is the difference between an independent general dental practitioner and an independent GP? They have exactly the same status, do they not?

Richard Simpson (Labour, Mid Scotland and Fife)

Contractually they do, but the number of private dentists who were established as a result of the charging system has been massive. Oral ill health has been a real problem as a result and our Government and the SNP have been trying to roll that back.

The problem with the prescription charges system is that it is hugely flawed, as many members have said. For example, an MP colleague of mine who does not get free prescriptions on the ground of age does get them because she has diabetes—she gets free prescriptions not just for diabetes drugs but for all drugs. Wealthy people are therefore exempt from all charges if they have certain specific conditions.

I am scarred by the fact that, when I was a general practitioner, one of my student patients died because he failed to fulfil the three prescriptions for asthma that had been prescribed for him, and chose the wrong one to drop. He did so because he was one of the 600,000 people who were marginally ineligible for exemption. That is an important group. Those people have low incomes and they are about to have an additional VAT charge of £200 a year on their lives as a result of the Con-Dem coalition. Therefore, measures that we can take to try to relieve that are appropriate.

The other point is that the system is hugely bureaucratic, given the massive administration costs. We spend time on addressing fraud in relation to prescription charges, which is a complete waste of time. There are substantial costs. The bureaucratic element is a problem.

Derek Brownlee (Conservative, South of Scotland)

Will the member take an intervention?

Richard Simpson (Labour, Mid Scotland and Fife)

I really do not have time. I am sorry.

We and the SNP both started from similar positions in our manifestos in 2007. On page 40 of its manifesto, the SNP pledged that it would immediately abolish

“prescription charges for people with chronic health conditions, people with cancer, and people in full time education or training.”

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Will the member take an intervention?

Richard Simpson (Labour, Mid Scotland and Fife)

The cabinet secretary can respond in summing up.

The SNP then decided to change to a system of gradual abolition, which was the eventual policy that was to be introduced by 2012 and is now being introduced earlier. The SNP therefore chose a different route when it came into government.

Ian McKee asked why we focused on cancer patients. Read the Macmillan Cancer Support report: when people get cancer, they are so financially challenged, because of their change in circumstances, that we felt that free prescriptions could be extended to that group, even if we could not extend them to all long-term conditions immediately.

Ian McKee (Scottish National Party, Lothians)

Will the member take an intervention?

Richard Simpson (Labour, Mid Scotland and Fife)

No. I am sorry, but I do not have time. I am answering the question that Ian McKee asked. The Government should have introduced that.

In Wales, prescription charges were abolished for the under-23s immediately. That was sensible, because the proportion of under-23s who were not eligible for exemption on income grounds was tiny. Again, that step could have been taken immediately.

Ross Finnie referred to the Liberal policy that free prescriptions should have been extended to people with long-term conditions. Alasdair Allan made a very cogent point in the previous debate on prescription charges, that there were 2,623 prepayment certificates in the Western Isles. We are talking about people with long-term conditions. A high proportion of the 8 per cent of people who pay for prescriptions have long-term conditions. The policy is unfair and bureaucratic and it does not produce the income that could be produced from that area if there really were a fair policy of charging only the rich, as Jackson Carlaw has suggested. It is appropriate to get rid of the policy on principled and practical grounds.

The question of prescribing costs is important. We need to have generic substitution automatically. We need to reduce waste. We need to stop prescribing non-evidenced treatments such as homeopathic medicines, on the health service. We need to stop prescribing medicines that are found not to be working for the patient. There are many things that we can do, but the one thing that we should do now is abolish prescription charges.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I guess that we just have to accept that there is a disagreement between us and the Tory-Liberal coalition on this issue. It is an honest disagreement. People out there will make their own judgment, but we have to agree to differ.

I will make an important point at the outset that I do not think is made often enough when any of us—myself included—talks about universal benefits, including in relation to prescriptions. We have a tendency to talk about them as things that are free, but they are not free. People pay for these things through their taxes. Abolishing prescription charges simply ensures that they are not asked to pay for them twice. That point could do with being made more often.

I will respond directly to a couple of points. Jackie Baillie asked about the funding. This policy has been fully funded in every year of this parliamentary session, including in the budget that was published yesterday, with a built-in assumption for increased demand. The whole point of the policy is that if we argue that prescription charges are a barrier to people getting their prescriptions, we would expect to see demand increase if charges are abolished or reduced; otherwise, the policy would not be doing its job. If the SNP is re-elected next year, as I hope and expect that we will be, the policy will be fully funded for the future, too.

Jackson Carlaw said that, instead of paying for medicines over the counter, people will go to their GP. I have to be honest with him: I do not find the notion of people with busy lives who can afford to pay for over-the-counter treatments suddenly choosing to make an appointment with their GP to get a prescription a very credible one. If that were a credible notion—this might answer the point that Jackson Carlaw is leaping to his feet to make—as prescription charges have reduced, we might have expected to see a significant impact in the way that he suggests, but we have not. Of course, as with all aspects of this policy, we will monitor the impact.

Jackson Carlaw (Conservative, West of Scotland)

Will the cabinet secretary give way?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I might do later, but I want to make some progress. I want to stick with Jackson Carlaw, because his speech today reminded us of what we are missing in health debates. I am really sorry—I feel that I need to put this on record—that Jackson Carlaw did not receive the invitation to my wedding. I can only conclude that the invitation was lost in the same post as his wedding gift—we are quits.

However, Jackson Carlaw made an important point. He seemed to recognise that the prescription charges system that we have just now is not fair and that change is therefore needed. That leads us to ask what kind of change. The Tories and the Liberals—I think—have made two suggestions. The first is to extend the list of long-term conditions. I have been very open about the difficulty that we encounter with that. Richard Simpson is right to quote our manifesto because that was our starting position. However, when we looked at the reality of that, we realised that we would sort some anomalies but in the process create others. Why should one long-term condition be more deserving or more worthy than another?

The other suggestion from the Tories was to raise the financial threshold. Christine Grahame asked the key question: what would they raise it to at a time when family budgets are already under so much pressure? A threshold of £17,000, £18,000 or £21,000 appears to be the suggestion from Derek Brownlee, but the reality is that the higher we go and the more long-term conditions we add to the list, the less cost-effective the remaining system of gathering prescription charges becomes. That is the very point that the BMA made in the quotation that I read out earlier on.

Derek Brownlee (Conservative, South of Scotland)

Will the cabinet secretary give way?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I do not have much time just now.

I want to address one of the other central points that have been made. I know all too well how tight times are, but I guess that the fundamental difference between this Government and the Tory UK Government is that we do not believe that it is right to make the most vulnerable in society bear the brunt of those difficult times. That is why we have protected the health service. It is also why we are directing more of the budget to the front line—with the 25 per cent reduction in managers, the higher efficiency targets for some of our special boards and efficiencies in prescribing, which are extremely important.

Ross Finnie said that the policy does not exist in isolation and he is absolutely right, but he has to accept that that argument cuts both ways. Richard Simpson made this point very powerfully: if people with long-term conditions do not take the appropriate prescription medicine, the knock-on effect on their health and on the NHS can be significant.

Jeremy Purvis (Liberal Democrat, Tweeddale, Ettrick and Lauderdale)

Will the cabinet secretary give way?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I am coming to Jeremy Purvis’s point. The Liberal argument appeared latterly to be that, because we cannot remove all charges, we should not remove any. Jeremy Purvis will be interested to know that the tights and wigs and so on that he mentioned will also be free and their cost has been reduced in line with prescription charges. This policy is the right one.

Nanette Milne (Conservative, North East Scotland)

The arguments for and against the abolition of prescription charges have been well rehearsed in this chamber in recent years, since the Scottish Socialist Party proposal was roundly defeated in 2006. Today, we have heard the same arguments again, save that the Labour Party’s stance is radically different from its position at that time. In 2006, the Lib-Lab Executive robustly opposed the abolition of charges, with Andy Kerr, as health minister, describing the proposal as unfair on the NHS and unfair on the patients and saying that it would in effect rob the poor and the unwell and give to the rich. I am not normally very critical but, as with its U-turn yesterday on the Patient Rights (Scotland) Bill, Labour’s attitude today smacks of opportunism and electioneering.

Jackie Baillie (Labour, Dumbarton)

Where was Nanette Milne in January, when we debated prescription charges on a motion from Mary Scanlon? Our position then was clear and it remains consistent today.

Nanette Milne (Conservative, North East Scotland)

That position is nonetheless a radical departure from where Labour was in 2006, when it was in government. That is a significant change.

The Liberal Democrats initially agreed with their Labour colleagues, went on to support abolition and then returned to opposing it last year. I am pleased that the Liberal Democrats appear finally to have made up their minds and to have made a reasoned decision on the issue. Ross Finnie’s speech was measured. He demonstrated clearly the harsh realities of the choices that the NHS faces in the present financial climate and the need to spend resource wisely throughout the service. We have no difficulty in supporting his amendment.

As we have said, removing prescription charges for everyone has superficial appeal. The existing exemption criteria have inequities and it would be nearly impossible to produce a fairer list of exempt categories, as the cabinet secretary said. That is why we supported the initial reduction of the charge in 2008 from £6.85 to £5, which brought the cost of a 12-month prepayment certificate down to £48. As that was less than £1 a week and more than halved the previous cost, it was affordable and a significant help to people who require multiple and long-term drug treatment. The increasing take-up of such certificates shows that that was the case.

The initial reduction cost the NHS about £17 million, which was justifiable at the time. We opposed further reductions because of the increasing loss of revenue, which amounts to about £32 million this year. We do not support the final move next year to a zero charge, because to remove a further £25 million a year from the NHS is inappropriate given that it is under severe financial pressure, although its budget is protected, and given that the report of the Government-commissioned IBR referred to

“a pressing need to reconsider the planned abolition of prescription charges”.

As we know, the vast majority of people who require help to pay for prescriptions receive it. As 92 per cent of prescriptions are exempt from the charge and a further 6 per cent are issued to people with prepayment certificates, that leaves a small percentage of prescriptions subject to the full charge. Removing that charge completely would subsidise the prescriptions of people who can well afford to pay for them with money that could be better spent in the NHS. However, to avoid doubt, as Derek Brownlee said, we do not intend to put the clock back and to charge the elderly, the young or those who are in full-time education.

The cabinet secretary mentioned Wales. The Welsh experience of free prescriptions is of increasing demand for prescriptions for drugs such as paracetamol, Gaviscon and Calpol, which are readily available over the counter at low cost. That not only takes money out of the NHS but increases the demand on GP time that could be better used. I know that some members of the National Assembly for Wales regret the policy, particularly at this time.

Some people do not hand in a prescription that they have been given because they find—as Jackson Carlaw did—that buying the drug over the counter is cheaper. That is not uncommon.

Our resolve to keep prescription charges has, if anything, been strengthened by the current tough financial future that we face as a result of Labour’s mismanagement of the UK economy. It is more important than ever to spend public money as efficiently and effectively as possible. If revenue is removed from the NHS to pay for free prescriptions, something else in the service must suffer.

Many health services could benefit from the income that is derived from prescription charges. As the Parliament knows, a priority for us is the restoration and development of a universal service of practice-based health visitors, which would be of incalculable benefit to many families and young people. When one hears of malnourished children presenting in hospital, surely it is more important to spend money on health visitors who can advise vulnerable families and pick up problems before they have a serious impact on a child’s welfare than it is to spend scarce resources on providing free prescriptions.

Government is all about priorities, particularly in difficult times. Opening up the NHS to another indefinite spending commitment now is not the action of a responsible Government, so we oppose the move.

Hospitals (Free Parking)

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

1. To ask the Scottish Executive whether it plans to revise its decision to introduce free parking at hospital car parks. (S3O-12046)

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

There are no plans to revise the decision to introduce free parking at NHS Scotland-operated car parks.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

It is obvious that the cabinet secretary is unaware of the chaos that the Government’s instruction to end car parking charges has caused at Aberdeen royal infirmary. The ARI has the barriers, the machines and the staff available to issue passes for people who genuinely need to use the car park free of charge, but it has simply thrown open the gates and allowed shoppers and everyone else to park there for the whole day, which prevents the elderly and the sick who have to use their cars to travel in from rural Aberdeenshire from accessing the ARI. Will she accept an invitation to join me at the ARI’s car park and see the problem at first hand?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I have visited the ARI many times. Mike Rumbles is perfectly entitled to argue for the reintroduction of car parking charges and I will let him do that if he so desires. The abolition of charges was right and it is wrong to ask people to pay to park in hospital car parks.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

That was not the point.

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I am coming to the point that I thought Mike Rumbles made.

The abolition of charges did not remove health boards’ responsibility to manage car parks and car parking. As Mike Rumbles and all of us know, a feature of the society in which we live is that demand for hospital car parks and other car parks often outstrips supply. Many health boards, such as NHS Greater Glasgow and Clyde, have put in place policies to manage car parks, which are often unpopular but are required to avoid the problems that he identified. I suggest that Mike Rumbles discusses with his local health board the appropriate measures to put in place to manage car parking better and deal with the problems that he identified.

Bob Doris (Scottish National Party, Glasgow)

I welcome the abolition of car parking charges at national health service hospitals. Will the cabinet secretary reassure me that we will not return to the provisions that the previous Labour and Lib Dem Executive laid, under which nurses would have paid £12 a day to park at hospitals?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I assure Bob Doris that, as I said, the Government has no intention to reintroduce car parking charges at NHS-operated car parks. As he said, we inherited a proposal for car parking charges of £12 in parts of the country. First, we reduced and capped such charges; then we abolished them.

I repeat that it is important to have well-managed car parks, so that those who need to use them can access spaces. That sometimes leads to other initiatives that are unpopular but which—unfortunately—are necessary to deal with the issues that have been raised.

Lewis Macdonald (Labour, Aberdeen Central)

Is the cabinet secretary aware that one consequence of the volume of cars that are parking at Aberdeen royal infirmary is pressure on parking on nearby streets? Does she recognise that something has gone wrong when my constituents must pay up to £200 a year to park at their own doors while parking at the hospital site is free? Will she talk to NHS Grampian and Aberdeen City Council to try to put that right?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

I will always discuss such issues with health boards and I encourage Lewis Macdonald as a local member—as I encouraged Mike Rumbles—to do the same. The problem is serious in parts of the country and particularly in cities, and I do not take away from the point that Lewis Macdonald made, but it does not take much working out.

Many more cars are on the roads these days than car parking spaces can take, not just in the health service but in other sectors. That makes it all the more important that we as a Government encourage people to have alternative routes to work, but that also means that—as I have said—health boards must do what they can to manage their car parks as best they can. I will continue to encourage health boards to do that and I am sure that the local members who have made points today will do likewise.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question 2 has been withdrawn.

Public Service Design (Disabled Access)

Cathy Peattie (Labour, Falkirk East)

3. To ask the Scottish Executive what steps it has taken to ensure that public services such as health services are made fully accessible to disabled people, particularly when new facilities are designed. (S3O-12001)

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Building regulations apply to all new building work and seek to ensure that new buildings are accessible to as wide a range of people as possible. To deliver accessible environments, new planning regulations for national and major developments were introduced last year.

Cathy Peattie (Labour, Falkirk East)

In the last session of the Parliament, the Equal Opportunities Committee undertook a comprehensive review of the barriers that face people with disabilities. One issue that people raised was access to buildings, particularly old buildings. People were very clear that new buildings should be accessible. In our wonderful new hospital in Larbert—it is a wonderful hospital—the barriers still exist. There are heavy doors in the outpatient department and physiotherapy units, poor signage and problems with the loop system—

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question, please.

Cathy Peattie (Labour, Falkirk East)

In line with the disability discrimination legislation requirements, will the cabinet secretary ensure that future planning for new builds is fully equality proofed?

Nicola Sturgeon (Scottish National Party, Glasgow Govan)

Cathy Peattie is right to make reference to the Disability Discrimination Acts. Health boards are as bound by those acts as any other public agencies are. I have made it clear that the new planning regulations are designed to ensure that all new buildings are as accessible as possible.

Like Cathy Peattie, I put on record what a wonderful new hospital the new Forth Valley royal hospital at Larbert is. If there are issues of the kind that Cathy Peattie has identified, I will be happy to raise them with the health board. I encourage Cathy Peattie to do that as well, as the local member. I am sure that she will find the board receptive to responding to the issues as constructively as possible.

Flooding (Edinburgh)

Sarah Boyack (Labour, Edinburgh Central)

4. To ask the Scottish Executive what action it is taking to protect communities in Edinburgh from flooding. (S3O-11970)

Roseanna Cunningham (Scottish National Party, Perth)

We are helping to protect communities across Scotland from flooding by working with our partners to implement the Flood Risk Management (Scotland) Act 2009 and providing funding through the local government settlement for local authorities to continue to invest in flood prevention schemes. As the member knows, that includes the City of Edinburgh Council.

Sarah Boyack (Labour, Edinburgh Central)

I welcome the work on early warning that the minister has put in place. My constituents are really worried about the delay to the flood management works in Edinburgh; they worry every time that we have prolonged rain. Will the minister agree to meet me to discuss the funding shortfall in Edinburgh, which the City of Edinburgh Council tells me is the result of changes in Government funding that her predecessor put in place? Will she meet me to see whether there is any prospect of finding a solution to accelerate the speed of the works, which are now spread into three phases? My constituents do not even have the certainty of a start date for the phase 2 elements of the works, never mind the phase 3 part.

Roseanna Cunningham (Scottish National Party, Perth)

I am always happy to meet members who have particular concerns. The member need only ask and we will arrange a meeting. The question allows me to remind the chamber that, from 1999 to 2007, spending on flooding in Scotland was only £5.5 million per annum. In 2007-08, it went to £32.5 million and from 2008 to 2010, £42 million per year was included in the local government settlement for flood funding. I am always astonished when Labour members ask questions about flood funding, given that history.

I have only just opened the Braid burn flood prevention scheme in Edinburgh. As the member knows, the Water of Leith scheme is progressing—[Interruption.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Roseanna Cunningham (Scottish National Party, Perth)

It has already received money and will continue to receive support. That support will be wrapped up in the global local government settlement, the details of which will be announced shortly.

Policing (Budgetary Pressure)

Bill Butler (Labour, Glasgow Anniesland)

5. To ask the Scottish Executive what action it is taking to protect front-line policing from budgetary pressures. (S3O-11972) [Interruption.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Before we hear from the Cabinet Secretary for Justice, I suggest that members who wish to have conversations might like to do so outwith the chamber—unless they are answering or asking a question.

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

We are determined to put front-line services first. That is why we will maintain police officer numbers at their current level, which is at least 1,000 more than when we came into power. It is also why we are examining the options for more fundamental reform of our police service to put bobbies before boundaries and to ensure that the excellent policing we have now is sustainable into the future.

Bill Butler (Labour, Glasgow Anniesland)

The cabinet secretary will be aware that, on his watch, the justice portfolio has taken the biggest cut in percentage terms of all departments at 13.3 per cent. Given that fact, and that police boards have announced cuts that the Scottish Police Federation has said are equivalent to reducing police numbers by 2,900 and that Mr Swinney’s budget outlined a £31 million cut in the central Government grant to the police, where will the money come from to maintain police numbers? How will the cabinet secretary assure police boards that Mr Swinney’s plan will sustain the funding to maintain new recruits, when Mr Swinney himself has refused to set out a three-year budget?

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

I refer Mr Butler not only to the comments that my colleague the Cabinet Secretary for Finance and Sustainable Growth made, but to the press release and comments from the general secretary of the Scottish Police Federation. The Scottish Parliament welcomed the commitments that the Cabinet Secretary for Finance and Sustainable Growth has made, which the police have accepted and, indeed, welcomed. Those who continually talk down Scotland and continually talk up other matters in the face of the highest-ever number of police officers in Scotland and the lowest recorded crime in 32 years should recognise a good thing when a good thing is announced.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

I am sure that the cabinet secretary agrees that police support staff play a vital role in forces across Scotland. Indeed, they are key to allowing police to get out on to our streets and to do the job instead of being stuck behind the counter on administration work. Police support officers in my constituency—

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question, please.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

—are concerned that their jobs may be cut. What support is the cabinet secretary giving to staff who support our police?

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

I conjoin with Cathie Craigie in saying how excellent police support staff are. We are aware of their concerns as a result of the budgets that boards have provisionally brought in. Given the Cabinet Secretary for Finance and Sustainable Growth’s announcement, many of the apocalyptic views that were voiced by some—certainly those on Opposition benches—will be shown to be groundless. Indeed, I look forward to police forces looking forward to recruiting more and securing the position of those who give service as uniformed officers or in the back room.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Question 6 was due to be asked by Bill Kidd, but he is not in the chamber. Members are aware of my disapproval of that. In this case, it is exemplified by the fact that we are all deprived of hearing Jamie Stone’s supplementary question, which I now cannot call him to ask.

Carloway Review (Remit)

Robert Brown (Liberal Democrat, Glasgow)

7. To ask the Scottish Executive whether it has agreed a remit for Lord Carloway’s review, which was announced in the context of the emergency legislation on the detention of suspects. (S3O-12037)

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

Yes. The finalised terms of reference for Lord Carloway’s review of law and practice have been agreed and published. A copy has been placed in the Scottish Parliament information centre under bib number 52072.

Robert Brown (Liberal Democrat, Glasgow)

In doing so, did the cabinet secretary consult outside interests on the terms of the remit? For example, did he consult the Scottish Human Rights Commission, which was so shortsightedly ignored in the passage of the emergency legislation? He did not consult Opposition spokespeople on the issue. Who did he consult in arriving at the remit?

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

I consulted Lord Carloway. At the end of the day, the remit is Lord Carloway’s. We consulted him on the matter and he suggested some changes, which we accepted. It would be entirely inappropriate for me to seek to undermine the position of a High Court judge who was nominated by the Lord President to carry out a significant review into the law, practice and evidence that we have in Scotland.

Obviously, Lord Carloway will take on board those from other bodies to give him advice—we will discuss that with him—and he may, or may not, choose to select Mr Brown as one of them. I would have thought that Lord Carloway will take on board those from the defence agencies, the Law Society of Scotland, police officers and others with a remit. We should accept the significant stature of Lord Carloway and allow him to get on with his difficult job, which we expect him to deal with as expeditiously as possible given its critical nature in our criminal justice system.

Licensed Premises (Oversubscribed Areas)

Gil Paterson (Scottish National Party, West of Scotland)

8. To ask the Scottish Government what its position is on local authorities refusing additional alcohol licences in areas deemed to be oversubscribed in licensed premises. (S3O-12031)

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

Effective enforcement of existing laws is part of the Government’s alcohol framework for action and we encourage licensing boards to use their powers to their full extent. That is particularly important when alcohol misuse costs Scotland £3.56 billion every year, or £900 for every adult. The World Health Organization considers that restricting availability is one of the key ways of reducing consumption and harm, and availability of alcohol can be addressed by increasing price and by restricting outlet density.

The Licensing (Scotland) Act 2005 requires licensing boards to adopt a proactive approach to the overprovision of licensed premises. Having established such a policy, the board is in a position to refuse an application that has been made for premises in the localities that it has decided are overprovided for. The board must still, of course, consider each case on its merits and within the context of its overprovision policy.

Gil Paterson (Scottish National Party, West of Scotland)

The cabinet secretary will know that West Dunbartonshire Council decided recently to refuse to issue new alcohol licences in areas of overprovision. Will he encourage other councils in Scotland to consider taking that positive step to combat problems of alcohol abuse and easy access to the purchase of alcohol?

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

The member makes a valid point. I have heard about what West Dunbartonshire Council is doing. The council is acting within its remit to protect its communities from the harm that alcohol can do. It has also done extensive research into the medical harm that alcohol does and into its consequences for justice, society and the community in West Dunbartonshire. I support fully the drive and desire of West Dunbartonshire licensing board and the council as a whole to take steps to protect themselves. I do not doubt that other licensing boards will consider such measures. Where licensing boards take steps to protect their communities from the oversupply, excessive availability and—despite what has happened recently—ridiculous pricing of alcohol, they will have our full support.

Jackie Baillie (Labour, Dumbarton)

The cabinet secretary is right to point to the Licensing (Scotland) Act 2005, which enabled action to be taken on overprovision and to restrict the availability of licences. However, he will be aware that not all licensing boards are adopting such measures fully. Will he commit himself to monitoring implementation of those and other measures for which the 2005 act provides and to publishing a report setting out the progress that has been made on the act’s use?

Kenny MacAskill (Scottish National Party, Edinburgh East and Musselburgh)

I am surprised that Jackie Baillie should raise that issue. The 2005 act was brought in by the previous Liberal-Labour Administration. There are some difficulties associated with it, but we supported it when we were in opposition because we thought that that was the right direction in which to go; if only others who are in opposition now would show the same sense and look to the national interest.

We have reviewed some matters. Immediately after we came into office, we were lobbied by the police about the fit and proper person test. We reinstated that immediately, because there were issues that needed to be addressed. In the Alcohol etc (Scotland) Bill, which was passed recently, we have taken action to deal with issues relating to licensing. We can review, consult and take all sorts of steps, but at the end of the day tackling the problem of alcohol abuse in Scotland requires three Rs. First, alcohol must be consumed responsibly; we are on a journey in that regard. Secondly, it must be promoted responsibly; action has been taken in that area. Thirdly, it must be priced responsibly; shamefully, action has not been taken on that issue.

Youth Violence

Margaret Smith (Liberal Democrat, Edinburgh West)

9. To ask the Scottish Executive what is being done to tackle youth violence. (S3O-12048)

Fergus Ewing (Scottish National Party, Inverness East, Nairn and Lochaber)

The Scottish Government is working with the violence reduction unit and other partners to tackle violent crime by young people. Recent figures published in the “Scottish Policing Performance Framework: Annual Report 2009-10” show that crimes of violence committed by young people fell by 17 per cent between 2008-09 and 2009-10. Overall levels of youth crime are down by 12 per cent over the same period, and violent crime is at its lowest level in more than 30 years.

Those successes have been achieved through a combination of tough enforcement, supported by record numbers of police officers, and innovative early intervention initiatives such as our groundbreaking no knives, better lives campaign, which has led to a 35 per cent reduction in knife carrying in Inverclyde over the period of the campaign. We have also committed £20 million to cashback for communities, with £500,000 going specifically to reducing violence.

Margaret Smith (Liberal Democrat, Edinburgh West)

I thank the minister for that fulsome response. He may be aware of a couple of recent cases of violence in or just outside secondary schools in Edinburgh; I am sure that he shares my concerns about those incidents. What is the Government doing with local authorities to address the issue of violence in our schools, especially our secondary schools, where it appears to be on the rise?

Fergus Ewing (Scottish National Party, Inverness East, Nairn and Lochaber)

One initiative that the Government has taken is to encourage medics against violence, which involves volunteers from the National Health Service, in their own time, providing information to schoolchildren. Medics against violence is particularly active in Inverclyde, but the initiative is being rolled out in other parts of Scotland to warn children of the consequences of carrying a knife; for example, maxillofacial surgeons show them pictures of the consequences of a typical knife wound to the face. Medics against violence is an excellent initiative. I am pleased to say that I will support it tomorrow evening when I attend its charitable event, which is a masked ball.

Alex Fergusson (None, Galloway and Upper Nithsdale)

Before we come to the next item of business, I know that members will wish to join me in welcoming to the gallery the ambassador of Iceland, His Excellency Benedikt Jónsson. [Applause.]

Engagements

Iain Gray (Labour, East Lothian)

1. To ask the First Minister what engagements he has planned for the rest of the day. (S3F-2708)

Alex Salmond (Scottish National Party, Gordon)

Engagements to take forward the Government’s programme for Scotland.

Iain Gray (Labour, East Lothian)

The First Minister has a woeful record on building consensus, but yesterday he managed it: he united all the Opposition parties in the chamber in agreement—agreement that his budget is a cynical, short-term stop-gap measure, made in a vain attempt to get re-elected. Everyone knows that he put the short-term interest of his party before the long-term interest of his country. Especially at a time such as this, is that not an abdication of his responsibility as First Minister?

Alex Salmond (Scottish National Party, Gordon)

I will refresh Iain Gray’s memory with regard to the idea that this is the first time that Labour has been unified with the Tories and the Liberal Democrats. As I remember, there was unity on the Edinburgh trams project between the Labour Party, the Liberals and the Conservatives. I am surprised that Iain Gray, as the former minister who announced the trams project, cannot remember that.

The budget that was presented yesterday tackled the huge issue that faces this country, which is the thirteen hundred million pound cutback in the public finance that is available to Scotland this coming year. That is the largest decline in public expenditure not just in the history of devolution but in the history of public spending. That is what Mr Swinney faced, and that is what he faced down. That is why we have taken the tough decisions that are required, and that is why this Government will be re-elected next May.

Iain Gray (Labour, East Lothian)

Mr Swinney said yesterday that the budget was

“more than a one-year challenge”.—[Official Report, Wednesday 17 November 2010; c 30461.].

However, he then immediately failed his own test. Alex Neil admitted on television—I was standing right beside him—that, if the Scottish National Party gets past the election, it will bring out the three-year budget then. What is the First Minister hiding? What happens in years 2 and 3 of his spending plans that he will not tell us about now?

Alex Salmond (Scottish National Party, Gordon)

It is quite extraordinary—Andy Kerr used that line yesterday. That point is covered in the budget document. Andy Kerr could argue that he had only an hour or two to read it yesterday, but Iain Gray has had 24 hours to read it. As the budget document says, Campbell Christie and his commission—[Interruption.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Alex Salmond (Scottish National Party, Gordon)

The Christie commission will examine structural change in Scottish public services and will present a report in order to take forward the Government’s plans for Scotland. [Interruption.] I can see members on the Labour benches looking desperately. They have all had 24 hours. [Interruption.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Alex Salmond (Scottish National Party, Gordon)

Am I meant to assume that they cannot find the right section in the budget document? Do I need to draw it to their attention?

John Swinney has faced the biggest ever decline in Scottish public spending, and he has taken the decisions that are required to face up to it. Labour, the Conservatives and the Liberal Democrats are united on something else, too: they have no alternative future for Scotland, except a generation of cutbacks led by the Westminster Government.

Let us remember that, while Labour condemns the Con-Dem coalition, two thirds of the cutbacks were promised by Alistair Darling in a regime that was to be deeper and tougher than under Margaret Thatcher. We are not only facing down the immediate challenge; we are saying to Scotland, “Give us the economic power to grow the economy and take us into a better future.”

Iain Gray (Labour, East Lothian)

I have indeed read the budget document, and not even it was as tedious as Alex Salmond’s answers. It is full of commissions, reviews, contracts and concordats, but it has no answers in it. All budgets—

John Swinney (Scottish National Party, North Tayside)

What about your answers, mate?

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order!

Members: What are your answers?

Order! Sit down, please, Mr Gray.

I understand the political situation in the chamber, and it is entirely understandable that members are somewhat overexcited. However, I cannot tolerate the Presiding Officer not getting order when he or she asks for it. That situation cannot remain. I ask members that, when I ask for order, it is given.

Iain Gray (Labour, East Lothian)

All budgets—especially the one that we have been discussing—are about priorities. Let us look at the First Minister’s priorities. We have obtained the information that, last year, as Scotland tried to recover from recession, he spent £0.5 million on the 16 members of staff in his speech-writing unit. I have heard his speeches. Can we have our money back, please?

Alex Salmond (Scottish National Party, Gordon)

It is well known that this Government’s administration costs for special advisers are dramatically lower than they were in the Administration that Iain Gray was a member of and in the previous Administration.

Let us talk about the choices that Scotland faces. Yesterday, we announced a difficult policy of pay restraint in the public sector because we believe that it is right to maintain and save jobs in Scotland. That is not easy to do; it is tough. Iain Gray has said that he supports that policy. On 29 October, he said to the BBC:

“We have to have significant pay restraint, probably close to, or at, a pay freeze”.

He added:

“Certainly over a couple of years, maybe two or three years.”

Fine. However, yesterday, I saw him outside the Parliament demonstrating beside a banner that demanded no pay freeze. This morning, I heard him on the radio. He was asked whether he supports pay restraint. He replied that he does: he coughed, he said, “Excuse me,” and he said that he does support it and that he has said that before. If he supports pay restraint to save jobs, what was he doing yesterday? He is the first Opposition leader in history to hold a demonstration against his own policy.

Iain Gray (Labour, East Lothian)

I will stand alongside workers who are trying to save their jobs any day of the week. [Applause.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Iain Gray (Labour, East Lothian)

The only job that the First Minister is really trying to save is his own. He should start to do that job. He has no idea about reform of the teaching profession. Someone else can sort that out in June. He has no idea about public service reform. Someone else can sort it out in June. He has no idea about higher education funding. Someone else can sort it out in August. The First Minister has no ideas and no answers, and there is no leadership from him. He used to fancy himself as a Celtic lion. Does not the budget show that he is just a cowardly lion instead?

Alex Salmond (Scottish National Party, Gordon)

Iain Gray was not outside demonstrating for jobs yesterday; he was out demonstrating beside a banner that demanded no pay freeze. That is diametrically opposed to his policy. However, we should not be too surprised. Where does he stand on the other choices that Scotland faces? The Government has proposed a social contract that would say to people that we have made valuable gains in freezing the council tax and removing prescription charges in return for pay restraint. Where does Iain Gray stand on that? He has changed his mind about the council tax three times. First, he said that it was to rise. Then, in a BBC interview, he said that it was not to rise. Then, at his conference, he said that it was to rise, but that he was going to cap it. Rather than tell me what we should do over the next four years, why does he not make up his mind about what his policy is for next year?

John Swinney has taken the big decisions and faced up to the biggest decline in public spending in the history of devolution. He has put forward tough but fair policies to maintain jobs and protect workers in Scotland. Above all, like all Scottish National Party members, he has a vision of getting control over Scotland’s economy to grow our way, as opposed to taking the cut, cut, cut approach of Labour, the Tories and the Liberal Democrats.

Secretary of State for Scotland (Meetings)

Annabel Goldie (Conservative, West of Scotland)

2. To ask the First Minister when he will next meet the Secretary of State for Scotland. (S3F-2709)

Alex Salmond (Scottish National Party, Gordon)

I have no plans to meet the Secretary of State for Scotland in the near future.

Annabel Goldie (Conservative, West of Scotland)

Scottish Conservative plans would give more money to Scottish universities and greater support to the students who are most in need. We now know that Alex Salmond will give less money to our universities and less support to the students who are most in need. Will he tell me whether that is a five-month plan, a one-year plan or his long-term solution?

Alex Salmond (Scottish National Party, Gordon)

Yesterday’s settlement for higher education—and many other aspects of education—was widely welcomed. The reason why student leaders and others across higher education welcomed it is that they have been glancing south of the border to the tender mercies of the Con-Dem coalition as far as higher education in England is concerned. I remind Annabel Goldie that higher education teaching budgets in England are to be cut by 40 per cent over the course of the comprehensive spending review. That is why the announcement yesterday that our higher education institutions—universities and colleges—had agreed to maintain student numbers on the settlement that John Swinney was able to give them was so welcome.

If Annabel Goldie thinks about that for a second, will she accept that being able to maintain student numbers in Scotland, against what is happening to teaching budgets south of the border, is a considerable achievement? Will she also accept that we have to find a distinctively Scottish solution that does not put the entire burden of paying for higher education on future generations of students? That would not be fair, equitable or in the Scottish tradition of education.

Annabel Goldie (Conservative, West of Scotland)

The First Minister does not want to be reminded of the facts, but they are that the Scottish National Party Government is cutting funding to our universities and support for those students who are most in need.

Before the First Minister gets carried away with his rhetoric about the reaction of universities, I point out that the convener of Universities Scotland, Professor Bernard King, is damning. He said today:

“universities have agreed to take on a significant number of students at a fraction of the real cost of teaching them. This is borne out of extreme circumstances for one year only and is not a sustainable position for universities to be in.”

I repeat to the First Minister that Conservative plans are ready. They are for the long term, and they will—[Interruption.]

Alex Fergusson (None, Galloway and Upper Nithsdale)

Order.

Annabel Goldie (Conservative, West of Scotland)

They will put more money into the sector and give greater support to those students who are most in need.

What about the SNP? How many more reviews, task groups, working groups, green papers and acres of long grass does the First Minister need before he delivers a real, lasting solution?

Alex Salmond (Scottish National Party, Gordon)

As I remember, it was Annabel Goldie’s party that wanted the review of higher education funding with which we are proceeding at present. I am sure that her party will continue to make constructive contributions, despite the fact that unanimous Scottish opinion rejects the policy that it is imposing on students south of the border.

Annabel Goldie should really have completed the quotation from Bernard King. I have it in front of me:

“It’s clear from this settlement that the Scottish Government has sought to protect universities from deeper and more damaging cuts.”

What are the

“deeper and more damaging cuts”

to which Bernard King refers? They are the cuts of the Conservative Government on higher education south of the border.

Professor Anton Muscatelli, the principal of the University of Glasgow and somebody Annabel Goldie has quoted in her many Latin lessons to me, said:

“We are pleased that the Scottish Government has recognised the importance of universities at a time of major demands on the public finances. We particularly welcome the ring-fencing of research funding and widening access funding in cash terms, which will help to keep our Universities’ research competitive with other UK institutions.”

There is recognition across the sector that this Government is fighting for the future of higher education in Scotland. We shall not go down the road pursued by the Conservative party south of the border.

Cabinet (Meetings)

Tavish Scott (Liberal Democrat, Shetland Islands)

3. To ask the First Minister what issues will be discussed at the next meeting of the Cabinet. (S3F-2710)

Alex Salmond (Scottish National Party, Gordon)

The next meeting of the Cabinet will discuss issues of importance to the people of Scotland.

Tavish Scott (Liberal Democrat, Shetland Islands)

On Sunday, the Scottish National Party in Glasgow criticised the city’s council for having the wrong priorities. Mr Salmond’s party said that it was simply unacceptable that the council was increasing wages for those earning more than £80,000 a year. It said that that was financial incompetence. Does the First Minister agree with all that?

Alex Salmond (Scottish National Party, Gordon)

I agree with what John Swinney set out in yesterday’s budget: substantial efficiencies on higher salaries across the public sector in Scotland.

I also agree with the serious attempt that the Government is making—and has been making throughout our term in office—to procure better efficiencies across the public sector in a way that does not break contracts or have us up before employment tribunals or in the European courts, which would certainly have been our destination if we had listened to the advice of Tavish Scott and the Liberal Democrats.

Tavish Scott (Liberal Democrat, Shetland Islands)

The First Minister needs to make sure that what is right for Glasgow on Sunday is good for the rest of the country on Thursday. I have here figures that show that, across Scotland in the past year, public bodies have taken on hundreds of new people who are paid more than £80,000 a year. The total increase in high pay in just one year is £33 million. I want a cut in the top pay in the public sector, to save money and to invest in jobs. Last January, I agreed with the First Minister when he said

“those with the broadest shoulders should bear the heaviest burden”.—[Official Report, 21 January 2010; c 23007.]

That was okay for Glasgow on Sunday; is it right for the rest of his Government now?

Alex Salmond (Scottish National Party, Gordon)

I refer Tavish Scott to what John Swinney said yesterday:

“The costs of the senior civil service will fall by at least 10 per cent by the end of 2011-12 and by 25 per cent by 2014-15. The Government is now operating the presumption that, when a non-departmental public body’s chief executive resigns or retires, their replacement will start on a salary that is at least 10 per cent lower than that of the person whom they replace.

We are further reducing the number of chief executives who have access to bonuses from the level that we inherited in 2007. As I said, we will suspend bonus payments in 2011-12. We are working to reduce the number of board members of public bodies ...

We are committed to cutting the number of senior managers in NHS Scotland by 25 per cent over the life of the next Parliament.”—[Official Report, 17 November 2010; c 30463-64.]

Presiding Officer—[Interruption.] I hear Mr Rumbles, from a sedentary position, ask how we know that we can do that. We know that we can do it because we have managed to hit, match or exceed every efficiency target that we have set in the past three years, in stark contrast to the performance of the previous Administration.

Asylum Seekers (Accommodation)

Anne McLaughlin (Scottish National Party, Glasgow)

4. To ask the First Minister what the impact on local communities across Scotland will be of the decision by the United Kingdom Border Agency to cancel its contract with Glasgow City Council. (S3F-2711)

Alex Salmond (Scottish National Party, Gordon)

Both Glasgow City Council and the city of Glasgow have a positive record of welcoming and working with asylum-seeking families. The Scottish Government has no jurisdiction in matters between the UKBA and Glasgow City Council. Nevertheless, the Parliament and the people of Scotland should not lose sight of the fact that the needs of the 1,300 asylum seekers—vulnerable people who have often been through very traumatic experiences—must be foremost in all considerations of what must be done next. All asylum seekers who are dispersed to Scotland must be treated fairly and humanely, and, while they are in Scotland, they must be welcomed and supported in local communities. I understand that many of them are visiting Parliament today, and I hope that that offer is made to them on a cross-party basis.

Anne McLaughlin (Scottish National Party, Glasgow)

I, too, welcome the Glasgow asylum seekers and their friends who are in the public gallery and those who are watching in the public area.

I ask the First Minister to do two things. First, will he condemn the sickening, disgraceful letter that many asylum seekers received last week, telling them that they would have just three to five days’ notice to pack no more than two suitcases and move to a location somewhere in Scotland? Secondly, will he make the strongest representation possible to the Home Office, telling it that the UKBA must get round the table again with Glasgow City Council to ensure that the city whose Government, whose council and whose ordinary people—many of whom are in the public gallery today—have invested so much in providing the particular support that is needed by those who seek refuge is able to continue to provide that support?

Alex Salmond (Scottish National Party, Gordon)

As Anne McLaughlin knows, the matter is not within the Scottish Government’s devolved competence. However, that does not mean that we have not acted. Scottish Government funds have been used in projects to improve the lives of asylum seekers and refugees, such as the Bridges Programmes in Glasgow, which helps refugees to overcome barriers to employment, and the Maryhill Integration Network, which provides language classes and activities to encourage integration.

I condemn in the strongest possible terms the nature of the letter that the asylum seekers received. I have constantly made it clear that asylum seekers should be welcomed and treated with respect and dignity in Scotland. I therefore share the concerns about the letter, which shows a lack of sensitivity and respect. It would be totally inappropriate in any circumstances, but it is reprehensible when dealing with vulnerable people. I will make those views, which I hope are shared by the whole Parliament, known to the Home Secretary, and I will make it clear that negotiations between the UKBA and Glasgow City Council should be reopened immediately.

Johann Lamont (Labour, Glasgow Pollok)

I welcome and agree with the First Minister’s comments about the role that Glasgow citizens and Glasgow City Council have played in their long-standing support for asylum seekers.

The First Minister may be aware that young people from Lourdes secondary school in my constituency are at the Parliament today to highlight the impact of the issuing of those awful letters on individual school students and the school community. We know about the work that has been done on the matter by Glasgow MPs and the Scottish Affairs Committee and their broad approach to it, which the First Minister mentioned. Will he consider how he and his education minister might intervene in relation to their responsibilities for the young people whose schooling is being disrupted and for whom the actions that are being taken at UK level have huge personal, social and educational consequences?

Alex Salmond (Scottish National Party, Gordon)

As the member knows, on a number of occasions in the past, on education and other grounds related to our devolved activities, we have intervened to try to secure the position of asylum seekers, and we will be delighted to do so again, in the hope of securing a better position for them.

I welcome the tone and the nature of these exchanges. It must be of encouragement to people in their extremity to see a Parliament that is united in seeking to defend the interests of vulnerable people.