Scottish Parliament, 6 July 2000

599 contributions from 89 members. The official report.

Introduction

Enterprise Networks

David (None, Lothians)

Good morning. The first item of business this morning is a statement by Henry McLeish on a review of the enterprise networks. The minister will take questions at the end of the statement, so there should be no interventions during it.

Henry McLeish (Labour, Central Fife)

I announce this morning the interim conclusions from my review of the enterprise networks. Following on from the framework for economic development published last week, the review is another important step towards the most comprehensive assessment of economic development policy in a generation.

The assessment takes place against a positive background. The economy is in good shape. The economic fundamentals are sound. However, we face major challenges. The e-revolution requires a step change in the way we deliver economic development. Even more important, we must ensure that our business community seizes the opportunities. All of us need to recognise in a real and significant way that the e-revolution is here. It is vitally important therefore that our economic development system is capable of meeting the challenge.

The review was built on extensive consultation, analysis and evidence. There is a shared vision about the need for effective and focused economic development. That vision is of economic development bodies that have a clear sense of direction and a clear task to perform; that have milestones and targets to ensure that they are on course to deliver the vision; that have 21st century Government approaches to 21st century problems; that are customer focused, responsive and relevant to the business, trainees and communities they serve; and that are accountable to the Executive and to the Parliament.

There is consensus about what is wrong at the moment. We need a better and more focused strategy. Previous Governments were unwilling and ideologically opposed to making economic development policy. There should no longer be a policy vacuum for the enterprise networks.

We need more comprehensive targets and milestones. We need to marshal our public sector agencies behind clear and challenging targets. However, we need to go much further. No one should be in any doubt about how serious I am about that. The outcome-led approach has to be a top priority. We should be adding value to the economy and getting value for the taxpayer.

We need more flexible enterprise networks that can adapt and evolve—1980s systems are trying to tackle 21st century problems. The enterprise networks need to be more streamlined and more focused on delivering the strategy set to them. They need to be more customer focused, responsive and relevant. They should be more business orientated, not less. They should be more focused on jobs, skills and new company growth to deliver employment opportunity for all.

We need more effective partnerships between the enterprise networks and the range of other players in economic development. There is duplication and overlap. Organisations pull against each other, rather than together to achieve a shared vision. Enterprise networks must be more accountable, with effective mechanisms for dealing with appointments and ensuring the highest standards of propriety.

There is consensus about the vision and the problems. It is for the Executive to provide the solutions and the prescriptions. The solution is a better strategy. We will accept the responsibility to set the lead on economic development. The framework for economic development provides the high level. A new strategy for enterprise is urgently required to turn that into action.

The strategy will set out the Government's action plan for economic development. It will establish clearly what the enterprise networks will do to create economic opportunity for all, to foster the knowledge economy and a culture of enterprise and to promote the learning revolution, sustainable development and social inclusion.

I want to see a clear thread running from our framework at national level through all economic development activity at national and local level. The enterprise networks will stimulate the dynamic competitiveness of enterprise, by promoting new markets, inward investment, indigenous enterprise, innovation and commercialisation.

The enterprise networks will help deliver a fairer Scotland, focusing on employability and employment—developing, advocating and implementing work-based solutions to social problems. They will help build the organisational effectiveness of our social economy and tackle the digital divide.

The strategy will set clear, well thought-out but tough targets for those agencies and will ensure that they pull together and in the same direction, so that we can make the most of the available resources. It will be a strategy for enterprise, to build a sustainable, successful economy, and to play an important role in building a fairer society and achieving employment opportunity for people in every part of Scotland.

I want the strategy to be in place by the end of the year, and to that effect I am establishing a high level expert group to achieve that. It will report to me and will bring together the expertise of the Executive, Scottish Enterprise, Highlands and Islands Enterprise, the tourist boards and the funding councils in higher and further education.

The key challenges for the enterprise networks are to reduce the productivity gap, the skills gap, the e-commerce gap, the entrepreneurship gap and, as part of that, the business start-up gap. No one should be in any doubt as to the priorities of the Executive and of the Parliament. Ultimately, we must try to close the jobs gap across the country. We will bring together the major agencies to ensure that all of them are absolutely clear about their role.

To deliver the strategy, there was an option to set up new organisations and shift responsibilities between agencies. I do not share that view. Structural change will be a distraction of management effort from delivery of our vision and strategy. Structural change misses the point. The focus is on customers, not on structures, and Scotland cannot afford to lose that focus even for a year. That is why the interim conclusions that I am announcing today are about evolution. Let no one be in any doubt that I expect the strategy to lead to significant change. Some of that change is already under way.

The solution is to develop more effective ways of working. That means new management approaches, new people, better development of existing staff and a radical shake-up in our style, approach and attitude. In a sense, we need a wake-up call to everyone involved in economic delivery. The enterprise networks need to adapt. I have backed and encouraged the change in the Scottish enterprise networks that is being driven through by Sir Ian Wood and Robert Crawford. They are delivering greater coherence, effectiveness and customer focus.

At national level, Robert Crawford has undertaken a thorough review of operations at Bothwell Street. He has eliminated duplication and overlap and has created seven key directorates that report directly to him, bringing together network operations, international operations, e-commerce, knowledge management, finance, customer relations and human resources. He has also taken advantage of the greater coherence of the network to develop sharing of support services such as finance and human resources. That allows significant improvements in efficiency, but I want to push them further. I want to see real improvements in appraisal and evaluation, and we must have more transparency.

Local enterprise companies are burdened by the last vestiges of the failed internal market introduced a decade ago, which creates unnecessary red tape and transaction costs. As Crawford Beveridge said in response to our consultation, we

"need to decide whether the economic development strategy for Scotland is simply the aggregate of all the local development strategies, or whether you start with a National Strategy and manage it locally".

He goes on to say that if

"the second is the intent . . . then the notion of independent companies, limited by guarantee is nonsense."

The second is my intent, and I agree with him. I will remove the anomaly of the LECs' status as companies limited by guarantee. That will allow greater efficiency and streamlining, switching resources from the back office to the front line. It will also create the opportunity for a significant increase in real local responsibility.

I want to take this opportunity to thank all the LEC board members for their contribution over the years to developing their local economies. They give their time for nothing. I want to remove unnecessary barriers to help them make an even more effective contribution.

The Highlands and Islands Enterprise network had a different starting point and chose different ways of working. Overall, it has stood the test of time better. That message has come through very clearly from people in the Highland community and I respect their wishes. I applaud the work of Jim Hunter and Iain Robertson. We will encourage them to play a bigger part in the debate on national issues.

The Scottish Tourist Board also needs to meet the challenges in the new strategy for Scottish tourism. I expect a report from the board by December on how that will be achieved. Tourism will take its proper place in national economic development, and it must also play a full part locally. Area tourist boards must enthusiastically implement our new strategy for tourism, and I expect them to tighten the effectiveness of their visitor services and local marketing functions.

In the autumn, we will respond in full to the conclusion of the Enterprise and Lifelong Learning Committee's report into local economic development. There is much in the report to support, but it says that there is duplication and confusion at local level and we need to sort that.

Part of the solution is the small business gateway, which was launched yesterday. It will bring consistent and improved standards to the delivery of small business advice and it will ensure that the various agencies that deliver advice do so in partnership with one another. It is a first and important step.

However, we must go further. I want to see coherence and clarity at local level and I will charge local economic forums with achieving that. We will work up our vision for the forums over the summer and will issue guidelines in the autumn, when I intend to discuss this and other important issues flowing from our framework in a major conference. I invite the Enterprise and Lifelong Learning Committee, led by John Swinney, to get involved in that process.

Local economic forums will not be talking shops, they will not be another layer of bureaucracy and they will not be replacements for the LECs. We will look to the LECs to take the lead in setting up the local economic forums. The LECs have a key role in addressing the dynamic competitiveness of Scottish business, but our ambition, which is set out in the framework, is much wider than that.

I want the forums to focus on what they can do to remove the barriers to regional and social development for all individuals, promote opportunities for economic activity to prosper and help people to access those opportunities and take full advantage of them. I intend to set challenging targets on those matters for the forums, such as ensuring employment opportunity for all, improving adult basic education and widening access to further and higher education. We will therefore implement local economic forums, which will work to address overlap and duplication amongst partners. I will set a clear time scale for the forums to deliver to me what they can do to address this issue.

Forums will ensure that all the relevant local agencies pull together, including the ATBs, and will share best practice across the country. Again taking a lead from the Enterprise and Lifelong Learning Committee, I will look at incentives for good performance. We must demand value for money in the use of public funds—that is an imperative, which underpins the statement this morning. Forums will be locally driven and provide local solutions within a national framework.

In conclusion, we will: produce a strategy for enterprise by December; improve national co-ordination; streamline the enterprise networks; require better appraisal and evaluation; and cut unnecessary red tape in the networks by changing the LECs' legal status. Local economic forums will bring more coherence in local economic development.

I commend this statement to the Parliament.

John Swinney (Scottish National Party, North Tayside)

I thank Henry McLeish for his statement and the courtesy of giving advance notice of its contents.

I take issue with one point that the minister made at the beginning of his speech, which was that the economic fundamentals are sound. He may not have picked up on this morning's report from the Fraser of Allander Institute, which highlighted the fact that the Scottish economy went into reverse in the last quarter of 1999. We must be realistic about the economic conditions that we face.

I welcome the minister's comments on e-commerce and its application to business, but it is important that, in responding to that challenge, we do not ignore the requirements of our traditional economic base and its transformation.

I also welcome the minister's announcement yesterday of the small business gateway, which reflects concern across the country that when an individual wants to start a business, they want to go to one clearly defined contact point to get the answers that they require.

The minister has announced a fairly fundamental change to Government thinking about the responsibilities of the Scottish Executive in relation to economic policy. He has said that the solution to the problems, on which we all agree, is better strategy. I suggest that we must see a national strategy for Scotland that is implemented, which would make a pleasant change.

I welcome the fact that the Executive is prepared to accept responsibility and I welcome the minister's comments about how serious he is about implementing this. However, the minister must tell Parliament today how he intends to enforce this strategy and change the nature of the relationships between the Executive and the enterprise agencies to guarantee that they follow the strategy that the Executive and Parliament dictate. Parliament would also benefit from further information about the content and the remit of the high level expert group that he intends to announce to take this task forward.

Much in this statement is to be welcomed, but I am surprised that it is only the interim conclusions of the minister's review and that it does not go into more detail about what will change in the arrangements for economic development in Scotland. Our business community and the many agencies that have a stake in economic development want the talking to come to an end and the action to begin.

I hope that the minister will tell us exactly what is going to happen, and give us an absolute guarantee that the implementation mechanisms will have begun by the autumn and that by then agencies will be doing the work that they should be doing instead of reflecting on the issues yet again.

Finally, when will the minister tell Parliament about the format and structures of the targets and milestones for the agencies, and how those targets will be enforced if agencies cannot perform against them?

Henry McLeish (Labour, Central Fife)

Sir David, you would not expect me to agree with John Swinney's analysis of the state of the Scottish economy. I am always impressed by unemployment figures that are at a 24-year low, employment rates that are at a 34-year high, low interest rates, low inflation rates, and a Chancellor of the Exchequer who wants to underpin our science and technology base by investing an extra £1 billion, from which Scotland will derive significant benefits. In essence, John Swinney has highlighted what we want to avoid. We know that there will be differences in emphasis over macro-economic policy, but today we seek unity and consensus on how local economic delivery should progress in Scotland.

I am grateful for John Swinney's comments on several issues. I certainly agree with him about e-commerce. I also agree that we must seek to move traditional industry into e-business while acknowledging what it contributes from, in some cases, a non-technological point of view. I welcome his comments about the gateway. It is intended to provide a single focus and I think that it will be successful.

In December, we committed ourselves to an enterprise review and, a few weeks ago, we announced the economic framework. Sir Ian Wood and Robert Crawford are introducing major structural changes in Scottish Enterprise. Today we are holding a review. The time scale is not long, as by the end of the year the talking will have stopped. As I have told John Swinney, we intend to hold a conference in the autumn. We will ensure that the high level expert group will work out the strategy for enterprise, which will provide the targets and the milestones. They will be tough, as Scotland cannot afford the luxury of talking up targets and not delivering in added value and value for the taxpayer. I agree entirely with the urgency that John Swinney is injecting into this matter.

A supplementary paper on the changes that we have announced today will be available this morning. I think that John Swinney already has a copy. We will detail more information over the coming weeks. Today's statement is constrained by time. I hope to progress matters in consultation with the business community, John Swinney and other members of the Enterprise and Lifelong Learning Committee.

We are introducing some fairly significant changes. This is a wake-up call. Scotland will not prosper in the future if it continues to talk a good game without implementing change. Every LEC and forum, and every member of the Enterprise and Lifelong Learning Committee, the Parliament and the Executive, should be aware that the Scottish economy is vital for prosperity and that we now need to register our interest in making it a real success.

Annabel Goldie (Conservative, West of Scotland)

I welcome the minister's certainty of pronouncement that the talking will stop. Although that is a worthy aspiration, I fear that, as long as we have politicians in Scotland, it is one that will never be implemented in practice.

I join John Swinney in thanking the minister for the early copy of his statement. There is much in the statement that is helpful and positive. However, I will share a reservation. The statement is entitled "Statement for launch of the enterprise networks review interim conclusions". I looked for something meaty; something I could grasp. I thought that nuts would be cracked, and kernels would appear. However, the statement falls slightly short of what I had hoped for in identifying the objectives of the announcement. I will draw attention to certain features of the statement and ask three specific questions.

The minister said:

"The outcome-led approach has to be a top priority. We should be adding value to the economy and getting value for the taxpayer."

I support that priority, as it is very important. Will the minister confirm that an outcome-led approach is synonymous with customer-driven requirements? In this case, the customer is the enterprise sector of Scotland—our businesses need to know where they are. Will the minister also confirm that there is not a danger of the whole brave new world of review of the enterprise networks being a mere systematic substitution of one form of bureaucracy for another? It is important that the minister can reassure the business community about that.

I listened carefully to what the minister said about structural change. Page 7 of his statement states:

"Structural change will be a distraction of management effort from delivery of our vision and strategy. Structural change misses the point. The focus is on customers, not on structures."

I agree with that conclusion, but I am slightly less easy with the definition.

Later on in the statement, the minister says that he is engaging in structural change of the local enterprise companies. Is it appropriate to have an unacceptable level of the enterprise budget being spent on administration? Of itself, that may not merit structural change, but it does merit careful examination of what is happening in the provision of enterprise services through our enterprise network.

Page 9 mentions the minister's intended treatment of the LECs. The statement says:

"I will remove the anomaly of the LECs' status as companies limited by guarantee."

I am, however, unclear what will replace the LECs' structure. There is a need to reassure not only the people employed in our LECs, who in many cases do a very good job at local level, but also local business communities that they are not losing out on an essential point of contact with like minds, and that they will not be confronted with some massive bureaucracy emanating from Bothwell Street.

Finally, I am reassured that the minister welcomes certain aspects of the report of the Enterprise and Lifelong Learning Committee on business development at local level. The minister embraces, in particular, the concept of local economic forums. However, is it not the case that the whole process would make a lot more sense if we waited until the autumn, so that the minister could give his full response to the report? Then, not only the Enterprise and Lifelong Learning Committee, but the business people of Scotland would know how all the bits of the jigsaw fit together. There is a distinct danger that this fragmented approach will lead to a dislocation of effort and, I suspect, an incoherent perception among the business community of what the minister is trying to do, however worthy it may be.

Henry McLeish (Labour, Central Fife)

I thought things were going well until the end.

It is difficult at times, but we must look at the bigger picture. Within a year, we have had the first-ever framework for economic development in Scotland and huge changes are taking place in Scottish Enterprise. To be fair to Annabel Goldie, it may be important for me to invite either the chairman of Scottish Enterprise or Robert Crawford to give a presentation, first to the Enterprise and Lifelong Learning Committee and then perhaps to the Parliament, on the huge changes that are taking place. That would go some way to explaining some of the general concerns.

This will be a year of consultation and of change, but from January 2000 we will get on with the action. In that sense, I do not think that the approach is fragmented. Indeed, I believe that it is fairly coherent, because we are dealing with not only an enormous amount of expenditure—nearly £1 billion—but with the future of jobs, prosperity and the business community.

Annabel Goldie raised the issue of the new status of the LECs. I met the chairmen of most of the local enterprise companies yesterday in Lanarkshire to talk through some of the changes that we are outlining. I reassured them that the system would be more business led and more hard-headed, because the LECs will now have to be the tough edge of business implementation of the national strategy, through Scottish Enterprise and Highlands and Islands Enterprise. I told them that removing the status was something that I wanted to do, which would mean, at the end of the day, that they would have more flexibility at local level to implement the strategy. I made it quite clear to them that there is a national strategy, going downwards, which they will be asked to implement at local level. They were also reassured by the fact that they will be involved, as part of the consultation, in working out what the new model for and status of the LECs and their activities will be. I hope that they were reassured by that.

I entirely agree with Annabel Goldie that far too much is being spent on administration and not enough on front-line services. However, Robert Crawford has introduced far-reaching changes, one of which is to streamline the structure, which means that 150 fewer employees will be involved in the next few months in delivering that strategy.

Annabel Goldie asked whether the strategy would be customer focused. The customer is king; the customer is the business community. If we want more business start-ups, more skills in the workplace, more e-commerce, we must involve business. The customer focus will be resurrected to ensure that no one is in any doubt as to the way forward.

Annabel Goldie suggested that the document had no meat. We have a framework for economic development—something that we have never had before. There are fundamental internal reviews of Scottish Enterprise. There are new economic forums at local level with an ambitious agenda, embracing the Enterprise and Lifelong Learning Committee's desire to tackle duplication. We have the business gateway to which John Swinney referred. We will identify a new range of outcomes and we will set tough targets. That is a tough, radical programme. However, at the end of the day, that programme must work. When the strategy is implemented, we will ensure that we have the means to measure progress.

George Lyon (Liberal Democrat, Argyll and Bute)

On behalf of the Scottish Liberal Democrats, I welcome the minister's statement. I want to consider more closely the Executive's announcement that it is to set up economic forums across the country. The conclusions that the Enterprise and Lifelong Learning Committee reached, which underpinned our recommendation for the establishment of economic forums, were based on evidence that was gathered from around the country. In Aberdeenshire and North Ayrshire in particular, we saw evidence of best practice working. The forums in those areas showed real partnership between the agencies. However, when we took evidence, it was generally recognised that we cannot legislate for good will. Agencies must come to the table in a spirit of willingness, co-operation and a desire to strip out duplication and overlap.

The Enterprise and Lifelong Learning Committee recognised the importance of real sanctions, evaluations and monitoring of the economic forums once they have been established. Will the minister clarify what action the Executive proposes to take to ensure that the forums deliver the elimination of overlap, duplication and competition between agencies? What action will he take if he finds that major agencies treat the forum as no more than a talking shop and use it as an excuse to defend their own territory? That is the crucial issue; it is the nut that we must crack. We must ensure that partnership works.

Henry McLeish (Labour, Central Fife)

I agree with much of what George Lyon has said. First, I want to work out the guidance that we provide for the creation of the economic forums. There are examples of good practice, such as those in Grampian, Ayrshire and the Borders. We must build on that. Secondly, we must detail what the forums will be doing. I make no apology for that. We have a national framework and we must ensure that the local forums are part of that. We will outline the outcomes that we expect from the forums. Thirdly, we will specifically charge the forums with the Enterprise and Lifelong Learning Committee's main concerns about duplication, confusion and waste of public funds.

Fourthly, I have used the phrase "financial incentives", which has both a positive and negative element. If we want to encourage rather than criticise, we should try to find some way of challenge funding local developments, so that those who are enterprising, interested, coherent and committed will benefit, while those who simply pay lip service will not. Let me send a strong message to any potential player in the economic forums. I want to disabuse them of the idea that such forums are talking shops. Scotland cannot afford any more talking shops at national or local level. I assure George Lyon that that is the spirit in which I will pursue this agenda.

David (None, Lothians)

In theory, we have only just over a minute for back-bench questions, but as it is an important statement, I will let the discussion run on a bit. I urge members to keep questions and answers short.

Marilyn Livingstone (Labour, Kirkcaldy)

I welcome the minister's statement and the changes to the structure of Scottish Enterprise. I was going to ask a very similar question to that asked by George Lyon about the local economic forums, and the minister's comments about more effective partnerships being welcome. How will the local economic forums interface with the small business gateway, and how will the minister ensure effective delivery at that level?

Henry McLeish (Labour, Central Fife)

I was absolutely determined to ensure that, with these changes, we did not lose the business focus. That is why I told Annabel Goldie that, although we have the framework with the two agencies—Highlands and Islands Enterprise and Scottish Enterprise—a key business focus must run straight through to the LECs. However, we acknowledge that key players put hard finance and commitment into the delivery of business support services. Although the gateway is focused on the LECs, certain players in the local community have a business role and should be tied into the process. That said, the main point was to keep things tidy to avoid confusion between what the players in the forum were trying to achieve and Scottish Enterprise's delivery of hard-edged business aspects, which will be a function of the LECs. The small business gateway is an acknowledgement of that concern, and I hope that it will be supported throughout Scotland.

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

By what date will the forums be established and who will serve on them? Will the business and voluntary organisation voice be in the majority? If not, how will the minister ensure that the forums deliver their intended purpose, which is to remove duplication and overlap? What, precisely, are the mechanisms for ensuring that rationalisation takes place? Having read the statement and the supplementary statement, and speaking as a confirmed carnivore, I am left feeling that the question today is, "Where's the beef?"

Henry McLeish (Labour, Central Fife)

With the greatest respect I can muster, I have to say that nothing Fergus Ewing ever says in this Parliament surprises me. When we talk about raising the economic game in Scotland, it is high time Fergus Ewing faced up to some of the changes and acknowledged in a tiny, tiny way that some progress has been made. Although I do not think that I will live long enough to see that happen, I will nevertheless leave the thought with Fergus Ewing for him to savour for the rest of the day. I hope that it might make some difference.

I covered the points about guidance and tough targets in my response to George Lyon, because he asked a question—

John Swinney (Scottish National Party, North Tayside)

The same question?

Henry McLeish (Labour, Central Fife)

Yes, indeed; the same question, which I answered.

John Swinney (Scottish National Party, North Tayside)

Slightly more.

Henry McLeish (Labour, Central Fife)

John Swinney says, "Slightly more" but he did not finish the sentence—and I know why.

John Swinney (Scottish National Party, North Tayside)

Slightly more tough.

Henry McLeish (Labour, Central Fife)

Slightly more irrelevant. If one answers a question, one expects some people to absorb the answer.

That said, I will try to keep consensual.

Sam Galbraith (Labour, Strathkelvin and Bearsden)

Why?

Henry McLeish (Labour, Central Fife)

I refer Fergus Ewing to my answer to George Lyon.

We want to discuss with key players and partners the issues that Fergus Ewing has raised. My target is to get the forums up and running by 1 January 2000. The guidance will be available in the autumn. We want the work to start. As I have said, Scotland does not have the time to stand around when there is so much good work to be done—which is a major reason for establishing the forums. We will examine the composition, targets and outcomes of the forums. As this Parliament is about participation and inclusivity, I am offering the Enterprise and Lifelong Learning Committee and the business world an opportunity to shape that kind of destiny with the local authorities, the area tourist boards and other key social and economic partners.

Helen Eadie (Labour, Dunfermline East)

I welcome the minister's statement this morning, particularly its reference to changing the legal status of LECs. I saw a ripple of pleasure among my Labour colleagues when that was mentioned.

I want to ask the minister about the working group and the strategy that he is hoping to implement by the end of this year. Given the members' business debate on Standard Life's mutuality and the development of co-operatives, can we perhaps speak to universities and colleges in Scotland to cascade that message of co-operative development? I think that that way forward provides real hope for the people of Scotland.

Henry McLeish (Labour, Central Fife)

I have been in correspondence with Helen Eadie on the co-operative idea. I hope that it is taken further as a developmental idea at a local level. One of the key issues for the forum is employment opportunities for all. What Helen Eadie talks about is a good model of how they can be created.

As part of the exercise, we considered other countries. Israel, Finland, Ireland, Bavaria, Catalonia and other places have a range of good models, including the co-operative development models. I hope that, as well as having a firm national strategy, we will have creative diversity at a local level that is in tune with the national strategy and includes a flavour of certain areas of Scotland that have enormously differing economic difficulties—which is demonstrated by the approaches of Highlands and Islands Enterprise and Scottish Enterprise.

Alex Neil (Scottish National Party, Central Scotland)

I ask the minister to set realistic expectations of what the enterprise network can do. He says that it will be charged with closing the productivity gap, the skills gap, the e-commerce gap, the business start-up gap—everything but the Watford gap. We must bear in mind the fact that the total budget for the enterprise network is less that 1 per cent of Scottish gross domestic product. We should focus on the things the enterprise network can do best and not give it so wide a remit that it is unable to achieve anything.

Regarding the strategy, where will the jobs come from? That is the key question. Scotland relies on three or four sectors for around three quarters of its exports. We need to diversify the Scottish economy and move into growth areas. Will the minister give a guarantee that the strategy will seriously address that?

Will the minister clarify the new status of LECs? I applaud his decision to remove their current status, but I ask him to clarify what the relationship will now be between local enterprise companies—which are no longer to be companies—and Scottish Enterprise.

Henry McLeish (Labour, Central Fife)

I have partly answered Alex Neil's last point already. We have changed the name to local economic bodies. As a matter of urgency, we will have a discussion about the new status, the new constitution and the new description of those bodies.

I could not agree more with Alex Neil's point about widening our employment base. Our success is concentrated on a small number of companies in a few narrow sectors, especially in relation to exports. As part of the Scottish Enterprise review that Robert Crawford is conducting, we want to sharpen up the Locate in Scotland export drive. We are also preparing an export strategy for the five years from 2000. That will address the issue.

Alex Neil asked about employment opportunities for all in each of the areas. Given that unemployment in Scotland is at 4.9 per cent and falling, I do not want unemployment to be at 10.6 per cent in Dunbartonshire, 9 per cent in North Lanarkshire and at a similarly high level in Ayrshire and so on. The Executive and every economic forum must think creatively of ways of remedying that situation.

Alex Neil's first point was about focus. Our business advisers said that the framework for national economic development concentrates on productivity. Alex Neil knows that productivity is the product of a number of other things. Productivity is crucial and we have decided to give the hard-edged business focus to the LECs. Alex Neil is right to say that we can facilitate some improvement, but the bulk of the changes will come from the private sector.

In terms of skills, e-commerce, entrepreneurship and business start-ups, we do not compare favourably with other countries or other parts of the UK. That is part of the focus, but the overwhelming objective is productivity. I am sure that Alex Neil will agree that we should unite around that issue.

Irene Oldfather (Labour, Cunninghame South)

I welcome the minister's statement. Does he agree that to foster the dynamic enterprise environment that he has spoken about, we must do two things: foster entrepreneurship in primary schools and encourage responsible risk taking in the small and medium enterprise sector. Does the minister agree that, too often, this country—unlike the United States—does not give entrepreneurs a second chance?

Henry McLeish (Labour, Central Fife)

I agree entirely with Irene Oldfather's comments. We are developing new ideas for taking entrepreneurship into primary schools and right through to the university sector. We want to engage the best entrepreneurs in Scotland to give that lead. That issue will be addressed.

Part of the focus of LECs will be to step up their activities to ensure that small and medium enterprises are entrepreneurial. As part of yesterday's announcement on the small business gateway, we announced grants of £500 for e-commerce activities. Bigger aspirations are part of entrepreneurship. Why should not Scotland be a nation in which we take considered risks? Why should not we be a nation that wants to invest for the future? Entrepreneurship is crucial, not only in terms of substance but in changing the culture of Scotland, which really needs to be changed quickly.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The minister made no specific mention of our local enterprise trusts. Kincardine and Deeside Enterprise Trust, which is in my constituency, is concerned about its future. Could he comment on how he envisages the future of the trusts, as there is some uncertainty about that? It would be beneficial if he were able to make a statement about them.

Henry McLeish (Labour, Central Fife)

I will make two points about Mike Rumbles's comments on trusts. Yesterday, we considered the partners who will contribute to the business gateway. The trusts are involved in that partnership.

The economic forum will be a key way in which the trusts will further involve themselves. I say this to Mike Rumbles and to every organisation that is participating in the gateway: "If you can add value, provide value for money, avoid duplication and confusion and be part of the new surge at a local level to get the kind of success that I want, we are with you, but we will be tough on any organisation that receives public sector funding and simply does not deliver." Our approach will be as tough and as clinical as that, so the challenge to every organisation is to respond to that.

Nick Johnston (Conservative, Mid Scotland and Fife)

We thought, when we came to the chamber this morning, that we might cross the rubicon, but we are actually on a stepping stone in the middle. It would be churlish of me, however, not to acknowledge that at least we are half way across the divide, if not the whole way.

I want to ask the minister a specific question about the high-level expert group. While we welcome the establishment of that group—it is a move forward—one or two key players seem to be missing. I am thinking of the role of the transport infrastructure in economic development. Will the transport authorities be involved in that group—or local authorities, which are often responsible for quite a lot of the duplication and confusion that the Enterprise and Lifelong Learning Committee found during its deliberations? There should also be input into the high-level expert group from business organisations.

Henry McLeish (Labour, Central Fife)

I will take that half way, half-hearted welcome from the Conservative group as a slight compliment.

The high-level group is being established to get the strategy for the enterprise network in place as quickly as possible. We have identified core groups but, to be fair, I want the strategy largely to be driven by the head of Scottish Enterprise, Robert Crawford. Scottish Enterprise has already done a lot of work on setting some powerful targets. That work will be enriched by other organisations.

The electronic, physical and transport infrastructure will be a crucial part of the Executive's role, and of the Parliament's role. I imagine that infrastructure will become a key specialism in the local economic forums in different parts of the country.

I am not sure that the high-level expert group will be able to make a contribution to the targets for LECs, but we want to involve it as much as possible in the work of the forums and in the Executive's—and the Parliament's—further work on this issue.

David (None, Lothians)

I apologise to those members whom I have not called. I allowed the time to run on beyond the usual half hour, but I must protect the time available for the main debate of the day.

National Health Service

David (None, Lothians)

We now come to the debate on the modernisation of the national health service. Although it is not stated precisely in the business bulletin, it is intended that the debate should be interrupted at half-past 12 for a short debate on the Government Resources and Accounts Bill. The debate on the national health service will continue during the afternoon.

Susan Deacon (Labour, Edinburgh East and Musselburgh)

We live in interesting times. More important, we live in challenging times. Fifty-two years ago this week, the national health service was created. Fifty-two weeks ago, the Scottish Parliament took up its powers. It was new politics, a new system of government and a new opportunity to improve the health of the Scottish people and to address the needs of the people's health service. It was a chance to look afresh at the big picture and to address the big challenges. That is what today's debate should be about.

Let us all remember that the NHS is our biggest and most important public service. It is our country's biggest employer. It has more than 135,000 staff, 5 million patients and a £5 billion budget. That is the scale of the task and, more important, the scale of the opportunity.

There has been a lot of talk over the past week about £34 million. I will return to that later. For those who are interested in numbers, the important figure is the £5 billion—the five thousand million pounds—that is being invested in the NHS and in the health of our people in the current year. The important issue is what is being done with that investment. That is what NHS modernisation is about—matching investment with reform; not just about spending more, but about spending better. It is not just about tinkering at the margins of change, but undertaking the root-and-branch reform that is necessary to build a health service fit for the future; not by yet more restructuring, but by rethinking and reorganising services around the needs of patients.

John Swinney (Scottish National Party, North Tayside)

Some of the numbers particularly interest my constituents. In Tayside, we may face six years of austerity because of a projected overspend in the Tayside University Hospitals NHS Trust. Is the minister able to give a commitment today that some of the underspend from last year will be allocated to support the trust in coming to grips with the very difficult circumstances that it faces, to guarantee that my constituents and those of my colleagues who represent Tayside and Fife are not prejudiced by a reduction in the availability of health care in Tayside?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

I am pleased to say that more than £20 million in additional resources has already gone into the NHS in Tayside. It is precisely because I want that additional investment to be used effectively and to be managed wisely that I have taken action. It is why I responded to the report published last week by the task force on the management of NHS services in Tayside. It is why I will continue to act on the information that I have received to ensure that people throughout Tayside get the services they need and deserve.

People in Tayside, as in every other part of Scotland, need a modernised health service. That takes time to deliver. It takes investment, energy, commitment, determination, vision, pragmatism and principles—all in equal measure. That does not reduce to soundbites or to a single spending decision, but the results are real. The 568 extra heart bypass operations performed in the past year are real. The 50,000 more operations performed in the NHS in Scotland this year are real. The quarter of a million more contacts made by community nurses and by health visitors to people in their homes this year are real. The faster diagnosis and treatment now being delivered by more than 140 one-stop clinics across the country is real. The 62,000 more out-patient attendances at hospitals this year are real.

I can tell members what else is real: the commitment of this minister and of every minister in this Executive to invest in and to build in Scotland an NHS that is truly fit for the future.

Alex Neil (Scottish National Party, Central Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

That is why we made clear in the programme for government our commitment to deliver substantially increased real-terms spending on the NHS; to shape a modern NHS that cares as well as it cures; to improve the patient's journey and to strengthen the voice of patients, staff and the public; and to tackle the root causes of ill health in radical and innovative ways.

Christine Grahame (Scottish National Party, South of Scotland)

Will the minister take an intervention?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

In just one year of this Administration, we have made progress on all those things. I will give just some examples: the building of eight new state-of-the-art hospitals; the investment of more than £30 million in community health centres and general practices to provide modern, integrated health and social care services; the linking of GP practices and hospitals to NHS net—with pharmacies to follow—so that patients can get faster appointments, test results and prescriptions; major developments in telemedicine, which benefits rural communities in particular; investment in the Scottish NHS Direct service to provide 24-hour health and social care advice, with services to be launched later this year.

There has also been investment in staff.

Alex Salmond (Scottish National Party, Banff and Buchan)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

I cannot resist the temptation.

Alex Salmond (Scottish National Party, Banff and Buchan)

If the Minister for Health and Community Care is speaking on behalf of all her colleagues in the Executive, why did the First Minister feel it necessary to issue the no-spinning edict that seems to have been directed at her?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

Once again, the SNP leader disappoints but does not surprise. I said at the beginning of my speech that this debate is about the big issues, and it is the big issues in the NHS in Scotland that we are focusing on because those are what matter.

Brian Adam (Scottish National Party, North East Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

We are investing £6 million in a new NHS education, training and lifelong learning strategy and we are taking action to reduce junior doctors' hours. We are ensuring better pay, to recruit and retain nurses in the service, and £8.4 million was announced last week for more doctors and nurses, allocating skills and resources to the areas of greatest need, such as intensive care, accident and emergency services and our communities.

Margaret Ewing (Scottish National Party, Moray)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

We are placing emphasis on and providing investment in the NHS's clinical priorities of cancer, coronary heart disease and mental health, and we are providing £13.5 million for new cancer equipment.

As further evidence of our commitment to invest wisely, I am pleased to announce that we are allocating an additional £30 million for equipment for the NHS. That money, which is part of the additional resource that was received as a consequence of the chancellor's March budget, will be targeted specifically on much-needed X-ray equipment and scanners to provide better, faster diagnosis. It will also be used for sterilisation equipment, to take effective action to reduce the risk of hospital acquired infection.

Duncan Hamilton (Scottish National Party, Highlands and Islands)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

All those improvements and so many more are delivering real benefits to patients throughout the country and are rewarding the innovation and creativity that is taking place in the NHS throughout Scotland.

We are doing much more besides. The redesigning of services is delivering improved care and faster treatment, and preparations are under way for the launch in the autumn of our patients project to improve communications with patients and to strengthen their voice. In addition, we have been responsible for the learning disability review, the work of the Scottish Partnership Forum, the establishment of the Clinical Standards Board for Scotland and the Health Technology Board for Scotland, and the launch of the carers' strategy for Scotland. Much has been done over the past year, but there is much more still to do. I am not, have never been, nor will ever be complacent about that.

The NHS in Scotland delivers high quality care. In the main, it provides a service of which we can be proud. However, we all know that people are waiting too long for care and treatment and that too many people still do not get the right treatment in the right place at the right time. Today, I expect that the Opposition will yet again have much to say about problems. Instead, I would like to focus on solutions.

Money is always suggested as the solution. Of course investment is key. That is why almost £500 million more is being spent on health in Scotland this year than last, and why we have given a commitment to increase spending on health in Scotland by £400 million to £500 million in each of the next three years. That will take total spending on health in Scotland to more than £6.5 billion by 2003.

John Young (Conservative, West of Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

None the less, let us nail here and now the myth that money is the only answer. New investment will not, of itself, deliver the change that our people need.

John Young (Conservative, West of Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

As well as investment, we need reform in the NHS. Money will not, of itself, overcome the traditional cultural, institutional and professional barriers that have, for too long, militated against the delivery of effective patient care. Money, of itself, will not get rid of the blockages and bureaucracy, the professional demarcations or the gaps and duplication that still exist in the NHS.

Alex Neil (Scottish National Party, Central Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

Too often, still, the way services are delivered owes more to the needs of the service than the needs of patient. That is why the NHS needs modernisation, investment and reform.

Since the turn of the year, we have been mapping out our modernisation programme for the NHS in Scotland. I want to set it out to the Parliament today. In February, at a conference of the leaders of the NHS in Scotland, I set out the three broad themes of our modernisation programme. The first is a commitment to modernise the process of policy development. The second is to modernise service delivery, to transform the way services are designed and delivered. The third is to modernise the governance of the NHS in Scotland; to clarify roles and accountabilities and ensure that local health systems operate as a partnership to deliver seamless patient care. Work is now progressing on all those areas.

Duncan Hamilton (Scottish National Party, Highlands and Islands)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

As I agreed with the service in February, we are now taking forward the development of a national health improvement programme for Scotland to provide a clear strategic framework for the development of the NHS. We are developing a more open and inclusive approach to policy development and service design, locally and nationally, involving people in important decisions about the future of their local services. Sustainable change needs real involvement of communities, staff and other interests. The local acute services reviews taking place at present are prime examples of that approach.

We have identified key target areas for action, including shortening waiting times and speeding up treatment and radically improving the links between health and social care to ensure genuinely seamless services, especially for the elderly. We are moving towards launching our first walk-in, walk-out hospitals and we are harnessing modern communications technologies to drive and facilitate new ways of working. All that progress is now being accelerated, with clear objectives and time scales that over the past few months have been agreed with every health board in Scotland. It is a significant and ambitious programme of work that we are committed to taking forward.

A modern NHS also requires changes in the way the service is managed. Attitudes, behaviours and processes left over from the internal market persist. They must be replaced with practices and accountabilities that befit a 21st century, patient-centred NHS in Scotland. That is why we are developing and improving the appointments system for NHS trust and board members. That is why we are extending the governance framework for health boards and trusts. That is why we are ensuring that corporate contracts encompass wider health and social inclusion objectives, so that health boards work much more closely with their partners outside the NHS.

Duncan Hamilton (Scottish National Party, Highlands and Islands)

rose—

Patricia Ferguson (Labour, Glasgow Maryhill)

Order

Tom McCabe (Labour, Hamilton South)

Sit down.

Alex Salmond (Scottish National Party, Banff and Buchan)

Are you chairing this? Mr McCabe is giving instructions to the chair.

Tom McCabe (Labour, Hamilton South)

No—are you chairing it?

Patricia Ferguson (Labour, Glasgow Maryhill)

We will not have members addressing one another across the chamber. Members will address the chair.

Please continue, minister.

Susan Deacon (Labour, Edinburgh East and Musselburgh)

I am grateful for your intervention, Presiding Officer. It is important that Parliament has the opportunity today to hear what the Executive is doing to drive forward modernisation and improvement in the NHS.

I have spoken about investment. I emphasise that it is being used to support and lever effective change. The £60 million of additional resources that was released to health boards last week is being linked to the delivery of specific priorities such as tackling waiting times and reducing delayed discharges from hospitals to the community.

Duncan Hamilton (Scottish National Party, Highlands and Islands)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

To drive forward this formidable programme of work, we need to have the people and processes in place. Yesterday, the first meeting of the new NHS Modernisation Board for Scotland took place. The board will help drive forward our modernisation programme. It will also build on and co-ordinate the work of our national network and project groups, which bring together people from across the service to address issues such as waiting times, winter performance, delayed discharge and capital planning.

The members of the modernisation board are talented, knowledgeable and effective individuals—champions for change. They are people who will bring a fresh perspective to our thinking on modernising services.

We also need wider involvement in our work. That is why, in the autumn, we will hold the first meeting of the new NHS modernisation forum. It will bring together a wide range of key NHS stakeholders to ensure that they have the opportunity to have meaningful involvement in shaping the future of our NHS in Scotland. Professionals, NHS staff, trade unions, patients, carers and people working in social care will all have a seat at the table.

Of course we have a long way to go—transformation on such an ambitious scale takes time and commitment from politicians, professionals and partners in the health and social care system. Already our approach to the modernisation of health services, locally and nationally, is changing people's day-to-day experience of the NHS. The transformation is already under way all over Scotland as the staff who deliver services come together to design new services in response to local needs.

Tricia Marwick (Scottish National Party, Mid Scotland and Fife)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

New partnership-based structures have been put in place in the NHS. Those structures are empowering our professionals and liberating their skills. That is happening throughout the NHS in Scotland.

One of the real privileges of my job is being able to see at close quarters the work that is being done in the NHS. I hope that we in this chamber can get better at celebrating and championing that work. We need to remember how much has been achieved.

Brian Adam (Scottish National Party, North East Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

Of course more is still to be done. Of course we need to work hard to improve further people's experience of the NHS. Of course we must do more to turn around the divided and underfunded system that we inherited. I do not condone service failures and I do not condone services that build in waiting and anxiety, with the result that patients who might have benefited from early treatment are let down badly. That is not the sort of NHS that I want for my constituents and it is not the sort of NHS that I want for my family. However, neither do I condone those who would capitalise on such failures. I certainly have no truck with those who—often in a bid to win political points—only undermine patient confidence.

Christine Grahame (Scottish National Party, South of Scotland)

Will the minister give way?

Roseanna Cunningham (Scottish National Party, Perth)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

Scotland has a long history of clinical excellence that stands comparison with any other nation. We have staff throughout the NHS in Scotland who are capable of excellent work and excellent innovation. It takes courage to press on with NHS reform and it takes conviction to drive change forward, especially in an organisation as large and complex as the NHS in Scotland. There are vested interests and resistance to change, but there is also a growing demand for change and growing support for it, both among the general public and, crucially, within the NHS itself. People want practical, positive change. I want practical, positive change.

This Executive wants practical, positive change. That is why we are backing that commitment with real investment.

Let me return to the debate—or, rather, the sideshow—of the past week. Let me set out the facts. Opposition members may care to listen for a moment to learn those facts.

Shona Robison (Scottish National Party, North East Scotland)

Will the minister give way?

Alex Neil (Scottish National Party, Central Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

In a health budget of around £5 billion, £135 million—that is, around 2.5 per cent—was carried over from last year to this. Much the same has been the case in previous years. That money is not an underspend and it is not surplus money. In the main, it is continuing spend on continuing capital projects and continuing planned expenditure by health boards on continuing local services. Of that money, £101 million is carrying over within the health budget to be spent, as planned, on committed NHS expenditure. The remaining—and much talked about—£34 million is, as the Deputy First Minister stated clearly and unequivocally this week, being set aside for health-related projects.

Alex Neil (Scottish National Party, Central Scotland)

Will the minister give way?

Susan Deacon (Labour, Edinburgh East and Musselburgh)

This Executive wants a Scotland in which fewer people need health care because there is less illness. That is why we held a healthy Scotland convention this week, to bring ministers with different portfolios together with people with skills, expertise and perspectives from right across Scotland.

It is only by pulling together policies and resources across the Executive that we can deliver real health improvements to the Scottish people, such as action on drugs and homelessness and action for the elderly. People cannot have it both ways. They cannot call on the Executive to deliver joined-up government and then castigate us when we do.

Health improvement cannot be delivered simply by spend in the NHS, and the NHS cannot be improved simply by spend in the health service. As the Minister for Health and Community Care I am delighted that £10 million—almost one third of the much vaunted £34 million carry over from last year—is being directed towards improved community care. We have already allocated extra money to health boards for that purpose. Now the additional £10 million will help tackle the community care end of the problem. Those, quite simply, are the facts.

In closing today, I lay down a challenge to Opposition members—a challenge based perhaps more on hope than on expectation. I say to them, "Raise your game. Raise the debate. Rise to the real challenges of tomorrow rather than the cheap jibes of today." The national health service is more important than any political party. It is certainly far more important than any individual politician. The NHS is about people—the people who work in it and the people who use it. It is their interests and their future that matters.

I move,

That the Parliament recognises the Scottish Executive's commitment to the NHS in Scotland and to improving the health of the Scottish people; supports the Scottish Executive's commitment to build on the founding principles of the NHS and to providing a modern health service designed around the needs of patients; recognises that the delivery of a modern NHS requires both resources and reform; welcomes the Scottish Executive's commitment to target its record investment in the NHS to areas of greatest need and to those changes which have greatest benefits for patients, and supports the Scottish Executive's plans for the modernisation of the NHS in Scotland.

Kay Ullrich (Scottish National Party, West of Scotland)

What a tired, flat performance that was from the minister. Perhaps under the circumstances it was all that could be expected.

Today I want to examine the Executive's record on health over the past year and to suggest a way forward for the long-term future of the health service in Scotland. Tired though the minister's speech was, I must say that her performance must make her a major contender for the brass neck of the year award. However, this minister has had plenty of practice when it comes to defending the indefensible. For nigh on 14 months, we have been subjected to the same old complacency—the same old self-congratulatory doublespeak.

Of course, today's debate was never meant to be like this. It was meant to be the climax to a long-planned series of announcements designed to convince the people of Scotland that the health service was indeed safe in new Labour's hands. In order to achieve that aim, the spin machine department was put on double time. All the old announcements were dusted down and the venues were selected. It was to be Deacon's fightback to public credibility. Instead, what we have witnessed is more akin to Custer's last stand.

The minister had not reckoned on her wee pal Jack coming along with a perfectly planted knife right between the shoulder blades. Just after the minister had said last week with great fanfare what she was going to do with £8.4 million, along came her colleague the Minister for Finance, who told us not only that the health budget had been underspent by £135 million, but that the Minister for Health and Community Care had agreed that 25 per cent of the underspend was to be given to him for areas other than health.

Richard Simpson (Labour, Ochil)

Lies. Absolute nonsense.

Patricia Ferguson (Labour, Glasgow Maryhill)

Order.

Kay Ullrich (Scottish National Party, West of Scotland)

Did the minister not realise that it was accepted practice that all underspend on health should be retained in the health budget?

Richard Simpson (Labour, Ochil)

Nonsense. That is not true.

Kay Ullrich (Scottish National Party, West of Scotland)

Can the minister explain why she saw fit to relinquish so easily £34 million of much-needed money for the health service? Even the hastily cobbled-together compromise was made purely in the interests of Ms Deacon and Mr McConnell's careers—such as they are—rather than in the interests of Scotland's patients. As if that was not bad enough, remember that this was supposed to be a week of glorious headlines for Labour in the build-up to today's debate. The actual headlines recorded the stark reality of Scotland's health service under Ms Deacon's stewardship.

Richard Simpson (Labour, Ochil)

I feel constrained to speak, because the facts are being completely distorted. There has been an underspend in the NHS every year, certainly since I started in the health service. Every year, health boards used to rush to spend the money in March on all sorts of crazy things that were totally unnecessary to the service. The Finance Committee of the Parliament, in negotiations with the Minister for Finance, agreed that all spending departments—[MEMBERS: "Speech."] All spending departments—

Kay Ullrich (Scottish National Party, West of Scotland)

I think that we have got the message.

Richard Simpson (Labour, Ochil)

The facts need to be corrected.

Patricia Ferguson (Labour, Glasgow Maryhill)

Order.

Kay Ullrich (Scottish National Party, West of Scotland)

As I said, we have got the message—

Richard Simpson (Labour, Ochil)

The member allowed the intervention. Unless the Presiding Officer stops me, I have the right to conclude.

Patricia Ferguson (Labour, Glasgow Maryhill)

Order.

Richard Simpson (Labour, Ochil)

Twenty-five per cent of all spending departments—

Kay Ullrich (Scottish National Party, West of Scotland)

Presiding Officer, can you stop this? The member is making a speech.

Richard Simpson (Labour, Ochil)

I am just asking whether the member believes—

Patricia Ferguson (Labour, Glasgow Maryhill)

Order. Please sit down, Dr Simpson.

Kay Ullrich (Scottish National Party, West of Scotland)

The fact is that both local government and justice retained 100 per cent of their underspend. Why did Susan Deacon not fight for Scotland's health service?

After that speech from Dr Simpson, I will continue. The Tayside task force reported and revealed its concern over the standard of monitoring by Ms Deacon's department. The task force indicated that, had the management executive been doing its job effectively, the situation in Tayside could have been remedied much earlier.

Then there was the British Medical Association conference. Dr John Garner, chair of the BMA in Scotland, not only pointed out the fact that Scotland was not getting the 6.1 per cent uplift that was promised in the budget, but accused the Executive of indulging in

"sound bite politics linked to . . . a headline on the early evening news and in the morning papers."

The minister has certainly grabbed the headlines this morning.

Then came the publication of details—which have been known for some time—about the scandal of cancer patients in Scotland having to wait for up to 13 weeks for life-saving radiotherapy treatment.

Only this week, a clinical director of Lothian Primary Care NHS Trust, Dr Anna Glasier, compared conditions in her clinic to those in developing countries and said that she was ashamed to treat patients in such an environment.

Instead of today being the minister's opportunity to regain her credibility, we have a beleaguered minister. Not only has she been mugged by the Minister for Finance and shown the yellow card by the First Minister, her dismal stewardship of the health service in Scotland has been laid bare for all to see.

Let us take a look at that stewardship over the past year. We all remember the winter crisis, when we saw the classic Deacon approach. No matter that all elective surgery was cancelled and that seriously ill patients were being ferried around Scotland in search of intensive care beds, the Minister for Health and Community Care adopted what has become her standard response—deny that there is a problem, accuse the SNP of scaremongering and bang on about the new money that new Labour is putting into the health service. The truth, of course, is that the health service in Scotland was able to cope during the winter crisis only thanks to the dedication and good will of health service staff. Those staff worked extra hours, forwent days off and, in many cases, worked back-to-back shifts.

On Monday, we heard the evidence from a Unison survey that showed the increased work load for health service staff since 1995. In 1995, there was one doctor for every 92 patients; today, one doctor has to look after 110 patients. In 1995, there was one nurse for 18 patients; today, one nurse has 24 patients to care for. In 1995, there was one domestic—who are important people—for every 211 patients; today, there is one domestic for every 301 patients. And we wonder why there has been an increase in hospital-acquired infections.

Hugh Henry (Labour, Paisley South)

Will the member give way?

Kay Ullrich (Scottish National Party, West of Scotland)

No. I will be like the Minister for Health and Community Care and continue.

That is the reality of being a worker in the health service under new Labour. Even worse, those figures show the reality of the decline in patient care as a result of Miss Deacon's mismanagement of the health service in Scotland.

Margaret Smith (Liberal Democrat, Edinburgh West)

Will the member give way?

Andy Kerr (Labour, East Kilbride)

Will the member give way?

Kay Ullrich (Scottish National Party, West of Scotland)

I will give way to Margaret Smith.

Margaret Smith (Liberal Democrat, Edinburgh West)

Rather than stand there attacking people, will Kay Ullrich say what the SNP would do to improve the health service in Scotland? Given that the latest figures show that SNP spending pledges so far are around £3 billion, which would be an extra 15p on income tax, and that the Executive is already spending double what the SNP promised in its manifesto, what would the SNP do to improve the health service?

Kay Ullrich (Scottish National Party, West of Scotland)

I will tell the chamber one thing—if we were sitting on the amount of money that the minister is sitting on, the health service in Scotland would not be in the state that it is in today. [Interruption.] Presiding Officer, will you deal with the rabble?

Patricia Ferguson (Labour, Glasgow Maryhill)

I will make the chairing suggestions, thank you.

Kay Ullrich (Scottish National Party, West of Scotland)

There are many examples of Miss Deacon's do-nothing approach.

Margaret Smith (Liberal Democrat, Edinburgh West)

Answer the question.

Kay Ullrich (Scottish National Party, West of Scotland)

I have answered the question.

For example, the debacle— [Interruption.]

Patricia Ferguson (Labour, Glasgow Maryhill)

Order.

Kay Ullrich (Scottish National Party, West of Scotland)

This is serious stuff. The people out there want to hear about it. These are the issues that people care about. For example, we had the debacle of the closure of Scotland's only heart transplant unit. Members will remember Miss Deacon's discomfort as she ducked and dived during the debate on that matter. Members will also remember that she never answered the questions that we asked that day. I will ask them again—Scotland's heart patients deserve to know.

When did the minister know of the crisis at the unit? Was it when she first took over the health portfolio 52 weeks ago? After all, the unit was nationally funded, and it had been operating with only one surgeon since 1995. Alternatively, did the minister first become aware of the crisis last summer, when the sole surgeon asked for another to be appointed? Did the minister know in January, when all transplant surgery ceased, or was it when she opened her paper on the morning of 3 May? Was it the case that, by 10 May, she realised that she must be seen to be doing something, and gave the trust a whole two days to present an action plan? Either the minister was unaware of the situation, or she knew and failed to act. Either way, the only conclusion that can be drawn is of a minister not in control of her brief. When did the minister know? I will take her intervention now.

Hugh Henry (Labour, Paisley South)

rose—

Kay Ullrich (Scottish National Party, West of Scotland)

Do not look now, Susan; he is after your job.

Margaret Curran (Labour, Glasgow Baillieston)

rose—

Kay Ullrich (Scottish National Party, West of Scotland)

Last week— [Interruption.]

Alex Neil (Scottish National Party, Central Scotland)

On a point of order, Presiding Officer. Will you control Labour and Liberal Democrat members?

Kay Ullrich (Scottish National Party, West of Scotland)

I have lost three minutes because of this.

Patricia Ferguson (Labour, Glasgow Maryhill)

Carry on, Miss Ullrich.

Kay Ullrich (Scottish National Party, West of Scotland)

Last week, we had the publication of the research study in Glasgow that highlighted the fact that cancer patients were having to wait an unacceptably long time for radiotherapy. Again, that should not have been news to the minister. In September 1999, the Royal College of Radiologists issued a report on the shortage of linear accelerators and consultant radiologists. That was followed quickly by a British Medical Journal report, which showed that the UK has fewer radiotherapists per head than Poland and fewer medical oncologists than any nation in western Europe.

Richard Simpson (Labour, Ochil)

rose—

Kay Ullrich (Scottish National Party, West of Scotland)

I am sorry, we do not have time for another speech.

Richard Simpson (Labour, Ochil)

It will not be another speech.

Kay Ullrich (Scottish National Party, West of Scotland)

This is serious stuff. As a doctor, Richard Simpson should understand that.

During the 3 February health debate, I raised the issue of waiting times at the Beatson oncology clinic. That day, I highlighted the plight of a patient who was diagnosed with lung cancer on 19 November last year and given a start date for radiotherapy treatment of 24 January this year. The situation at the Beatson was not news to the health minister. What was her reaction when that scandalous situation became public knowledge last week? She said that it was up to the trust to plan appropriately. No it is not. The buck does not stop with the trust; it stops with the minister.

Here we have a health minister whose modus operandi seems to be to deny, to ignore, to blame someone else and, if pushed into a corner, suddenly to appear to be taking action—more in an attempt to be seen to be doing something than actually to address a problem.

Trish Godman (Labour, West Renfrewshire)

On a point of order, Presiding Officer. We are supposed to be discussing the modernisation of the national health service, not giving a tirade against Susan Deacon.

Patricia Ferguson (Labour, Glasgow Maryhill)

That is not a point of order. Carry on, Miss Ullrich.

Kay Ullrich (Scottish National Party, West of Scotland)

I have already lost three minutes because of the behaviour of the other parties.

Patricia Ferguson (Labour, Glasgow Maryhill)

I will be the judge of the time, Miss Ullrich. Please carry on.

Kay Ullrich (Scottish National Party, West of Scotland)

I am coming to the end-of-term report for the minister. I am afraid that the report that she must take home today will read, "Susan's coat is on a very shooglie nail." As we all know, it is not just the SNP that is saying that. The truth is that new Labour is in deep trouble over its handling of the health service. That is why we are seeing such a flurry of activity.

Money is being found from the depths of already-announced budgets—reannouncements and more reannouncements. Where, I must ask, is the long-term planning? Where is the long-term strategy for the delivery of health care in Scotland?

Robert Brown (Liberal Democrat, Glasgow)

On a point of order, Presiding Officer.

Patricia Ferguson (Labour, Glasgow Maryhill)

Is it a genuine point of order, Mr Brown?

Robert Brown (Liberal Democrat, Glasgow)

Is it in order for members to speak to a motion that calls for action and for new and imaginative methods without giving us some insight as to what those are and what the alternatives are?

Patricia Ferguson (Labour, Glasgow Maryhill)

That is not a point of order, Mr Brown. Miss Ullrich, please carry on. I am keeping a close watch on your time.

Kay Ullrich (Scottish National Party, West of Scotland)

Every action and every announcement by the health minister is for the short-term benefit of new Labour, or Susan Deacon, or both. Last week's events provide a clear example of what a political football the health service has become, not just between political parties but, here in Scotland, between Labour ministers seeking election to what we shall call a promoted post. This short-termism must stop. Health is too important to be subject to the constraints of electoral terms of office.

There is, however, a small glimmer of hope in what the minister said today about the modernisation board. That goes some way towards embracing the SNP policy of establishing a national health care commission. The minister has failed to understand one crucial element of that SNP policy. [Interruption.] Members have been saying that they want to hear what SNP policy is, so they should now listen.

The one crucial element is to include cross-party representation of MSPs. After all, surely no one in this chamber does not want the health service in Scotland to rate alongside the best in the world. With cross-party representation on a health care commission, we could develop a long-term strategy with a consensual approach to ensure that the maximum health care benefit is achieved for the people of Scotland. Cross-party representation would allow us to move away from the current headline-grabbing, short-term approach of the Executive. Cross-party representation would also allow for a consistent approach to spending and commitments, in line with the long-term strategies developed by the commission. That would remove the tendency towards big spending rises in election years. It is no coincidence that new Labour's current panic about the health service coincides with the forthcoming Westminster election. Only a consensual approach will ensure that Scotland's health record is brought closer to European averages.

Patricia Ferguson (Labour, Glasgow Maryhill)

Will you wind up, please?

Kay Ullrich (Scottish National Party, West of Scotland)

It is unacceptable that despite the Executive's exaggerated claims— [Interruption.]

Patricia Ferguson (Labour, Glasgow Maryhill)

Order.

Kay Ullrich (Scottish National Party, West of Scotland)

If members listen, they will learn something.

According to World Health Organisation figures for expenditure on health as a percentage of gross domestic product, Scotland ranks below nations such as Costa Rica, Nicaragua, Honduras, Panama, Namibia and Mozambique. The minister cannot—

Hugh Henry (Labour, Paisley South)

Will the member give way?

Kay Ullrich (Scottish National Party, West of Scotland)

I am winding up.

The minister cannot seriously believe that, given the dreadful record of the her stewardship of the health service in Scotland over the past year, anyone other than the whipped masses behind her could support that self-congratulating fiction of a motion.

Susan Deacon will be glad to hear that the SNP is not calling for her resignation today. She may wish to listen to public opinion, or indeed the First Minister's opinion, and take it on herself to consider her position. However, let her be in no doubt—today the Parliament has put her on a final warning.

I move amendment S1M-1091.1, to leave out from first "Scottish" to end and insert:

"failure of the Scottish Executive to tackle the chronic problems which currently exist in the health service in Scotland; calls upon the First Minister to take immediate action to address the situation; condemns the mismanagement and inaction on the part of the Executive, and demands new and imaginative methods of ensuring that the NHS in Scotland is run on the basis of patient need and not political expediency."

Mary Scanlon (Conservative, Highlands and Islands)

We come to this debate in the fourth year of a Labour Government with a chancellor's war chest of £18 billion and a further £22.5 billion from the mobile phone auction. The Government said that it would hit the ground running; it has been running ever since. The bigger the problems, the faster it runs in the opposite direction, towards focus groups, commissions, inquiries, glossy brochures, working groups, consultation—anything that prevents it from addressing the problem. Never before have we heard daily of so many problems. Never before has the medical profession been so outspoken about those problems.

Maureen Macmillan (Labour, Highlands and Islands)

Will Mary Scanlon give way?

Mary Scanlon (Conservative, Highlands and Islands)

I have not even started. Maureen Macmillan should sit down and listen to what I have to say.

Today we are faced with a motion that does not address the crisis; it is self-congratulatory and ill deserving in the extreme. It is insulting and wholly insensitive to those working in the national health service and the patients whose lives depend upon it. The Executive will not be forgiven for its arrogance, complacency and total lack of sensitivity to NHS staff and their patients.

Hugh Henry (Labour, Paisley South)

rose—

Mary Scanlon (Conservative, Highlands and Islands)

The motion refers to "commitment to the NHS". Would that be the commitment to the £135 million underspend, to the ever-rising financial deficits, to the 135 vacancies for consultants, or to more spin and fewer doctors?

Hugh Henry (Labour, Paisley South)

rose—

Mary Scanlon (Conservative, Highlands and Islands)

The voice of Scotland's doctors states that the Executive is all spin and no doctors.

Hugh Henry (Labour, Paisley South)

Will the member give way?

Mary Scanlon (Conservative, Highlands and Islands)

If I had been going to give way, I would have done so by now. [Laughter.] It is the last day of term—Hugh has had a busy year and should have a rest.

The motion refers to

"improving the health of the Scottish people"

at a time when the cure rate for lung cancer in Scotland is half that of France. Would that be the improvement in waiting lists, which have increased by 17 per cent in the past 12 months? Could it mean the Executive sitting on £135 million while cancer patients die as they wait for treatment?

The motion mentions "a modern health service". This modern health service cannot afford training and has had to slash investment in medical equipment and technology. This modern health service cannot even reply to the man who invented keyhole surgery, which is now practised throughout the world—he cannot get a reply to his letters, despite being promised funding by the previous health minister, Sam Galbraith. This modern health service cannot even give Scotland's 26 medical directors their terms and conditions of employment, despite the fact that they have been in post for 16 months. At a time when the aim is to change the way in which clinicians practise, who better than the medical directors to bring about that change? When they move, the doctors move, and, until the doctors move, no one moves.

The motion says that the Parliament

"welcomes the Scottish Executive's commitment to target its . . . investment . . . to areas of greatest need".

How would Susan Deacon know the areas of greatest need? She does not even talk to the British Medical Association. John Garner said at the BMA's national conference:

"We currently have no significant involvement in the development and direction of health policy."

While the minister talked of partnership, John Garner went on to say that

"the BMA in Scotland has had no dialogue at all with the Executive over the new monies . . . But we are not alone, the other health professions and indeed the public are equally frozen out from the process."

As for targeting resources, the minister called the members of the Health and Community Care Committee numpties when they dared to disagree with her over the Arbuthnott report. It would seem that the modernisation board can propose anything so long as Susan agrees.

Margaret Smith (Liberal Democrat, Edinburgh West)

On a point of order.

Patricia Ferguson (Labour, Glasgow Maryhill)

I hope that it is a genuine point of order, Mrs Smith.

Margaret Smith (Liberal Democrat, Edinburgh West)

I think that Mrs Scanlon will find that she has made an error in saying— [Interruption.]

Patricia Ferguson (Labour, Glasgow Maryhill)

Order. If members will allow me to hear Mrs Smith's point of order, I will be able to make a judgment on it. Mrs Smith, do you wish to continue with your point of order?

Margaret Smith (Liberal Democrat, Edinburgh West)

I think that Mrs Scanlon will find that the minister did not call committee members that name.

Patricia Ferguson (Labour, Glasgow Maryhill)

That is an intervention, not a point of order, Mrs Smith. Carry on please, Mrs Scanlon.

Mary Scanlon (Conservative, Highlands and Islands)

The spin-doctors have to apologise for that, as it was published throughout Scotland.

There is not even a pharmacist on the modernisation board, despite the fact that Scotland's pharmacists see 600,000 people every day. What are the modernisation plans? Is there a plan? Is there a vision? Is there a strategy? Or is it the case, as John Garner of the BMA said, that everything is being done by

"a new army of special advisors, civil servants and spin-doctors"?

The BMA is the voice of Scotland's doctors. John Garner went on to say:

"We believe it is vital that the Executive understands that those who work in the service, those who pay for the service and most importantly, those who use the service, are central to modernising the service. Scotland needs a long-term strategic plan of expansion and modernisation involving meaningful and constructive dialogue".

One would not have thought that the Executive needed to be told that.

Hugh Henry (Labour, Paisley South)

Will Mrs Scanlon give way?

Mary Scanlon (Conservative, Highlands and Islands)

John Garner went on to say that, rather than sound-bite politics—

Hugh Henry (Labour, Paisley South)

Will Mrs Scanlon give way?

Mary Scanlon (Conservative, Highlands and Islands)

Hugh Henry is so persistent that I shall give way.

Hugh Henry (Labour, Paisley South)

I am grateful to Mary Scanlon; she is always the lady.

Mary Scanlon mentioned paying for the service. Does she agree with Ann Widdecombe, who stated that, if someone wants to pay to see their GP, they should be encouraged to do so? If she agrees, what advice does she have for those who cannot pay?

Mary Scanlon (Conservative, Highlands and Islands)

I am delighted to say that William Hague has given us carte blanche to make health policy in Scotland to suit Scotland's needs and Scotland's patients. Ann Widdecombe is not the health minister; the next time that Hugh stands up with his wee interventions he should remember that. We are talking about something called devolution. I know that it is difficult for Tony Blair to understand, but that is what it is called.

All the shortcomings that John Garner described come from an Executive in which one is sacked for leaking but keeps one's job for incompetence. If the minister had discussed with the professionals how best to use the money for Scotland's health, she might have used £80 million to invest in and modernise the aging diagnostic equipment to bring it up to satisfactory minimum standards. A written answer to a question from Kenny Gibson confirmed the huge reduction in investment in medical equipment. How can trusts invest when they have to transfer capital to revenue budgets to meet political, rather than clinical, targets?

Money could have been invested in training, by revitalising the study-leave budgets that, over the past five years, have continually decreased in real terms. Even £50,000—a drop in the ocean—could fund a Scottish course to train tutors of lip-reading, which would benefit 370,000 hearing-impaired adults in Scotland.

Surely, as a management consultant, the minister must recognise that change must be managed. However, the clinical director of Tayside University Hospitals NHS Trust, who quit after 40 years of service, described

"the stress of trying to run clinical services when instructions from the centre, particularly the Health Minister, are incompatible with running that service".

When the minister wants to talk about partnership, I suggest that she starts by looking for a dictionary definition and then works on that.

The £135 million underspend is a result of sheer hard work by staff in the NHS who, as Kay Ullrich said, were under the illusion that it would be ploughed back into the health service. Many of those staff worked 16-hour shifts to get the NHS through the winter. It is hardly surprising that good will and trust has now been broken and that morale is seriously dented. Is it any wonder that staff in the NHS are feeling let down, angry and frustrated? This should be about clinical priorities, not political priorities. Let the health service get on with managing. Let NHS staff get on with treating the patient—they know what needs to be done.

The £135 million underspend did not just appear on 31 March. When did the minister know of the potential underspend? Was it when patients in Inverness were being offered the nearest intensive care bed in Birmingham? Did she know of the underspend when the cancer patients in Tayside and Glasgow found out that their tumours had grown too big to be treated? Did she know of the £135 million underspend when services were cut at Stracathro month by month? Why was it that justice, local government, the Parliament and administration all negotiated to keep the full underspend with no clawback? Previous practice was that the health service retained 100 per cent of any underspend, not 75 per cent. Why did the budget rules change this year? Why did the minister agree to a £34 million loss to the core services of the NHS? Did the civil servants not tell her about common practice, or is Jack McConnell a little bit too smart for her? If she cannot fight to retain £34 million in its rightful place in our NHS, how can she be trusted to represent Scotland's interests in negotiating the Barnett formula for our funding from Westminster?

However, the Minister for Health and Community Care has a contingency plan. When things go wrong, she blames the managers. If that does not work, she threatens to sack them and to dock their pay. If that does not work, she threatens to cull them. If that does not work, she blames the doctors and consultants. If that does not work, she blames the GPs. If that does not work, she blames the patient. If that does not work, she blames Jack McConnell.

Those policies sound like the rhyme "Solomon Grundy". They are born on a Monday, leaked on a Tuesday, spun on a Wednesday, denied on a Thursday, rejected on a Friday, dead on a Saturday, buried on a Sunday. That is not the end of Solomon Grundy, however, because it is all reannounced the following Monday. Surely the time has come for the Executive to put Scotland's patients before ministers' career prospects.

I move amendment S1M-1091.2, to leave out from first "the Scottish" to end and insert:

"that the delivery of a modern NHS requires both resources and reform; calls upon the Scottish Executive to abandon those policies which foster a spirit of divisiveness, to adopt policies which will restore the morale of the health service workers at all levels and to work with medical professionals and relevant authorities to address the need for investment in equipment and training and ensure that the £135 million underspend is fully committed to benefit patient care, and further calls for the development of a new approach to long-term and community care through unified health and social work budgets."

Nora Radcliffe (Liberal Democrat, Gordon)

The motion asks us to note

"that the delivery of a modern NHS requires both resources and reform."

I reiterate what I have said on every possible occasion since I was elected. I say yes to resources, yes to reform, but please do not reorganise the NHS. Leave the structure alone and let us and the NHS staff concentrate on what is important, which is service delivery.

What are the essential elements of a modernised NHS? I have come up with three. It must be carefully and consciously people-centred, it must be equitable and its resources must be used effectively. I say people-centred rather than patient-centred because it should be a health service, not a treatment for ill health service. We say that prevention is better than cure, but the phrase is so familiar that we sometimes ignore the truth of it. I will say more about that when I speak about the effective use of resources.

Being people-centred demands a willingness to consult people about their needs and wants, to listen to what they say, to take that seriously and to act in accordance with people's wishes rather than one's own. That can be difficult for any professional, medical or otherwise. It is much easier to take a nanny-knows-best attitude than to take the time and trouble to find out what a patient wants or—often more pertinently—what the patient does not want. As part of that exercise, a patient must be given the information that he or she requires to make an informed decision. Barriers to understanding should be recognised and overcome. How often are our health professionals given the time with patients and, where necessary, the support of translation or patient advocacy services to consult patients properly? Perhaps they are sometimes, but certainly not always.

Feedback from those who have been through the system highlights time and again that people want to be kept informed and to be involved in decisions about their care. It would be good to involve people in decisions about what care should be available, but it is notoriously difficult to persuade the public to enter into a dialogue about setting priorities. They are only too happy to leave such difficult debates to others.

The public interrelate with the health service via the local health council. In 1975, there were 48 local health councils, but several years ago that number was reduced to 15—one in each health board area. There is a strong case for increasing the number of members in each local health council. In that way—as used to be the case—each community is more likely to have a local health council member living in it, who is better known to people in the community. The public could have more direct influence through directly elected health boards.

Being people-centred means delivering services in a way that is convenient for people. Considerable effort has been made in recent years to move service delivery as near as possible to people's homes. That raises issues that have to be addressed. Resources—funding and personnel—have to be moved from large centralised hospitals to general practices, which requires the rationalisation of hospital services. It is necessary to preserve critical mass to maintain skills levels in different techniques.

As more services are moved away from hospitals and into the community, health professionals will need to be trained differently. If minor surgery is to be carried out by general practitioners, hospital surgeons' time will be freed up, but that means that only the more difficult and complex surgery will be done in hospitals. Implications arise from that because the balance of the work load will change. Also, a nurse who treats patients in their homes needs a different set of skills from a nurse who works in a large hospital.

By moving health service delivery into the community, we highlight the importance of relating health to all the factors that affect well-being, which emphasises how important it is that all the professionals whose services affect people's lives co-operate with one another. The most obvious partners are health and social work and much joint working is being developed. Grampian Health Board and Grampian Regional Council were producing a joint community care plan about 10 years ago. Although the north-east was well ahead of the game at that time, such joint planning is now happening more widely. It is easy to list numerous local authority responsibilities that impact on health—responsibilities that relate to environmental health, leisure and recreation, education and housing. Co-operation in those areas reinforces the benefits of each and enhances people's well-being.

As well as the increase in work that is done with outside professionals, a welcome start has been made on breaking down divisions between health professionals. The old, blinkered attitude that doctors were the only health professionals has given way to greater recognition of the professions that are allied to medicine, such as physiotherapy, chiropody, speech and language therapy, occupational therapy, dietetics and so on. Pharmacists play a greater role in advising doctors on prescribing. Increasingly, the value of the amount of contact that community pharmacists have with the public and the way in which that can be used to disseminate health information and advice is being recognised. Nurses are being given more responsibility and their skills are being given higher status.

I want to mention one or two staffing issues. One of the strengths—or weaknesses—of the health service is the status of doctors as self- employed contractors. That situation arose for reasons that are history, but the issue has been skirted around for many years. It is, perhaps, time to grasp the nettle and have a debate about whether that is the best or only option.

In recent months there have been instances when it has proved impossible to fill vacancies at specialist and consultant level, which suggests a supply shortfall. It is necessary to reconsider how the number of training places is calculated, because the gender balance in medicine has shifted dramatically. More than half of medical students are female, so provision for maternity leave and career breaks to raise families must be factored into the calculation of the number of trainees that is required to ensure an adequate number of consultants and specialists.

Continuing professional development for doctors is reasonably well organised and funded, but a lot more needs to be done to afford other health professionals similar opportunities. It might be of interest to members to know that student nurses from Napier University are in the gallery. I hope that they find today's proceedings edifying. We wish them well in their future careers in the new, modern NHS.

The second essential element of a modernised NHS is that it is equitable. I will start with the allocation of resources to health boards. The Scottish health authorities revenue equalisation—SHARE—system dates from the late 1970s and was ready for an overhaul. Professor Sir John Arbuthnott was asked to chair a committee to review resource allocation and produce recommendations on methods of allocating resources that were as objective and needs-based as the available data and techniques permitted. He did that, but in the light of the difficulties it faced in completing its work, the review committee identified the need for considerably more research to improve understanding of the causes of the clear inequalities in health care, between affluent and deprived and between urban and rural communities. The review also identified the need to find effective and cost-effective policies to tackle such inequalities.

Good decision making depends on good information. Much more information is needed on who falls through the net and why and on how to facilitate access to services for those who may be barred by lack of information, lack of language skills, disability, poverty, disaffection, remoteness, or even the attitudes of the professionals whose services they need.

Effective use of resources is also helped by good information. A lot of work has gone into moving towards evidence-based medicine, whereby drug treatments and procedures are evaluated much more critically. It takes time to do such investigations and every drug and procedure cannot be covered just like that. Even when the evidence has been gathered, the task of disseminating the information and persuading practitioners to take cognisance of it is lengthy and difficult. Through the work of the Scottish intercollegiate guidelines network and the clinical outturns group, the process has begun well and should gather momentum.

Clinical governance is very much to the fore these days and can be assisted by the ease of statistical comparison in the computer age. In recent weeks, the effectiveness of clinical governance mechanisms has been demonstrated by the acute hospital trust that serves my area, where problems that can be dealt with now were identified.

There is currently a belt-and-braces approach to medical competence—the General Medical Council is embarking on a revalidation initiative to provide regular and robust evidence of fitness to practise throughout a doctor's career.

A more contentious area, in which there is scope for more effective use of resources, is organ donation. There have been dramatic advances in transplantation in recent years, but thousands of people still die from conditions that could be overcome by the transplant of a donor organ. The BMA's medical ethics committee recently published a report entitled "Organ Donation in the 21st Century: Time for a consolidated approach", with which it hopes to stimulate debate and encourage action.

In time, transplants might be rendered obsolete by gene modification, either to eliminate congenital conditions or to clone spare parts from animals. Realistically, however, that is years away. In the meantime, there is groundwork to be done in educating the public.

At a recent Aberdeen University graduation ceremony, Professor Neil Gow of the department of molecular and cell biology is reported as saying:

"Scientists must help society understand technological advances so the public does not reject them out of fear"

and that

"it was ironic that scientists and doctors had become the object of suspicion and lack of trust."

He also said:

"Genetic engineering, GM foods, human genetics, genetically manipulated micro-organisms are just some of the controversial scientific realities that face a society in which too few of its citizens are comfortable or capable of making the kind of informed decisions that our technological advances demand of us."

Patricia Ferguson (Labour, Glasgow Maryhill)

Please wind up.

Nora Radcliffe (Liberal Democrat, Gordon)

He also said:

"It is a tremendous irony that, in an era where science and medicine are yielding so many advances, that scientists and doctors have become for some the objects of unprecedented suspicion and perhaps even lack of trust. Education has therefore become of paramount importance in framing and explaining the issue."

The other contentious debate is on fluoridation of water to improve dental health, but I mention that without rehearsing the pros and cons.

When we talk of effective use of resources, we should not forget the enormous part that is played by the voluntary sector.

Patricia Ferguson (Labour, Glasgow Maryhill)

Please come to a close.

Nora Radcliffe (Liberal Democrat, Gordon)

The voluntary sector can range from large organisations, such as Macmillan Cancer Relief—which provides highly trained specialist nursing care—to the local volunteer who drives visitors to hospital.

In recent years there have been increasing pressures on health budgets and local authority budgets, so funding for the voluntary sector has been badly squeezed. It is a trend that must be reversed because the returns on a relatively small investment are absolutely huge. We should also be conscious—particularly if we are to be as people-centred as we would like to think—that we might depend too heavily on volunteers.

Patricia Ferguson (Labour, Glasgow Maryhill)

Please close now.

Nora Radcliffe (Liberal Democrat, Gordon)

Sorry?

Patricia Ferguson (Labour, Glasgow Maryhill)

Please bring your speech to a close.

Nora Radcliffe (Liberal Democrat, Gordon)

I thought that I had 18 minutes.

Patricia Ferguson (Labour, Glasgow Maryhill)

No, you have 12 minutes.

Nora Radcliffe (Liberal Democrat, Gordon)

We need to do more for carers. Early intervention makes sense—money spent on that saves money later. We should support parents in establishing healthy eating habits in young children. Sensible health education in schools prevents unplanned pregnancies and helps to prevent young people from taking up smoking or being persuaded into drug or alcohol abuse. Helping people to stop smoking, eat better and to take more exercise is an effective use of resources.

When health services become more integrated into the community, develop stronger co-operation with other agencies, involve people more in their own health care and take a more holistic view of health, we will arrive at a modernised health service and, more important, we will have a healthier population.

Patricia Ferguson (Labour, Glasgow Maryhill)

We move to the open part of the debate. The time limit for speeches is four minutes.

Margaret Ewing (Scottish National Party, Moray)

This is a serious debate and the fact that so many members have attended it is an indication of the importance that we attach to the health service. We must remember that we are speaking not only among ourselves, but to the people of Scotland who are looking to us to deliver the national health service. I have worked in politics for many years—sometimes more years than I care to remember—and have seen many changes enacted by various Westminster Governments. Some of those changes have been for the better and some have been for the worse. One of the Scottish Parliament's greatest challenges was to ensure that the national health service in Scotland was put in the safe hands of the 129 members who serve here. Our constituents want us to deal with the complexities of the NHS and to deliver its services efficiently and competently.

As Kay Ullrich pointed out, members should ensure that Scotland has a health service that is a success—a world-beater. Some of the changes that have taken place over the years seem to have been carried out merely for the sake of change and so that the Government is seen to be doing something. We must instil a sense of confidence in the Scottish public about how Parliament is dealing with issues.

Despite my intention to be constructive in my speech, I am sorry to say that during the past week, the most sympathetic observers and kindest critics of the Executive cannot have seen anything other than a week of utter confusion over the NHS. It has been almost like "The Paul Daniels Magic Show"—now you see it, now you don't; now you need it, now you don't. I therefore want to emphasise the crucial points for those outside the chamber who are genuinely concerned, because politics is about people.

To whom do we turn first when we are not feeling well? Kids usually turn to their parents, who are full of homespun remedies, but the first real port of call for us all is our general practitioner and the surgery in our local community. GPs do not want to be seen as Dr Finlays and Dr Camerons any more than nurses want to be described as angels. GPs and the ancillary staff who work with them, such as practice nurses, midwives, district nurses, health visitors, ambulance services and psychiatric nurses are vital to all of us. Those front-line people comfort, counsel and—if necessary—refer us to hospital for care.

Too often, our debates centre on hospitals and consultants and we do not talk about the daily work that is done so willingly by surgery staff. Every member in the chamber should display a great deal of support for the front-line troops in the health service.

GP co-operatives represent an important structural change and are vital to our communities, particularly in rural areas. There should be more emphasis on local practices and I ask the minister to consider the possibility of developing schemes to train more triage nurses to co-ordinate administration for GPs, especially for important out-of-hours services.

Patricia Ferguson (Labour, Glasgow Maryhill)

Wind up, please.?

Margaret Ewing (Scottish National Party, Moray)

I have lots to say. However, unlike Nora Radcliffe, I did not think that I was getting 18 minutes. I will miss out some of my speech—I can always write to the minister, as I do from time to time, although I am still waiting for replies to some of my letters I tried to intervene in the minister's speech on the issue of mental health. I noticed that she gave way only twice during her speech, despite the fact that there were about 20 other attempts to intervene. I want to pay tribute to the Deputy Minister for Community Care, Iain Gray, who brings genuine commitment to mental health—a very complex area in which we share an interest. As Nora Radcliffe is asking an oral question this afternoon on the crisis in the mental health service, I will not pre-empt the issue. However, is not it possible for Iain Gray and Susan Deacon—if they can stop their private conversation for a moment—to thaw the freeze on the Mental Welfare Commission's budget and the mental illness specific grant? Money needs to be spent on that important area; it should not be seen as a cinderella service.

Richard Simpson (Labour, Ochil)

I will start with a declaration of interests, as I believe that one must do so. I am a member of the British Medical Association, the Royal College of General Practitioners and the Scottish Association for Mental Health and I am a fellow of the Royal College of Psychiatrists. I perform occasional consultancy work for pharmaceutical companies. I have directorships of Nursing Home Management, which has nursing home beds in England and of the Forth valley primary care research group.

Today's debate has been a good example of Dr Jekyll and Miss or Mrs Hyde. In the Health and Community Care Committee, Kay Ullrich and Mary Scanlon are co-operative and acknowledge the changes that the Executive is attempting to make. When we come into the chamber, everything they say is negative and regressive. They do not mention the eight new hospitals that have been commenced or the health centres that have been built. Four of the 10 health centres in my constituency are being renewed and another two are planned. They do not mention the advances in cancer treatment or the new intensive treatment unit beds that we will open and the staff who will support them. They do not mention the investment that was made last September in a linear accelerator, which cannot be created in a few months. They want all that to have been done yesterday. They acknowledge none of what has been done—all they do is attack.

The unprecedented boost in funding for the NHS over the next three years provides a unique opportunity to modernise the service for the benefit of patients. That was not taken up by Mary Scanlon or Kay Ullrich. A partnership between patients, carers, health professionals and management is being forged through the forum that was announced by the minister, the board of which met the other day. That forum has a heavy responsibility to challenge and improve accepted practice. If it fails to meet that challenge, there is unlikely to be another chance to improve practice in the foreseeable future.

The easy route would be to throw money at acute trusts, such as the Tayside primary care NHS trust, which has shown ineptitude and an inability to live within its budget that is almost unique. Such an approach would be perverse and must be avoided.

Shona Robison (Scottish National Party, North East Scotland)

Does the member acknowledge that, although some responsibility for the case that he mentions must lie with the local managers, the interim report also criticised the management executive, for which the Minister for Health and Community Care is responsible, for its handling of the situation in Tayside?

Richard Simpson (Labour, Ochil)

The Minister for Health and Community Care announced the establishment of a task force within a few months of taking office. Again, that was not acknowledged by the Opposition. The task force has taken a few months to establish what is going on, which shows how poor the reporting systems in that trust were. That is made absolutely clear in the report.

As Nora Radcliffe said, the process of modernisation must begin with the journey that a patient is required to make. Patients should not have to struggle to find the appropriate route to services. The Scottish version of NHS Direct—which we have not introduced rapidly, but have taken time to examine in a considered way—will provide a single point of access to the primary and emergency services. Too many professionals find themselves overwhelmed by demands. The Scottish NHS Direct will provide expert advice and could ensure that only those who need to see a health professional will do so.

Christine Grahame (Scottish National Party, South of Scotland)

I call upon the member's professional expertise. In a letter to The Herald on 9 June, Andrew Muirhead, a consultant orthopaedic surgeon at Ayr Hospital, referring to a 67 per cent cut in the funding for nursing homes in his unit, said:

"I would like to record a vote of 'No Confidence' in the present Labour administration, which has undermined the NHS in our area."

The minister would not comment on that. Will Dr Simpson?

Richard Simpson (Labour, Ochil)

There has not been a cut in funding. If a cut in resources has been reported by that surgeon, that health board must be called to account.

The patient should be able to obtain the highest standard of care from the right professional, as close to home as is practical. Across Scotland and the UK, there are many examples of good practice. Those examples need to be spread across the whole of the service. In Lothian, some patients have almost immediate access to minor surgery of the highest quality, provided by GPs in their local health centre. Elsewhere in Scotland, patients have to travel many miles to hospital for the same service, unnecessarily taking up the time of people such as the surgeon whom Christine Grahame mentioned. Many problems can be dealt with easily if we get the case mix and the skill mix right. That has to be managed locally.

Ben Wallace (Conservative, North East Scotland)

Will the member give way?

Richard Simpson (Labour, Ochil)

No—I have taken quite a few interventions. I might give way if I get more time, but I doubt whether that will happen.

In Liverpool and Bradford, a variety of endoscopic procedures are carried out on patients safely and to the highest standards in a local health centre, while other patients must wait for months for a hospital appointment in the same cities, because the hospital will not consider developing the skills that are required.

This country has a unique primary care system, yet its potential to provide a high-quality service has been completely, or largely, unfulfilled. If we do not grasp the opportunity now, we will be in real trouble.

Patricia Ferguson (Labour, Glasgow Maryhill)

Please come to a close.

Richard Simpson (Labour, Ochil)

Every survey of public opinion shows a high level of regard for doctors and nurses, but patients who need medical advice need more than seven minutes for a consultation. We must release our professionals to deal with the real and serious problems—that is as true for hospital staff as it is for primary care staff.

It is absolutely imperative that we tackle again the amount of bureaucracy and paperwork, which was being reduced but which is beginning to grow again and which plagues the system.

The Labour party's vision for the renewal of the NHS in Scotland places the user at the centre of services. We will encourage a partnership between health professionals and the patient that provides as quickly as possible the highest quality of service close to the patient's home.

Yes, there are problems, and yes, the service is not perfect. However, at least we have a vision of the future. Our vision is achievable if we grasp the opportunity now.

Robert Brown (Liberal Democrat, Glasgow)

Margaret Ewing's and Dr Richard Simpson's speeches were a welcome contrast to that of Kay Ullrich and the negativity and vitriol that went with it. The challenge of government is to control the direction of events, to remedy the problems and to use the instruments of public policy to deliver something better. Behind all the clamour of the chattering classes and the SNP's vitriol, that is exactly what the Scottish Parliament and the Scottish Executive are beginning to do.

Foremost among the radical changes is the raft of measures to improve public health, which was a major demand of the Liberal Democrats at the election and which is coming through in increasing measure in decision after decision from the minister.

Ben Wallace (Conservative, North East Scotland)

Will the member give way?

Robert Brown (Liberal Democrat, Glasgow)

I want to get started before members begin to intervene.

Among those public health promotion measures are the minister's recent announcement of the establishment of the public health institute; the health promotion fund, which is backed by some of the funds from the hypothecated tobacco tax—also called for by Liberal Democrats at the election—the national free fruit scheme for Scottish schoolchildren, which is a major innovatory initiative; and support for the reduction in smoking addiction, not least through the prescription of new drugs. When 35 people a day die in Scotland as a result of smoking, to my mind, it is offensive in the extreme that the most public contribution of the Conservative party should be the cigarettes and alcohol party that was hosted by the Conservative education spokesman: some spokesman; some education.

Dorothy-Grace Elder (Independent, Glasgow)

Is not the Minister for Health and Community Care dependent on smokers continuing to smoke at the same rate, so that the Government can claw back the tobacco tax to put into the health service?

Robert Brown (Liberal Democrat, Glasgow)

The short answer is no. There is a linkage; I am trying to stress the present investment in changes for the better in Scotland's health.

Major changes are taking place that will revolutionise the NHS. Richard Simpson touched on some of them. There are shifts and balances between the primary and secondary care sectors, as well as the issues of tackling the drugs budget to get more out of it, better health spending and husbandry of resources and so on. However, no magic wand can make those changes happen overnight, by tomorrow or by the end of the parliamentary recess. The changes will take time, perseverance and leadership.

I offer one piece of advice to the Scottish Executive and to the Minister for Health and Community Care: trust the people on this issue. Far more damaging to the credibility of the NHS and the Government is the perception that health board consultations are a sham, and that they result in preordained decisions taken by the great and the good. The Scottish Executive must insist that effective ways are found to bring to bear the force of informed public opinion in developing options and in the ownership of the consultation process—what a friend of mine calls the democracy of complex decisions.

Brian Adam (Scottish National Party, North East Scotland)

Mr Brown referred to leadership in the NHS. Is he content with the leadership that our current health minister is giving to the NHS?

Robert Brown (Liberal Democrat, Glasgow)

We all have to make our contribution.

I was talking about the situation at the level of the local trust and trust board. There is a consultation in south Glasgow on the acute services review. There are lots of pamphlets and public meetings—a much more sophisticated campaign than those that health boards have usually conducted.

That is soured by the perception that the decision appears to have been taken by the health board before the consultation, rather than as a result of it, and that all the effort is going not towards consulting the public, but towards persuading the public, which is the wrong way to go about it. I suggest to the minister that the proper way to proceed is by an approach in which the public are partners in this great enterprise of the NHS, not spectators on the sidelines at some arcane, occult ceremony.

What does the SNP have to offer on health spending? A fanfare of negativity, abuse, mismanagement, inaction and all the rest of it. We are still waiting to hear a call for new, imaginative methods, and the SNP will certainly need them to pay for its spending pledges, which currently stand at £3.6 billion, which is equivalent, as Margaret Smith said, to 15p on income tax.

The statistics show that the Scottish Executive and the Scottish Parliament are delivering on health spending. We have to make sure that the money is well spent and does the trick in its results. This is not an issue for spin doctors and counter-spin doctors; it is about what happens with regard to ill health and to the health of the people of this country, not least in my constituency of Glasgow.

Tricia Marwick (Scottish National Party, Mid Scotland and Fife)

Will Robert Brown give way?

Sandra White (Scottish National Party, Glasgow)

Will Robert Brown take an intervention?

Robert Brown (Liberal Democrat, Glasgow)

No, I am finishing.

Let us ensure that the efforts of every member of the Scottish Parliament are directed towards success, rather than towards point scoring on the great and liberating enterprise that is the national health service in Scotland. Let some people take some lessons from that approach.

Nick Johnston (Conservative, Mid Scotland and Fife)

It would be very easy for the debate to degenerate into a rant against the Executive, but we in the Conservative party wish to move the debate forward.

The Labour party has succeeded in doing certain things. Over the past three years, it has managed to convince the people of Scotland that they no longer have a health service that they can trust. It has destroyed the confidence and morale of medical staff at all levels, and it has systematically undermined the work of professional managers in the service by interference and bullying.

Most of the modernisation initiatives are either a continuation of Conservative policies or part of the natural progression, spun with more momentum than a candy floss machine. It is an insult to hard-working, dedicated staff such as Dr Simpson to suggest that improvements, changes and development have been taking place only since Tony Blair ascended to the throne in 1997. The staff in the NHS, if allowed freedom to manage, will always move to modernise the service.

Let us examine the facts at the root of modernisation. Ms Deacon likes facts. Fact 1: of the eight hospitals being built, seven were approved in 1998 or before. The four major private finance initiative proposals were all well under way when Labour came to power, and required only the signature of the secretary of state.

Fact 2: the business case for the Royal infirmary of Edinburgh was approved by Ian Lang in 1994, and the invitation to tender was approved in 1996.

Alex Neil (Scottish National Party, Central Scotland)

Will Nick Johnston take an intervention?

Nick Johnston (Conservative, Mid Scotland and Fife)

In a minute.

Fact 3: the outline business case for Hairmyres hospital in East Kilbride was approved by Ian Lang in March 1994, and the tender was approved by Michael Forsyth in August 1995.

Fact 4: the outline business case for Law hospital in Wishaw was approved by Ian Lang in March 1994, and the tender was approved by Michael Forsyth in 1995.

Fact 5: Michael Forsyth signed off the business case for East Ayrshire community hospital in 1995—Donald Dewar simply signed the contract.

Alex Neil (Scottish National Party, Central Scotland)

Will Nick Johnston give way?

Nick Johnston (Conservative, Mid Scotland and Fife)

Will it move the debate on?

Alex Neil (Scottish National Party, Central Scotland)

Nick Johnston is boasting about the PFI, another Tory policy adopted by new Labour. Lothian University Hospitals NHS Trust has pointed out, with regard to the Royal infirmary of Edinburgh, that the additional cost of such funding, over traditional funding, is equivalent to the cost of 19 consultants. Is that something to boast about?