Scottish Parliament, 18 December 2003

382 contributions from 75 members. The official report.

Introduction

Variant CJD

George Reid (None, Ochil)

Good morning. The first item of business is a statement by Malcolm Chisholm on the development in variant Creutzfeldt-Jakob disease. The minister will take questions at the end of his statement. There should therefore be no interventions.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I am grateful for the opportunity to inform the Parliament of the circumstances surrounding a blood transfusion incident involving variant Creutzfeldt-Jakob disease and of the action that is now being taken.

The background is that, in March 1996, a blood donor, who was at the time free of the signs of variant CJD, donated blood to the National Blood Service in England and Wales. Shortly after that, the donated blood was transfused into a patient who underwent surgery for a serious illness. Three years later, in 1999, the donor developed variant CJD and died from it. The recipient of the blood died in the autumn of 2003.

Initial post-mortem examination of the recipient of the blood showed changes in the brain indicative of CJD. Further examinations and tests confirmed the diagnosis of variant CJD. The link between the donor and the recipient was first reported to officials in the Department of Health in England on 9 December 2003, at which time the diagnosis of variant CJD in the recipient was still being confirmed.

I was first alerted to the incident on Friday 12 December. In the light of the statement delivered yesterday in the House of Commons by the Secretary of State for Health, I thought it right that the Scottish Parliament should be similarly informed and made aware of the action that has been taken in Scotland and in the rest of the United Kingdom.

In the light of the facts that I have outlined, it is possible that the disease was transmitted from donor to recipient by blood transfusion. I wish to emphasise, however, that that is a possibility and not a proven causal connection. It is also possible that both individuals separately acquired variant CJD by eating BSE-infected meat or meat products. This is a single incident and it is thus impossible to be sure what the route of infection was. However, I am advised that the possibility of transmission being transfusion related cannot be discounted, albeit that this is the first report from anywhere in the world of the possibility of transmission of variant CJD from person to person via blood.

As yet, there is no blood test for variant CJD. There is therefore no way of screening blood donations for the presence of the CJD group of diseases. In recognition of that, since 1997, a range of precautionary measures—based on expert advice—has been put in place. It might be useful if I briefly rehearse them. In 1997 a research study, the transfusion medicine epidemiology review, was funded to examine links between all variant CJD cases and any form of blood transfusion. It is through that study that the association between the two patients was identified. Since 1997, all cases of variant CJD that are reported to the national CJD surveillance unit and which are diagnosed as having "probable" variant CJD result in a search of blood donor records. If the patient has given blood, any stocks of that blood are immediately destroyed.

On 17 July 1998, a £70 million programme was introduced to remove most of the white cells from blood that is destined for transfusion. That process of leucodepletion was progressively implemented by the Scottish National Blood Transfusion Service and completed by the end of August 1999. On 12 November 1998, a further £30 million programme was announced to phase out the use of UK-sourced plasma in the manufacture of blood products. From the end of September 1999, all blood products in Scotland have been made using plasma that is sourced from the United States of America and Germany. On 17 December 2002, to ensure continuity of supply, the Department of Health purchased the largest remaining independent US plasma collector, Life Resources Incorporated.

As indicated yesterday by the Secretary of State for Health, the National Blood Service informed the Department of Health that 15 people in England and Wales had received donations of blood from donors who subsequently developed variant CJD. In Scotland, two similar cases are known to us. Of those individuals, we have been informed that some received blood after leucodepletion had been implemented and others before that happened. The earliest such transfusion was in 1993 and the latest in 2001. All will be told about the circumstances of their case and will be given the opportunity to discuss the risks with an expert counsellor. The Scottish centre for infection and environmental health, supported by the Health Protection Agency, is in the process of contacting the affected patients in Scotland.

Of course, other patients, including haemophiliacs, will have received plasma products before plasma was sourced from the USA and Germany. They will have received products that, because they are derived from the large pools of plasma that are donated from many thousands of people, are heavily diluted. The UK-wide CJD incidents panel considers the risks for this group to be even lower than it is for those who received whole blood.

It is very difficult to trace all individual recipients of products that were made from those plasma pools, but the incidents panel will be advising on a case-by-case basis which recipients will need to be contacted as the necessary information becomes available. Those people will also have the opportunity for a discussion with an expert on an individual basis.

These are very significant arrangements that are designed to counter the possibility of transmission from blood. The need for continuing vigilance remains, however, and the relevant expert groups have been considering whether further measures are required in relation to variant CJD and blood.

In October 2003, our expert advisory committee on the microbiological safety of blood and tissues for transplantation advised, on the basis of a risk assessment, that further action, such as stopping people who have received a blood transfusion giving blood, was not necessary. However, in the light of the present case, the committee was asked to look comprehensively at whether further precautionary measures could be taken that would not adversely impact on the safety or availability of blood. Meanwhile, in Scotland, we have asked the Scottish National Blood Transfusion Service to begin to assess the implications of deferring the taking of blood from those who have received transfusions.

In conjunction with the other health departments, we are also initiating action to consider whether the use of blood and blood products can be confined to situations in which, medically, that is absolutely needed. Although that has been an on-going activity for some time, it will now be given added impetus. We have been concerned to ensure that people who may be worried about the implications of this incident are given appropriate advice. The NHS helpline has therefore been briefed with relevant information and the chief medical officer has written to health professionals updating them on the present situation. We will take any further appropriate steps to inform and reassure people who remain concerned.

Finally, I emphasise that this tragic case must be seen against a background in which, since 1996, some 24 million units of blood or blood components have been given to patients in the United Kingdom. Blood transfusion can be a life- saving treatment but no medical treatment is free of all risks. A wide range of measures is routinely used to reduce the risk of transfusion by screening for HIV/AIDS, hepatitis B and C and other infections. Indeed, we are generally regarded internationally as having a very safe blood service, especially because of our precautionary approach. That said, we will continue to strive for yet further improvement.

George Reid (None, Ochil)

The minister will now take questions on the issues that were raised in his statement. I will allow about 20 minutes for the process.

Shona Robison (Scottish National Party, Dundee East)

I thank the minister for the advance copy of the statement. His prompt decision to make a statement this morning is to be welcomed Given that scientists have warned that people living in Scotland are twice as likely to develop variant CJD and that there is, as yet, no blood test for CJD and therefore no way of screening blood donations for the presence of CJD, what further precautionary steps will be taken to safeguard our blood supplies to ensure that they are not a means of spreading variant CJD?

Furthermore, the minister said in his statement that the expert advisory committee on the microbiological safety of blood and tissues for transplantation advised that it was not necessary to stop people who have received blood transfusions giving blood, but that that is now under review. What are the implications of excluding that group of people from giving blood and when will the SNBTS complete its assessment of the issue? Given the fears that will be raised about the issue in the public domain, how can the public be reassured that our blood supply is safe? What action will the Executive take to reassure the public?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I thank Shona Robison for those important questions—they go to the heart of the matter.

The simple answer to Shona Robison's questions on the advisory committee on the microbiological safety of blood and tissues for transplantation is that it will act soon and quickly. The committee has been asked to come up quickly with its view on this important matter. All members will accept and agree that the correct approach is to ask the United Kingdom experts to examine the matter and it is important that the committee comes up with a view very quickly, in the light of the new knowledge. I discussed that point yesterday with Melanie Johnson, the Parliamentary Under-Secretary of State for Public Health in England, and we agree that that must and will happen quickly.

On potentially excluding people who have received blood transfusions from donating blood, we have—as I indicated in my statement—asked the SNBTS to begin to assess the implications of that. Again, that will be done promptly and urgently.

On reassuring the public, we must be honest about the fact that, owing to the lack of tests for variant CJD, we cannot be at all confident about the extent of the problem. In relation to blood, the figure that I quoted at the end of my speech puts the matter in context. Twenty four million units of blood or blood components have been given to patients since 1996, and out of those 24 million units this is the only such incident—I remind members that a causal connection is only a possibility. We should explain the context to the public, while following the precautionary principle. That is why we have asked for urgent pieces of work to be done by the SNBTS and the advisory committee on the microbiological safety of blood and tissues for transplantation.

David Davidson (Conservative, North East Scotland)

I congratulate the minister on giving the Parliament such a clear statement of the current situation. It is important that we use the opportunity this morning to reassure the people of Scotland that our blood transfusion systems provide an excellent service. We must take the measures that are necessary to maintain that confidence.

In the light of recent shortages in supplies of blood, will the SNBTS seek—on an emergency basis—to identify people volunteering to give blood who may have had a transfusion in the past so that, on a precautionary basis, blood can be held and processed separately at an early stage? Would not that allow a decision to be made about how any risks will be dealt with when the advisory committee on the microbiological safety of blood and tissues for transplantation has done its work?

The minister talked about the sources of plasma being countries with low risks of variant CJD contamination, such as the USA and Germany. In the light of the possible shortfall in supply, can the minister tell us whether other countries would be in a position to assist us in maintaining the volume of safe blood products? What measures are being taken to ensure the safety of that supply?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I thank David Davidson for his questions. As I indicated, the SNBTS has begun its work on assessing the implications. I am sure that part of that assessment will relate to the second point that David Davidson raised. If the assessment shows that it may be difficult to secure enough blood from this country, the SNBTS would have to consider the implications of that, as would the Executive. We must let the SNBTS do that work, and David Davidson's point must be considered within that broader context.

That leads back to David Davidson's first point, which is that it becomes even more important that blood is donated in this country. We all support that and we welcome the publicity that has been given, particularly at this time of the year, to blood donation. I am sure that we would like to thank all the people who generously give blood.

On David Davidson's other point about identifying those who have had a transfusion, I am confident that the SNBTS will do that in its current work.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I thank the minister for coming to the chamber to make a statement as soon as practically possible after the statement that was made yesterday in the House of Commons. However, when issues of such importance affect the people of the United Kingdom in future, could we bear it in mind that there should be more co-ordination between statements made in the House of Commons and statements made in this Parliament? It is important that we get the co-ordination right.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The fact that there has been a gap of a few hours between the two statements is not a major issue. It was more important that we should do all the necessary preparation in Scotland. Obviously, we plan to do that. The fact of the matter is that the statement was made in the House of Commons slightly more quickly than we anticipated. I do not think that that is a major issue.

Kenneth Macintosh (Labour, Eastwood)

I thank the minister for his statement, which reminds us of the need to maintain our awareness of this most devastating of conditions and not to be complacent about variant CJD. He will know of my own interest in the subject and that two of my constituents have lost a loved one through variant CJD. Is he aware of the Human BSE Foundation, which is the leading charity representing families affected by the disease throughout the UK? Is he aware that Strathclyde has the highest incidence of variant CJD in the whole of the UK?

Although the Human BSE Foundation receives a modest grant of about £30,000 from the Department of Health, it will be funded only for a further two years and will have to rely on charitable donations after that. Graham Steel, the vice-chair of the Human BSE Foundation, has recently written to me and to the minister. In the light of today's development, I ask the minister to look favourably on the possibility of providing direct support for the Human BSE Foundation here in Scotland.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I thank Ken Macintosh for drawing the information about Strathclyde to the attention of the Parliament and also for speaking about the Human BSE Foundation. I shall look closely at the correspondence that he mentions, now that he has drawn it to my attention. I certainly applaud all the work that the Human BSE Foundation does on this important matter.

Tommy Sheridan (SSP, Glasgow)

The minister has correctly emphasised the importance of the safety of our blood supply. He will recognise that at this time of the year in particular there are problems with the quantity of blood that is donated in Scotland. We currently have dangerously low supplies and the publicity that may be generated by this case could undermine blood donation even more. In the light of that, will he consider launching an urgent, high-profile, nationwide campaign to encourage even more blood donation in every part of Scotland, because people's lives depend on it?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

Although Tommy Sheridan expresses the concern that this case might undermine blood donation, we all hope that it might have the opposite effect. Issues have been raised about people who have had transfusions, but it is clear that the vast majority of people have not, so there is no question mark over their donation of blood. As I have indicated, I praise the campaigns that have been conducted by the SNBTS and I support and encourage further publicity on this important issue.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

I welcome the minister's timely statement. He says that we will no longer provide blood products except where medically absolutely necessary. Previously, blood products have been provided prophylactically to a range of people, including people who receive gamma globulin boosts prior to travelling to medically dangerous parts of the world. What steps are being taken to identify people who may have had blood products that have not been provided through the normal medical service to ensure that they are aware of any risks to which they may have been exposed?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The first point that I made on that matter related mainly to blood transfusions given during operations, and I understand that that is an area in which Scotland has been making more active progress than other parts of the United Kingdom have. The principle that is now followed is that blood transfusions are, of course, given where necessary, but perhaps not quite so readily as in the past, because the medical view in Scotland now is that they used to be given more often than was necessary. Further action will be taken to ensure that blood transfusions are given only when they are necessary, not when other procedures and processes that modern surgeons can carry out can be used. That was my main point on that matter.

I do not know whether I took in the whole of Stewart Stevenson's second point on blood products. I referred in my statement to blood products in the pre-1999 situation, but I will look into any other issues on the sourcing of blood products and try to give him a fuller reply in writing.

Phil Gallie (Conservative, South of Scotland)

The minister and several other members have referred to the current shortage of blood supplies. Given the fact that any further limitations on who is allowed to give blood might have undesirable implications, will he look into whether those who are not allowed to give blood because of their age, such as the Presiding Officer and I, could supplement the supply of blood?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I will be in that category soon as well, but it is not for me to give a view on that matter: it is for the clinicians to decide on it. However, I will communicate Phil Gallie's point to the chief medical officer. The best way in which I can reply to Phil Gallie will be to send him a letter with the medical view of his suggestion.

Carolyn Leckie (SSP, Central Scotland)

We should obviously start by extending our sympathies to the two people in Scotland who are about to be given the news that they may have received contaminated blood, and we should be especially concerned about that at this time of year. What discussions have taken place, and with whom, about the ethical dilemma that arises from vCJD not yet being curable? What resources will be allocated to those patients and to addressing the ethical questions? What resources are being devoted to research into developing a screening mechanism for vCJD in blood?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I am sure that we all join Carolyn Leckie in extending our sympathies to the two individuals who are involved and, indeed, to all the other individuals and families who are affected by vCJD.

On her next point—if I understand it correctly—there is a CJD incidence panel, which has met for some time and comprises not only clinicians but ethicists and others. It has been considering what to do about informing people about such situations, particularly as there is no cure for the illness. Therefore, the difficult question of when we inform people has been considered.

Research into a screening tool continues. The fact of the matter is that no such screening is available at present. It is being investigated, but I am afraid that I have no good news to report on the matter at present.

Christine Grahame (Scottish National Party, South of Scotland)

What information is given to a potential recipient of a blood transfusion, or to someone who is authorised to consent to one on their behalf, so that consent can be fully informed?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

Consent is central, perhaps far more than it was in the past, but I will have to write to Christine Grahame about the precise information that is given.

John Scott (Conservative, Ayr)

If we were to stop taking blood for transfusions from those who have received one, how quickly could that be implemented and what implications would it have for the availability of blood for transfusion? What percentage of the population has had a transfusion—is it, for instance, 1 per cent, 10 per cent or 20 per cent?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

That, too, is a central question, and the SNBTS has already started to work on it. The SNBTS is considering the implications of such a change, which will include the time scale in which it could be implemented. The conclusions of the deliberations of the advisory committee on the microbiological safety of blood and tissues for transplantation and of the SNBTS's work will be communicated to the Parliament at the earliest possible opportunity.

Business Motion

Trish Godman (Labour, West Renfrewshire)

The next item of business is consideration of business motion S2M-747, in the name of Patricia Ferguson, on behalf of the Parliamentary Bureau, setting out a timetable for stage 3 consideration of the Primary Medical Services (Scotland) Bill.

Motion moved,

That the Parliament agrees that, during Stage 3 of the Primary Medical Services (Scotland) Bill, debate on each part of the proceedings shall be brought to a conclusion by the time limits indicated (each time limit being calculated from when the Stage begins and excluding any periods when other business is under consideration or when a meeting of the Parliament is suspended)

Group 1 - no later than 1 hour and 30 minutes Groups 2 and 3 - no later than 2 hours Groups 4 and 5 - no later than 2 hours and 30 minutes Motion to pass the Bill - no later than 3 hours and 50 minutes—[Patricia Ferguson.]

Motion agreed to.

Primary Medical Services (Scotland) Bill: Stage 3

Trish Godman (Labour, West Renfrewshire)

We now move to stage 3 proceedings on the Primary Medical Services (Scotland) Bill. As this is the first time that many members have participated in stage 3 proceedings, I will remind members about the procedure that will be followed. First, we will deal with the amendments to the bill; then we will move on to the debate on the motion to pass the bill. For the first part, members should have the bill—that is, SP bill 4A—as amended at stage 2, the marshalled list, which contains all the amendments that I have selected for debate, and the groupings, which I have agreed.

Amendments will be debated in groups where appropriate and each amendment will be disposed of in the order that is shown on the marshalled list. When we reach a series of amendments that have already been debated and which are consecutive in the marshalled list, I may invite the minister to move them en bloc and, unless any member objects, I will put a single question on those amendments. The aim of that procedure is to avoid repetition, but I will employ it only if members agree, and I am prepared to put the question on amendments individually where that is preferred.

An amendment that has been moved may be withdrawn with the agreement of members present. Of course, it is possible that members might wish not to move their amendments when they are called, and they may do so. The electronic voting system will be used in all divisions, and I will allow an extended voting period of two minutes for the first division this morning. Thereafter, I will allow a voting period of one minute for the first division after a debate on a group of amendments. All other divisions will be 30 seconds long.

Trish Godman (Labour, West Renfrewshire)

Amendment 16, in the name of Carolyn Leckie, is grouped with amendments 17 and 18.

Carolyn Leckie (SSP, Central Scotland)

I am glad that you are keeping me right, Presiding Officer.

It is with regret that I address the chamber. Previously, members have indicated a consensus on the bill, and it is noteworthy that no non-Executive amendments have been lodged other than those that the Scottish Socialist Party has lodged, which leads me to think that there should be serious concern that there has been a lack of scrutiny of the bill. Why is that? Our amendments address our very serious concerns about the increased threat of privatisation. The Labour and Liberal Executive tries to pretend that the bill will not lead to increased privatisation—that is how it deals with the concerns behind our amendments. The Tories are quite happy to acknowledge that there is a concern and that there is an increased opportunity for private provision. They are absolutely delighted to welcome that; they are almost licking their lips—at least they are honest.

Then there is the Scottish National Party. Could it be that its members missed this, and that they are so mortified that they, too, have to pretend that there is not an increased threat of privatisation? Is it that Jim Mather, who was courted by the Tories just last week, has extended his right-wing economic influence to SNP health policy? As the bill has been considered, we have witnessed the SNP joining the privatisation bandwagon. [Laughter.] Absolutely. I will tell SNP members exactly how big the threat of privatisation is and why they have joined the privatisation bandwagon—they might not even know why themselves.

From 1 April 2004, general practitioners will be able to withdraw from out-of-hours cover and additional and enhanced services. However, there will still be a duty on health boards. We are still not clear about how services will be provided, where and by whom. Who will take up the slack in cervical screening, immunisation and out-of-hours services? The British Medical Association acknowledges that 95 per cent of GPs in Glasgow are likely to opt out. Glasgow has the four poorest and sickest constituencies in Britain. There are already fewer GPs per head of population in poorer areas. Those in the greatest need receive less care, and it is exactly those populations who are set to suffer most.

A BBC survey has found that, of 3,000 GPs and 950 local practices, 80 per cent intend to opt out of out-of-hours services. Throughout the UK, £140 million has been allocated to fund new out-of-hours arrangements. That is less than what is currently spent funding out-of-hours services. Early official figures—the Executive's figures—show that, on any one night, 60 GPs are on call in the Highlands. All but six of them will opt out of out-of-hours provision. Mr Chisholm has been made aware of that.

Thousands of GPs have said that, once the new contract is in place, they will no longer provide out-of-hours cover. In an area of North Yorkshire covering 200,000 people, only three out of 545 GPs have said that they are prepared to continue to provide emergency cover. With no disrespect to the Executive, I look forward to seeing its plans for recruiting the GPs who will be supposed to provide health boards' out-of-hours services. Who has been recruited, where are they and how will that recruitment have been achieved by next April or October at the latest?

The other day, I attended a meeting about emergency out-of-hours services in Lanarkshire. I asked representatives of Lanarkshire NHS Board whether they expected the new GP contract to lead to an increase in the use of private providers. At present, four private agencies provide locum services to that health board area. The board is concerned that 52 per cent of referrals to acute services come from locums, which puts additional pressure on acute services, contrary to the spin that we hear, which says that the pressure on acute services will be relieved. The answer that the health board gave to my question was, "We're in discussions about that." The health board recognises that there is an opportunity for increased private provision and I think that the health board is seriously worried about it. Is the Executive worried, or is that its intention?

The current situation in relation to nursing agencies will be replicated with implementation of the new contracts and the opportunities for the private provision of out-of-hours and enhanced services. According to Robert Black, 50 per cent of wards are currently understaffed. That has led to an increase in agency costs from £25 million a year to £35 million a year last year, which has allowed such organisations as the parasitic Scottish Nursing Guild to hold hospitals to ransom if they need an intensive therapy unit nurse, for example. We are told that nurses will plug the gap in out-of-hours services. Will the Executive please tell me where they are going to be knitted?

Members should be warned: there is nothing in the bill to stop GPs opting out and joining agencies, taking the more profitable route to providing out-of-hours services. The bill will explicitly allow that. That is before companies such as Boots and BUPA, pharmacies and whoever else can spot a scam a mile off jump on the bandwagon. This week, we have been talking about fraud in the NHS. I will tell members who is being defrauded: it is the patients, especially the poorer ones, who will be piling up in waiting rooms in queues for telephone switchboards and on trolleys, as private profiteers pile up the swag. The £100 million of pilfering pales into insignificance beside the fortune that is being and will be made by pharmaceutical companies, private finance initiative consortia, construction companies and nursing and locum agencies—the expanding businesses of the future. The Tories ask us where the money is going. They need look no further: the money is going straight to private profiteers.

Given the staff shortages in the national health service, and without measures to allow health boards to employ directly—leading NHS boards to contract with private health care providers—without our amendments, the bill is likely to result in the total loss of a comprehensive NHS service. I do not make that claim lightly. We have the experience of the NHS, of PFI and of nurse agencies to look to—

Phil Gallie (Conservative, South of Scotland)

Will Carolyn Leckie give way?

Carolyn Leckie (SSP, Central Scotland)

On you go, Phil. I am surprised that nobody has asked me to give way already.

Phil Gallie (Conservative, South of Scotland)

Is it not the case that the NHS is built upon the professionals in it? Is there not a problem with GP recruitment, GP morale and staff morale in general practices? Surely Carolyn Leckie must care about those issues, and surely the bill attempts to address them.

Carolyn Leckie (SSP, Central Scotland)

I agree with the points about morale, pay and recruitment problems—we have never disagreed with them. However, although the bill might deal with them on a short-term basis, we are storing up massive problems for the future. Instead of having an enhanced service and instead of the increased spending going on front-line patient care and on improving access for poorer people and the quality of care, the spending will go down the plug of profit. That is our concern, which our amendments address.

Why has the SNP, in particular, not lodged amendments that it might consider to be better or possibly more technical than ours? Does the SNP not believe that there is an increased threat of privatisation, or is it that, like the Tories, it is quite happy to welcome that? The SNP should be clear about this. There is an ideological question here: does profit have a place in the NHS or does it not? Yes or no: that is the question.

In case they have not read it, I refer SNP members to the definition of those that this group of amendments deals with:

"For the purposes of this section "private healthcare provider" means a company limited by shares (other than a company of the type mentioned in the definition of "qualifying body" in section 17D(2) or section 17L(1)(c)) one of whose purposes is the provision of medical services on a for profit basis." Do SNP members accept the aim of the amendments and the ideology behind them or do they reject them? Their votes will determine where they stand on profit in the NHS. I ask them, please, to support our amendments.

I move amendment 16.

Trish Godman (Labour, West Renfrewshire)

Before calling those who have signalled that they wish to speak, I remind new members that, if they wish to speak to amendments, they should press their request-to-speak button when the amendment is called.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

First, let me say that I am a bit disappointed to see these three amendments reappear at stage 3. I am also disappointed that the business managers have allowed an hour and a half for the debate on this non-issue. I appreciate that they want a fair debate, but this debate was well and truly hammered out in the Health Committee, which voted nine to zero against the amendments.

Phil Gallie (Conservative, South of Scotland)

I am slightly puzzled at Mike Rumbles's opening remarks. He regretted the fact that we have an hour and a half to debate the issue, but he did not step in when the Presiding Officer suggested that anybody who opposed the business motion could do so. Why did he not take that opportunity?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I certainly did not want to oppose the Scottish Executive's business motion. I was indicating only my disappointment that the business managers decided to devote an hour and a half to this issue. I did not oppose the business motion.

Tommy Sheridan (SSP, Glasgow)

Will the member take an intervention?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

No. Let me get started, Tommy.

In the committee, which is, above all, where such debates should be held—

Tommy Sheridan (SSP, Glasgow)

Will the member take an intervention?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I will not take an intervention yet. I will take it in a moment. Just hang on.

The point about the amendments in group 1 is that they were thoroughly examined in committee. The Presiding Officer is quite right to select them for stage 3 if he so wishes. I do not question his right to do so, but I am disappointed that we seem to be here again. I have a sense of déjà vu.

Given what happened during our consideration of the bill at stage 1, I find Carolyn Leckie's statement that the bill has lacked scrutiny outrageous. The scrutiny of the bill was quite remarkable, because the committee ensured that the draft regulations were brought before members. Ministers had not done that before but it happened at the committee's request. Ministers moved heaven and earth to bring draft United Kingdom and Scottish regulations before the committee. That is why the committee is unanimous on these matters.

Carolyn Leckie (SSP, Central Scotland)

Will the member take an intervention?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I will in a moment, but let me get to the meat of the subject. There is hypocrisy writ large here.

The Scottish Socialist Party has brought the amendments to the chamber yet again, but on no occasion during the whole process did any member of the Scottish Socialist Party appear at the committee. It did not question any of the witnesses that appeared before the committee. When the minister came before the committee to be grilled by members, any member of the Parliament could have attended the meeting, but not one Scottish Socialist Party member turned up. We have hypocrisy all right, but it comes from the SSP benches. Quite simply, the amendments should be seen for what they are.

Carolyn Leckie (SSP, Central Scotland)

I find it quite astonishing that Mike Rumbles should in effect argue against the democracy of the chamber, but I suppose that exposes his position. Will he tell us why, if the Health Committee was so vigilant in scrutinising the bill, the Executive felt it necessary to amend its bill at stage 2 and now at stage 3? Why did members of the Health Committee not pick up a single issue for amendment?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

That is pathetic, I must say. Carolyn Leckie talks about democracy, but democracy is about engagement. Carolyn Leckie is not engaged in the democratic process but is grandstanding, which undermines the whole democratic process.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

I wonder whether Mr Rumbles has observed Mr Colin Fox's peregrinations in Australia. An article reports:

"'The parliamentary road to socialism', he said, will be found 'alongside the weapons of mass destruction in Iraq'".

The article also mentions his case

"for why fundamental social change will never be achieved via parliament."

Does that perhaps answer Mr Rumbles's question?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I do not want to be drawn on Colin Fox, so perhaps we can just leave it at that.

Tommy Sheridan (SSP, Glasgow)

Perhaps Mr Rumbles will be drawn on another matter. I was surprised at what he said earlier and I wanted to draw the matter to his attention as early as possible. He expressed disappointment that amendments have been brought back to Parliament, whereas the amendments have not in fact been in Parliament as they were discussed only in committee. How can Mr Rumbles argue against a political party that is denied representation on the very committee to which he referred—[ Interruption. ]

Trish Godman (Labour, West Renfrewshire)

Order.

Tommy Sheridan (SSP, Glasgow)

I think that the children are a wee bit demob happy today, Presiding Officer.

How can Mr Rumbles argue against a party bringing amendments to the chamber to enable it to vote on those amendments, given the fact that it and other parties were denied that opportunity at committee—

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Is this an intervention or a speech?

Tommy Sheridan (SSP, Glasgow)

The children willnae be quiet for a minute. Is there any chance that I could finish my intervention, Presiding Officer?

Trish Godman (Labour, West Renfrewshire)

Mr Sheridan, ask the question, please.

Tommy Sheridan (SSP, Glasgow)

I am trying to, but the well-paid kids down the front willnae be quiet.

Does Mr Rumbles accept that any party in the Parliament without representation on a committee has the right to present its amendments to that committee and then, because it does not have a vote in the committee, bring those amendments to the chamber where the party has a vote? Is that not basic democracy?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I wish that Tommy Sheridan would understand a little bit more about the procedures of the Parliament. The committees are integral to the Parliament. They are the powerhouse and driving force of the Parliament. Tommy Sheridan should know that, so he should stop pretending. The SSP was not denied an opportunity to make its case in the committee.

Tommy Sheridan (SSP, Glasgow)

Did we get a vote?

Trish Godman (Labour, West Renfrewshire)

Mr Sheridan, you must not intervene from a sedentary position.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The SSP is just not interested. If Tommy Sheridan wants me to keep digging, I will point out that the stage 2 meeting at which the three amendments were first discussed took place in the chamber. I suppose that we were privileged that Carolyn Leckie stayed for those three amendments, as she did not stay to speak to the other amendment that she had lodged at that stage. She could not even be bothered to hang around to do that. Members need to be aware of the behaviour of Scottish Socialist Party members in the democratic process. The SSP members are not engaged. That is the point.

Let me return to the issue. The reason why the SSP members are not engaged is that they are not engaged with the subject. At no time was the subject matter of the amendments an issue for the witnesses that came before the committee. It is a non-issue. The issue has been raised only to allow the Scottish Socialist Party to stand up and make dogmatic statements, which we must put up with to get through consideration of the bill. I am sure that the vote at the end of today will reflect that. The Scottish Socialist Party is involved in a travesty of the democratic process.

Trish Godman (Labour, West Renfrewshire)

I call Shona Robison.

Shona Robison (Scottish National Party, Dundee East)

Where do I start? For the record, let me say that the SNP has never been backward in coming forward to defend our public services against privatisation. Our record in opposing the private finance initiative and public-private partnerships is consistent and long term. I will take no lessons from the SSP on that front.

Let me get to the nub of the issue, which I think should be debated. I do not subscribe to the conspiracy theory that the SSP promotes that somehow the entire bill has been engineered to open the door to a mass influx of the private sector into the health service; that is just not the case. The paranoia exhibited by Carolyn Leckie is staggering even by SSP standards. It extends to suggesting a right-wing takeover of SNP policy.

Carolyn Leckie (SSP, Central Scotland)

Will the member take an intervention?

Shona Robison (Scottish National Party, Dundee East)

No, thank you.

The bill is about trying to reverse the real recruitment and retention crisis in our GP services that is there for all to see—all apart from the SSP. The jury is still out on whether that will be achieved. The SNP is prepared to give the bill the benefit of the doubt to try to turn the crisis around. That is why we have lodged an amendment to the motion to pass the bill.

Let us pause for a second and reflect on what the result of the SSP amendments would be. They would stop community pharmacists—because they are private providers—providing services such as smoking-cessation services, diabetes checks and blood pressure checks in the deprived communities that the SSP claims to represent. Those services would stop overnight if the SSP amendments were agreed to. Are the community pharmacists the great private profiteers that the SSP talks about? They provide such important services to our most needy to try to turn around the dreadful health situation in Scotland. The health promotion and the prevention work that community pharmacists carry out is an essential part of our health service. The SSP members would have learned about those issues if they had listened to and taken part fully in debate on the bill. The SNP will be quite happy to vote against the SSP amendments on the basis that I have outlined.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

The context for the amendments is clear. At stage 2, Carolyn Leckie said:

"the SSP's political position is for full public ownership of the NHS, including GP services."—[Official Report, Health Committee, 2 December 2003; c 390.]

That is fair, unambiguous and clear. The question is whether that serves the interests of patients, and that is far less clear.

Amendments 16, 17 and 18 do not even serve the purposes that the SSP intends. For example, they do not exclude along with companies that have shares, partnerships or contractual arrangements; they do not exclude a variety of things. Not only did the SSP not contribute to the evidence-taking at stage 1, submit to the committee a position paper or attend with due diligence the stage 2 committee debates, it has not even been able to draft the amendments in an appropriate way to achieve its objectives. Rather than there being a lack of scrutiny, as Carolyn Leckie said in her remarks on amendment 16, the SSP has shown a lack of commitment, energy and care in promoting its case.

I was brought up in a primary care household. My father was a GP before the health service was introduced and he welcomed it, because it changed forever the discrimination that existed before, when people came to the door for treatment and the issue was whether they could afford treatment. My father absolutely refused to take private patients, because the health service gave him the ability to treat patients on the basis of their medical needs. Of course, he was a private contractor of the health service—that was part of the deal that was done in 1948. Providing the public with an ability to choose the doctor that they wish to treat them is important.

Colin Fox (SSP, Lothians)

The member mentioned me earlier on. I am glad that he has so much interest in my Australian tour and that the SNP seems to have found it as popular as did the people of Australia. He talked about people's ability to afford treatment. Does he accept that the national health service is undermined by profiteering, given that Audit Scotland said last week that the relationship between the NHS and drugs companies is not delivering a good deal for the NHS?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

I hope that Colin Fox is not seeking to deceive members, as he did in The Dominion Post in New Zealand, where he claimed to have been thrown out of the Parliament on the day that he was sworn in. Exaggeration is a hobby of the SSP in which it indulges at every possible turn.

I return to the matter at hand. We are asked whether there is a place for profit in the NHS—yes or no. We have been and remain consistently opposed to the funding associated with PFIs, because that takes money out of the health service and there are other ways of ensuring that we get value for money. I have answered Carolyn Leckie's question.

The key thing is that we have private contractors in primary medical services, including GPs.

Carolyn Leckie (SSP, Central Scotland)

Will the member take an intervention?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Not now, as I am closing. They have delivered value since the health service's inception. Their commitment and sacrifice have kept primary health care afloat for many years. We are now in crisis; the Executive is responding to that crisis and we are prepared to give it a fair wind.

I oppose amendments 16, 17 and 18.

David Davidson (Conservative, North East Scotland)

I declare that I am a registered pharmacist, although I no longer have any connection with primary care services. I mention that because I recall that, in my youth—I had one once—when I was newly qualified in partnership, I worked with a private firm to deliver out-of-hours care and dispensed services for a good chunk of the county of Kent. But for that facility's coming together, the GPs with whom I was involved would have found it impossible to deliver that care.

This morning should not be about political posturing—we have had enough of that already. There are opportunities for scrutiny in the Parliament. Any member can go to any committee at any time and, with the permission of the convener and the committee, they can even attend some of the private sessions. That has been done, with discretion, over the past four years. I suggest that the SSP try to find out a little more about how it could use the opportunities for democratic input that the Parliament offers every member, without exclusion.

We have heard proposed again this morning nationalisation—under another name—of the health service. Yes, as Tommy Sheridan said, Ms Leckie is entitled to lodge the amendments—I take it that that is the view of the Presiding Officer—even though they were thrown out at stage 2. However, we have to recognise that the great national institution of the health service in this country was based on a public-private partnership—a coming together of the private and public sectors for the common good. That principle has never altered and the bill will not alter it. The bill is about the attraction and retention of GP services for the benefit of patients. It is not about takeovers of the NHS; it is about guaranteeing that wherever people live in Scotland they have fair access to GP services.

We must ensure that we not only produce enough doctors for our needs, but encourage them to participate in the primary care services, including in rural and remote areas. We must do all in our power to ensure that that is an attractive proposition and that the patients are at the heart of the NHS. That is where we are coming from.

Carolyn Leckie (SSP, Central Scotland)

rose—

David Davidson (Conservative, North East Scotland)

Before I talk about working with the private sector, I will take an intervention from Ms Leckie.

Carolyn Leckie (SSP, Central Scotland)

I wonder whether David Davidson is willing to repeat what he said during the stage 1 debate, when he confirmed that he saw opportunities in the bill for increased private provision in primary medical services. Does he foresee the extension of the use of agencies in providing locum services?

David Davidson (Conservative, North East Scotland)

I cannot remember my exact words at stage 1, but I say to Ms Leckie that what the health service needs is additional capacity, which could be provided cost-effectively by the private sector in appropriate partnership. The question is not "instead of"; it is "in addition to".

Yesterday morning, I visited a Huntercombe hospital near Larkhall. It is a dedicated residential unit for people with eating disorders, with staff who are highly skilled and motivated and who are provided by the private sector. The unit has yet to have any referrals from the NHS. I find that scandalous, because the services that it provides are not duplicated in the NHS and the unit's weekly charge is less than the similar NHS tariff. That is why I talk about value for money and additional services. However, that is not the issue today. The issue today is that the Parliament has to provide mechanisms that will attract staff to primary care services and ensure the delivery of those services to every person in Scotland on a reasonable basis.

Later on, Ms Leckie might support an amendment of mine. Amendment S2M-698.2 is not about political posturing; it is about ensuring that due scrutiny will continue—not on the voluntary basis that the minister has very kindly conducted with the committee so far, but on a more formalised basis so that, when all the regulations begin to deliver the outcomes that we seek from the bill, they will be scrutinised by the Health Committee. If that happens, I hope that the SSP might send a representative to participate in the discussions.

Tommy Sheridan (SSP, Glasgow)

Amendments 16, 17 and 18 relate to the definitions and provisions in the bill that will allow NHS boards to contract with "any person" to provide primary care services. The bill defines "any person" to include companies where at least one of the shareholders is a GP or other health professional. The opponents of the three amendments may accuse the SSP of grandstanding, but that does not undermine the fact that the bill will facilitate a bonanza for the private health sector. The bill will allow health boards to contract with private providers for primary medical care services. The Tories recognise that, which is one of the reasons why they are very relaxed and happy for the bill to be given such a good wind. They clearly believe that their friends in the business of making profit out of providing health care will now be able to make even more profit—the bill facilitates that.

It is incredible that the SNP, the Tories and the Executive—who consistently preach to public sector workers about the need for modernisation and progress, which everyone in the public sector knows is about cuts in services—will, when it comes to GPs, defend a 55-year-old deal, struck in 1948 when the NHS was founded. No modernisation or progress there—they defend the archaic deal that allows GPs to be private providers instead of employees of the national health service, which is what they should be.

Even though members throughout the chamber might support other provisions in the bill, I say to them that, if amendments 16, 17 and 18 are not agreed to, the bill could open up wholesale privatisation in primary medical care. The SSP will not stand by and let that happen without opposing it.

I am glad that the Presiding Officers have recognised the need to defend democratic rights in the Parliament. When only four political parties are represented on a parliamentary committee—despite the fact that six political parties are properly registered, and seven parties are represented, in the Parliament—it is quite proper for any of the political parties that are not represented on that committee to be able to lodge amendments.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Tommy Sheridan muses about how appropriate it is for parties to use their democratic rights, but his party was not interested in using its democratic rights at stage 1. We have made that point clear and I would like Tommy Sheridan to explain why his party did not turn up.

Tommy Sheridan (SSP, Glasgow)

That is not a point at all in relation to this debate. The point that Mike Rumbles made was that it was shocking that someone dared, after lodging an amendment at stage 2 that got beat 9-0, to bring the amendment back at stage 3. I remind him that the Health Committee has members from only four political parties, despite the fact that six parties are registered and seven parties are represented in the Parliament. When Mike Rumbles's party is in the minority, I guarantee that we will allow him to introduce amendments at stage 3 even if his party is not represented on all the committees. That is a democratic right and I would have thought that Mike Rumbles, who is supposed to be a Liberal Democrat, would defend that.

I support the amendments. We have to defend our health service from further privatisation—led by the Executive, with support from the Tories and, unfortunately, the SNP.

Tom McCabe (Labour, Hamilton South)

As the debate continues, we will demonstrate the fallacy of the arguments that have been made. A charitable interpretation would be that there has been a failure to understand the various sections of the bill; a less charitable interpretation would be that amendments 16, 17 and 18 represent the promotion of outright hypocrisy.

As others have said, Carolyn Leckie has already made one attempt to amend the bill. At stage 2, the Health Committee had the good sense to reject her amendments. This morning, she has said that the committee was less than diligent in its scrutiny of the bill—simply because it disagreed with her point of view. It is surely inappropriate for members, simply because there has been a disagreement, to challenge the diligence of the work of any committee of the Parliament.

I want to return to a point that was raised by Mike Rumbles and, to be frank, dodged by Tommy Sheridan. The fact is that Mr Sheridan's party lodged an amendment at stage 2 and then left the meeting before the amendment was called. That is not participation in the democratic process; it is grandstanding.

It is disappointing, although not surprising, that, having lost the argument once, Ms Leckie is prepared to put her party's ideological hang-ups before what is good for patients in Scotland. However, this is a welcome opportunity to refute the SSP's arguments once again. I strongly urge members to reject the three amendments. What we heard from Ms Leckie was blatant scaremongering.

I said a moment ago that we could have a charitable interpretation, suggesting that there had been a misunderstanding, or a less charitable interpretation, suggesting that there had been the promotion of outright hypocrisy. A few moments ago, Mr Sheridan spoke about the definitions in the bill. He referred to a proposed new section that lays down the condition that

"at least one share in the company is legally and beneficially owned by a medical practitioner".

He stopped there, but that is not the whole story.

The next condition lays down that all the other shareholders must be individuals who would qualify under the conditions listed to be partners in a partnership that could hold a general medical services contract. The bill therefore provides protections. It is incumbent on members to ensure that, when they put forward arguments, they quote all the relevant provisions in the bill. They should not selectively quote the provisions that suit their argument.

Surely quality and availability of care is more important than the nature of the provider and surely we must allow health boards to make decisions that are based on the best needs of patients. Let us not forget—even though Mr Sheridan does not like the argument—that the vast majority of GPs are independent contractors and have been since the very start of the NHS.

Tommy Sheridan (SSP, Glasgow)

Would the minister care to state categorically that he defends that settlement? Does he think that that 55-year-old settlement is right? Is that part of the modern health service in the 21 st century?

Tom McCabe (Labour, Hamilton South)

No. Mr Sheridan has just summed up his misunderstanding; our purpose today is to modernise that 55-year-old settlement. That was a timely intervention, because I remind the Parliament that, during the stage 1 debate, even Carolyn Leckie accepted that the employment status of that hard-working group of employees did not affect their dedication.

Carolyn Leckie has said that her amendments seek to prevent the private sector from piling up the swag. That is a strange logic. As we move on in our consideration, we will break down that argument.

I fail to understand why it is acceptable for private health care providers to be involved in the provision of primary medical services at certain times of the day but not at others. That seems to suggest that piling up the swag is okay during the hours of daylight but unacceptable during the hours of darkness. I simply do not understand the logic of that.

If it is thought that private health care providers in some way provide a lower-quality service, why is it somehow safer for them to provide it during the hours of daylight than at night? That is what amendment 17 suggests in practice. If the argument against private health care providers is about profit, why is it acceptable to make a profit from a patient during the day, but not at night or at the weekend? I hope that Ms Leckie will take the opportunity to explain that rather strange logic when she sums up. [Interruption.] The children are getting a bit loud again; perhaps the Presiding Officer could address them.

As Malcolm Chisholm and I have said before, we expect GP practices to continue to provide the vast majority of care, just as they have for the past 55 years. The bill is not about the mass privatisation of primary care; it is about improving the position of GPs and patients and sustaining general practice rather than replacing it with private companies.

Under the proposed arrangements, existing practices will have the right to continue to provide essential and additional services. In other words, a practice that provides those services on 31 March 2004 will not have the right to provide them taken away on 1 April. Under the bill, that right will not be given to a private health care provider, whoever that may be. Let me be explicit. Big, private health-oriented companies will not be able to hold a GMS contract. The fact that we expect that the vast majority of primary medical services will be provided through the GMS arrangements considerably reduces the scope for private health care providers to provide services.

I am sure that Ms Leckie has investigated whom her amendments would affect. We believe that, strangely, amendment 18 would not catch an organisation such as BUPA. Our information is that BUPA is a provident association that does not pay out to shareholders and that any profit that it makes is put back into the association. Amendment 18 would bar "a company", but BUPA is not a company, so it is unlikely that it would be caught by the SSP's definition of a private health care provider. In the stage 1 debate, Ms Leckie expressed concerns about what she called the "BUPA bunny" taking on primary care medical services, but the way in which her amendments are drafted means that they would fail to prevent just that.

I urge members to reject amendments 16 and 17. Moreover, if they agree with the Executive that those amendments should be rejected, they must also reject amendment 18, which seeks to define "a private healthcare provider"—the phrase that is used in amendments 16 and 17. I urge members to reject the amendments, which are ill advised and unnecessary.

Carolyn Leckie (SSP, Central Scotland)

The response to that is to ask where in the bill the Executive excludes the BUPA bunny or whomever else. The truth is that there are no such exclusions, because the Executive does not want any. It wants to have the opportunity, through a ministerial directive some time down the line, to plug the gap using that very method.

The Executive just has not listened. No one has addressed the question of who will provide out-of-hours services. Ninety-five per cent of GPs in Glasgow say that they will opt out of out-of-hours provision and rural practices are struggling to provide cover—in the Highlands and Islands, only six practices will be left to provide cover. Who will provide the cover? Why is Lanarkshire NHS Board concerned about profits?

Tom McCabe (Labour, Hamilton South)

There is a fundamental misunderstanding about GPs who want to move away from their responsibility to provide out-of-hours care 24 hours a day, seven days a week and GPs who are prepared to sign up to the new provisions on out-of-hours care without taking on the burden of responsibility for such care 24 hours a day, seven days a week.

Carolyn Leckie (SSP, Central Scotland)

I would appreciate an answer from the minister on how many hours of out-of-hours services GPs will provide through the GP contract. Will all the hours be covered? In Lanarkshire, is it the case that the four private agencies that provide locum services will not increase their profits? I wish that someone would address those questions.

If members vote to pass the bill, they should not cry crocodile tears or complain a year, two years or three years down the line when they see astronomical rises in agency costs, just as we have seen such rises in nursing costs. If we are wrong, members will be able to come back and tell us that we were wrong, but I have 100 per cent confidence that we are not wrong.

Does the Executive deny that opportunities for privatisation are inherent in the bill? The Tories do not deny that such opportunities exist. The Executive should put some substance to its arguments; it should lodge amendments that ensure that the bill will not offer opportunities for privatisation. If we are being paranoid or unduly nervous or if we are grandstanding, why does the Executive not give us the assurance that we want? Why does the bill—unless it is amended by the SSP—contain no such assurances? We should not be blamed for not lodging enough amendments. If the Executive's political position is that the BUPAs of this world should not profit from the GMS contract, where in the bill is there such an assurance?

Stewart Stevenson is a laugh. I was not going to tell him this, but I will. Last night, my daughter told me that her English class was having the usual end-of-term Christmas debates and that she moved—completely of her own accord—that Stewart Stevenson be placed in room 101. The class voted unanimously that he should be placed in room 101. That is about all that I will say.

Although the Liberals in the Scottish Parliament are in favour of the bill's proposals and foresee no difficulties with them, Dr Evan Harris—the Liberal Democrat health spokesperson in Westminster—is against the new contract and says that it will result in

"the end of the one-stop shop. It means less access to some services, which will now be classed as optional ... Patients know that this is a sticking plaster over the fundamental problems of understaffing and lack of access to family doctors."

There we have it. The Liberal Democrats are never afraid to be completely inconsistent, as long as that results in a few more votes.

David Mundell (Conservative, South of Scotland)

We can agree with that.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I did not hear that remark, but I am sure that it was amusing.

On a United Kingdom level, we are not against the bill, even though some concerns were expressed about the GP contract. I do not share those concerns in the context of the bill, because the Executive is putting in a huge amount of resources to ensure that the bill will bring about successful modernisation of the NHS in Scotland. Those resources are at a much higher level.

Carolyn Leckie (SSP, Central Scotland)

We are discussing legislation, but Mike Rumbles says that the issue is not legislative but a question of resources. Although the Liberal Democrats are opposing the proposal south of the border, it is all right here in legislative terms, because the Liberals here are so confident that the resources are guaranteed. For goodness' sake—how ridiculous!

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

You are, aren't you?

Carolyn Leckie (SSP, Central Scotland)

I beg your pardon. On a point of order, Presiding Officer. Is it not against rule 7.3 of the standing orders for a member to call another member ridiculous?

Trish Godman (Labour, West Renfrewshire)

That is normal debating. Please carry on. [ Interruption. ] Order, please.

Carolyn Leckie (SSP, Central Scotland)

All right. If that is normal debating phraseology—

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

She used it.

Carolyn Leckie (SSP, Central Scotland)

I was quoting Mike Rumbles. In the words of my daughter, "You're a tube." [ Laughter. ]

Trish Godman (Labour, West Renfrewshire)

Please be careful. My ruling was that Mike Rumbles's comment was made in normal debate. I suspect that what you said might have been slightly outside normal debate. Please finish now.

Carolyn Leckie (SSP, Central Scotland)

Well. Somebody has already mentioned hypocrisy. I will finish.

The SSP has a small party group of only six MSPs. There has been much ranting and raving because members cannot deal with the ideology around stage 1 evidence taking. I am not a member of the Health Committee, although I would have liked to have been. However, I am an active member of the Public Petitions Committee and an active MSP. If there is a serious question about the political commitment of SSP MSPs—it cannot be a serious question: that is almost a contradiction in terms—I will swap schedules with Tom McCabe. I will shadow him for a week and he can come and shadow me for a week. We will see who is still standing at the end of that week.

Tom McCabe (Labour, Hamilton South)

That is a very tempting offer, but I have decided to resist it.

Trish Godman (Labour, West Renfrewshire)

The question is, that amendment 16 be agreed to. Are we agreed?

Trish Godman (Labour, West Renfrewshire)

There will be a division.

Trish Godman (Labour, West Renfrewshire)

The result of the division is: For 4—[ Interruption. ] Order. Are members finished? The result of the division is: For 4, Against 92, Abstentions 6.

Amendment 16 disagreed to.

Trish Godman (Labour, West Renfrewshire)

Amendment 17, in the name of Carolyn Leckie, has been debated with amendment 16. I ask Carolyn Leckie to move amendment 17.

Carolyn Leckie (SSP, Central Scotland)

I move amendment 17 and ask everybody to pull their finger out and get their act together.

Trish Godman (Labour, West Renfrewshire)

The question is, that amendment 17 be agreed to. Are we agreed?

Trish Godman (Labour, West Renfrewshire)

There will be a division.

Trish Godman (Labour, West Renfrewshire)

The result of the division is: For 5—[ Applause. ]—Against 92, Abstentions 6.

Amendment 17 disagreed to.

[Amendment 18 moved—[Carolyn Leckie].]

Trish Godman (Labour, West Renfrewshire)

The question is, that amendment 18 be agreed to. Are we agreed?

Trish Godman (Labour, West Renfrewshire)

There will be a division.

Trish Godman (Labour, West Renfrewshire)

The result of the division is: For 5, Against 98, Abstentions 0.

Amendment 18 disagreed to.

Trish Godman (Labour, West Renfrewshire)

Group 2 is on ancillary services. Amendment 1, in the name of the minister, is grouped with amendment 6. I call the minister to move amendment 1 and to speak to both amendments in the group.

Tom McCabe (Labour, Hamilton South)

The bill will already allow a section 17C arrangement or a GMS contract to include services that are not primary medical services. An example of such a service might be physiotherapy. The bill will also allow for primary medical services that a health board provides, or secures provision of, to be delivered outside that health board's area or outside Scotland. That will ensure that patients can continue to register with the GP practice closest to their home although it might be in another health board's area.

Together, amendments 1 and 6 make it clear that, when services that are not primary medical services are included in a section 17C arrangement or a GMS contract, they may be performed at any location where primary medical services can be performed. Under the bill as drafted, Lothian NHS Board could contract with a practice in the Borders to provide primary medical services and, for example, complementary medicine. The bill will already allow the practice in the Borders to perform primary medical services in the Borders for Lothian NHS Board. Amendments 1 and 6 will allow the practice in the Borders also to provide complementary medicine in the Borders for Lothian NHS Board.

I move amendment 1.

Amendment 1 agreed to.

Trish Godman (Labour, West Renfrewshire)

Group 3 is on references to providers. Amendment 2, in the name of Malcolm Chisholm, is grouped with amendment 3.

Tom McCabe (Labour, Hamilton South)

Amendments 2 and 3 are necessary to ensure consistency in the wording and phraseology that are used in the bill and to ensure that references to an earlier subsection work.

I move amendment 2.

Murray Tosh (Conservative, West of Scotland)

No member has asked to speak to the amendments and I do not suppose that the minister wants to wind up the debate. We will go straight to the question.

Amendment 2 agreed to.

[Amendment 3 moved—[Mr Tom McCabe]—and agreed to.]

Murray Tosh (Conservative, West of Scotland)

Amendment 4, in the name of Malcolm Chisholm, is grouped with amendments 5, 7, 8, 9 and 10.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The amendments in the group cover dispute resolution. They will clarify our intention to use a panel of persons for dispute resolution and they will allow us to make it clear how the regulations that will cover the dispute resolution process for providers of primary medical services will interact with other similar primary legislation powers in the National Health Service (Scotland) Act 1978. The amendments will also make it clear that the regulations may be applied to existing GMS providers as well as to potential providers.

Amendment 4 will simply clarify wording. It will add the word "and" to the end of proposed new section 17E(3D)(a) of the 1978 act. Amendment 5 relates to pre-contract disputes about arrangements under section 17C of the 1978 act and amendment 7 relates to pre-contract disputes for GMS contracts.

It has been decided that a panel of three people will be appointed to hear pre-contract disputes about section 17C arrangements and GMS contracts. Amendments 5 and 7 will make it clear that regulations may make provision for that because that is our clear policy intention.

Amendment 5 will insert a reference to a "panel of persons" into the new provision about pre-contract disputes in proposed new section 17E(3D), which contains an illustrative list of what pre-contract dispute regulations that are made under section 17E might cover. The amendment will make it clear that regulations may establish a panel to hear such disputes. That is also our clear policy intention.

Amendment 7 will insert a reference to a "panel of persons" into the regulation-making power in proposed new section 17O(1) of the 1978 act, which provides the power to make regulations about GMS pre-contract disputes. The new wording will clarify that those regulations might provide for a panel to be appointed to hear such disputes, as is our policy intention.

Amendment 8 will make it clear that regulations may also provide for persons who are already providing primary medical services under a GMS contract to become health service bodies. That is in addition to the availability of that option to persons who are about to enter into a GMS contract. The amendment will make it clear that the regulations that can be made under proposed new section 17O(2) can deal with the election to be a health service body by those who have entered into a GMS contract, as well as by those who will enter into a GMS contract.

As for amendments 9 and 10, in its stage 1 report, the Health Committee called for draft GMS regulations to be made available to assist the committee in its scrutiny of the bill. In drafting those regulations, it was noted that some ambiguity might arise because the bill had similar primary powers on dispute resolution for all GMS contracts to the powers in section 17A of the 1978 act, which deals with dispute resolution on NHS contracts. The policy intention is to allow the same panel to decide disputes on NHS GMS contracts when the dispute resolution procedure is compulsory, and to decide disputes on non-NHS GMS contracts when the dispute resolution procedure is elected.

Amendments 9 and 10 will allow ministers to prescribe in regulations how section 17A of the 1978 act will operate in relation to GMS providers or potential providers that elect to become health service bodies by making any necessary modifications. Therefore, the provision is for a limited purpose only. It will allow the panel to apply the same dispute resolution procedure to all contracts, under the same primary powers, without concern over ambiguity about the primary powers or the regulations that can be made under them.

I move amendment 4.

Amendment 4 agreed to.

[Amendment 5 moved—[Malcolm Chisholm]—and agreed to.]

Murray Tosh (Conservative, West of Scotland)

Group 5 is on consequential amendments and repeals. Amendment 11, in the name of Malcolm Chisholm, is grouped with amendments 12 to 15.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The amendments will add to the schedule of modifications. Some of the amendments will update legislation to reflect the new terminology and the new regime that the bill will introduce. The amendments also make several consequential repeals of sections of legislation that are no longer appropriate.

Amendment 11 will add to the schedule a consequential amendment to the 1978 act. It will remove an unnecessary "and" from the definitions in section 17D(2), in which the penultimate definition will no longer be the penultimate definition.

Amendment 12 will add to the schedule several consequential amendments to the 1978 act. Amendments 13 and 14 add to the schedule amendments to the National Health Service (Primary Care) Act 1997 that will tidy the statute book by removing redundant references. Amendment 13 will add the repeal of section 33 of the 1997 act, which inserted additional sections into and amended the 1978 act in respect of old GMS provision. Those changes will be redundant because the bill will bring old GMS provision to an end.

Amendment 14 will add to the schedule the repeal of paragraph 40 of schedule 2 to the 1997 act. Paragraph 40 changed section 22 of the 1978 act, so because the schedule to the bill will repeal section 22, paragraph 40 is no longer needed. The amendment will tidy the statute book.

Amendment 15 will insert into the schedule consequential amendments to the Scottish Public Services Ombudsman Act 2002. Subparagraph (2) of the amendment will amend schedule 2 to the 2002 act, which lists the persons who are liable to investigation by the ombudsman. Schedule 2 refers to persons providing old general medical services or personal medical services, so those references will be replaced by their successors under the new regime.

Subparagraph (3) of amendment 15 will amend schedule 4 to the 2002 act, which sets out matters that the ombudsman must not investigate, which include actions by a health board under section 19 of the 1978 act. The bill will repeal section 19, so the 2002 act will be updated to refer to proposed new section 17P of the 1978 act.

Amendment 15 will also insert a consequential amendment to schedule 1 to the Freedom of Information (Scotland) Act 2002, which lists various public authorities and includes providers of old general medical services and personal medical services. The amendment will replace those references with their successors—those who provide primary medical services under a GMS contract or section 17C arrangements.

I move amendment 11.

Amendment 11 agreed to.

[Amendments 12 to 15 moved—[Malcolm Chisholm]—and agreed to.]

Murray Tosh (Conservative, West of Scotland)

That ends consideration of amendments.

Primary Medical Services (Scotland) Bill

Murray Tosh (Conservative, West of Scotland)

The next item of business is a debate on motion S2M-698, in the name of Malcolm Chisholm, that the Primary Medical Services (Scotland) Bill be passed, and two amendments to the motion.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I am delighted to open this final debate on the Primary Medical Services (Scotland) Bill. This important legislation will impact on every person in Scotland and I am pleased to note that the bill's principles have been accepted by Parliament from the start of its passage.

In commending the bill to Parliament, I think it only right and proper that I pay tribute to those who have been involved in its progress. First, I thank all of those who have been involved in discussions on the bill, including groups from outside Parliament who took the time to come and give evidence to the committees. The bill will affect everyone who accesses primary care, so I am pleased that Parliament was able to hear the views of doctors—through the British Medical Association and the Royal College of General Practitioners—and of patients, through the Scottish Association of Health Councils and the Scotland Patients Association.

I am also grateful to the members of the Health Committee, the Finance Committee and the Subordinate Legislation Committee, all of whom worked hard to scrutinise the bill within what I accept was quite a short time frame. In particular, I thank the members of the Health Committee, whose desire to understand the detail of how the new contract will work has been an example to us all. During the stage 1 debate, the committee convener suggested that I was having nightmares about the regulations. I hope that the draft regulations that we have now shared with the committee are providing Christine Grahame with some light bedtime reading rather than causing her sleepless nights. Finally, I want to thank the clerks of the various committees and—last but not least—our wonderful bill team.

This bill represents significant modernisation of the way in which primary medical services will be delivered throughout Scotland and will improve the working lives of doctors and practice staff. Even more important, it will improve things for patients. In many ways, primary medical services are the front line of the national health service. As more than 90 per cent of patients' experiences with the NHS begin and end with primary care, it is essential that we have a strong, modernised system of delivering primary medical services to the people of Scotland.

As we modernise how primary care services are delivered, I want to ensure that they are delivered in modernised up-to-date premises. Patients have already seen, and are using, new and improved premises throughout Scotland, which have benefited from the Executive's modernisation programme. That development has meant better service delivery and more accessible services for patients.

Today, I am pleased to announce a further £19 million investment for primary care premises throughout Scotland, which will be used to deliver more services in primary care settings or to bring together primary care and social care services. That investment will build on the £51 million that has already been spent on updating and modernising primary care premises.

David Davidson (Conservative, North East Scotland)

Will the minister share with us the areas of primary care towards which the money will be directed?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I will say more about that in a moment. Indeed, at this point, I will say that I want patients to continue to benefit from the programme. As a result, £4 million of the money that I am announcing today will pump-prime the development of the community health service centres that are described in the partnership agreement. Those centres help to bring together treatment, diagnosis and support services in a single centre. The funding will also help rural areas to develop outreach facilities using information technology and video-link technology. The development of community health service centres and the investment in remote and rural areas will ensure that a wider range of services is available in communities.

The second part of my answer to David Davidson's question is that the remaining £15 million will be available over two years, starting in 2004-05, to provide top-up funding to joint working projects that have been agreed between NHS boards and their partner local authorities.

There are already a number of good examples of such joint working. For example, at the Dalmellington resource centre in East Ayrshire, patients can access from the same building not only general practitioner, practice nurse, community care and mental health services, but a wide range of local authority services. That type of joint working is very much in the interests of the patient and I am delighted to be able to provide additional resources to allow such an approach to spread across Scotland.

The bill is not about privatising primary care. Indeed, we have already debated that issue at some length at the bill's previous stages. I am pleased that Parliament has accepted the Executive's views and rejected the Scottish Socialist Party's suggestions. I want to reiterate my position one more time—GP practices that provide services under the current arrangements will continue to do so in the new world. Big private companies will not be able to hold a general medical services contract.

The provision of out-of-hours care is already changing. People who pick up the phone at night in many parts of Scotland find that their call is not answered by their own GPs. Everyone agrees that a tired GP who has worked all day should not have to work through the whole night. Many GPs have formed co-operatives to share the burden of out-of-hours care. Moreover, we have set up NHS 24, which is a confidential 24-hour nurse consultation telephone service that is available to everyone in Scotland for the cost of a local call. We will build on these changes for the new system and people will still have access to help, advice and treatment whatever the time of the day.

Mary Scanlon (Conservative, Highlands and Islands)

Does the minister understand that GPs in the Highlands are having to make very difficult—indeed, agonising—decisions about opting out of out-of-hours commitments to their patients because of uncertainty about what is being put in place for their patients?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

Tom McCabe will deal with that issue in some detail in his closing remarks. However, a report will be published today by the group that has been carrying out work on out-of-hours services. Members might want to read that detailed report, because it describes some of the models that are being developed. The group has been set up to share some of that good practice and to work alongside NHS boards to come up with solutions.

I should also say that Mary Scanlon knows about the difficulties of recruiting and retaining GPs in rural areas—the contract will be a great benefit in that respect. As I said, Tom McCabe will make other points on that subject when he closes.

The bill is not about removing services. Patients will still be able to go to their local GP practices for the vast majority of their needs. As far as more specialised needs are concerned, people might have to go to a different practice if, for example, their doctor does not provide minor surgery. However, they will still be able to access such services in a primary care setting instead of needing an outpatient's appointment at their local hospital, which is perhaps what happens at present.

Patients will not be left to find their way round the new system on their own. Practices and health boards will have to ensure that patients are helped to access the full range of primary medical services. I am happy to repeat that key commitment today.

The bill seeks to empower GP practices to recruit the right mix of people in order to provide high-quality services to patients. Under the new contract, funding will follow the patient. Practices will receive funding for the services that they provide, not for the number of GPs in them. Moreover, they will be able to decide how to use funding to recruit and retain the right mix of staff for those services. That approach recognises the unique contribution that nurses and other health-care professionals can bring to general practice, and will free up GPs' time to allow them to carry out the work that they are trained to do.

By offering more opportunities for GPs to work flexibly, the bill seeks to make general practice an attractive career option for the next generation, and to retain GPs who already provide such a high level of commitment to the NHS. It will also make it easier for them to move in and out of salaried and independent contractor status. With that measure and a new portfolio approach to career development, GPs will find it easier to adapt their careers to suit their aspirations.

The bill is about safeguarding and developing services in rural areas as well as in our towns and cities. The whole bill and the contract are designed to aid recruitment and retention in all parts of Scotland. However, the contract tries to address specific remote and rural issues.

The new Scottish allocation formula—used to allocate the global sum to practices and the enhanced service floor, and board-administered funds to health boards—will directly benefit remote and rural areas. The Scottish allocation formula reflects the additional costs of providing services in remote and rural areas and ensures that practices in those areas receive proportionally more than practices in urban settings. Rural boards will also receive proportionally more to help with the costs of providing enhanced services and with expenditure on, for example, premises and information technologies. I hope that that reassures members that GP practices and patients in rural areas will benefit from the new arrangements.

The bill is about ensuring that resources follow the needs of patients. Under current arrangements, money follows the doctor, so the more doctors there are in a practice, the more money there is. If a GP leaves, the income of the practice reduces. That will not happen in the future.

Of course, the bill is part of a much wider modernisation agenda. We are also improving contracts for consultants and for nurses and support staff through the agenda for change. Neither of those contract changes will require primary legislation, as members may be relieved to hear, but they demonstrate our commitment to creating a modernised pay system across the NHS. We need to reward the actual responsibilities that staff take on rather than the job title that they work under. We need to offer the prospect of higher inclusive salaries rather than rely on expensive, outdated and inflexible special allowances. We need to provide flexibility so that jobs can be designed to suit patient needs rather than with rigid demarcation lines on what staff think they are allowed to do. The bill will help to introduce those changes for those staff who provide primary medical services.

The bill will also link into other changes that will be brought in by the National Health Service Reform (Scotland) Bill. That bill will allow community health partnerships to evolve from local health care co-operatives. In relation to the general medical services contract, community health partnerships will play a key role in working with NHS boards to identify service needs, particularly those in the enhanced categories. As I said in the stage 1 debate, community health partnerships will then work with local practices and other providers to ensure that those services are delivered most effectively within each community health partnership area. The involvement of community health partnerships will also ensure that we take a broad, multi-professional and multi-agency approach to provision of services. It is in supporting the development of new services in local settings and in supporting the shift from hospital-based care to community-based care that community health partnerships will come into their own.

Let us remember: if it can be done in primary care, it should be done in primary care. Services should and must be organised around the needs of patients, not for organisational convenience. Services should and must be organised in a way that ensures that resources are marshalled appropriately for the type of care that is necessary and in the right place, at the right time. Some services that have been traditionally provided in hospitals can be provided in the community; we will look to community health partnerships and the new GMS contract to promote that shift in activity.

I will listen with interest to the speeches from Shona Robison and David Davidson on their amendments to the motion. I am sure that Tom McCabe will provide a detailed response once he has heard their speeches, but I would like to make some general comments about why I think they should be rejected.

I understand the sentiment behind David Davidson's amendment, but it is unnecessary. In the stage 1 debate, I said that I was confident that we would be able to share drafts of the GMS regulations with the Health Committee before the end of November. I am pleased to say that my confidence was not misplaced. Copies of the regulations were sent to that committee on 24 November and the following day Tom McCabe appeared before the committee to discuss them. We have further undertaken to provide another draft to the committee before the final version is ready to be laid. I am happy to repeat that undertaking today.

Shona Robison is concerned about out-of-hours services in relation to rural practices and single-handed GPs. I should perhaps point out that those are not necessarily one and the same. For example, a large number of GPs in Glasgow are single-handed practitioners; I cannot see that they will have any difficulty in transferring their responsibility for out-of-hours cover should they choose to do so. More fundamentally, any GPs who cannot opt out will receive additional funding. Tom McCabe will have more to say on that detail of that.

For the past 60 years, GPs have been at the heart of the NHS, but the NHS is changing and it is only right that general practice changes with it. The bill will help to achieve that. There is much in the bill for GPs, but there is even more for patients and for the whole NHS. That is why we introduced the bill and have supported its passage through Parliament. I am grateful for Parliament's recognition of the key principles of the bill. The Health Committee supported our changes at stage 2 and we have had had some interesting discussions today at stage 3. I now ask Parliament to approve the bill and allow us to begin to implement the benefits that we all agree it contains.

Accordingly, I move,

That the Parliament agrees that the Primary Medical Services (Scotland) Bill be passed.

Shona Robison (Scottish National Party, Dundee East)

I begin by thanking those who came to the committee to give evidence, and I thank the Health Committee clerks, who always keep us right when we are dealing with a bill of this nature.

I start by restating that I believe that the thrust of the bill is not about privatisation, but about trying to resolve the GP recruitment and retention crisis. However, it is interesting to note that a person who did not vote for Carolyn Leckie's amendments was none other than Tommy Sheridan himself—perhaps he had a road-to-Damascus conversion during the speeches, which made him see the light. We can only hope so.

We have said on a number of occasions that we cannot underestimate just how great a crisis is being faced in the GP profession, in which there is an aging work force and low morale. That is why the legislation will be so important in trying to turn that around. However, the backdrop to the bill also involves training of general practitioners and some concerns remain, despite the bill. One of those concerns is about the lack of training places for students in Scotland, and of funding to go with them. That issue was raised by general practitioners and their organisations, and by others who expressed concerns. If we cannot produce enough GPs through our training system, we will not be able to solve the problem in the long term. The jury is still out on whether enough is being done to achieve that.

I turn to the amendment in my name. The focus of a lot of the evidence to the Health Committee and of the concerns that were raised was on rural practices and GPs who are unable to opt out of the out-of-hours services. That is obviously where some of the biggest pressures on recruitment and retention fall. There are still areas of Scotland that cannot get GPs to go there and provide services, and there are still concerns about the need to address that problem. It is important that assistance is secured, and I welcome the additional funding for GPs in that situation. I do not know whether that will be enough to attract GPs to remote and rural areas; the jury is out on that question, too. I felt that it was important to restate in an amendment to the motion the principle that we must provide assistance for recruitment and retention of GPs in rural areas.

Primary care is definitely the way forward to delivering services to the people of Scotland. It is the way forward in trying to turn around the state of the nation's health. I welcome the investment that has been announced today, but I expect primary care to deliver much over the next few years. We have huge expectations of community health partnerships and what they will deliver. The SNP certainly hopes that the investment will be enough and that such partnerships will be a success.

We have discussed our concerns, but I am happy to support the bill.

I move amendment S2M-698.1, to insert at end:

"but, in so doing, is concerned that rural practices unable to opt out of out-of-hours services will have serious difficulty in recruiting new doctors and therefore believes that it is imperative that the Scottish Executive ensures that NHS boards honour the principles of the Patient Services Guarantee in all areas, in particular in securing assistance for single-handed GP practices in the provision of out-of-hours services to remote and rural Scotland."

David Davidson (Conservative, North East Scotland)

The bill is one of the most important in a long time to help to improve access to health care in Scotland. It has become obvious, to the Health Committee and to many members, that GPs, patient groups, community councils and individuals have been concerned for a long time that the bill should make general practice attractive, that it should lead to an increase in staffing levels in local surgeries and that it should mean that the experience of existing GPs is retained. Many of those GPs are seeking early retirement because of a crisis in morale, the amount of bureaucracy that is involved and, in many cases, overwork. Such experienced people need to be kept in place so that new practitioners can be brought in who can work with them. That will enable new practitioners to develop more quickly and play their full role in providing health care.

There is an issue relating to what happens with young doctors who are trained in Scotland. We produce far more doctors than we retain. The bill recognises that and I think that all parties welcome the fact that it does so. It is important that young doctors who come here to train want to stay, practise and contribute to the health of the Scottish people—and not just in urban areas.

There is a particular concern about problems in rural and remote areas. Rural and remote practitioners are still concerned as to whether transition systems for funding will allow them the critical mass to keep going. My biggest concern is whether health boards will be able to deliver the out-of-hours cover or general time-off provision needed by rural and remote practitioners, not only to stay happy with their work, but fit for practice. It is important that we recognise the loads that are placed on rural and remote practitioners and the stresses that many face in working alone. I am not yet convinced that the minister can give us a clear statement that all health boards will be in a position to provide such back-up and service by a certain date.

I am happy that the minister commented on the models that are being considered. To be frank, NHS 24 is not a substitute for access to a GP if a matter is essential, particularly in a rural and remote area when time might be of the essence in acquiring medical care.

I lodged my amendment as a result of concerns in the committee. The minister has voluntarily, and without too much coercion, appeared before the committee and discussed draft regulations, but there have been concerns. The British Medical Association was recently concerned that the committee's seeking access to sight of the regulations, through a democratic process, might delay the implementation of the bill. I am happy that the BMA has changed its view and understands that the committee does not and never did want to go down that route. We wanted to scrutinise the bill to ensure that the bill's ultimate objective—improvement of access to medical care in primary services in all parts of Scotland—is achieved.

I lodged the amendment to formalise the proposal that the minister would put draft regulations before us. I thank the minister for what he has done so far, but there is still a long way to go before regulations are laid before the Parliament. If the minister is prepared to give a guarantee today that all changes to regulations will be considered by the Health Committee before they are laid before the chamber, I will not press my amendment. I wonder whether the minister will comment on that matter now. Obviously, he will not.

My amendment is meant to be apolitical and practical. It enshrines the principle of the Parliament that every piece of legislation that affects the life of anyone in Scotland should be seen and approved though the parliamentary process. I would worry if we were to rely only on good will in such matters.

One or two points that the minister has made have raised concerns. On the additional and welcome £19 million for practice premises, I am concerned about whether dentists and pharmacists throughout Scotland will be able to participate in what has been proposed. Such concerns are partly to do with disability access, but also relate to the provision of some new services that the minister thinks are required.

In general terms, the Conservative party welcomes the bill, although we still have concerns about the ability of various organisations to deliver things. As a result—and since the minister is not prepared to give the guarantee that I requested—I move amendment S2M-698.2, to insert at end:

"but, in so doing, expresses concern that the delivery of the objectives of the Bill requires scrutiny of all draft regulations by the Health Committee before they are laid before the Parliament."

Murray Tosh (Conservative, West of Scotland)

I have guidance for members who wish to speak later. It is difficult to work out timings for the rest of the debate. The principal parties in the chamber have been consulted and it looks like the debate will continue beyond First Minister's question time and question time this afternoon. Therefore, I anticipate that I will offer those members who have moved amendments the opportunity to make closing speeches after question time. Thereafter, Mr McCabe will conclude the debate—he will have the opportunity to make detailed responses to points that have been made, as Mr Chisholm said that he would. Before midday, I hope to call all other members who have asked to speak, but if any member is not called before then, there should be enough time after 3.10 pm to call any member who has not been chosen this morning.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The Primary Medical Services (Scotland) Bill is an important part of the reform process in the NHS in Scotland. It includes major changes to how NHS services are delivered. First, there is a duty on NHS boards to provide services throughout their areas. Secondly, there will be a practice-based contract that will help to develop the multidisciplinary approach that is needed in the 21 st century. Thirdly, as I said earlier, the proposals are backed up with huge increases in resources to ensure that the new system works better.

At stage 1, I was concerned about the bill on two counts. First, I was concerned that single-handed GP practices in remote and rural parts of Scotland would be penalised by the proposals. The minister appeared before the committee and gave assurances that no current practice would be worse off and, indeed, that the vast majority would be better off under the system. Secondly, I was concerned about the bill's being an enabling bill and that the details of the new contracts would be in regulations that the committee could not amend.

In the previous session, my first experience of such a process was with the National Parks (Scotland) Bill, which was also an enabling bill. The formation of the actual national parks was left to unseen regulations. That experience was not satisfactory. There is no doubt that the Parliament would not have voted through unamended the new Cairngorms national park boundaries. Parliament had the choice only to accept or reject the regulations and we reluctantly accepted them.

With the Primary Medical Services (Scotland) Bill, the Health Committee requested from the minister sight of the Scottish and United Kingdom draft regulations before we considered the bill further at stage 2. If any amendments were needed to the bill, we could therefore lodge them then.

The ministers—Malcolm Chisholm and Tom McCabe—went out of their way to oblige the committee. They produced the draft regulations that we requested as quickly as possible. That was a remarkable achievement. I recommend such an approach with other enabling legislation.

The amendments that we are discussing are unnecessary. In particular, now that David Davidson has heard the minister repeat his commitment to bringing the redrafted regulations before the committee before they are laid, I hope that he will seek to withdraw his amendment—that would be the most appropriate thing to do. By forcing a vote and being defeated on the issue, he might undermine the whole process that he intends to support. I ask him to think about the matter carefully before he forces a vote.

David Davidson (Conservative, North East Scotland)

I made the minister a genuine offer to withdraw my amendment if he gives a guarantee in the chamber, for the record, that all regulations or potential amendments that might affect the bill will go to the Health Committee before they are laid before the Parliament. He has not yet chosen to give such a guarantee.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I understand that, but we have not yet heard the minister's summing up. I see that the Deputy Minister for Health and Community Care is nodding.

The Health Committee was criticised in some quarters for its stand on the bill, but we were not prepared simply to rubber-stamp a UK-wide deal. There was some mischief in the press, as it was suggested that the committee would somehow delay the implementation of the bill. No delay has been necessary, so such comments were unfounded. The committee was entirely right to ensure that the legislation that came before it was properly scrutinised—it was the committee's job to do that and the committee did its job.

Janis Hughes (Labour, Glasgow Rutherglen)

I welcome the opportunity to participate in today's debate, at the end of what has been another very busy year for the Health Committee. I thank the clerks and all the parliamentary staff who have been associated with the committee for the work that they have put in over the past 12 months.

The Primary Medical Services (Scotland) Bill contains much that is to be welcomed. As we heard, more than 90 per cent of patient contact with the NHS begins and ends with the primary care team, and 87 per cent of that work is dealt with entirely by the primary care services. The improvement and expansion of health care in the community must therefore be a key priority for the Executive.

During the passage of the bill, much press coverage was given to the committee's desire to see the draft regulations that would underpin the new GP contracts. Health Committee members were contacted by a number of GPs, who expressed concerns that any hold up in implementing the new contracts would have a devastating effect on general practice in Scotland. I was reassured by the minister's commitment, which he honoured, to show us the regulations before stage 2 and I am delighted that, if the bill is passed today, there will be no hold up in the establishment of the new contracts in Scotland.

The proposed legislation delivers for patients and for staff. The new GP contract will offer patients more choice, better quality of care, new ways of accessing services and greater access to services in the local community. The provisions will allow GPs to control their work loads better, while offering them rewards for delivering high-quality services. That is necessary if we are to encourage new recruits to the profession.

I hope that there will be real investment in the modernisation of health centres. The new Rutherglen primary care centre, in my constituency, is a fine example of a modern, integrated health care facility. We should strive to achieve that standard in every area.

We have come a long way since the time when GPs were the first and only primary health care providers. Optimum care is now provided by a large number of health personnel, including the Scottish Ambulance Service, NHS 24, community nurses and allied health professionals.

Like other members, I was somewhat surprised that Carolyn Leckie lodged her amendments at stage 3, given their overwhelming defeat at stage 2. Carolyn Leckie asked today for yes and no answers, but I say to her—as one health professional to another—that medicine is not an exact science, as she knows. We are not dealing with an ideological issue that has black and white answers. Carolyn Leckie should accept defeat, especially now that that defeat has been endorsed by the Parliament.

The bill represents another good piece of legislation that the Parliament has produced. Much work has yet to be done by the large number of people who will be involved in the negotiations that must take place before April, when the new GP contracts will be implemented in full. By passing the bill today, we will enable those people to move on with that work. I offer the bill my full support and urge the Parliament to pass it.

Christine Grahame (Scottish National Party, South of Scotland)

I associate myself with other members' remarks and thank the clerking teams, the Scottish Parliament information centre and members of the Health Committee.

Members of the committee scrutinised the bill and raised the spectre of regulations—which I look forward to enjoying when I cannot get to sleep at night. The minister kindly sent the committee a letter on 15 December in answer to our letter about regulations and I will pick up on one or two rather technical points that arise from that.

The first issue, which was raised at a committee meeting by Janis Hughes, is with regard to informing patients when a practice opts out of certain elements. In the minister's letter, he says:

"There is no ... duty on Health Boards"

to inform patients that a practice has opted out of additional services. He proceeds:

"However, work on a further set of regulations will soon begin to prescribe the information that a Health Board must publicise".

He states that those regulations are being drafted and that they will be ready early in the new year. In line with David Davidson's comments, I hope that the minister will give an undertaking that the committee will have the opportunity to consider the new regulations—that would resolve the issue. I thank Tom McCabe for coming before the committee with his officials to give us advice on the regulations.

The second issue, which I raised, is third-party rights. The draft regulations narrated that no third party would have a right arising from the bill, because the bill simply puts a contract into statutory form. I understand the law of contract and that it is not usual to have third-party rights within contractual terms. However, I am still concerned about what the minister's letter says regarding a person who has been removed from a GP practice list, how that is done, how the person will know about it, and how they can appeal—I use the word "appeal" loosely.

In the minister's letter to me, as convener, and to the committee, he says:

"Taking the specific example about a person who has been removed from a practice's list, in the first place a contractor would have to demonstrate that it had good reason to remove a patient from its list. If this was judged to be badly founded, the contract terms would provide for sanctions to be imposed by the Health Board."

In other words, there would be redress for the wronged patient.

"Patients would instigate this process by using the formal complaints procedure set down in the contract regulations as a feature to be included in all GMS contracts."

That takes us beyond Scottish statutory instruments into regulations that pertain to a contract. Again, the committee might want to consider that. How does somebody access the information if they find that a doctor has taken them off the list? The doctor might have a bad reason for doing that—for example, the patient might be about to complain about the doctor.

I also raised the third issue, which relates to the draft regulations under the heading "Compliance with legislation and guidance", and is the question of how strong the regulations and guidance are in terms of law. I asked the minister what the words "have regard to" mean, in the phrase

"have regard to all relevant guidance".

In terms of the force of law, where do the words come on a scale of 0 to 10, if 10 means "shall"? In his answer, the minister says that

"this wording is simply included to make it a term of a contract that ... the contractor must have regard to guidance"

and that "have regard to"

"has its ordinary meaning".

I am not satisfied with that. I do not see why the wording could not be "shall comply in so far as is reasonable" or "shall comply in so far as is practicable with the guidance". That would be much stronger.

On David Davidson's amendment, I will wait to see the minister's position and I will reserve mine.

Eleanor Scott (Green, Highlands and Islands)

Like everyone else here, I generally welcome the bill. The modernisation of primary medical services is clearly required. I also welcome the minister's announcement of extra funding, particularly for rural areas, and I hope that we will hear more detail about where that money will go. I have concerns about the remote and rural areas research initiative, which has been an important driver of innovation and quality in medicine in rural areas. It is due to come to an end and it is not clear what will follow it. I also hope that the minister will make an announcement about where the Executive is with the transitional arrangements for inducement practices, because it is not clear where it has got to and there is concern about that.

I support Shona Robison's amendment; I share her concerns about provision in rural areas and the recruitment of GPs. I hope that the health boards that cover rural areas will be empowered to employ salaried general practitioners, but even that is not the answer because there would be recruitment problems. It should be noted that one of the things that affects the recruitment—and particularly the retention—of GPs, as well as their morale, is the paperwork that is involved in their daily lives. I hope that the regulations that follow the bill will not add to that paperwork, but that they will streamline it. Otherwise, we will simply have an adverse effect on GPs' morale.

I am aware that the provisions in the bill have been generally welcomed by doctors, but I am not sure that the public have much awareness of the bill. Primary medical services are going to look a bit different in future and I am not sure that that is being communicated to the people out there.

People are quite happy that, when they call a doctor out of hours in an emergency, a different doctor from their own will respond. That is accepted as the norm nowadays. I am not sure that people are ready to accept that, in cases of routine care such as the monitoring of diabetes, their own doctor might choose not to do that and that they might have to go to another practitioner for monitoring. That change in primary medical services has not been put across to the public and I will be interested to hear from the minister how such information sharing will take place.

I will say a few words about the new GP contract and quote from Doctor magazine on 4 December this year:

"The new contract may create 'tunnel vision' among GPs, warn authors of a report on NHS quality ... They say rewards for meeting quality targets will have benefits for the health service, but at the expense of areas not covered in the new GMS deal."

I have looked at the quality indicators and one cannot argue with many of them. There is a page and a half of indicators for coronary heart disease, which adds up to 121 points. There is a page for stroke and a page and a bit for diabetes mellitus, but I have not added up those points. Then we come to the quality indicators for mental health, which is probably a huge part of a GP's work load, and the number of points is tiny at 41 points, a huge number of which are for monitoring patients with severe mental health problems. In fact, three of the points are for monitoring people on lithium. I am concerned that, yet again, mental health is to be the cinderella. It has been the cinderella of the health service for a long time and it looks as though it will be the cinderella of primary medical services.

Although I want that point to be addressed, as well as the rural issues, I welcome the bill in general, and I will support Shona Robison's amendment.

Jean Turner (Independent, Strathkelvin and Bearsden)

I thank everybody who helped us on the Health Committee, especially the clerks and SPICe, because everything was new to me.

I will vote for and support the bill because I have no difficulty with its principles. I spoke to a GP last week who was desperate that the bill should go through. He was terrified that something would hinder its progress and therefore the implementation of the new contract. I assumed that he was one of those who had voted for the contract. He said, "Absolutely not." He said that he knew few folk who had voted for the new contract, but that they were all desperate to get on with it. The reason was that uncertainty breeds doubt, and more uncertainty, and that makes for low morale, which we are trying to improve. Morale in general practice is at the lowest that it could be; let us hope that the bill does the job.

As a member of the Health Committee, I spoke to people throughout the west coast of Scotland, which was very interesting. Patients in the north-west of Scotland are asking their general practitioners what will happen to them if their doctors opt out of the new contract. Patients are worried about what is going on; perhaps they need more education about what the changes will mean for them.

It is my understanding that general practitioners in rural and remote areas will have a conscience and provide cover as before, so they have fewer choices than they would have if they worked in towns. GPs in such areas cover vast distances and one house visit could take hours—it might involve both a car and a boat journey. In town, the general public does not understand the changes in primary care; they are more focused on the loss of hospitals and changes in their hospital services. They do not understand the impact that that will have on primary care services.

I spoke to a patient representative the other day who was on a local health care co-operative, which will be replaced by a community health partnership. She felt that she was in the dark, that everything was in limbo and that nobody was giving her any information about what was going to happen. We could improve on that. Although I fully support the bill, I do not have a blanket faith that everything will work out all right. I know that the Executive has the will and the money to put into the services, but one cannot put people where they do not exist.

Mary Scanlon (Conservative, Highlands and Islands)

Does Jean Turner have sympathy for the GPs in Lochaline and Lochcarron who worry that, if they opt out of the new out-of-hours arrangements, the community will turn against them? GPs have a moral commitment to their patients and if a patient dies, they will be cast out by the community.

Jean Turner (Independent, Strathkelvin and Bearsden)

I share that fear; I spoke to people in Gairloch who were accosting GPs in the street to ask those questions.

In order to plan ahead, doctors need to know who is opting in, who is opting out and who will stay the way they are. When a doctor opts out, as the minister said, they opt out of 24-hour cover and the health board has to cover for them. I wonder how that will work in rural areas, as well as in the cities. However, we have to go ahead and the proof will be in what happens when we get all the regulations and when the changes are working—because they have to work.

The regulations will put everything in place and only then will we see whether we have a comprehensive health service in Scotland. I support the bill.

Nanette Milne (Conservative, North East Scotland)

I declare an interest as the wife of a retired general practitioner who still does locum work to try to keep the service going.

As I said in the stage 1 debate, the passage of the bill is crucial to the future of primary care throughout the United Kingdom because recent years have shown a severe crisis in morale in the service. Many GPs have been retiring early and in the past 10 years in Aberdeen, there has scarcely been a GP over 60 years of age in full-time work.

Recruitment has been difficult, with too few medical graduates opting for a career in general practice and there has been an increase in the number of GPs working part time. Without the frequent use of locum practitioners, parts of Scotland would have been completely without primary care cover. I hope that the new contract will achieve the necessary balance between recruiting new GPs and retaining more of the older ones to make general practice a more attractive career option for medical graduates.

If Carolyn Leckie and Tommy Sheridan had their way, however, GPs would flee the health service like snow off a dyke—unless they plan to lock them into their surgeries and take away the keys.

The passage of the bill today will allow the implementation of the new contract to go ahead next April in Scotland as well as in England, which is important if we are to retain GPs in this country.

By and large, the terms of the contract have been welcomed by the profession. The focus on the primary care team and funding based on patient need as well as numbers will allow GPs to plan their work load more easily and, at the same time, to improve the service that they give to patients. For the first time ever, they will be rewarded for any enhanced services that they provide over and above the essential and additional services that most GPs currently give their patients. The transfer of responsibility for the provision of out-of-hours care to health boards will take an enormous load off GPs. Having been married to one for over 30 years, I know what that work load is.

Many GPs will opt out of out-of-hours provision, but many will continue to work out of hours in co-operatives, as they do now. In most parts of Scotland, that will be adequate and satisfactory provision. There is natural concern about out-of-hours cover in remote and rural areas, where alternative cover will be difficult to find when GPs opt out. I look forward to reading the report that the minister promised this morning.

There is still concern among GPs who run community hospitals that a nurse-led service at night in those hospitals could result in a lesser service to their patients. Patients will no doubt take time to understand how the contract will affect them, particularly when they hear that they might have to attend another practice for certain investigations or treatments. I hope that there will be an intensive education programme for them before the contract comes into force in April.

All in all, however, the new contract will be welcomed by the profession. I hope that, in the interests of doctors and patients, the passage of the bill today will result in the much hoped for and needed boost to morale, recruitment and retention in primary care.

First Minister's Question Time

John Swinney (Scottish National Party, North Tayside)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-464)

Jack McConnell (Labour, Motherwell and Wishaw)

The next meeting of the Cabinet will discuss important issues facing Scotland and the Scottish Parliament in 2004.

John Swinney (Scottish National Party, North Tayside)

On the subject of top-up fees, the Scottish Parliament's Enterprise and Culture Committee said this morning:

"our Committee is united in its belief that the proposals ... will have an adverse effect on Scottish higher education".

However, on 18 November, Jim Wallace said:

"The impact of top-up fees is far from certain."

I ask the First Minister, who is right?

Jack McConnell (Labour, Motherwell and Wishaw)

There is no doubt that if the introduction of top-up fees and, therefore, additional income in England and, potentially, Wales ensured that universities south of the border were able to make greater resources available for certain research units through centralisation, to build new facilities or to attract more members of staff, that would have a direct impact on the university system in Scotland. However, partly because the proposals that will be put to the Westminster Parliament are not yet clear, their impact is not yet clear. That is why we are doing the sensible thing and are conducting a review to examine the potential impact of top-up fees and the solutions that might be appropriate for Scotland. That review has been welcomed across the sector, because it wants to engage with us rather than indulge in simple political debate.

John Swinney (Scottish National Party, North Tayside)

That did not sound like a ringing endorsement of the Deputy First Minister.

The Enterprise and Culture Committee also said this morning:

"If the aspiration is to grow the Scottish economy, the Executive should significantly increase its investment in higher education in real terms."

However, on 18 November, Jim Wallace said:

"I am not confident that large additional injections of government money into the system would actually provide a long-term solution".

Once again, I ask the First Minister, who is right?

Jack McConnell (Labour, Motherwell and Wishaw)

The question is not whether any of us wants more money to go into Scottish higher education. If there is anyone in the chamber who does not want more resources to be available for Scottish higher education, they are not fit to be a member of the Scottish Parliament. We would all want to secure more resources for Scottish higher education. The issue is what is affordable and what is the right way to spend that money. The difference in the chamber is that we in the devolved Government continue to ensure that additional resources are available for Scottish higher education and are committed to its expansion and to the attainment of quality in the sector, while the SNP wanders round Scotland campaigning for tax cuts that would reduce the amount of money that is available for Scottish higher education and wants to take Scotland out of the United Kingdom and break up the links within the university sector, which would yet again reduce the amount of money that is available for Scottish higher education. That divide in the chamber is becoming increasingly clear.

John Swinney (Scottish National Party, North Tayside)

Just like last week, when the questions get difficult, the First Minister starts ranting about other issues. That tells us all that we need to know.

The First Minister said that anybody who would not argue for more money for the university sector was not fit to be a member of this Parliament. In that regard, I will quote to him from the long speech that was delivered by the Deputy First Minister to the Universities Scotland conference on 18 November. The Deputy First Minister said:

"Universities Scotland, the NUS and AUTS issue a joint statement, which on the one hand calls for imaginative funding solutions to be found to address the perceived funding crisis in Scotland, and yet concludes with no more than a call for the Executive to provide an additional £100m. You will forgive me for saying that I don't find that particularly imaginative."

Jim Wallace (Liberal Democrat, Orkney Islands)

Read the next sentence.

John Swinney (Scottish National Party, North Tayside)

We will give Mr Wallace the whole lot if he wants it. The speech continued:

"And although I shall certainly bid as hard as I can for higher education in the forthcoming spending review"—

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

Hear, hear.

John Swinney (Scottish National Party, North Tayside)

Mr Rumbles came in a little bit too quickly because the rest of that sentence goes like this:

"I confess that I am not confident that large additional injections of government money into the system would actually provide a long term solution to the challenges we now face."

So, the committee says that top-up fees will have an adverse impact, but the Government says that they will not, and the committee says that higher education needs more investment but the Government says that it does not. Is it not the case that the report that was published this morning by a cross-party committee on which the Government parties have a majority has shredded the Government's policy on higher education? I ask the First Minister this specific question: will he use the £47 million that was allocated in the pre-budget report to invest in higher education? Yes or no?

Jack McConnell (Labour, Motherwell and Wishaw)

I wonder what the SNP will be asking us to spend the money on tomorrow. Every day it is a different demand or a different request. That is a stupid way in which to try to do business.

I welcome Mr Swinney's conversion to the importance of the issue. At least the Conservatives had the decency to ask me about Mr Wallace's speech the week after it happened and not four weeks later. The reality is that the speech made the very important point that the solution that is required in the Scottish universities is not simply about whether more resources will be available but about the increased specialisation that the English universities need in order to compete internationally. In my view, we have some of the best universities in the world. That said, we need to address some of the other issues as well. How do we ensure that the research in our universities is co-ordinated and effective? How do we ensure that it is not only well resourced but of a high quality? This is not only about chucking public money at an issue. That is certainly not the case when Mr Swinney spends the rest of the week proposing tax cuts to Scottish businesses. He has to be consistent. I agree that resources will be important but quality is also important and we will deliver both for our university sector.

Annabel Goldie (Conservative, West of Scotland)

To ask the First Minister when he next plans to meet the Prime Minister and what issues he intends to raise. (S2F-460)

Jack McConnell (Labour, Motherwell and Wishaw)

I have no meetings scheduled with the Prime Minister early in the new year.

Annabel Goldie (Conservative, West of Scotland)

When the First Minister does get an opportunity to meet the Prime Minister, I hope that they will consider the lessons that all of us can learn from the proceedings of the Soham murder trial, which has implications right across the United Kingdom. One of the key lessons of that tragic and horrific case is the importance of the exchange of information between police forces not only in England but throughout the United Kingdom, as criminals do not respect boundaries. Can he assure me that, as the inquiry that David Blunkett announced proceeds, he will liaise with the Home Office to ensure that there is an effective system for the exchange of information throughout the United Kingdom?

Jack McConnell (Labour, Motherwell and Wishaw)

I am sure that every member in the chamber will sympathise with the families who have had to suffer such a traumatic ordeal over the past very difficult months. I spoke with the Home Secretary this morning. I confirm that he is willing not only to receive evidence and information for his investigation into the co-ordination of information between police forces in England and Wales but to look at the issue from a UK perspective. He will do so to ensure that information is properly exchanged not only in England and Wales but between England and Wales and Scotland.

We have some new and effective procedures, some of which are in place already and some of which are about to be put in place as a result of the Protection of Children (Scotland) Act 2003, which was introduced largely as a result of the terrible tragedy that took place in Dunblane. Although we learned some lessons from that tragedy, I am sure that there are many more that we need to apply. We will work closely with the Home Secretary to ensure that that happens.

Annabel Goldie (Conservative, West of Scotland)

I thank the First Minister for what was not only a politically reassuring message but one that will offer considerable reassurance to the people of Scotland. I hope that he will agree that it is not rafts of new regulations that are needed to prevent such tragedies from occurring in Scotland but a sensible application of existing regulations. I hope that he will also share my concern about the increasing pressure that is being put on the police force, for the best of reasons, in respect of the background checks that take up an enormous amount of police time. Will he undertake to consult the Minister for Justice and our chief constables to ensure that any individual in Scotland who has a pattern of behaviour like Ian Huntley's could not slip through the intelligence net?

Jack McConnell (Labour, Motherwell and Wishaw)

The Minister for Justice will certainly discuss that matter with the chief constables as part of her regular pattern of meetings. Peter Peacock has asked his officials in the Scottish Executive Education Department to give him an update on the different checks that are in place and on the progress in implementing some of the legislation that we have already agreed in Scotland.

I reassure the Parliament and Scotland more generally that the systems that operate in the police force in Scotland are different from those that were being hotly debated for England and the English police force yesterday. The rules on holding information are different in Scotland. If the police have suspicions about an individual, they will pass the information to intelligence, which will hold on to the information. There is no specific length of time after which information is taken off the system; the information is taken off the system only if it is no longer relevant and if it is no longer suggested that the individual is a threat. There is no weeding out of information. If information relates to a serious offence or potential offence, it will stay on the system indefinitely. The Scottish police forces share the information nationally.

Following the outcome of the court case in England yesterday, we have to ensure that information that is available in Scotland is also available to the police in England and that any information that they have is available to us. I hope that that co-ordination will become even clearer as a result of the investigation that the Home Secretary launched yesterday and to which we will make a substantial contribution.

Alasdair Morrison (Labour, Western Isles)

Can the First Minister confirm that the European Commission indicated last Saturday its intention to submit a proposal to establish a European Union fisheries control agency and to site such an agency in Spain? Does he agree that the creation of a central agency runs counter to our desire for regionalisation of the common fisheries policy and that it will lead to the impression being given that Spain has undue influence over EU fishing policy? What action has he taken to raise this very serious matter with his colleague the Foreign Secretary?

Jack McConnell (Labour, Motherwell and Wishaw)

The proposal to have a Europe-wide fisheries agency is not new, but it has not previously been taken forward with any haste at the level of the European Union. If such an agency were to be a centralising force on the common fisheries policy, it would run counter to the policy that we have supported and argued for and are arguing for again in Brussels this week, which is for there to be more regional management of the fisheries of Europe. Therefore, we are expressing serious concerns not only about the proposal but about its location in a member state that has at times been in direct competition with Scotland and the United Kingdom over fisheries policy. We have made those representations to the Foreign Secretary and we intend to continue the discussion with him in the months ahead.

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

Does the First Minister support Fife NHS Board's proposals to cut 37 nursing posts and to make further cuts to physiotherapy, occupational therapy and speech therapy? Will he explain the impact of the proposals on waiting times and health care in Fife? Will he now order an inquiry into the management of Fife NHS Board, which has lost the confidence of the people of Fife?

Jack McConnell (Labour, Motherwell and Wishaw)

I have not seen such proposals and in the past when Ms Marwick has raised such issues in the chamber in relation to Fife NHS Board, her claims have regularly been shown to be grossly exaggerated. If what she suggests has any basis in fact, the Minister for Health and Community Care will write to her as soon as possible to clarify the situation.

Tommy Sheridan (SSP, Glasgow)

To ask the First Minister what the Scottish Executive's position is on the average nursery nurse's salary being a quarter of an MSP's and one sixth of a minister's salary and what the Executive's response is to nursery nurses' industrial action to secure a salary increase. (S2F-485)

Jack McConnell (Labour, Motherwell and Wishaw)

As I have said before in the chamber and elsewhere, nursery nurses have a key role to play with other early-years workers in providing the best possible opportunities for our children's development. The pay negotiations for nursery nurses are a matter between the employers and the trade unions that represent the employees. I am pleased that deals have been agreed in some parts of the country and urge all those still involved in negotiations—or who are not yet at the table—to reach a speedy conclusion.

Tommy Sheridan (SSP, Glasgow)

I raised the case of Scotland's nursery nurses with the First Minister more than a month ago. At that time, he refused to intervene on their behalf. They are still compelled to take industrial action in pursuit of their just claim. Will he at least state today that Scotland's nursery nurses deserve a national salary, a national grading system and a national career structure, or does Scotland's First Minister believe that a nursery nurse in Aberdeen is worth £1,000 a year more than a nursery nurse in South Lanarkshire? If so, why?

Jack McConnell (Labour, Motherwell and Wishaw)

I respect the agreement that has been reached between the employers and the trade unions, which has led to a situation in which there are now local negotiations on the matter. It is important that those local negotiations be seen through to a proper conclusion in each part of Scotland, and I urge all those who are involved in them in each area of Scotland to ensure that they continue—where they are not taking place, they should be. The sooner negotiations come to a conclusion, the sooner everybody's salary will be able to improve because, throughout the country, where deals have been struck, salaries have increased at above the rate of inflation.

Tommy Sheridan (SSP, Glasgow)

The First Minister is dodging the question. The deals that have been struck in Aberdeen and South Lanarkshire value a nursery nurse in Aberdeen £1,000 a year more than one in South Lanarkshire. Nursery nurses meet national targets, have national qualifications and deliver on national responsibilities, so will he state today that the nursery nurses of Scotland deserve a national deal, instead of being thrown to the 32 winds for each local authority to come up with a different deal? Does he agree that the union that represents the nursery nurses—Unison—is right to pursue a national deal, or does he support the local deals that are being cobbled together, which mean that a nursery nurse in one part of the country is worth less than a nursery nurse in another part of the country?

Jack McConnell (Labour, Motherwell and Wishaw)

The single-status agreement, to which the employers and the unions signed up, endorsed the move towards local negotiations. I, for one, will not second-guess the decision of the trade unions that set up that agreement, which ensures that local negotiations should take place. Where such negotiations are not taking place, they should be. Negotiations should take place in good faith and produce results that suit the demands on nursery nurses in the area and the responsibilities that are agreed in their contracts. If that is the way ahead that the unions and the employers have agreed, that is exactly what should happen in every part of Scotland.

James (Conservative, Lothians)

Does the First Minister agree that nursery education is every bit as important as primary and secondary education, that attitudes to the contrary must change and that, if they do change, progress can surely be maintained?

Jack McConnell (Labour, Motherwell and Wishaw)

Nursery education—in fact, the provision of child care more generally—is vital in ensuring that we have provision that helps mothers and, at times, fathers to get to their work and have their children properly looked after. It is also important to try to even out the inequalities that exist in Scotland at a very young age and to ensure that young people and children have the best possible start in life. I warmly welcome the conversion of Lord James Douglas-Hamilton and others to that cause.

Johann Lamont (Labour, Glasgow Pollok)

I understand the fact that, as the First Minister has said before, the current dispute must be settled by the employers and the union that represents nursery nurses. Does he agree that this issue highlights not only the importance that the Government and the Scottish Executive place on the pre-five sector in challenging inequality, but the gap between men's and women's pay and the value—or, perhaps, the lack of value—that we place on work that is predominantly done by women? Will he reflect on how and at what stage a full review of the role, responsibilities and conditions of those in the pre-five sector could be carried out, because such a review would be in the interests not only of those who work in the sector, but of the families and communities that they serve?

Jack McConnell (Labour, Motherwell and Wishaw)

As I have said before, there might be a time and place for a review in the future, but the current priority is to ensure that the local authorities and the unions implement speedily the agreement that has been reached nationally for local negotiations to take place and that the series of disputes be concluded before we consider what might be possible in future.

Elaine Murray (Labour, Dumfries)

To ask the First Minister whether public-private partnerships continue to be an effective way of improving education and health provision. (S2F-484)

Jack McConnell (Labour, Motherwell and Wishaw)

Yes, they do. Public-private partnerships help to deliver better public services, combining the best of public and private expertise, innovation and financing.

Elaine Murray (Labour, Dumfries)

The First Minister will be aware that Dumfries and Galloway Council is about to submit revised proposals for upgrading its school estate using a public-private partnership agreement, for which the Scottish Executive had previously offered £103 million. In light of the problems that have recently been encountered by other local authorities and the concerns of some members of the work force, can he advise us whether the £103 million will remain available, if the council's proposals are acceptable? Could a similar level of investment be made available to the council by the Scottish Executive through any other mechanism?

Jack McConnell (Labour, Motherwell and Wishaw)

I wish to clarify two things. First, it is important that all councils in Scotland, including Dumfries and Galloway Council, take advice on public-private partnership contracts when they are offered, and that they ensure that the best advice is used so as to implement an effective tendering process and, ultimately, agree a successful contract. Secondly, it is important that, when councils have prepared their final decisions, we assess them against the provision that will then be available, and that we then allocate an appropriate level of resources. We have indicated to councils throughout Scotland the level of resources that might be available to them, but each and every one of them needs to deliver the right number of new and refurbished schools for that resource. There has to be value for money for the Scottish taxpayer. If there is value for money for the taxpayer, approval will be given by the Executive.

Fiona Hyslop (Scottish National Party, Lothians)

Is the First Minister aware that, although there might be a prospect of another single bidder coming in to replace the collapsed Ballast consortium in East Lothian, books and computers are being withheld from schools? Is he aware that schools are having to appeal to the Scottish Qualifications Authority for special consideration, because of problems with continuous assessment? Is he aware that the prudential borrowing that is meant to be on offer from the Executive will not be in place until next April and that, even when it is in place, the schools fund that is available to councils—which is around £190 million—will not be available for prudential borrowing, although it will be available for PPP? Will he stop his ideological obsession with PPP, which is robbing our schools and services of the resources that they very much need? That is not value for money, and it is about time he woke up to that.

Jack McConnell (Labour, Motherwell and Wishaw)

If there was ever a convoluted way of asking a question, it is to start off by admitting that a new bidder has been identified in East Lothian, and that the current problems there are being resolved by East Lothian Council, which I think we would all welcome, although it might disappoint some members because they can no longer make points about it. It is then to admit, in the second half of the question, that we are changing the rules of local authority borrowing to allow local authorities throughout Scotland to have larger capital programmes, to spend more money on schools and other services and to borrow more money on the markets of their own free will and under the prudential regime, which will allow them to make proper financial decisions, while at the same time accusing us of having an ideological obsession with only one method of financing. That is a ludicrous way to ask a question, and Fiona Hyslop is lucky that it even deserves a response.

The changes that are taking place in local council financing are liberating councils throughout Scotland not only to build new schools and renovate existing schools, but to borrow more money on the markets, to ensure that they can manage their own finances and, ultimately, to have more choices available to them for financing projects that are urgently needed, and which are now being delivered.

Bruce McFee (Scottish National Party, West of Scotland)

To ask the First Minister whether the Scottish Executive will intervene to ensure that the selection process for a site for a medium secure care unit for the west of Scotland is fair, transparent and robust. (S2F-465)

Jack McConnell (Labour, Motherwell and Wishaw)

The Minister for Health and Community Care will consider carefully the report on that particular site selection process, which he expects to receive soon from the committee responsible. On today of all days, the need to ensure public safety is uppermost in people's minds. I reassure the Parliament that I take my responsibilities as First Minister in relation to applications to move mental health patients around Scotland with the utmost seriousness. In every case that crosses my desk, I err on the side of caution.

Every party represented in the Parliament is committed to care in the community; every party represented in the Parliament supported the principles of the Mental Health (Care and Treatment) (Scotland) Act 2003. There was a consensus in the chamber that if people no longer pose a threat, they should have the chance of gradual rehabilitation in the community. That means medium secure units. By definition, each medium secure unit will be sited in someone's community and in someone's constituency. It is the responsibility of those of us who are elected to the Scottish Parliament to show leadership, principle and backbone on the issue, and not to put ourselves at the head of ill-informed local scaremongering campaigns.

Bruce McFee (Scottish National Party, West of Scotland)

I thank the First Minister for that predictably inadequate answer. He will by now have received from the Paisley and Barrhead community action group a dossier that details the catalogue of inaccurate and out-of-date information, omissions, incorrect applications of weightings and benefits criteria and numerous inconsistencies in information that were used throughout the whole process. Not only the Paisley and Barrhead action group but East Renfrewshire Council, councillors of different parties, the Lanarkshire action groups, community councils, MPs of different parties and the Deputy Minister for Justice consider the process to be fundamentally flawed.

George Reid (None, Ochil)

You must ask a question.

Bruce McFee (Scottish National Party, West of Scotland)

Is the First Minister aware of Mr Hugh Henry's letter of 10 December to John Ross, who is the chair of Dumfries and Galloway NHS Board? In that letter, Mr Henry says:

"I have been concerned for some time about the process of reaching the short leet of three. I am not convinced that the Steering Group has been able to demonstrate to the satisfaction"—

George Reid (None, Ochil)

You must come to the point.

Bruce McFee (Scottish National Party, West of Scotland)

The letter calls for an independent review of the process. The Executive started the process—

George Reid (None, Ochil)

You must put your question now.

Bruce McFee (Scottish National Party, West of Scotland)

When will the Executive take its obligations seriously and intervene in the process, which has been a shambles from start to finish?

Jack McConnell (Labour, Motherwell and Wishaw)

I recognise that these are sensitive issues. In my days both as a councillor and as an MSP, I have taken such issues very seriously and I hope that everybody will do so. Where processes need to be improved, they should be improved. However, improving the process is not the same issue as some of the scaremongering that is going on.

All parties in the chamber have been united about the need for medium secure units. In March, when she was SNP health spokesperson, Nicola Sturgeon said:

"we know that the problem is a lack of medium secure places."—[Official Report, Health and Community Care Committee, 4 March 2003; c 3915.]

Shona Robison backed up the case for changing the right of admission to the state hospital so that people can be transferred to medium secure units.

These units are needed across Scotland and that will be uncomfortable for some local representatives in some situations. However, we have a duty and a responsibility to take the issue seriously. This kind of scaremongering by raising the issue in the way that Mr McFee has done does the issue no justice whatever. I hope that, in the weeks ahead, he will tone down his language and the way in which he approaches the issue.

Michael McMahon (Labour, Hamilton North and Bellshill)

As member for Hamilton North and Bellshill, I have two of the proposed locations in my constituency, but I participated in the scoring event last week, unlike Mr McFee, who would rather grandstand and talk to the press than participate in the process. Does the First Minister agree that any perception by the public of a haphazard decision-making process would undermine the ability of professionals to deliver the services that the public expect, especially services for those with mental health issues? Does he therefore agree that an independent review should be a requirement in any NHS consultation process so that the public can have confidence in it?

Jack McConnell (Labour, Motherwell and Wishaw)

As I said at the beginning, I do not want to pre-empt the due consideration by the Minister for Health and Community Care of the report that he expects to receive from the group that is dealing with the matter in the west of Scotland. However, where there is stalemate or difficulty in reaching a decision, I believe that some independent element to the final decision would be helpful. I hope that that is being considered.

I also believe strongly that the need to resolve any difficulties with the process should not allow us to move away from the principled position that people should not be in the Carstairs state hospital if they can be dealt with closer to the community. No one should be in the community or in any secure unit in the community if that is unsafe for the public who live nearby, but nobody should be in Carstairs unless they absolutely have to be.

Brian Monteith (Conservative, Mid Scotland and Fife)

To ask the First Minister whether the Scottish Executive will use the £47 million allocation for Scotland announced in the pre-budget statement to address the needs and concerns of council tax payers. (S2F-479)

Jack McConnell (Labour, Motherwell and Wishaw)

Any additional resources available for the Scottish budget will be used to invest in Scotland's long-term interests and in ways that deliver value for money for Scottish taxpayers.

Brian Monteith (Conservative, Mid Scotland and Fife)

I am interested to hear that response. Gordon Brown clearly intended the money to reduce council tax levels in England. Given that the Convention of Scottish Local Authorities has already intimated that yesterday's financial settlement cannot guarantee that there will be no council tax increases in future, will he use the money for what Gordon Brown intended—the reduction of council tax?

Jack McConnell (Labour, Motherwell and Wishaw)

We are in the extremely fortunate position in Scotland of not having many Tory councils. They are the problem in England that Gordon Brown has had to subsidise in order to bring down their council tax rises.

I refer Mr Monteith to a statement that he made in August in his internal memo to his Conservative colleagues suggesting ways in which the Executive's financial carry-over from year to year might be spent. He said:

"It is my view that offering piecemeal relief to the Council Tax will not be politically beneficial to us."

I know that it is a lot for the modern Tory party to be consistent for five months, but it should please try.

Iain Smith (Liberal Democrat, North East Fife)

Does the First Minister agree that the concerns and needs of council tax payers in constituencies such as North East Fife are to see improvements in services such as roads, schools, public transport and policing? Does he therefore agree that the needs and concerns of council tax payers in Fife will be met by spending additional money on extra services and not on council tax cuts?

Jack McConnell (Labour, Motherwell and Wishaw)

That is exactly the sort of debate that we need to have in Government and we will report to Parliament in due course. The money needs to be used to make the maximum impact on the people of Scotland and their services. It should not be thrown away on short- term measures or allocated on the spur of the moment in response to one committee report one morning, as Mr Swinney proposed earlier. We need to take a considered approach. We will do so in the new year and between now and then I wish everybody a very merry Christmas.

Bruce McFee (Scottish National Party, West of Scotland)

On a point of order, Presiding Officer. I seek your guidance. Mr McMahon indicated in his question that he had participated in the scoring event. However, he refused to score and walked out of the event. Is it in order for him to mislead Parliament in that way?

George Reid (None, Ochil)

That is not a point of order.

Question Time — SCOTTISH EXECUTIVE

Susan Deacon (Labour, Edinburgh East and Musselburgh)

To ask the Scottish Executive what steps it is taking to address head lice infection. (S2O-973)

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The Scottish Executive issued the "National Guidance on Managing Head Lice Infection in Children" in March this year. We were aware of a lack of consistency and clarity in the advice that was provided for parents and carers across Scotland. We wanted to ensure that all children and their families were given accurate and impartial advice and support from professionals on the detection and treatment of head lice.

Susan Deacon (Labour, Edinburgh East and Musselburgh)

The minister will be aware that the guidance to which he referred says:

'"Alert letters' should not be sent to the parents of other children in the class of a child who may be infected with head lice." A number of reasons are given for that advice. Is the minister aware that the effect of that guidance, if not the intention, has been to shut down communication on the issue between many schools and nurseries and parents at the very time when there needs to be—indeed, when the guidance requires—better communication, more information and greater awareness?

Will the minister look into the issue as a matter of urgency in order to address a very real issue for many parents and the professionals who work with children across Scotland?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I agree with Susan Deacon about the need for communication and information about head lice infection. Although people sometimes make light of head lice infection in the wrong kind of way, it is a serious matter. I am pleased that NHS Health Scotland is producing an information leaflet that will come out in January. The leaflet will give facts about head lice, deal with detection and give treatment options.

The advice on the issue of alert letters is that, because at least one or two children in each school normally have head lice, alert letters could be going out regularly. We are advised that the sending out of alert letters can sometimes lead to the wrong kind of response, such as the preventive application of lotions, which is not recommended. The important thing is to have an information leaflet. I accept that perhaps the leaflet could have been produced sooner; I know that Susan Deacon was the minister who started the work to set up the group that produced the guidance. We are making progress now, particularly as the leaflet is being produced.

Eleanor Scott (Green, Highlands and Islands)

The minister will be aware that head lice are increasingly resistant to some of the available treatments. He will also be aware that some of the available lotions contain ingredients such as malathiom. Given that malathiom is an organophosphate, surely it is not the sort of thing that we want to be putting on our children's heads? Will the minister initiate a public awareness campaign to stress the need for parents to inspect their children's heads regularly? The campaign could also advocate the use of other methods of control like wet combing, which can be used to remove lice.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

As I indicated, treatment options are dealt with in the leaflet that is coming out in January. I also indicated that over-use of lotions is neither effective nor desirable, although, obviously, some lotions are acceptable. I agree that wet combing, which is important for detection, can be used as a treatment option. The wet combing method, which is called bug busting, avoids the use of lotions.

Fiona Hyslop (Scottish National Party, Lothians)

Is the minister aware that I wrote to the Executive about the issue in June? Head lice infection is causing concern and practical problems for many parents. I told the Executive about the situation in West Lothian, where there is concern that the practical implication of alert letters not being sent out is that outbreaks are not being dealt with. I agree that we must ensure that we do not over-use chemicals. However, mothers—indeed, parents—are very responsible and if they are given the right information, they can deal with the issue promptly. Will the minister review the guidelines quickly? Head lice infection is causing real problems in the here and now.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

As I said at the start of my answer, I accept that we need more and better communication and information. The expert advice is that the correct way to proceed is for parents to be informed about the issue; that is the way to ensure that they take the action that is appropriate. The advice, however, is that alert letters do not complement the key issue of better communication and information. That is because they would have to be sent out on an on-going basis. The advice is that that would not add very much to the fundamental information that people require.

Shona Robison (Scottish National Party, Dundee East)

To ask the Scottish Executive whether it intends to review the definition of household income that is used in the Scottish house condition survey. (S2O-990)

Margaret Curran (Labour, Glasgow Baillieston)

The definition of household income that is used in the Scottish house condition survey is regularly reviewed to ensure that it remains up to date and fit for purpose.

Shona Robison (Scottish National Party, Dundee East)

The minister will be aware that the survey's current definition of income may distort the true level of fuel poverty in Scotland, because it includes benefits such as free school meals, community care grants and maternity and funeral payments, which, in reality, people cannot use to meet fuel costs. Given the fact that Citizens Advice Scotland, the Chartered Institute of Housing in Scotland, Energy Action Scotland, Help the Aged and others all support the redefinition of income to exclude those benefits, will the minister commit to undertake that reform so that we can know the true extent of fuel poverty in Scotland?