Scottish Parliament, 30 September 2004

397 contributions from 81 members. The official report.

Introduction

Health Services

George Reid (None, Ochil)

The first item of business is a debate on motion S2M-1784, in the name of David Davidson, on the centralisation of health services, and three amendments to the motion.

David Davidson (Conservative, North East Scotland)

The Scottish Conservatives have once again brought a health debate to the Parliament. It is our third health debate in this session of the Parliament—they have been the only ones on the subject from Opposition parties. Scotland is up in arms about threats to local health services as a result of the Minister for Health and Community Care's centralisation agenda. Not one member can have missed that point. We listen to the people of Scotland, which is why we are using our parliamentary time to debate what is an issue of growing national importance.

Many Labour members, with the support of others, have lodged motions criticising centralisation. Today, Scotland will examine how each and every MSP represents their constituents on the threats. I will set the scene and leave my colleagues to detail specific problems. Scotland's health care system is better resourced than that in any other part of the United Kingdom. The national health service budget is more than £1,400 per head and will be even higher under the proposals that the Minister for Finance and Public Services outlined yesterday. No one could argue that the Executive has not spent more money, but we do not see what is coming from the spending.

Given the financial context, it is incredible that Labour and the Liberal Democrats have managed to get the Scottish national health service into such a mess. The situation is certainly not the fault of front-line staff, who are dedicated and loyal. The percentage of out-patients who are seen within six weeks is down 6 per cent; the number of people on waiting lists has increased by 25 per cent; the percentage of in-patients who are seen within three months is down by 12 per cent; total hospital discharges are down by 11 per cent; and there has been a 28 per cent increase in hospital administrative and clerical staff, compared to a mere 7 per cent increase in nurses and a 2 per cent increase in general practitioners, with many consultant posts unfilled. Those are the minister's own figures.

The latest crisis, which is the reason why we are here today, arises because of the threats that face an alarming number of health services throughout the country, particularly services that are needed in emergencies. It is not only the Scottish people and the Scottish Conservatives who see the situation as a problem; even Charles Kennedy stated recently:

"Scotland is in uproar from coast to coast over hospital reorganisation plans".

A stalwart Labour member of Parliament, Robin Cook, said in the Edinburgh Evening News recently that he believes that the process is part of

"a strategy of centralising services at a handful of elite hospitals."

I do not normally agree with Mr Cook, but I might make an exception today.

In Jamie Stone's constituency, threats of closure hang over the consultant-led maternity services at Caithness general hospital, which could result in mothers travelling 100 miles on bad roads in bad weather to Raigmore hospital in Inverness to give birth. The proposals in Duncan McNeil's constituency could signal the end for the Inverclyde royal hospital's accident and emergency department, along with all surgery, which will force patients to travel to Paisley instead. In Bristow Muldoon's constituency, emergency general surgery has already been transferred from St John's hospital to the Edinburgh royal infirmary. There are also threats to the Queen Mother's hospital in Glasgow, the Balfour hospital in Kirkwall, Western Isles hospital, Perth royal infirmary, Falkirk and district royal infirmary, Stobhill hospital and Hairmyres hospital. I could go on with the litany, but I do not have enough time.

Helen Eadie (Labour, Dunfermline East)

Will the member take an intervention?

David Davidson (Conservative, North East Scotland)

In a moment.

We must ask why so many services are facing threats, given that so much extra money has been put into the health service in Scotland. I put it to members that the chief culprit is the continuing centralisation of services. The Scottish Conservatives have accused the Labour and Liberal Democrat parties of centralising the NHS for the past five years and now even members of those parties are becoming concerned.

George Lyon (Liberal Democrat, Argyll and Bute)

Many of the changes are being driven by the need to improve patient safety. The Royal College of Surgeons is insistent that surgeons should carry out a certain number of operations to ensure that their skill levels are high and that there should be specialisation, and junior doctors' hours have been reduced from more than 100 hours a week under the Conservative Administration to 56 hours a week. How would the Tories tackle those challenges?

David Davidson (Conservative, North East Scotland)

Where does Mr Lyon sit? Is he trying to save his local services or the minister?

Robin Cook and Charles Kennedy have criticised the Executive and an increasing number of Labour and Liberal Democrat MSPs and MPs are voicing their disquiet in parliamentary motions and in the press. Duncan McNeil's motion on maternity services in the Argyll and Clyde NHS Board area, which mentioned the need to

"stop the march towards the centralisation of NHS services",

received the support of 11 Labour MSPs and one Liberal Democrat member. The march towards centralisation is the direct responsibility of Labour, the Liberal Democrats and the Scottish National Party. The merger of NHS trusts in 1999 was supported at Westminster by Labour, the Liberal Democrats and the SNP, and those same parties supported the complete abolition of trusts in this Parliament, while only the Conservatives opposed that measure. Those moves were the beginning of the loss of local control and of the move to the centralisation of services.

When the First Minister informed us at First Minister's question time last week that he wants to reduce the number of health boards even further, everybody realised that the writing was on the wall for any form of local input into the management of health services. Given that the Minister for Health and Community Care appoints health board chairmen to deliver his policy—that is what they say—that puts almost every decision in the NHS on his desk.

Sylvia Jackson (Labour, Stirling)

Will the member take up George Lyon's point about unsafe services? In my area, paediatrics and other services would have been unsafe unless we brought the hospitals in Falkirk and Stirling together. What would be the Conservative's answer to the problem of unsafe services?

David Davidson (Conservative, North East Scotland)

I recall being in a members' business debate with Sylvia Jackson in which she supported my argument that moving accident and emergency services to a new site was no use to people in the north of her constituency. I recall that she was supportive of my point.

The truth is that no trusts plus fewer health boards equals more centralisation. This week, I visited the Belford hospital and the Lorne and Islands district general hospital and was impressed by their wish to co-operate to provide emergency overnight care for their communities. If the solutions group, which reports tomorrow morning, recommends that measure, it will not be the hospitals or local managers and clinicians who make the decision. Two separate decisions will have to be made: one by Highland NHS Board and one by Argyll and Clyde NHS Board. We have a situation in which local cross-border solutions to deliver care are available, but they cannot be decided upon locally. That is what centralisation means.

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

Many of the difficulties that face local health boards, and all of us, come from the European working time directive, which was brought in under the Conservatives, who had several years to deal with its impact. What exactly did the Tories do to prepare for the impact of the directive?

David Davidson (Conservative, North East Scotland)

Very simply, the working time directive has been ignored totally during the seven years plus in which Labour and latterly the Liberal Democrats have been in power. Why did those parties not apply for the derogation that we were seeking when we lost power? Those parties must answer that question.

We hear a lot about closures for reasons of clinical safety, but in real terms, that safety is dependent on what some people call the golden hour or the platinum half hour in which access to emergency care is required. That issue lies behind much of the debate. We recommended foundation hospitals, which seem to be delivering for English patients. Why can Scottish patients not have something similar? In England, ministers who represent Scottish seats have happily introduced a modernising agenda to improve access to care and deliver care more quickly. Why are minds closed against that here?

We need systematic reform. We need reform that gives power back to patients and professionals, not politicians. Many of the recommendations that we have made consistently since the establishment of the Scottish Parliament would have been beneficial, if they had been listened to. Ultimately, local services need greater operational freedom, unencumbered by interference from the centre. We have said that time and again and seem to be the only party that listens to that message.

Malcolm Chisholm has been at the helm of the Scottish health service for the past three years. He oversaw the centralisation of the Scottish health service—I think that he admitted that on the radio this morning. How, then, can Malcolm Chisholm be trusted to fix the mess that he has got us into?

I gather that this will be a well packed debate, so I will not push my time. However, I can say that Pauline McNeill, Duncan McNeil, Jamie Stone, Jackie Baillie, Bristow Muldoon, Elaine Smith, Trish Godman, Bill Butler, Ken Macintosh, Mike Watson, Wendy Alexander, Janis Hughes, Helen Eadie, George Lyon, Elaine Murray, Marilyn Livingstone, Cathie Craigie, Karen Gillon and doubtless other Labour and Liberal Democrat MSPs, have voiced concern in their local newspapers about the threats of closure.

Helen Eadie (Labour, Dunfermline East)

Will the member take an intervention? He is telling lies.

George Reid (None, Ochil)

Order. Not that word.

David Davidson (Conservative, North East Scotland)

There is a simple choice to be made. Those members whose names I have mentioned can back their people and their local hospital or they can back Malcolm Chisholm. It is make-your-mind-up time for them. Will they save local hospitals or save Malcolm Chisholm?

I move,

That the Parliament is opposed to the centralisation of health services across Scotland; notes the threat facing many local hospital services including those at Caithness General Hospital, Western Isles Hospital, Lorne and Islands District General Hospital, Belford Hospital, Inverclyde Royal Hospital, the Vale of Leven Hospital, St John's Hospital, Stobhill Hospital, the Victoria Infirmary, the Western Infirmary, Wishaw General Hospital, Hairmyres Hospital, Glasgow Homeopathic Hospital, Queen Mother's Hospital, Ayr Hospital, Perth Royal Infirmary, Forth Park Hospital, Queen Margaret Hospital, Stirling Royal Infirmary, Falkirk Royal Infirmary, Monklands Hospital and Balfour Hospital and the additional threat to many community and long-term care hospitals right across Scotland; believes that this is part of a strategy of centralising services at a handful of elite hospitals which has led to uproar from coast to coast over hospital reorganisation plans, and therefore has no confidence in the ability of the Minister for Health and Community Care to devise and implement a strategy for the NHS which serves the needs of local communities throughout Scotland.

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I thank the Conservatives for giving me the opportunity to expose the omissions, contradictions and distortions that characterise their position on health. However, what can we expect from a party whose spokesman has convinced himself that he heard me on the radio this morning?

The Conservatives' omissions relate to the fact that they are silent about their real intentions, which are about ending national health service provision based on need and giving preferential treatment to those who can afford to pay. Their contradictions relate to the fact that they reject all clinical arguments for service change while, in their election manifesto, they trumpet more say for doctors in how the NHS is run. Their distortions relate to the fact that they have invented a position for us, particularly on centralisation, that bears absolutely no relationship to anything that we have ever said or done.

In the interest of the avoidance of distortion, I repeat the following statements. The maximum amount of care that can safely be kept local will be kept local. Some services, but not of course all services, can be most safely and effectively delivered by clinical teams in specialist settings. Up to 90 per cent of all patient care is provided by doctors, nurses and allied health professionals in the community and, increasingly, the management of chronic disease and some acute care is happening there. The regional and national dimensions are crucial and we are therefore requiring boards to plan services more effectively across board boundaries that are of no interest to patients. Several months ago I set up an expert group to develop a national framework for service change, since we believe in a national health service, not a centralised one, nor the privatised and fragmented one that the Conservatives believe in, which would make the maintenance of local services far more difficult. I will not make decisions on new proposals that come before me until the group has reported, unless there are genuine issues of clinical safety. In response to the proposals of NHS boards, I can say no as well as yes. Finally, I have a great deal of control over those issues, but do not and should not have control over what is the proper training supervision for junior doctors.

There is, of course, no strategy to centralise services in a handful of elite hospitals, as the motion states. However, who would believe a word that the Conservatives say about health, in a parliamentary motion or anywhere else?

David McLetchie (Conservative, Edinburgh Pentlands)

It is timely that the minister has allowed me to intervene at the point in his speech when he noted that the motion talked of

"a strategy of centralising services at a handful of elite hospitals",

because those are not the words of a member of the Conservative party, but of the minister's colleague, Robin Cook MP. Can the minister tell us whether Robin Cook is battling to save St John's hospital services? Is Robin Cook guilty of deception and distortion?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

The point that I made a few moments ago about the fact that, rightly, I do not have control over what is the proper training supervision for junior doctors answers the point about St John's hospital.

John Swinney (Scottish National Party, North Tayside)

Will the minister give way?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I have no time at the moment.

The list of hospitals in the motion is also a simplistic distortion. Of course, there are controversial proposals for service change in some of the hospitals listed, but most of them have not yet come to me for consideration and many are still under discussion. For example, the solutions group chaired by Baroness Michie is working constructively across board boundaries to keep as many services as possible in Fort William and Oban. I support that objective. Two Forth valley hospitals are mentioned in the list, but there is silence about the splendid new hospital that is planned—referred to by Sylvia Jackson—and which could not come too quickly for Dennis Canavan at question time last week.

Further, while Perth is mentioned in the motion, having lost its consultant-led maternity unit, nothing is said about the wide range of new services that Perth is to receive, including an oncology and haematology centre, a kidney dialysis unit and an acute stroke unit, or about the repatriation of 3,000 in-patient and 10,000 out-patient episodes from Ninewells to Perth. That is the two-way movement that we want, with some services moving appropriately into more specialist settings, in accordance with clinical safety and quality care, while others move in the opposite direction to local hospitals and community settings.

Mary Scanlon (Conservative, Highlands and Islands)

Will the minister give way?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

If I have time at the end, I will.

The Queen Mother's hospital is also on the list. As I have said repeatedly, I have been giving a great deal of consideration over the summer to maternity services in Glasgow and have had a series of visits and meetings with doctors, nurses and midwives. I have been listening with great care to the various clinical arguments and to the large body of public opinion that has been expressed on this matter. As a result, I am persuaded of the clinical case for having a maternity unit alongside specialist paediatric services. I recognise that the Queen Mother's hospital and Yorkhill provide an important national service for the whole of Scotland and I am determined that such a service should and will continue.

At the same time, I recognise the clinical arguments for having a maternity unit on the same site as adult clinical services, which were recognised by Greater Glasgow NHS Board.

Sandra White (Scottish National Party, Glasgow)

Will the minister take an intervention?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I do not have time at the moment.

I have therefore concluded, as did many who responded to the consultation, that the gold-standard solution is a triple co-location of paediatric, maternity and adult clinical services. Following the spending review announcement yesterday, I am able to make £100 million available to enable Glasgow to hasten the development of such a service, hopefully within five years.

I am also appointing an advisory group that will have strong clinical representation from Glasgow and further afield as well as public and user involvement. It will monitor plans for the co-location of paediatric, maternity and adult clinical services, carry out an option appraisal of possible sites and ensure that there is no diminution in the quality of care available to mothers and children up to the time that the new gold-standard service is up and running.

Nicola Sturgeon (Scottish National Party, Glasgow)

Will the minister give way?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I have no time. I must finish making these points.

I am confident that Greater Glasgow NHS Board will co-operate wholeheartedly with the advisory group. If there is any doubt that that is happening, as minister, I have powers to direct the board. I am also confident that clinicians will co-operate across the different maternity sites.

Pauline McNeill (Labour, Glasgow Kelvin)

May I be the first to say that I think that Malcolm Chisholm is a brave health minister and that the families of Scotland will be indebted to him for the decision that he is about to make. Does the minister agree that that is the decision that matters and that it is an important decision for families and the future of children's services in Scotland?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I agree, and pay tribute to Pauline McNeill, who has led the campaign for the Queen Mother's hospital in the Parliament.

Sandra White (Scottish National Party, Glasgow)

Will the minister give way?

Malcolm Chisholm (Labour, Edinburgh North and Leith)

I am in my last minute.

If there are difficulties with staffing three units in the intervening period, or if there are other developments that are relevant to the continuing viability of three units, the group will advise on how those issues should be resolved without diminution of the quality of care. I hope that members will welcome that announcement and recognise that it injects a dose of reality into the simplistic distortions of the Conservative motion.

While the Conservatives strive to make political capital out of difficult health issues, we listen to clinicians and the public and act in the interests of patients. While they conceal their plans to end universal health care for all, we act on our principles of fairness for all and quality health care based on need. While they forget the rock bottom level of hospital investment in the 1980s and 1990s, we carry on with the largest hospital building and development programme in the history of the NHS. The people of Scotland know what the dividing lines are and they will reject the Conservatives as surely as we reject this ridiculous and ignorant motion.

I move amendment S2M-1784.3, to leave out from "is opposed" to end and insert:

"acknowledges public concern about the extent of proposed centralisation of health services across Scotland; believes that improvement is essential to ensure that all patients have access to both high-quality specialist services and appropriate medical care delivered locally; recognises that NHS boards must pursue clinical strategies which demonstrate regional planning; notes that boundaries are irrelevant to patients; welcomes the determination of the Scottish Executive to develop the planning of healthcare services across NHS board boundaries, within the context of a national strategy; notes the work of the Parliament's Health Committee on this issue; welcomes the decision of the Minister for Health and Community Care to make no decision on new proposals for service change that come before him until such times as the Expert Advisory Group chaired by Professor David Kerr has reported; notes that this provides an opportunity to debate what services are best provided locally, regionally and nationally and that the presumption in the interim is that services will be maintained unless there are genuine issues of clinical safety, agreed by the Minister; affirms the Executive policy outlined in Partnership for Care that the patient must be at the centre of the process, and supports a patient-centred policy that acknowledges safety and quality and that also ensures that as many services as possible are provided locally."

Shona Robison (Scottish National Party, Dundee East)

I begin by welcoming the news that the Queen Mother's maternity hospital will remain open, if that is what the minister means. He seemed to indicate that he thought that the consultation process was flawed. I say to him that many consultation processes the length and breadth of Scotland have been equally flawed. I hope that he will examine those other flawed consultations and review the decisions that were made.

Throughout Scotland there is widespread concern about the centralisation of our health services. Today, the Parliament has an opportunity to listen to those concerns and act on them. When we came into this new building, there was a sense of change and of being able to do things differently. We want to build consensus around issues of great importance to the people whom we represent and the amendment in my name seeks to do just that. The fact that Jean Turner will close the debate is significant because it signals a departure from the usual party politics in the chamber, but the very fact that she is here should remind every one of us how important the issue of hospital closures is to communities throughout Scotland.

From Caithness to Fort William, from Greenock and Inverclyde to St John's in Livingston, to name but a few, communities are seeing their hospitals close or be downgraded by unelected, unaccountable health boards under a health minister who seems powerless or unwilling to intervene. We are where we are, and this is the best opportunity that the Parliament will have to do what Robin Cook said and stop the madness. We should make it clear to the Executive that the Parliament has a different view on the way forward for our health service. I heard the minister's pledges this morning, but to admit that reform can lead to centralisation is to admit only that there is a problem. I say to him that we are looking for solutions. To say that it is good for health boards to work together across boundaries is to state the obvious. The minister reiterated the contents of a letter on new proposals that was sent to the Health Committee two weeks ago, but that was just a restatement of what we already know. Everyone knows that there is nothing new in the minister's pledges.

There must be a halt to any further dismantling of our health service until we agree what type of health service Scotland—with a population of 5 million people in urban and rural areas—actually requires. If one started with a blank sheet of paper, one would not design the health service that we have or the way that it is going. It does not have to be this way; there are plenty of international examples of different health service models. We must start to challenge the perceived wisdom of those who tell us that they know best. The SNP amendment in my name gives the Parliament the best opportunity to speak with one voice on the subject and signal that the Parliament is listening. The amendment uses the wording of motion S2M-1656, as amended by Bristow Muldoon. Jean Turner lodged motion S2M-1656 on 7 September and it was signed by 35 members representing six out of the seven political parties and independent members.

Tommy Sheridan (SSP, Glasgow)

Does the member share my deep dismay at the breaking of an agreement that we thought we had made with Annabel Goldie, on behalf of the Conservatives, in Kirkintilloch? It appeared that we had all agreed that the first party to have the chance of a debate would write an amendment that could unite the Parliament, but the Tories broke that agreement.

Shona Robison (Scottish National Party, Dundee East)

I hope that we still have the chance to do that; the Tories could rally around the amendment in my name and I call on them to do so.

My amendment seeks to suspend—

Annabel Goldie (Conservative, West of Scotland)

Will the member take an intervention?

Shona Robison (Scottish National Party, Dundee East)

I will take an intervention later.

My amendment seeks to suspend all planned reorganisation while a national strategy is developed. Bristow Muldoon's amendment, which leaves Jean Turner's motion intact—

Annabel Goldie (Conservative, West of Scotland)

On a point of order, Presiding Officer. An allegation has been made against me in the chamber and I require an opportunity to respond to it.

George Reid (None, Ochil)

I think that it is reasonable for Miss Goldie to have a chance to answer.

Annabel Goldie (Conservative, West of Scotland)

I am grateful, Presiding Officer. I say to Mr Sheridan that my recollection of the meeting in Kirkintilloch does not accord with his recollection. I certainly remember—

John Swinney (Scottish National Party, North Tayside)

This is outrageous.

George Reid (None, Ochil)

Order. Mr Swinney, please.

Annabel Goldie (Conservative, West of Scotland)

I certainly remember that there was agreement that we should try to find a form of words that might attract all-party support, but I do not recall giving a commitment to debate the matter in my party's debating time. It is not within my gift to do so; I could not commit to debate a motion whose terms I did not know, nor could I commit my party to debate a motion at a time when I had no idea what circumstances would prevail.

George Reid (None, Ochil)

We have cleared that. We put that to one side. You have an extra two minutes, Miss Robison.

Shona Robison (Scottish National Party, Dundee East)

I should think so too, given that it was not my point of order.

I return to the important issue in the debate. Bristow Muldoon's amendment S2M-1656.1 leaves Jean Turner's motion intact, but takes it a stage further and calls on the health minister to reinstate any services

"that have been withdrawn without full public consultation and ministerial approval."

That amendment was signed by several members, including Margaret Jamieson. Members from every party in the chamber, and members of no party, support my amendment. I say to the Tories that the terms of their motion, which involve a vote of no confidence in the Minister for Health and Community Care, make it impossible for the Executive parties to support it. It excludes too many people. If the Tories' motion is voted down, as I suspect that it will be, I urge them to support the amendment in my name to try to salvage something from this debate.

I say to the Scottish Socialist Party that although its amendment is well intentioned, it will not attract the necessary support in the chamber. I say to Labour and Liberal Democrat members that the Executive amendment provides, at best, only some comfort on some new proposals for service change—such as those in Argyll and Clyde—that will come before the minister between now and March, when the expert group will report. Although I welcomed that at the time as evidence of some movement from the health minister, it does not go far enough. It is clear that Bristow Muldoon and Margaret Jamieson do not think so either, and the Executive amendment provides no comfort to hospitals such as St John's, which has just lost its emergency surgery provision. The minister's letter provides no comfort to services that could close without ministerial approval or services where ministerial approval has been given but service cuts have not been implemented.

It is impossible to have a debate about the future of the health service in Scotland when local communities are seeing cuts to their local hospitals go ahead at the same time. As Duncan McNeil said, this is not just about Argyll and Clyde; it is about services across Scotland. For the sake of those services, I urge every member of this Parliament to support the amendment in my name so that a clear signal is sent to the health minister that the Parliament speaks as one voice on the matter and supports communities the length and breadth of Scotland that are concerned about the future of their health services.

I move amendment S2M-1784.2, to leave out from "is opposed" to end and insert:

"is concerned about the centralisation of health services across Scotland; believes that there must be a clear national strategy for the future structure of the NHS in Scotland; therefore calls on the Scottish Executive to suspend all planned reorganisations while a national strategy is developed involving the public and health professionals, and calls on the Minister for Health and Community Care to issue instructions to NHS boards to put in place appropriate arrangements to retain services faced with centralisation and reinstate any that have been withdrawn without full public consultation and ministerial approval."

Carolyn Leckie (SSP, Central Scotland)

At last we have a debate on this issue. I start by welcoming what seems to be a decision to retain the Queen Mother's hospital, but the question remains unanswered: will the Minister for Health and Community Care retain three maternity units in Glasgow? To do so is the only answer, because we cannot trade off the Queen Mother's for the Southern general hospital.

This should be a mature and intelligent debate, but the Tories could not resist turning it into a joke. When nearly the whole country is up in arms about local services and the failure to plan NHS services in such a way as to meet the needs of urban and rural communities alike, the Tories want a free-for-all—not for patients, but for the private profiteers. Can they spell out just how, if there is no plan to take account of the needs of rural and urban communities, a passport will get me an emergency Caesarean section in Wick?

David McLetchie (Conservative, Edinburgh Pentlands)

Will the member give way so that I can tell her?

Carolyn Leckie (SSP, Central Scotland)

No. I want to move away from the joke and on to the intelligent debate.

Community campaigners, health professionals and medical staff who are not embedded in the establishment royal colleges are rightly fed up both with the arch-centralisers in health boards and at the top of the medical profession and with the Executive advisers who act as if they have a monopoly of understanding of the complexities of the debate—their arrogance alone would set communities against them.

The debate needs to start from an acknowledgment of the truth. We would not be in this mess if it were not for Tories, trusts, three years of Tory spending plans under Labour, the private finance initiative by which money seeps out faster than it goes in, pharmaceuticals' profits and the myriad other means by which public money becomes private profit. There has been a failure to plan a work force that is appropriate to Scotland's demography and geography and to take account of the working time directive. There has also been a failure to do anything to reverse the incidence of ill health, which can generally be explained by one word—poverty.

Johann Lamont (Labour, Glasgow Pollok)

On the need for truth and for a serious debate, does the member accept that Glasgow, which is the city that is best served for hospitals, also has the poorest health and the lowest life expectancy? The debate should be about not just buildings and services, but how we address ill health, which is often worse the closer people are to a hospital.

Carolyn Leckie (SSP, Central Scotland)

Try telling that to the patients in Glasgow royal infirmary and Stobhill hospital who have to hang around for hours waiting on trolleys because no one can see to them.

Anyone who reads the letters pages in The Herald or who has read the work of Allyson Pollock or Matthew Dunnigan knows that the claims for biggest being best and safest do not stand up. Clinical outcomes might improve in specific examples, but there are no data to support the extrapolation of those outcomes to all health specialties including general medical and surgical health care. Nevertheless, current health board plans are set to rip up years of development of excellent services on the basis of an unproven premise. Evidence from the Government's own data suggests that local and general is as least at safe and, given the incidence of MRSA in big hospitals, probably safer.

Health is not just about the physical. There are no qualitative data to measure the psychological or sociological damage to people's health that is caused by reduced access to services, but we can all give horrendous examples of where that has happened. For instance, what will happen to the women who will have to travel hundreds of miles from Wick for a delivery? They will be separated from their children and their families The Executive's statistics show that there has been a haemorrhage of beds. The answer to one of my parliamentary questions showed that the loss of beds is running at 20 per cent across the board and more in individual specialties. Funnily enough, in a scary coincidence health boards seem to have managed to co-ordinate bed cuts in the past five years, whereas their current centralisation plans fail to co-ordinate reviews and strategies across boundaries.

Helen Eadie (Labour, Dunfermline East)

Will the member give way?

Carolyn Leckie (SSP, Central Scotland)

Sorry, I do not have enough time. I might give way later.

I got an answer to my question on beds, but when I asked how many staffed day-care and day-surgery beds there have been in each NHS board area since 1998—given the argument that the beds have been replaced by other services in the community—I was told that Audit Scotland could not provide that information and the Executive's answer was:

"The specific information requested is not available centrally."

I am sorry, but that is not good enough. The Executive needs to prove its claim that community services have replaced acute or medical beds.

It is revealing that the Tories cite Labour members of Parliament such as John Reid in support of their motion. The Labour MPs who voted for foundation hospitals in England share the increasing-privatisation vision of the Tories. That is why they are cited as soul mates. It is absolutely unacceptable that Labour MPs can summon our health minister to Westminster to question him about health when we cannot summon David Blunkett here to question him about immigration and asylum.

The calls from within and outside Labour for Malcolm Chisholm's head are being made by those who pretend to be the friends of the campaigners but whose agenda is to dismantle the NHS so that it can be taken over using a private insurance model. That is the game. I look forward to the day when we can summon Blunkett here. We need to debate the future of the NHS. The agenda of the people I mentioned is, as I am sure they will admit, the private insurance model; my agenda is a public model that drives out the private profit motive from the NHS so that we have a service that meets the needs of everyone. That is the debate that we should have. We should not try to disguise the issue in any other way.

I move amendment S2M-1784.1, to leave out from "is opposed" to end and insert:

"notes the succession of profound concerns expressed in debates and motions on the NHS; further notes that these concerns are so serious that calls for a moratorium on NHS closures and centralisations have been made for over a year; notes that communities remain at odds with NHS boards and the Scottish Executive over the future of the NHS, that NHS boards implement Executive policy and budgets, notably the expensive PFI/PPP model of funding for capital projects and have no control of pharmaceutical profits, which represent a massive strain on their budgets, that the application of the working time regulations has neither been planned properly nor budgeted for, that new contracts for medical staff at all levels have not been fully funded and that numbers of graduates in all health professions have been, and are, consistently insufficient to meet the needs of patients or a 21st century NHS; believes that NHS boards should be democratically accountable for their responsibilities but that it is the Executive that sets the structural, strategic, financial and political context that they operate in and regrets the failure of the Executive to acknowledge that responsibility in relation to NHS re-organisation or engage in a debate with the public; further believes that the threat of closure of so many important facilities is entrenching the disengagement between communities and government; believes, therefore, that all reorganisation plans in the NHS should be revisited in a national context so that a wide-ranging and meaningful debate about the security and future of the NHS can take place in Scotland, involving all trade unions and professional organisations who represent NHS workers, community organisations, voluntary organisations, the public at large and academics whilst ensuring that resources and strategies are put in place to protect local services until such a debate has taken place and a national strategy is developed that has the confidence of the Scottish people, and sends its support and solidarity to all campaigners attending the demonstration called by the Scottish Health Campaigns Network in Glasgow this Saturday."

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

There is no question but that a serious situation exists across Scotland as health boards engage in the process of reorganising the delivery of our health services. There has been a huge public outcry, as people have seen their local health services being threatened with closure or amalgamation. Our health boards seem to take decisions on their own without the meaningful co-operation with neighbouring boards that has been demanded and without any national strategy. That is why the Scottish Liberal Democrats welcome the move that the Executive has made in setting up the expert advisory group that is headed by Professor Kerr to develop such a strategy. We also welcome the work that is being done by the Health Committee, which should be in a position to report to the Parliament by the end of the year.

I welcome the fact that today's motion is on important health issues, but I must say that the Conservatives seem to have completely missed the point. Their health spokesperson David Davidson has consistently criticised the health service for centralisation. He has criticised Malcolm Chisholm for taking decisions on the health service from the centre. No. The problem has been that the health boards, which were set up under the Tories, have taken decisions without the benefit of a national strategy. It is clear that the boards are less than accountable to the people whom they are supposed to serve and, despite being required to do so by the Minister for Health and Community Care, they are not properly consulting one another.

David McLetchie (Conservative, Edinburgh Pentlands)

Will the member tell us which Government appointed the chairs and most of the current members of the health boards?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I thank David McLetchie for that intervention, but he knows that the Tories set up the whole process. Not only has the minister instructed health boards to work together, but the Parliament has passed a law to require health boards to consult one another.

Let me come back to the point. The worst example of what I am talking about was the building up of services at both the Paisley Royal Alexandra hospital in the Argyll and Clyde NHS Board area and the Southern general hospital in the Greater Glasgow NHS Board area, despite the close proximity of those hospitals to each other.

In addition to boards failing to co-ordinate properly with one another, some boards are taking decisions that threaten the viability of hospitals in our more rural areas, such as by threatening the provision of consultant services at Wick general hospital. I have no doubt that my colleague Jamie Stone will say more about that later.

Rob Gibson (Scottish National Party, Highlands and Islands)

Mr Rumbles might have been present at the Health Committee meeting at which I asked the Minister for Health and Community Care about the training of doctors and consultants to do those jobs. Given that his party has been in coalition with the Labour Party for the past five years, what has he done to ensure that we have enough consultants to staff Caithness general hospital? Will he tell us that?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

We have record numbers of doctors and health professionals in the national health service in Scotland. The numbers are going in the right direction, so I do not think that that was a particularly useful contribution to the debate.

Malcolm Chisholm has done what no previous health minister has done and set up an expert group to advise on a national strategy, which is exactly the right way to go. The Conservatives have got things completely the wrong way round. We need to ensure that health boards operate locally, within a national delivery framework. That is the solution to the crisis that we should all strive to achieve. The Conservatives' motion completely misses the point. Malcolm Chisholm is taking the action necessary to address the issue and the Conservatives' motion of no confidence in his ability

"to devise and implement a strategy for the NHS which serves the needs of local communities throughout Scotland"

deserves to be defeated.

Today, the Conservatives have been silent about the impact that their plans to divert public money to the private health care sector would have on our national health service. The NHS would certainly not be safe in Conservative hands.

The Scottish Liberal Democrats believe that there has been a breakdown of trust between the public and many health boards across Scotland. Radical change in the health board system will be necessary to deliver both accountability and relevance.

David Davidson (Conservative, North East Scotland)

Will the member gave way?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I must press on.

Other change is also necessary. Rob Gibson highlighted the problem of the relatively low number of doctors per head of population in Scotland, which needs to be addressed. We have about 2.4 doctors per 1,000 people, whereas the European average is 3.4. Italy has twice the number of doctors per head of population that we have in this country. Addressing that issue will require making better use of our universities. Only half those who train in Scottish medical schools are domiciled in Scotland, but Scotland-domiciled students are twice as likely to work here after graduation. The Executive is addressing such matters, but there is a great deal of work still to do.

On the Executive's amendment, there is no doubt

"that improvement is essential to ensure that all patients have access to both high-quality specialist services and appropriate medical care delivered locally".

The Liberal Democrat position is that, if care can be delivered locally, as well as safely and practically, it should be delivered locally. In our view, the Parliament should welcome the fact that the Minister for Health and Community Care will not make any decisions on new service redesign proposals that are put to him by the health boards—except on clinical safety grounds, which is right—until the expert advisory group has reported. We should also welcome the work that the Parliament's Health Committee is doing.

Every MSP in the chamber should rally round the Executive's amendment as the best way forward. The health boards cannot proceed on service redesign as though they were in a vacuum. We must have a national health service policy that is based on safety and quality and that ensures that as many services as possible are provided locally. On behalf of the Scottish Liberal Democrats, I urge members to support the Executive's amendment.

Mary Scanlon (Conservative, Highlands and Islands)

On behalf of the Conservative party, I congratulate the campaigners in Glasgow who fought so long and hard to retain services at the Queen mum's hospital on their great victory. Well done to them. I have no doubt that, if the motion were not being debated today, they might still be faced with that uncertainty.

As the minister would not allow me to intervene during his speech, I remind him about the consultation document on services in Caithness. The minister concentrated on clinical safety. I remind him that affordability has very high priority among the criteria. Let him be in no doubt about that.

The debate is about the centralisation of health services, but from our mail we could easily raise concerns about out-of-hours services, ambulance services, NHS 24, hospital-acquired infections, lack of dentists and cuts in chiropody—I could go on for almost all my six minutes. I will quote from two letters on health matters that I received this week from the Highlands. The first is from Nethy Bridge community council, which states that it

"cannot accept the proposals put forward for out of hours care—the plan is ill conceived, inadequate, under-funded and creates a threat to the health and well being of the Highland community—with NHS Highland telling the public that additional funding for out of hours would mean a reduction in cancer care and acute services".

The second is from Latheron, Lybster and Clyth community council, which feels

"that the downgrading of services at Caithness General would be a retrograde step and because of its distance and winter road conditions could lead to deaths of expectant mothers or their babies".

The Belford hospital in Fort William services a huge area, as well as thousands of tourists to the outdoor capital of Scotland each year. People choose to live and work in the area on the basis that health services will be there when they need them. Over recent years, services at the Belford have been built up. People now face the threat and uncertainty of lesser services, as the Belford integrates with Oban hospital.

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

First, does Mary Scanlon agree that, if tomorrow the solutions group comes up with something constructive, that proposal should be sent to Wick and NHS Highland for consideration? Secondly, does she agree that Professor Andrew Calder's failure to address the issue of distance with reference to maternity services in Caithness is a disgrace?

Mary Scanlon (Conservative, Highlands and Islands)

It is a disgrace that Professor Calder flew in and out of Wick. He should have had some experience of trying to manoeuvre across the Berridale braes on a rainy, wintry, icy night. Baroness Ray Michie has done an excellent job on the solutions group and I look forward to seeing its findings.

The problem is that changes at Oban affect not only people in that area. Hospital services in Argyll and Clyde are also under threat. The difference between the situation that we face today and the one that led to the petitions that the Health and Community Care Committee considered on Stracathro, Stobhill and so on is that I have never known such clinical involvement. Fergus Ewing and I were present at a meeting in Fort William attended by more than 2,600 people, with hundreds turned away, where consultants, general practitioners, anaesthetists, medical staff, nurses and physios all said that local lives and services were in danger. It was not just the people saying that; it was also the medical staff.

Jamie Stone mentioned Caithness. Professor Calder's report states that management from Inverness has led to "dysfunctional relationships between consultants", poor communications and lack of appraisal and medical audit. That is what happens when there is centralisation of medical services and distant management systems.

When David McLetchie and I visited Caithness, everyone we met raised the issue of maternity services. The trade unions and management at Dounreay, the North Highland College, the Thurso Bowling Club, firemen, community councillors and local councillors were all up in arms about maternity services. As Councillor Bill Fernie said:

"Nothing has united the Caithness community so much as three attempts in just over six years to remove the level of cover at Caithness General."

The standing of the health board is the lowest it has ever been in Caithness.

The problem is that NHS Highland is only carrying out the instructions of the Minister for Health and Community Care and of the Liberals. The Liberals are equal partners in decision making at Cabinet level, so they cannot abrogate their responsibilities on this matter. Charles Kennedy recently criticised health services in Scotland. I say to him that the Liberals cannot be equal partners in Edinburgh but in opposition in London and the Highlands. Let us have some honesty from the Liberals.

There are further concerns about transporting pregnant women. There is no point in having gold-plated standards in Inverness when women are giving birth in lay-bys down the A9, between Wick and Inverness.

I refer also to the neurology service that the Highlands buy in from Grampian. After 30 years of being built up, the service, which has a nine-month waiting time for routine referrals, will be cut from eight days a month to two days a month.

In Moray, the Spynie and Leanchoil hospitals are closing, but the long-awaited purpose-built hospital and health centre is still a distant dream for the local population. As far as the NHS in the Highlands is concerned, it is Lochaber no more, Sutherland no more and Raigmore no more. After the next election, I hope that it is Labour no more.

Duncan McNeil (Labour, Greenock and Inverclyde)

I will need to watch—my name has been taken in vain so often this morning that it is giving me a complex.

What have we got in the Tories' motion? It says that

"the Parliament is opposed to the centralisation of health services".

So far, so good. I am glad that they agree with me. The motion says that communities across the country are up in arms over hospital reorganisation plans. Again, well spotted—although I wonder how Tories would know. The motion says there is a centralisation agenda in the national health service. I know—I have been trying to tell them that for years.

The Tories recognise the problem—albeit belatedly—but what do they say we should do about it? How do we resolve this emotive, important and complex problem? Sack the minister? Is that it? If the minister goes up in a puff of smoke tomorrow, will the artificial health board boundaries disappear? Will the royal colleges throw away the rule book? Will the European working time directive cease to exist? Will neighbouring health boards leap into each other's arms and start co-operating? I think not. The Tories know it, and I know it.

I do not believe for a minute that the Tories have suddenly converted to the hard-left creed that everything is politics. Somehow, I do not think that the motion was forged by Comrades McLetchie and Davidson at the revolutionary command council of the Tory party. Rather, I suspect that the motion represents more than a spot of opportunism—cynically playing games with the most serious of issues.

The Tories do not share the genuine concerns of our communities. To them, those concerns are just another political opportunity. What an insult to those communities and to the people in the chamber who have put aside their political differences over a long period, who have shared platforms and who have made common cause against centralisation and its impact on communities.

Bruce McFee (Scottish National Party, West of Scotland)

Will the member take an intervention?

Duncan McNeil (Labour, Greenock and Inverclyde)

Sorry, Bruce—I have limited time.

In Inverclyde, people of all political persuasions have come together—except the Tories.

Alex Johnstone (Conservative, North East Scotland)

Will the member take an intervention?

Duncan McNeil (Labour, Greenock and Inverclyde)

No, I will not. Tory members already have too much time for my liking.

There have been a couple of questions from David McLetchie at First Minister's question time and there have been three Tory debates in five years on the issue. That does not give the Tories any credibility at all. However, every cloud has a silver lining and, as others have said, at least we are debating some of the real issues here this morning.

Carolyn Leckie (SSP, Central Scotland)

rose

—

Duncan McNeil (Labour, Greenock and Inverclyde)

Again as others have said, it is not only in the Parliament that we need a serious debate. We need a serious national debate, one that involves service users and taxpayers and not just bureaucrats and clinicians. The public, the professionals and the politicians are demanding that debate. It must be a national debate because we need to reach consensus on the issue. The voices of our communities must be heard. People must not be dismissed as being too emotional or too thick to understand the issues. They, and we, must be involved in a genuine debate about what care can be delivered locally.

There must be access to emergency services and elective services. Health inequalities must be considered, as must specialised care and care for the elderly and our children. None of those issues was raised by the Tories this morning; the Tories seek to diminish serious issues.

I believe that we have all the ingredients for a truly national debate. The minister has created, beyond any reasonable doubt, a stable environment that will allow David Kerr and his advisory group to inform that debate.

The Parliament's Health Committee is led by Roseanna Cunningham, who will be a key person in the debate in the coming months and years. I do not flatter to deceive; I seriously believe that she can play an important role, along with the members of the Health Committee, in developing the debate and the committee's inquiry into work force planning. The campaign of The Herald has been very useful in informing the debate and that campaign has to be built on. We should ask The Herald how it could sponsor debates throughout Scotland.

Can we do more? Can the BBC—the public broadcaster—be used to take the debate to the country? Can we have health-in-the-chamber sessions similar to the business-in-the-chamber sessions? We should be able to give this chamber over not just to politicians but to the campaigners and the professionals. At the moment, the debate is taking place outside the chamber rather than inside it.

I believe that we have the opportunity to have a real debate so that the Parliament can, on behalf of our constituents, influence the future of health services in Scotland in the next 30 years. I hate the phrase, but it is time to "raise our game". We must have the debate and influence the whole process.

Roseanna Cunningham (Scottish National Party, Perth)

For years now, people in Perthshire have been having meetings, marches and postcard campaigns and lobbying Parliament because of the erosion of services at Perth royal infirmary—particularly in maternity provision and paediatrics. When those services go, concerns arise over the knock-on effects on accident and emergency services, and frustration grows about decisions that seem to be made before farcical consultations and about the apparently one-way nature of the so-called specialisation of services in Tayside.

This morning, the minister gave a long list of services to be transferred to the PRI. However, it is years since it was conceded to me that it made sense for a full out-patient satellite dialysis unit, for example, to be set up in Perth, or for Perth to be the base for a mobile unit. That was promised again earlier this year, but we still do not have it. In fact, just this morning, because of what the minister said, we double-checked. Our calls to NHS Tayside to clarify the situation on dialysis were met with the telephone equivalent of a blank stare.

Somehow, amazingly, the withdrawal of services takes far less time than the introduction of any new services. We lose services but still await the arrival of new ones. No statement that the minister has made in the past few weeks will make any difference to what has already been lost.

I know that such concerns are not restricted to Perth. From every corner of the country, from television, from colleagues, from lobbying of Parliament and from every party, the voice of protest is loud and clear. It can be as loud and clear as Duncan McNeil has just shown us. Some debates are about local hospitals that currently provide a service that administrators regard as outdated or inefficient but which communities regard as absolutely essential. Other hospitals, such as the Queen Mother's and the homoeopathic hospital in Glasgow, provide services that are sought out from far beyond their own immediate geographical areas.

Until now, everyone has been fighting on their own patch, but the common threat and the common aim are now being recognised. Campaigners from all over the country are beginning to come together. Wherever we look in Scotland, there is anger about what is happening in the NHS. The common primary cause of the symptoms of dissatisfaction is a general sense that the public have completely lost ownership and control of the health service. Democratisation of the health service is and should be an important part of this debate and any future debate that we have. The NHS is the great public service. Acknowledgement of that fact is one thing that distinguishes all the other parties from the Tories.

Nobody expects a maternity hospital at the end of every street or an accident and emergency service round every corner; but people expect politicians and administrators to recognise their demands for the sort of health service that they want. However, we have health boards that run consultations that are little more than cosmetic cover for fait-accompli programmes of centralisation—and the minister has finally accepted today that there has been centralisation.

I now want to concentrate on consultation. The current combination of circumstances is doing untold damage to democracy in Scotland, not just to the health service. At election time, politicians complain about the lack of engagement in the political process. However, can there be any surprise at that lack of engagement when—on an issue as important as the shape of the health service—the people speak and the officials and ministers listen, and then the officials and ministers go and do what they were going to do anyway? Consultation after pointless consultation means that the scunner factor is rising—and who can blame people for that?

At one of the many public meetings that I have attended in Perth—and this is after years of so-called consultation—a senior health service official stated:

"It doesn't matter if every household in Perthshire objected to the removal of consultant-led maternity services; it wouldn't make a blind bit of difference."

That was a breathtaking insult to the thousands of people who had participated in what they expected to be a genuine consultation. I could give that official 10 out of 10 for honesty, but what was the point of the exercise that we had gone through during the previous four years?

Given that an NHS official can so openly acknowledge the pointlessness of all that consultation, can we be at all surprised when voters learn the lesson and apply it to the rest of politics? Town halls throughout the country have been packed to the rafters. A member who campaigned on the single issue of hospital services has been returned to the Scottish Parliament. How much more will it take for the Executive and all politicians not just to listen, but to take on board what they hear?

Janis Hughes (Labour, Glasgow Rutherglen)

During the past few weeks the phrase "rationalisation and centralisation of health services" has dominated the political and news agenda throughout Scotland. Many people throughout the country have legitimate concerns.

Historically, systematic underinvestment—most notably by the Tory party, which has the gall to claim that it has no confidence in the minister—left Scotland with an NHS that was drastically in need of reform. Let us face it, if there had been investment during the Tory years the situation might have been very different now. However, because of the stagnation of those years we have to effect radical change, which is always difficult to accept.

In south Glasgow, the acute services review will lead to the centralisation of in-patient services at the Southern general hospital and the construction of a brand new ambulatory care hospital at the site of the Victoria infirmary. The new facility will treat more than 80 per cent of the cases that are currently dealt with at the Victoria infirmary and will be bigger than the recently built Hairmyres hospital in East Kilbride. During the acute services review I argued against siting the main hospital at the Southern general and favoured a more central site, but I did not argue that we should keep the Victoria infirmary, which was not built for 21st century health care and cannot provide the optimum health provision for my constituents.

Some campaigners argue that we should stop the work that is going on in Glasgow. However, when Glasgow colleagues and I recently met the area medical committee, which comprises clinicians from the primary care and acute sectors across the city, the clinicians called for an acceleration of the acute services review on the ground of clinical safety. Clinical safety is often a driver for change, but we cannot expect the public to accept the arguments if they are not provided with the information that backs up those arguments. The public often regards the use of the term "clinical safety" by health boards as an excuse to change or close services. I questioned the minister on that point at the most recent Health Committee meeting and I was pleased that he made a commitment to ensure that boards examine the evidence rigorously and provide a clear definition of clinical safety. Clinicians, too, must make a strong case to back up their arguments. As a result of my discussion with the area medical committee, I agree with the clinicians that any further delay to acute services reform in Glasgow would be to the detriment of patients.

Notwithstanding that point, at the outset of the acute services review we missed a real opportunity properly to engage with the public and explain exactly how the proposed changes would improve the delivery of their health services. We should remember that the review involved a record investment in Glasgow's hospitals of £700 million, which should have been warmly welcomed. Unfortunately, Greater Glasgow NHS Board consulted poorly and did not manage to persuade people of the need for and benefits of change. Sadly, those problems have beset other communities throughout Scotland.

We need to look beyond the boundaries of health boards and ensure that there is greater co-ordination throughout the country. We must be confident that hospital provision is of the highest standard, no matter where the patient lives. Often that means that people will have to travel a bit further for that provision. I have criticised the fact that regional planning has often been ignored when decisions about health services have been taken and I agree with the First Minister that we need to consider the number of health boards in Scotland. Artificial boundaries are often created and I hope that the First Minister and the Minister for Health and Community Care will consider the matter closely.

According to the NHS Confederation in Scotland, the scientific evidence is that the time that it takes to reach a specialist is the more crucial factor in patient survival than the time that it takes to reach a hospital. In small units in which specialists are available out of hours only on an on-call basis, delays in seeing the appropriate consultant can be longer than in larger centres in which specialist staff are available day and night.

I am disappointed that the Conservatives think that they have the right to criticise anyone about health issues. I accept that many people in the Parliament and throughout Scotland have legitimate concerns about hospital provision, but I cannot accept that many of those people would like the Tories to be in charge of the NHS again. It is rich of the Tories to call for a scalp, instead of telling us how they would modernise the health service.

David Davidson (Conservative, North East Scotland)

Will the member give way?

Janis Hughes (Labour, Glasgow Rutherglen)

I am winding up.

The issue is emotive and it is clear that there are no easy answers. Like Duncan McNeil, I welcome the opportunity to have a bigger debate. The Health Committee's work force planning inquiry will help to inform that debate, as will the work of the expert advisory group on the national framework for service change that the minister has established. However, we can be sure of two things: first, the status quo is not an option; and secondly, the Conservative party has nothing to offer the people of Scotland.

Eleanor Scott (Green, Highlands and Islands)

I am happy to speak in the debate. The Green group will support the amendment in the name of Shona Robison. We support a moratorium on hospital closure, not because we think that change is not necessary—we acknowledge that change will be necessary—but because there is no clear vision of the end point of the proposed changes.

There has been a lack of meaningful dialogue between communities that will be affected by the changes, health boards and ministers, and there is no shared understanding about what local health services should look like. The lack of a shared vision has led to uncertainty and insecurity among NHS staff and the people who use the service. Consultation is not the same as dialogue and, as Roseanna Cunningham said, people might have had unrealistically raised expectations of the extent to which their views were likely to influence decision making.

In other parliamentary debates on health I have talked about the effect on staff morale of repeated changes in the NHS. During the past two decades we have witnessed the establishment of trusts and the purchaser-provider split, the reversal of that system and the abolition of trusts. People cannot see where those repeated changes are leading and staff do not know what their jobs will look like in 10 years' time. The effect on staff morale has an impact on recruitment and retention in the service and should not be underestimated.

The drivers for change in the NHS are not always about patient care or safety. The British Medical Association briefing document that members received in advance of the debate mentions moves to a patient-centred health service. I am still a member of the BMA—I should have declared an interest when I started speaking.

The BMA primarily represents doctors—it is reasonable that it should do so, as it is the trade union for doctors. However, the drivers for change often reflect the impact of cases that receive a high profile in the media and in which patient care appears to have fallen far short of what is acceptable. The professional bodies' reaction to such cases is to want clearly to be seen to drive up standards. For example, stringent revalidation and retraining requirements for doctors have been imposed in relation to continuing professional development and the standards of evidence that doctors must supply to demonstrate that they are maintaining their professional expertise. The requirements are particularly onerous for doctors who work part time, who are predominantly women. Such drivers for change can raise standards, but sometimes they have the opposite effect. In an increasingly risk-averse and litigious society, it is more likely that clinicians will be willing to treat only low-risk patients in specialist units. That does not help patient care.

Results are generally better in specialist units and such units provide the best possible care. Sometimes that is what is needed, but at other times people who are suffering from less complex conditions want and expect care that is good enough and can be delivered nearer to their home. If we were to superimpose on a graph of the benefits of specialist units a graph of the disbenefits of long journeys to access health care, the lines would intersect at different points for different conditions of different severity. Provision should be available corresponding to each of those intersection points, with a range of provision starting with local primary care facilities, passing through smaller district general hospitals and going through to specialist centres.

Not all clinicians want to be specialists. For example, many doctors and surgeons would enjoy the challenge and variety of working in a smaller unit as general surgeons or general physicians. There would, of course, be procedures that they would never attempt, but I am yet to be persuaded that it is no longer possible in the NHS of the 21st century to be a generalist. I think that that is a service for which there is a demand and which would be rewarding, and it would aid recruitment and retention in some areas. However, if people are going to become generalists, they must feel that they have the support of professional bodies, the Scottish Government and the NHS in general, and the support and confidence of the communities that they serve and of society at large. That is a dialogue that we have to have.

Margo MacDonald (Independent, Lothians)

I hesitate to intervene on a professional, and I hear what Eleanor Scott has to say about the possibilities for general surgeons and about the job satisfaction that that would carry, but is she aware of how difficult it is for Edinburgh, which is supposed to be the most attractive place to live in Scotland, to attract generalist surgeons, never mind specialists?

Eleanor Scott (Green, Highlands and Islands)

I think that that reflects recruitment generally in the NHS. When I was training in general practice in the north of Scotland in the late 1970s, people could not get a general practitioner job for love nor money. As trainees, we used to have little discussions among ourselves about which of the GP principals in post at the time was likely to retire or, dare I say it, have a heart attack and have to retire. When a vacancy arose, there were multiple applicants, but now there are unfilled GP jobs. The situation has changed entirely over 20 years, and it is not peculiar to rural areas or urban areas or to particular specialties. It is the case across the board. Our NHS is no longer an attractive or rewarding place to work, and I think that that is because people do not always feel valued.

On the subject of not feeling valued, I would like to take issue with the use of the word "downgrading" in connection with some reductions in facilities. In some cases, it is a perfectly fair description, but it is a bit insulting to midwives to talk about downgrading maternity services when referring to a midwife-led unit. Pregnancy and childbirth are natural processes, after all, and I think that midwives can provide the care that the majority of women would prefer, rather than have their condition over-medicalised.

At bottom, people need to feel safe. They need to feel that services are available for them, especially in the most remote and rural parts of our country.

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

I am not on my feet this morning to demand Malcolm Chisholm's scalp. I certainly do not want that, but I do want to preserve the consultant-led maternity service in Caithness.

Let us be quite honest here today in addressing the broader issue of change in the NHS. Surely none of us is saying that we cannot change things, otherwise we would be where we were 100 years ago. I shall give an example of where change could happen. My own wife, as members know, was diagnosed with a meningioma some five years ago and was operated on successfully in Aberdeen by David Currie's team. However, if the suggestion were made that we should have one supercentre of excellence for neurosurgery, that might be music to my ears. Lots of people will not come out and say this clearly, but let us be honest about it. Such a centre of excellence could work, because there would be peer support for our overstretched consultants. When it is something as life and death as neurosurgery—thank God my wife survived—one does not mind travelling that distance. We have to be honest and up front about that.

That said, there are horses for courses, and although certain services could be centralised, other services—maternity services among them, I maintain—cannot be centralised. I have been talking about honesty, but there is a fundamental dishonesty at every stage in the debate surrounding maternity services in the far north. The issue of distance and inclement weather is the awkward fact that will not go away in the cosy medic-led board rooms of Inverness or Edinburgh. Professor Andrew Calder failed to address that issue. He recognised that there was an issue of distance and inclement weather but he failed to suggest any solution. When I pressed him, he said, "That is for NHS Highland to act on." In my view, that is a cop out that invalidated his entire report. As part of his remit, he was told to address the issue and he did not. Whenever the issue is raised, NHS Highland itself prefers not to comment. It does not like that awkward fact that is staring it in the face.

I have to ask the minister—I am covered by parliamentary privilege so I can say this—what NHS Highland is up to. Why were two Polish consultants hired and then fired days later? The matter is sub judice, I believe, because at least one of the consultants is taking legal action against NHS Highland. It would prove instructive to the minister to keep an eye on that situation. The First Minister and all right-thinking people are saying, "Let's get the skills we need into this country from other countries." If we take people in but do not give them the support or induction that they need in their first days and weeks and if we then sack them, that must send out very contradictory messages indeed. I openly question what NHS Highland thinks it is doing. So far, I do not have much confidence.

Rob Gibson (Scottish National Party, Highlands and Islands)

Will Jamie Stone give way?

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

I will not give way at this stage.

I turn to the substance of the amendments that are before us today. I am for a moratorium. So is Shona Robison and so is Malcolm Chisholm. I shall just read out what Malcolm Chisholm's amendment says. It states that, until Professor David Kerr has reported, there will be a

"presumption in the interim ... that services will be maintained unless there are genuine issues of clinical safety".

I really have to be up front and push ministers hard on that issue. What is meant here? If clinical safety means medic talking unto medic in a board room in Inverness and making recommendations, that is not good enough for me. There are mums in ambulances travelling more than 100 miles. If the maternity service—with all due respect to Eleanor Scott's honesty in tackling the issue—is downgraded to being midwife-led, that will mean more mothers travelling that road, which is the longest distance that one can imagine. That is the most acute example of a distance problem in Scotland. I put it to Parliament that that is a unique problem.

Carolyn Leckie (SSP, Central Scotland)

Will Jamie Stone give way?

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

I must conclude my remarks.

No matter how many ambulances are on the road and no matter how many air ambulances there are, if the road is blocked, if the ambulances and trains cannot get out and the planes and helicopters cannot fly, what is to be done? Somebody is going to die. It is as simple as that.

I shall be straight with ministers. My vote is up for grabs this morning, and I want reassurance on the issue. Some months ago, Tom McCabe committed himself in print, in the pages of the John O'Groat Journal and Weekly Advertiser, to saying that he recognised that distance was an issue. I hope that NHS Highland does not make any proposals to downgrade the service, but if it does I need an absolute reassurance that the issue of distance and weather will be the one thing that will persuade ministers not to support any such move.

Paul Martin (Labour, Glasgow Springburn)

I will not spend too much time talking about the Tories, but I would like to make passing reference to an adjournment debate that took place on 27 May 1993. That adjournment debate, on the subject of Stobhill hospital, was raised by a close colleague of mine, Michael Martin MP, who asked the then Parliamentary Under-Secretary of State for Scotland, Allan Stewart:

"Does the Minister still maintain that 1,000 beds must be lost in the Greater Glasgow catchment area?"

Allan Stewart replied:

"The figure of 1,000 ... was arrived at through various planning models. It has been discussed ... with many clinicians through the internal consultation process".—[Official Report, House of Commons, 27 May 1993; Vol 225, c 1052.]

Carolyn Leckie (SSP, Central Scotland)

It is interesting that Paul Martin mentions the loss of 1,000 beds during the Tory years. Is he aware that, since 1998, 2,000 beds have been lost in greater Glasgow, and can he offer an explanation for that?

Paul Martin (Labour, Glasgow Springburn)

I would just like to raise the Stobhill figures. Over the past year, from 2003-2004, 20 beds have been lost at Stobhill, and that has been due to consultation exercises that took place some time ago.

I would like to raise a serious issue. I am not here today to defend Malcolm Chisholm, nor am I here to challenge him in any way. I am here today to hold the Executive to account in respect of one of the issues that affects my constituency and which Johann Lamont raised earlier. We have some of the most appalling health statistics in Scotland. Heart disease in my constituency is 173 per cent above the Scottish average, and the incidence of cancer in Glasgow Springburn is 213 per cent above the Scottish average. That sets out clearly the serious challenges that we face in this Parliament. When we talk about raising our game, those are the issues that we should be challenging.

That brings me to the serious issue that I raise today. We are trying to challenge those statistics, and with an acute site in Glasgow Springburn we have a serious opportunity to do just that. If we move acute services from the Stobhill campus, will we improve those unacceptable statistics? Will the patient experience improve as a result? The devil is in the detail. I have not received any serious information from the various consultants who have made the case for acute services to be moved from Stobhill hospital about how they will improve the patient experience or how they will attack those unacceptable statistics that we face in Glasgow Springburn. That is why I raise concerns about whether the patient experience will be improved if acute services are relocated to Glasgow royal infirmary and about whether Glasgow royal infirmary will be able to deal with that additional capacity.

In an age of creativity, we hear about modernisation and flexible working practices in many public sector areas. When the site to which we propose to relocate acute services is 3 miles away, why can we not consider the Stobhill campus as part of the acute services strategy?

Although I welcome the compromise that the minister has made in regard to the Queen Mother's hospital, with which Pauline McNeill has been involved—I also congratulate the Evening Times on its campaign—I ask for a compromise in relation to Stobhill hospital. I ask the minister to consider in his closing remarks the possibility of retaining some acute services at Stobhill hospital in partnership with the new ambulatory care and diagnostic unit that will be developed at a cost of £83 million.

Like Jamie Stone, I have some concerns about the Executive's amendment, but if I receive a commitment from the Executive that it will meet me and other campaigners, and if the minister will at least consider developing a clinically-proven strategy that will include Stobhill, that will give me some food for thought.

Like Roseanna Cunningham, I have serious concerns about the way in which consultation exercises have been carried out in the past. They have not been consultation exercises; they have been information processes. We have to modernise the way in which such exercises are carried out. I ask the minister to consider my member's bill, which seeks to give local communities the right of appeal to a sheriff if they feel that a consultation exercise has not been carried out properly.

We continue to face serious challenges in the form of unacceptable health statistics in Glasgow. I ask the minister to ensure that, whatever strategies are adopted, they attack those statistics, and that he considers a clinical strategy that includes the retention of acute services at Stobhill in partnership with the new ambulatory care and diagnostic unit that will be developed.

Annabel Goldie (Conservative, West of Scotland)

Today, this Parliament debates an issue that affects everyone in Scotland and which, as the motion in my colleague David Davidson's name states,

"has led to uproar from coast to coast".

Nowhere is public discontent with, anger at and lack of confidence in the insidious centralisation of health services throughout Scotland more apparent than in the West of Scotland, where the public and clinicians are acutely conscious of a fundamental fact to which the Executive seems oblivious: health care provision is useless if the patient cannot reasonably access it.

It is no wonder that the people of Inverclyde are at war with the Scottish Executive in their determination to preserve Inverclyde royal hospital. It is simply impractical to expect people from Gourock, Greenock and Port Glasgow to make their way swiftly and without difficulty to the Royal Alexandra hospital in Paisley. That option is flawed and dangerous and no one knows that better than Ross Finnie and Duncan McNeil. I was disappointed that Duncan McNeil did not take interventions to his speech this morning, if only to test the worth of what he said. His speech would have been much more convincing had he done so.

It is no wonder that the people of Dumbarton, Cardross, Helensburgh, Alexandria, Renton and Bonhill are up in arms about the threat to the Vale of Leven hospital, the Jeanie Deans unit in Helensburgh and the Dumbarton joint hospital. If requiring the ill and the frail to make their way from Inverclyde to Paisley is challenging, the prospect for the Vale of Leven area is no less daunting. The friends of the Jeanie Deans unit and the Victoria hospital say:

"We feel that Paisley which is two 'local authorities' and a 'river' away (or three trains and a taxi) is too difficult to access regularly from this area for both out-patients and in-patients as well as visiting relatives."

No one knows that better than Jackie Baillie, who described the moves to take services away from the Vale of Leven hospital as indefensible.

It is no wonder that people are manning the barricades in East Dunbartonshire to preserve services at Stobhill, fearful of impossible journeys through the Glasgow rush hour to try to access the Glasgow royal infirmary. Trying to access the Glasgow royal infirmary from Glasgow in the non-rush hour is bad enough.

The proposals for Glasgow affect other constituents in the West of Scotland. A and E facilities at the Glasgow royal infirmary and the Southern general hospital will introduce pressure and clinical congestion in Glasgow. What does that mean for East Dunbartonshire and those parts of Renfrewshire that are accustomed to using the Southern general? What about the senseless proposal to close a showpiece facility in the Glasgow homeopathic hospital?

The proposals have other ramifications. What about the effect on intended centres of excellence? In my home area of Renfrewshire, communities might breathe a sigh of relief that the sword of closure does not hang over the Royal Alexandra hospital in Paisley, but they are deeply worried about the hospital's capacity and its ability to cope with the convoys of the sick and frail from Inverclyde and the Vale of Leven. A facility preserved that cannot cope is just as useless as a facility that is not there at all. With such proposals before us, not just for the West of Scotland but throughout the country, we will be relying on Harry Potter's Nimbus 2000 to get patients to hospitals, and on owls to deliver messages from their loved ones. A cynic would say that there is a concerted effort to make our hospital provision as centralised and inaccessible as possible in the hope that people will be discouraged from using hospitals, and that is reprehensible.

I am clear that, without local health trusts—which were abolished by three parties in this chamber on a previous occasion—health boards are remote bureaucracies charged with the impossible task of delivering the Executive's health care strategy, whatever that is, within a fixed parcel of resource determined by the Executive.

Shona Robison (Scottish National Party, Dundee East)

Can Annabel Goldie explain how on earth the trusts, if they had been retained, would have saved any of the services that are currently under threat? What difference would the trusts' being in place have made when most of them were in place when the decisions were being taken?

Annabel Goldie (Conservative, West of Scotland)

I can give a simple answer that will strike a chord with people throughout Scotland: there would have been local influence, local management and local awareness of local conditions, without which the boards have become remote and unaccountable.

The mockery of the Executive overseeing this shambles while affecting to be aloof from the turbulence and running behind the skirts of the health boards is disgraceful. For the past seven years, Labour and, since devolution, the Liberal Democrats have run our health services in Scotland—[Interruption.] They have done so whatever Mr Rumbles might affect to argue to the contrary. The working time directive and clinical pressures and patient needs have been known about for years, yet the Executive has taken not one radical, strategic step to increase the recruitment of doctors and nurses or to restore local influence to health care provision.

George Lyon (Liberal Democrat, Argyll and Bute)

Will the member take an intervention?

Murray Tosh (Conservative, West of Scotland)

The member is in her last minute.

Annabel Goldie (Conservative, West of Scotland)

Instead, the Executive has abolished health trusts, which—to meet Ms Robison's point—has removed local influence, and has bought a hospital for £37 million that it did not need to buy.

No wonder the public has lost confidence in the Minister for Health and Community Care and the Scottish Executive—that is clear from the deluge of representations from all over Scotland. That public loss of confidence must be translated into a political judgment of loss of confidence if the mess is to be arrested.

Pauline McNeill (Labour, Glasgow Kelvin)

I hope that I will be forgiven for dwelling on the Minister for Health and Community Care's announcement this morning. It is a good day for the Scottish Parliament and a good day for democracy, because our elected minister has demonstrated that he will say no as well as yes—no to the plans of Greater Glasgow NHS Board to destroy our unique service. More important, it is a good day for children and maternal health services. Like Mary Scanlon, I put on record my gratitude for the hard work that has been done by Dr Turner, Dr Cameron, Dr Davis, Sue Forsyth, all the midwives and campaigners and, indeed, MSPs in this chamber, in campaigning hard to get our Minister for Health and Community Care to listen.

Stewart Maxwell (Scottish National Party, West of Scotland)

On saving the Queen Mother's—which, like Pauline McNeill, I welcome—given that the health board put all its eggs in one basket and said that there was no alternative, should it now resign?

Pauline McNeill (Labour, Glasgow Kelvin)

I knew that that question would be asked in the course of the day. For me, what is important is the result. Lessons have to be learned. Clearly, we have a health board that pursued an unpopular decision. The issue is a matter for board members.

We need to understand what was at stake. Scotland has developed a model of child and maternal health services that is respected throughout the world. The Minister for Health and Community Care's decision means that our work will continue to be respected.

Sandra White (Scottish National Party, Glasgow)

Does Pauline McNeill agree that we have to know about the site and the plans for the new hospitals, which must be kept close together?

Pauline McNeill (Labour, Glasgow Kelvin)

Yes, I agree. It is important that the implications of the announcement are clarified. I ask the minister to confirm that he is, in effect, moving the Queen Mother's hospital to a new building on an adult site, thus maintaining the model of care by keeping the services together and strengthening them. I seek his assurance that the type of child-centred service that we have at the Queen Mother's—in that radiographers and nurses are specialists in the delivery of children's care—will continue under future arrangements.

The motion is about centralisation. David Davidson asks the public and the chamber to believe that the march towards centralisation is a recent policy, but we know that that is not true. Centralisation has occurred since at least the early 1990s. Labour members have argued for some time that centralisation has gone too far. It is important to realise that the debate is complex, not simple—Carolyn Leckie is right to say that. She said that we would not be in this mess if it were not for trusts, pharmaceutical companies, the failure to implement the working time directive and a long list of other matters. However, she dismissed Johann Lamont's point that in a city such as Glasgow we also need to prioritise resources to tackle serious ill health, because preventing ill health is an important aspect of the acute services strategy.

What is the centralisation debate all about? The starting point is that our constituents expect increased life expectancy and have a greater understanding of medicine. Evidence shows that bringing some specialties together can have benefits. We see that in Glasgow with the establishment of the cancer care centre at the Beatson oncology centre, which will be a world-renowned centre for cancer services when it is completed. We accept that there has to be some centralisation. If David Davidson had let me intervene, I would have challenged him on that point. Perhaps the issue is the language he uses. Some centralisation is important.

David Davidson (Conservative, North East Scotland)

Will the member give way?

Pauline McNeill (Labour, Glasgow Kelvin)

Why should I? He did not let me in.

We are not doing so well in other fields. For example, we could do better in cardiology and in neurology, about which there is an on-going discussion. However, I plead for evidence-based research. We need to be engaged in decisions. Larger clinical teams have been shown to be beneficial, because doctors collaborate and learn techniques from one another, which makes their working lives more manageable and gives us more advances in medical technology. We believe in our clinicians, because they have our best interests at heart but, in health, as serious politicians, we must ensure that we get the balance right. We should not put all our trust in what we hear from the royal colleges; we should ask for evidence on centralisation. The crucial question in this debate is: what is a justifiable level of centralisation and what is not?

Too much trust has been destroyed, as little has been done truly to engage communities in determining what is in their best interests. Services have been whipped away from district hospitals without engaging with the public to explain why that is important. Centralisation has gone too far and, crucially, without accountability. That is a matter for politicians.

Clinical safety is a scary phrase that is used too often. It must be justified. We must be allowed to test what is meant by clinical safety. We want evidence. That is our job as politicians.

It is important that the Executive amendment acknowledges that the public are concerned. The public trust the medical profession. Like us, doctors have a responsibility to engage with the public, to discuss what is in their best interests and to allow them to have a say.

The working time directive came into force in 1988, resulting in screeds of regulations in the NHS, but it was only in August that we finally implemented all the provisions. Members can work out for themselves who is responsible for the failure to implement them.

Like Duncan McNeil and other Labour members, I have raised concerns. I agree with him that if we are serious, we must build a consensus, have disagreements and work across parties in the best interests of the people of Scotland.

Trish Godman (Labour, West Renfrewshire)

It is not going to be possible to call everybody who wishes to speak, but it would be helpful if members would stick to six minutes.

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

It is important to recognise the NHS as a whole. No one has mentioned the ambulance service. First, I want to mention something that happened as a result of a decision that was taken purely for financial reasons by Highland ambulance service in the summer. It decided to institute the use of single-person crews. If anyone travels up the A9, the A96 or the A92 and they are in a road traffic accident and suffer a spinal injury, or if any of my constituents has a heart attack in their home, and an ambulance arrives with one person, it will be impossible for them, or for people suffering from many other conditions, to receive a proper service. The ambulance service did that without any consultation. NHS Highland did not even know about it. Has the Minister for Health and Community Care intervened? Not entirely, because what happened is still allowed to happen in exceptional circumstances.

This week, I received an anonymous letter from a female ambulance driver, who stated that she is afraid to go to her job, because she is afraid to go out by herself. Of course, many neds know that ambulances are good places to get drugs, yet there are still single-person crews. Will the minister stop it? Answer came there none.

The second issue is the out-of-hours service, on which proposals have been made by NHS Highland. I do not demonise people on health boards, because they have a job to do. In some ways, they do the dirty work of the Labour Party. The original proposal was that not one GP would be based in Badenoch and Strathspey. The area is around the same size as, or bigger than, the whole central belt, yet that is what the board came up with. Fortunately, as a result of two public meetings that I attended and huge work on the part of the local GPs, led by Boyd Peters, who proposed a safe and workable alternative plan, we have persuaded the health board to change the plan and put a GP in Aviemore. However, the small print is key, and I am not sure that the health board can deliver.

The third issue that I want to advance in the short time that I have available today is Belford hospital. On 11 November last year, 2,500 people—more than one in five of the population of Lochaber—turned out on a windy, cold night to express their complete contempt for the idea that the Belford should be downgraded and should no longer be a consultant-led, 24/7 hospital with accident and emergency, but should become a cottage hospital of some sort. From the presentation at that meeting, it was absolutely clear that that was what was going to happen, but it did not happen, because 2,500 people turned up. Eight days later, I met the Minister for Health and Community Care and I put to him the following argument, which goes to the nub of the debate: the health boards cannot deliver the solutions because they do not have the powers.

George Lyon (Liberal Democrat, Argyll and Bute)

Will Mr Ewing take an intervention?

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

I will take an intervention from the minister if he wants to contradict anything that I am saying.

I suggested to the minister that he should consider a number of things that have to be done so that we have, in the long term, a 24/7, consultant-led hospital in the west Highlands. Those include, first, recognising general surgery as a speciality. It so happens that the Belford hospital has the second-best record in Europe for dealing with trauma. Each year, 1.1 million visitors go through Lochaber, yet it has been considered that the hospital should be downgraded.

George Lyon (Liberal Democrat, Argyll and Bute)

Will Mr Ewing take an intervention?

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

No. Mr Lyon will get his turn later no doubt.

Secondly, there should be more importation of elective surgery. That needs to become a facet of the Scottish health service, so that consultants in the smaller hospitals have a critical mass of operations to carry out.

The real arguments were advanced in a letter from Dr Neil Arnott in response to The Herald's excellent campaign. Dr Arnott asks who is running the health service in Scotland: is it the Labour-Liberal Executive, or is it the various royal colleges? He made three points. His first point was that, despite the Executive's white paper promise that it is opposed to centralisation, the royal colleges are driving a centralising agenda. Secondly, he made the point that there are serious potential

"threats of consultant posts not being recognised by national panels."

Who is responsible for that? The answer is the royal colleges. His third point is that the alleged lack of clinical safety through "skill decay" is being used as the reason for closing units. Mr Chisholm's amendment refers to services being maintained

"unless there are genuine issues of clinical safety".

The significant part of that is the word "genuine".

If the Executive, as it seems to be intent on doing, is just following the line of the royal colleges and applying the rules willy-nilly to teaching hospitals and hospitals such as the Belford or those in Oban and Wick, inevitably we will be unable to find the right solutions for Scotland. Dr Arnott has said that; David Sedgwick—God bless him—has said that; the GPs and consultants from around rural Scotland are saying that. When will the Executive take those points on board?

Bristow Muldoon (Labour, Livingston)

I agree with much of what members of the various parties have said. We need to have a broader agenda to address the health inequalities in communities throughout Scotland, and I commend much of the work that the Executive has done in that regard. Many good things are happening in the national health service. In my area, there have been welcome developments in primary care services and there is the construction of a new renal unit at St John's hospital, which is welcome and supported. However, the big problem is that the current process of centralisation of many acute hospital services is completely undermining the confidence of people in the NHS and completely undermining all the health policies of the Executive and the Parliament.

I wish to address the motion and two of the amendments. First, the Conservatives' position is opportunistic; they have, wrongly, tried to personalise the issue against the health minister. I could never support that position. Duncan McNeil mentioned that the Conservatives have been missing from many of the local campaigns—certainly, they have been posted missing in action in West Lothian—therefore their position is hypocritical. Many other parties have worked with Labour politicians in raising concerns about health issues in communities throughout Scotland, and I give them credit for that.

There is little in the Executive amendment that I would disagree with. My problem with the Executive's position is not what it is saying in the amendment but the lack of action to save services at St John's hospital in my constituency. I look to the Executive to take action, to intervene and to support the excellent services that were, until recently, being delivered in West Lothian. I agree with everything in the amendment in the name of Shona Robison, as I signed an amendment to that effect a few weeks ago. For me, the important issue in that amendment is the need for health boards to have a full public consultation and to get ministerial approval before they make changes to health services.

I turn to why those issues concern me so seriously. First, the Executive talks in its amendment—and we have talked in previous Labour manifestos—about the need for a patient-centred NHS. That is not what has been happening in West Lothian. There has been a redesign of services driven by bureaucrats and doctors—hence my comment when Eleanor Scott mentioned her membership of the BMA. We need genuinely to engage with the public. Changes are not just happening to services that are clinically unsafe; they are happening to services in West Lothian that are clinically excellent. Many of the surgical services at St John's hospital in Livingston outperformed parallel surgical services in other Lothians hospitals. Clinical safety is not the issue.

On broader issues of safety, St John's hospital is the cleanest hospital in mainland Scotland as far as MRSA infection is concerned. Surely that is a clinical safety issue too. On financial performance, St John's hospital outperformed the two main Edinburgh hospitals. It is clinically excellent; it is clean; it is financially efficient; and it is supported by the community. If it is impossible for us to deliver acute surgical services in a setting such as that, there must be something seriously wrong with the current orthodoxy, which is moving towards greater centralisation of health services.

There is a solution to the problem, which would result in two acute emergency sites in the Lothians: one at the royal infirmary in Edinburgh and one at St John's, with the Western general playing a major role as the Lothians centre for specialist services such as neurosurgery and oncology. I challenge the Executive to put that solution to NHS Lothian and to require it to change its position. I say to my colleagues throughout Scotland, some of whom already face such challenges and some of whom will face them in future, that if we do not change the orthodoxy of centralisation at this point, what is happening at St John's in Livingston will be coming to a hospital near them.

Sandra White (Scottish National Party, Glasgow)

I thank the Conservatives for using their time today to debate one of the greatest issues affecting the Scottish public. However, I take issue with the way in which they have turned it into a resignation matter. The people of Scotland deserve a lot better when it comes to such an important issue. I am sorry that the Conservatives chose to do that, and I will not support their motion.

I turn to the minister's announcement about the Queen Mother's hospital and Yorkhill hospital. Like Pauline McNeill and others who have worked closely with every party to retain that unique hospital service, I thank the minister for listening to the people. We have been telling people all along that the consultation process was flawed. I am glad that the minister has at last admitted that.

I, too, congratulate the people who came out—rain, hail or shine—and stood in the streets with placards to lobby the health board. A special thank you must go to the Evening Times for the hard work that it has done and, I have no doubt, will continue to do.

While I welcome the announcement, there are a couple of questions that I would like to ask the minister. He mentioned that it could be five years before the advisory group comes up with a proper site or before the site can be developed. Five years is a long time, so I ask the minister whether, during that time, the board—or whoever oversees the project—could keep the staff and the public fully informed about what is going on. The problem in the Glasgow area and throughout Scotland—from Inverness and Wick down to Glasgow and the Borders—is that the public have not been informed about what is going on. They have basically been told, "That's it." I ask the minister what exactly is going to happen. Are the Queen mum's and Yorkhill going to have new hospitals built on the present sites, or are the hospitals to be moved to a brand-new site or a site at the Southern general? What are the minister's thoughts on that? I and colleagues from all parties have been speaking to the groups who have been working with us. The first question that people ask is whether their local hospital is being retained on the same site or whether it will be moved. We need those answers, if not today then as quickly as possible. I ask the minister to respond to that when he sums up.

I urge members to vote for our amendment, which outlines the proper way forward. Everybody has spoken about the reorganisation and the strategies that are being developed. We need a national strategy; we need to examine what is happening with the reorganisation throughout Scotland. In his amendment, the minister says that

"boundaries are irrelevant to patients".

Jamie Stone and others agree with me that boundaries are very relevant to patients.

Duncan McNeil (Labour, Greenock and Inverclyde)

indicated disagreement.

Sandra White (Scottish National Party, Glasgow)

If the member reads the minister's amendment, he will see that it says that

"boundaries are irrelevant to patients".

They are not irrelevant to patients. People do not want to travel many miles to have treatment. In Caithness, Inverness and other areas, people do not want to travel long distances to have babies, which can be dangerous.

I believe that we need a moratorium to ensure that people's voices are heard properly and that the health service is seen to work for them. People see the health service as working for the health board and for consultants; they do not see it working for them. We have to be transparent and ensure that the health service works for people. That is one of the big problems.

I turn to the homeopathic hospital in Glasgow. For the sake of less than £400,000, in-patient beds are being lost. At a public meeting, the health board responded to questioning by saying that the hospital was owed £10 million because it does not have a tracking system for monitoring how much money comes in from different health boards. I have received a written reply from the minister that says that there is, in fact, a tracking system. Is that true? Do health boards have tracking systems? If they do not, why not?

Only a moratorium will suffice. It would deal with the reorganisation of health services and it might clarify exactly what the health boards are doing. If different health boards are accessing activities in one hospital, we should know how much money is being paid in, yet in the case of the homeopathic hospital, Greater Glasgow NHS Board does not seem to know. I would like the minister to address that.

Phil Gallie (Conservative, South of Scotland)

The minister, in his opening remarks, castigated David Davidson for suggesting that the issue is the centralisation of the health service. I draw the minister's attention to his amendment, which fully acknowledges the current concerns among the public over centralisation. I challenge the minister on his audacity in suggesting that we are wicked Tories for politicising the health service. Labour politicised the health service to win office in 1997; I remind the minister of the message that was sent out then about there being

"24 hours to save the health service".

We have not been as irresponsible as that; we have presented a reasonable case today.

Let us look back to 1997, to a health service that had grown, under 18 years of Tory rule, both in the level of financing and in the development of services. It was a national health service that attempted to put patients' interests and local needs at its heart. It was an NHS that had local facilities of the highest standard, provided by the Conservative Government. It was an NHS that was managed locally in a way that would address many of the concerns that have been expressed today by Duncan McNeil, Jamie Stone, Bristow Muldoon and others.

Mary Scanlon claimed some success for our motion having reversed the minister's decision, and she was absolutely right to do so. I also give credit to the Labour MPs, including Robin Cook, who called Mr Chisholm to Westminster to tell him what they thought; he obviously listened to them. Perhaps those MPs drove some sense into the situation, but they have great audacity because they were part of the problem when Labour voted against the local health trusts. Labour got that entirely wrong.

I turn to some of the problems in the area that I come from, Ayr. Paediatric services have been lost and we will lose a place of excellence as the Arrol Park resource centre, which provides for people with learning difficulties, is being taken out of health service control. Under the review of services, the next threat will be to the accident and emergency facilities at Ayr hospital, another excellent NHS facility that was provided by the Tories when they were in Government.

The main issue that I want to address, which has been picked up by other members, is the effect of the working time directive, on which I have heard some hypocritical—I use that word guardedly, Presiding Officer—statements in the chamber today. Back in the 1990s, the Tory Government took considerable criticism from most of the parties that were represented at Westminster for failing to bring about changes to junior doctors' hours. The Tories recognised what the implications would be, yet people were wringing their hands and saying how terrible it was that junior doctors had to work all those hours. Those people took their eyes off the 8-ball, as the Tories recognised. That was one reason why we did not support the social chapter, which the Labour party signed up to immediately after it took over the reins of office. Responsibility lies there, and Labour members should take it upon their shoulders. The working time directive has a major effect on the present situation.

Now, we are all frightened of cutting across European law. There is a threat there, which has to be addressed. The fault lies not with past Administrations but with the current Administrations, with those who have given them support and with those who supported the working time directive. If things are bad now, and if we consider the European Union's past involvement in our health service, I urge all members to take a look at the draft European constitution. We should ensure that we do not make another great mistake, a mistake that virtually every party in the Parliament—except the Conservatives—is now pursuing.

Carolyn Leckie (SSP, Central Scotland)

The Tories started the debate with a joke, and that last speech was a joke. Their idea is that the answer to the problems of the working time directive is not to have it. We should remember that the Tories did nothing to plan for having more doctors in the health service. The Tories are telling doctors that they do not want centralisation, in return for which junior doctors would have to work 120 hours a week. What a laugh.

Let us get back to the serious debate. I offer my congratulations to all those who have made considered contributions. We intend to support the amendment in the name of Shona Robison, which is also supported by Jean Turner. I hope that the amendment is agreed to. If it is not, I hope for reciprocal support for our amendment.

I challenge what has been said about our attitude towards ill health and poverty, to which I did in fact refer in my earlier speech. Some people were obviously not listening. I am not in any position to take lectures about challenging ill health and poverty if one simple and inexpensive measure that could be taken to tackle that—the provision of free school meals—is not being supported. What does the Executive offer? A free glass of water. The recent landslides testify to the fact that we are not exactly dry. I urge support for the amendment in my name. I hope that SNP members will support our amendment if their amendment is not agreed to. I appeal to all members to vote for a tight amendment that leaves no room for interpretation.

During my opening speech, I did not get a chance to talk about NHS staff and the agenda for change. I want to expose contradictions in the approaches to medical and non-medical NHS staff. When non-medical NHS staff, such as admin and clerical workers, face losing up to 30 per cent of their pay, it seems a bit rich for consultants to receive 40 per cent pay rises. The Government is in favour of a carrot-and-stick approach when it comes to public sector pay: the consultants get all the carrot and everybody else gets all the stick.

We have to challenge all the vested interests in the health service. An indication that the Executive is prepared to take that on would be its making a commitment, once and for all, to abolish the unequal boys club merit awards—abolish them now. We should take on the vested interests of the BMA and the royal colleges when it comes to split-site working and the rotation of consultants. If consultants were prepared to work and rotate out of Inverness, clinical safety in relation to Wick would not be an issue. There has to be persuasion in that regard and a challenge to the vested interests.

I take issue with Jamie Stone. It is not that I disagree with his analysis of what is happening in Wick, but it is unfortunate that the question of midwife-led care has been rolled up in the question of the whole future of maternity services, because midwifery care is not inferior care and it is not a downgrading of care. Midwifery care is appropriate and excellent care for the majority of women in pregnancy, labour and after. Sometimes—in the minority of cases—it is appropriate for women to receive care from registrars and sometimes it is appropriate for them to receive care from consultants. The issue is women getting access to appropriate care; it is not about inferior or superior care.

I am glad that Duncan McNeil referred to there being a need for a real debate. That is what I asked for in my amendment; that is what I have been asking for for more than a year. I hope that Duncan McNeil will support our amendment; I hope that he is supporting the Scottish health campaigns network; and I look forward to seeing him at the demonstration on Saturday.

Duncan McNeil (Labour, Greenock and Inverclyde)

Will the member take an intervention?

Carolyn Leckie (SSP, Central Scotland)

No. Duncan McNeil did not take an intervention from me and I am sorry but I do not have an awful lot of time.

Roseanna Cunningham mentioned democracy and accountability. She is absolutely right that health boards are unelected and unaccountable quangos. However, they act within the parameters of policy, strategy and resources that the Executive sets. Let us not pin all the blame on health boards, because, essentially, the responsibility lies with the politicians, the Executive and the Government, which dictate the policy and the resources.

There is no doubt that the pressure that has been applied by campaigners, NHS workers and others across the board has resulted in a shift by the Executive, which I welcome. The Executive would not have shifted if it had not been for all the campaigns on the streets and the common sense and intelligence of people who were prepared to challenge the vested interests and the received wisdom of those who are too arrogant to listen. I welcome that, but the key question is what happens post Kerr and post the Westminster general election. Those issues are not going to go away. Some people might think that it is enough to agree now to a moratorium, which Jack McConnell claimed was a silly idea. It is not enough to suspend hospital closures for six months—or however many months there are before a general election takes place. The Executive needs to be consistent, because we will have long memories about what happens.

George Lyon (Liberal Democrat, Argyll and Bute)

Today's debate has been about improving patient safety and the public's cry about the need for local delivery, which is a difficult circle to square. We all know the main drivers for change in the national health service in Scotland, to which many members have alluded: accreditation of consultants by the royal colleges; increased specialisation by surgeons and consultants; and reducing junior doctors' hours from 100-plus a week to a safer level. Clinicians tell us that all those measures are designed to improve patient safety and outcomes—objectives against which I am sure that nobody in the chamber, apart from perhaps Mr Gallie, would argue. However, some clinicians, such as Dr Sedgwick at Fort William hospital, argue that outcomes at specialist hospitals are no better than those that are achieved by him and his colleagues at Fort William and other district hospitals.

Phil Gallie (Conservative, South of Scotland)

Will the member take an intervention?

George Lyon (Liberal Democrat, Argyll and Bute)

I am sorry, but I have to make progress.

The debate would be helped by there being published statistics on consultant performance, which might let the general public have a real debate about the safety issues involved in being treated at a specialist hospital or at a local district hospital. I say to the minister that that issue needs to be addressed to allow us to have a sensible and rational debate and to take on the royal colleges in the drive towards specialisation and greater accreditation.

Margo MacDonald (Independent, Lothians)

George Lyon seems to be echoing something that Carolyn Leckie said most concisely about there not being published data. We do not want a witch hunt of consultants, so we should have the figures published but not the names. If the names were published, that could lead to consultants being judged by the public in the way that judges will be, as we saw in a paper today.

George Lyon (Liberal Democrat, Argyll and Bute)

I completely agree with Margo MacDonald on that.

The key question for us all is how health boards are responding to the challenges that lie ahead. Are they responding in the best interests of our constituents? I think that the answer is a resounding no.

However, I want to give an example of health boards getting it right. I suggest that the joint working that the solutions group—chaired by my colleague, Baroness Michie—is doing on behalf of Argyll and Clyde NHS Board and NHS Highland is a shining example to other boards of how to tackle the challenges that lie before the health service in Scotland. The consultants, doctors and, most important of all, the community in Fort William are working together under Baroness Michie's chairmanship to come up with a solution that means that consultant-led services will continue to be available to patients in the west Highlands. Tomorrow Baroness Michie will make an announcement about the result of the discussions. I am confident that the group will come forward with a proposal that will mean that consultant-led services will still be available in the west Highlands. I hope that all politicians will back the good work that has been done by the community, doctors and consultants in that exercise.

However, Argyll and Clyde NHS Board needs to do what it has done in relation to Oban and Fort William in working with NHS Greater Glasgow on the plans for Inverclyde and the Vale of Leven hospitals. What on earth is the rationale behind the decision to locate consultant-led services at Paisley when the Southern general is only two miles away? It is time for Argyll and Clyde NHS Board to engage with NHS Greater Glasgow and begin discussions on a west-of-Scotland solution to the challenges that confront them both.

I welcome the minister's announcement that no decision will be taken on changes until the expert group reports in March 2005. I hope that that will allow time for proper discussions to take place between Argyll and Clyde and Glasgow to ensure that alternative solutions are considered. I hope that a west-of-Scotland solution to the challenges that the health service there faces is properly worked out and that the interests of patients are taken into account.

The Tories have sought to portray themselves as the defenders of the national health service. Phil Gallie claimed that they had presented a reasonable case, but the reality is far from that; they are interested only in playing politics on this issue, which is important to many of our constituents. There is no greater example of the Tories' cynicism than Tommy Sheridan's revelation about the Tory-Trot talks. Mr McLetchie and Mr Sheridan on the same side—that says it all about the Tories' cynicism and willingness to play politics on the important issue of safety and the need to deliver services locally. Let us not forget that it was the Tories alone who voted at Westminster against the 1 per cent increase in national insurance contributions to increase health spending in Scotland and the rest of the United Kingdom. Let us not forget that it is the Tories who want to rob the NHS budget to fund private operations for the well-off. Their only interest in this debate is to destroy the public's faith in the NHS to allow them to pursue their goal of privatisation of the service. Let us reject the Tories' motion and support the amendment from the Scottish Executive.

Jean Turner (Independent, Strathkelvin and Bearsden)

I thank the Conservatives for giving their time for the debate, and I thank the SNP for allowing me to sum up. I also thank the SNP for taking on board the motion that I lodged, to which Bristow Muldoon lodged an amendment.

Malcolm Chisholm's amendment takes us no further than what campaigners already know—we totally understand what he is saying. We should not underestimate the intelligence of the electorate. I see no point in asking for the head of Malcolm Chisholm—that is just folly. We have had Sam Galbraith, Susan Deacon and now Malcolm Chisholm, but folk forget that it is change in policy that matters. There are patients out there today who need to see some changes being made now. Roseanna Cunningham said that although it is easy to withdraw services, it takes a long time to replace them, if they ever can be replaced.

The other thing that we have to keep in mind when we are thinking about rearranging services is that, if we could wave a magic wand and stop everybody smoking cigarettes and gaining weight today, along with all the illnesses that pertain to those two things, we would save the health service a lot of money.

I would like to defuse the party political debate. I came here as a voice of the people, and the people would like to see us working together. The debate has been interesting, and I agree with much that has been said by every party. If I had time, I would love to mention all that.

However, the fact is that we are closing hospitals such as Belford and Stobhill, which have done everything correctly. They have passed the test and are centres of excellence for what they do. Their patients acknowledge and accept that. I am pleased that the Executive has listened to clinicians in relation to the Queen Mother's hospital. The Queen Mother's hospital and Yorkhill hospital should not be separate, so I am glad that the Executive has decided not to do that. I hope that it will listen to the clinicians who are looking after patients at the Vale of Leven hospital, which is under threat, and those in the rest of Scotland.

The Executive must think about what it is doing from the point of view of safety.

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

Does Jean Turner support me in the argument that I have maintained on the distance issue?

Jean Turner (Independent, Strathkelvin and Bearsden)

Of course I do. It is ridiculous to accept that it is safe to leave pregnant mothers miles away from consultant services. I agree totally with Carolyn Leckie that it is not a downgrade for someone to have a midwife. The important thing is to have services that are appropriate. No mother wants to end up in hospital if she can have her baby at home with a midwife or in a cottage hospital.

I worked in the health service for 35 years. For the first 10 years, I worked in hospital and spent eight of those years as a full-time anaesthetist. We used to have lists as long as your arm for surgery to repair mothers who had had their babies in places that were not the most appropriate. They ended up with tears down below and prolapses of the urethra, rectum and uterus. I hope that we are not going to go back in time, but that we are going to think about what we are doing.

We must think about poverty, which has been mentioned, and the illnesses that exist because of it. We need capacity: why on earth would we shrink our health service? I cannot believe that we would do that when we have about a million diabetics in the UK who still need to be treated.

Helen Eadie (Labour, Dunfermline East)

We have had 10,000 new clinicians in the health service in the past 10 years. Does Jean Turner agree that that represents good progress compared to what happened when the Conservatives were in power, when we had 19,000 new managers in post and 25,000 fewer nurses in post?

Jean Turner (Independent, Strathkelvin and Bearsden)

Helen Eadie is going down a road that I did not want to go down. I was in the health service for 35 years and have seen all the Governments in that time—none of them got it right. We are where we are today because people have got it wrong. We are in this building to work together to get it right. It looks as though we might have got it right with the Queen Mother's hospital.

I have not mentioned everybody I intended to mention in summing up because I am so passionate about the subject. I would like to see a health service that is local to the people and that the people can support. I will finish with a quotation from "Keeping the NHS Local - A New Direction of Travel", a Department of Health publication that calls for

"a health service that local people can support and feel confident in."

People have lost their trust in the NHS. I would like Duncan McNeil and members of all the other parties to join me in a solutions group, in which every solution would be complementary to the others.

While we are waiting for things to change, we are losing essential services in Glasgow and other places. Malcolm Chisholm said that he would not go back to the acute services review, but unsafe decisions are being made by health boards. I would like him to listen carefully and to meet me again to see whether we can avoid the dangers and unsafe practices that are taking place. It is wrong to have a whole unit shifted without increasing the number of high-dependency beds—that is unsafe. There are other ways of looking at the safety measure that he is talking about: one should not hide behind it.

Tom McCabe (Labour, Hamilton South)

We know that the national health service remains the most important public service for the people of Scotland. Today's debate tells us that the politicians in this chamber are acutely aware of that. We also know that the public understands that the health service must evolve and develop as medicine advances and as public needs change. That is exactly what the service has done successfully since 1947; it has managed that even during times of challenge and underinvestment, such as the 18 years of torturous Tory rule. The Tories do not like to hear it, but the health service remembers their time in office. The health service remembers those years and the same public who express legitimate concerns today remember them, too. They will not be fooled by the crocodile tears that are being cried by the Conservatives this morning, and the Executive will not tire of reminding the public that the Conservative agenda is the same now as it was then: to starve the NHS of cash, demoralise its staff and wax lyrical about the benefits of private health care.

David McLetchie (Conservative, Edinburgh Pentlands)

Will the minister give way?

Tom McCabe (Labour, Hamilton South)

No.

The coalition Executive is determined to tread a different path—one that invests unprecedented amounts of money and sees unprecedented success in the fight against killer conditions. The ambition that the coalition Executive has for a world-class public health service is compatible neither with reluctance to take hard decisions nor with reluctance to make the best use of scarce specialist staff.

Shona Robison (Scottish National Party, Dundee East)

Will the minister give way?

Tom McCabe (Labour, Hamilton South)

Not at the moment.

We know and accept that if we are to make that ambition a reality patients and the public must be fully engaged with clinicians and politicians in the decision-making process. That process has to produce a modern and responsive service that works to higher standards of clinical care than have existed at any time in the past.

John Swinney (Scottish National Party, North Tayside)

Will the minister give way?

Tom McCabe (Labour, Hamilton South)

Not at the moment.

Let no one be in any doubt that we also know and accept that the way patients and the public are engaged in the never-ending dialogue—which must surround an ever-changing service—has to improve radically.

Jamie Stone made a point about the definition of clinical safety. I am happy to say that when we address clinical safety, it will be within a broad definition that includes distance and access to appropriate and modern infrastructure.

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

I thank the minister very much for that statement. Will he please make it abundantly clear to Highland NHS Board that that is the modus operandum of the Scottish Executive?

Tom McCabe (Labour, Hamilton South)

I assure the member that we will make clear to all health boards the direction that we expect them to take.

John Swinney (Scottish National Party, North Tayside)

Will the minister clarify a point in the Executive's amendment where reference is made to the

"Expert Advisory Group chaired by Professor David Kerr".

If that advisory group comes up with proposals that have been the subject of debate in the chamber today, and which are unacceptable to members and the broader community, will ministers accept them?

Tom McCabe (Labour, Hamilton South)

That expert group's proposals will be the result of intensive dialogue that will have been carried out the length and breadth of Scotland. I therefore expect the proposals to have a body of support that is different from previous proposals.

Paul Martin and Johann Lamont made good points about unmet need; the fact is that the status quo will not address the vast issue of unmet need that exists throughout Scotland.

Paul Martin (Labour, Glasgow Springburn)

I reiterate the point that I made earlier. I welcome the move in respect of the Queen Mother's hospital. However, if I and other representatives can present a clinical case for some form of acute service to be retained at Stobhill in partnership with the ambulatory care and diagnosis project and the Glasgow royal infirmary, will the minister take that case seriously and ensure that we can move forward as he has moved in respect of the Queen Mother's hospital?

Tom McCabe (Labour, Hamilton South)

Where there is a clinical case, we will consider what has to be done to address it and we will meet representatives if that is required.

We have to put some context around the debate. The health service is not in the type of crisis that the Conservatives and the nationalists would like to portray. We must remember the £60 million investment in cancer services, which continue to reduce mortality rates; the £87 million in a new Beatson clinic, which will strengthen our fight against cancer and improve our search for its causes and the £40 million investment in a coronary heart disease and stroke strategy that has resulted in a 14 per cent reduction in deaths by stroke and coronary heart disease in the under-75 age group.

Progress has also been made in the shape of the Golden Jubilee national hospital, which in its first year treated more than 9,000 patients. There is progress in the shape of yesterday's announcements by the Minister for Finance and Public Services that spending on health in Scotland will pass the £10 billion mark by 2008. That progress will continue with the capital investment in new hospitals that will end the days of treatment in temporary accommodation or treatment in outdated Victorian institutions.

Of course, progress will mean that change must and will happen within our national health service. When that change happens it will be to sustain and improve clinical standards; we must ensure that it improves and does not dilute services to patients and the public.

I urge every member who is determined to see a modern and responsive health service that is delivered as locally as possible to support the amendment in the name of Malcolm Chisholm.

Nanette Milne (Conservative, North East Scotland)

In the almost 40 years during which I have been associated with the health service in Scotland, I have never seen such widespread concern about the service from patients, the public at large, increasingly from medical staff—as Mary Scanlon emphasised—and, indeed, from politicians.

Of course there have been local concerns when decisions have been made to close a community hospital here or a maternity unit there. However, the widespread unease and lack of confidence in the system is new. Even five years ago, at the start of the Parliament, who would have imagined that Jean Turner would be elected on the back of a hospital closure issue? When Jean Turner and I graduated in medicine in 1965, neither of us dreamed that the NHS would ever face such a crisis, especially at a time when the NHS has never been better funded.

Pauline McNeill (Labour, Glasgow Kelvin)

Will the member give way?

Nanette Milne (Conservative, North East Scotland)

I will not give way; I am concerned about time.

When communities from Caithness to the Western Isles and throughout central Scotland are protesting about centralisation of services, and when those communities have the outspoken support of their local MSPs, many of whom are members of the coalition parties, something is very wrong and the minister has to be held to account for it. That is why our motion is worded as it is.

We have heard many impassioned speeches today—from Mary Scanlon, Carolyn Leckie, Duncan McNeil, Jamie Stone, Roseanna Cunningham, Fergus Ewing and others—all of whom are concerned about and are campaigning against closure of their local hospitals or the threatened withdrawal of local facilities. The impetus for centralisation is being driven by several factors, including justifiable clinical concern for the safety of patients in departments that are running below establishment and which are finding it difficult to attract consultant, junior and allied professional staff. That is the result of several factors.

Karen Gillon (Labour, Clydesdale)

Will the member take an intervention?

Nanette Milne (Conservative, North East Scotland)

No, I am not taking interventions.

The Executive should have foreseen the clouds on the horizon and taken action before the storm that threatens to destroy the very fabric of the NHS in Scotland.

Certainly technology and treatments have advanced to the stage at which it makes sense to concentrate very highly specialist and extremely expensive services in a few specialist units that are staffed by experts in the field. That is the best way—indeed the only way—to get widespread access to transplantation, certain complex forms of neurosurgical or cardiac treatments and the like. However, people ought to be able to access routine surgical, accident and emergency and maternity services speedily, safely and reasonably close to home in acute general hospitals and they should still be able to get their minor surgical procedures or simple general medical care in their communities.

The fear of losing local services is the reason why people turn out in force at public meetings in the hope that they can influence decisions. Roseanna Cunningham made a valid point about such public consultation too often not being acted on—no wonder people are disillusioned. The public clearly does not want a centralised health service; it does not want to see the closure of perfectly good hospitals, many of which were built, modernised or planned under the Conservatives. People do not want to be forced to travel 100 miles from Wick to Inverness in the dead of winter to have their babies. I hope that it will not be long before Caithness hears the sort of good-news boost that the minister has given Glasgow today.

Patients throughout the country, including the north-east, are devastated by the prospect of the closure of in-patient beds at the Glasgow homeopathic hospital, which gives many people their only respite from pain and is a lifeline for many others. In Fort William, consultants are rightly angry that their hospital might be downgraded when they have the capacity and expertise to provide an excellent service to people who live well beyond their boundaries. As Fergus Ewing said, those consultants have second-to-none experience of dealing with trauma.

A head of steam is building up throughout the country. People want the Executive to carry out its stated aim of providing a health service that is based on local need and which is safe and within easy reach of patients. To achieve what people want, there will have to be some imaginative thinking. Do we need to apply the working time directive so rigorously that enthusiastic trainees are not allowed even to enter their hospitals when off duty to tackle procedures under close supervision, or even to watch their seniors at work? Other European countries do not do that: why should we? What kind of consultants will we produce in the future if they have too little hands-on experience? I dread the day when some of us need expert care.

What about expanding the use of telemedicine and videolinking between local hospitals and centres of expertise? It already happens; so let us expand it. What about incentives for young staff, such as help with housing, flexibility of working hours and more job sharing and child care for those who need it? What about attractive retention packages for senior staff, whose expertise is commonly lost because of early retirement?

Many local solutions for local problems could be found if the service was truly based on local needs and not operating under the diktat of central Government and the targets that it imposes on health boards. That is, of course, where our proposals for patient passports and foundation hospitals come in. NHS foundation hospitals would be run locally by local directors and would have significant operational freedom that would allow them to develop according to local demand. Patients who chose to use them would bring funding with them, which would allow the development of well-run hospitals where they are needed and wanted by patients. That would be a genuine effort to localise services and it would not give unfair advantage to those who are well-off, as Carolyn Leckie and others asserted.

After hearing Tom McCabe's speech, I think that the Executive should perhaps take Robin Cook's advice and examine John Reid's strategy paper, which challenges many of the centralising assumptions that lie behind health policy in Scotland. That might help the Executive to sort out its problems.

Things cannot go on as they are. People have made it clear that they want speedy access to safe health care, with most treatments being available within a reasonable distance from their homes. It is high time that politicians handed over the reins to patients and to professionals who know what is needed. Only in that way will we develop the services that people need and want, restore confidence and secure the future of the NHS in Scotland. I inform the minister that people are waiting and they will not go away.

First Minister's Question Time

Nicola Sturgeon (Scottish National Party, Glasgow)

To ask the First Minister when he will next meet the Prime Minister and what issues will be discussed. (S2F-1097)

Jack McConnell (Labour, Motherwell and Wishaw)

I have no immediate plans to meet the Prime Minister, but when I next do so I will certainly wish to offer him support for the commission for Africa and the efforts in planning for next year's G8 summit in Scotland, which was highlighted yesterday so well by a certain guest speaker at a certain conference in Brighton.

Nicola Sturgeon (Scottish National Party, Glasgow)

I begin by saying how relieved I am that the campaign to save the Queen mum's hospital has today succeeded. That proves what we can achieve when patients, the public and politicians unite in defence of our health service. Last week, the Minister for Health and Community Care pledged to put on hold further cuts and closures but, this week, emergency surgery at St John's hospital in West Lothian closed. If the First Minister can intervene to keep the Queen mum's open, why has he refused to save emergency surgery at St John's?

Jack McConnell (Labour, Motherwell and Wishaw)

As the Minister for Health and Community Care made perfectly clear earlier, ministers can say no as well as yes to proposals from health boards that are properly for the consideration of ministers. I noticed that members of the Opposition on both sides of the chamber made this very point during the debate, which is that what we need in the health service is slightly less interference by politicians and slightly more decision making based on clinical judgments, which is the right way ahead in the eyes of those who work on a day-to-day basis inside the service.

As I said in the chamber last week, the decision that has been made in St John's hospital in West Lothian is of great personal interest to me. That decision has been made on the basis of a clinical judgment, in which the minister would be entirely wrong to intervene, as to do so could threaten clinical safety.

Nicola Sturgeon (Scottish National Party, Glasgow)

Let us get this right: in relation to St John's, the First Minister is saying that a big, bad doctor did it and ran away. I remind him that Greater Glasgow NHS Board was saying for months that the Queen mum's had to close on clinical grounds, and we know that that was not true. So, if it is right—and it is—to save the Queen mum's, why is there no consistency of approach and why is Malcolm Chisholm not lifting a finger to save services at St John's or at the many other hospitals across Scotland that face service cuts?

Jack McConnell (Labour, Motherwell and Wishaw)

That is entirely untrue. As I said two weeks ago, the Minister for Health and Community Care rejected proposals from Argyll and Clyde NHS Board last year because he wanted the board to think again. He can and will do the same thing again. Government is working closely with people in the Highlands, for example, to try to find solutions to difficult, complicated problems and to ensure that rural services remain in as many parts of Scotland so that people receive services in their area, without clinical safety being endangered.

Politicians should make those difficult judgments on the basis of strong advice. There was a clear difference of opinion on the Queen Mother's hospital among clinicians in Glasgow. The Minister for Health and Community Care spent months listening to those opinions and to local people and, ultimately, he made the right decision, not just for Glasgow, but for the rest of Scotland. I accept that Miss Sturgeon welcomes that decision and I hope that other members will welcome it. The decision is the right one and it will secure a strong future, not just for the health service and for those who work in it, but for the mothers and children who will use the service in the years to come.

Nicola Sturgeon (Scottish National Party, Glasgow)

Does the First Minister appreciate that the public see a complete lack of consistency in the Minister for Health and Community Care's approach? The Executive's health policy is a complete and utter shambles. The Executive says first that it cannot halt cuts, then that it might postpone some and now that it will save the Queen Mother's hospital, although it cannot explain why emergency services at St John's hospital have been closed. At 5 o'clock tonight, we will have a chance to call a halt to the piecemeal approach. I have one simple question: in that vote, will the First Minister allow his MSPs to vote with their consciences, for constituents and to save our hospitals?

Jack McConnell (Labour, Motherwell and Wishaw)

There might not have been an awful lot of people listening at the SNP conference, but not one Labour or Liberal Democrat MSP has ever said at a conference that they would deliberately break consensus in Scotland just for the sake of a disagreement. However, that happens far too often in the Parliament, on health and other issues. The Labour and Liberal Democrat members will put Scotland first, not party interests, and ensure that their constituents are represented properly.

The Minister for Health and Community Care has laid out the fundamental principles of our approach. The maximum amount of care that can be delivered locally will be delivered locally. Where specialist centres are required, they will have the most modern up-to-date equipment and the right staffing levels to ensure that they deliver for patients. If health boards should co-operate across boundaries in patients' interests, they will be made to do so. If clinical decisions are made about training and the safety of patients, the Minister for Health and Community Care will back the clinicians, but if there is a difference of opinion, we will ensure that the patients' case comes first, as we did in Glasgow through the decision that was announced this morning. That is a consistent approach; it is not based on raising false disagreements for party-political reasons—which we see in the Parliament, week after week—but on a firm commitment to ensure that we raise our game, put Scotland first and have a health service of which Scotland can be proud.

Nicola Sturgeon (Scottish National Party, Glasgow)

This afternoon, the Parliament has an opportunity to unite to save hospital services. Shona Robison's amendment comes word for word from a motion that was lodged by the Labour back bencher Bristow Muldoon. Will the First Minister allow his MSPs to vote with their consciences to save hospital services throughout Scotland and to act in the interests of Scottish patients and the Scottish public?

Jack McConnell (Labour, Motherwell and Wishaw)

This afternoon, we will have a clear choice. We can vote for the Tories' plans to privatise the Scottish health service and ensure that those who have money and can buy their way into the private system get subsidised for doing so. We can vote for the SNP, which does not want any change and would rather people were treated in old hospitals with old equipment, by staff who are not in the right place at the right time and in a system in which patients do not come first. Alternatively, we can vote for a policy that involves a national strategy that ensures that the right decisions are made one at a time throughout Scotland and carefully considered by the minister when he has to do so, but which at all times recognises that the world is changing round us and that we can use new technologies to save lives and the new skills of nurses, doctors, consultants and many others to ensure that our health service is far better than it was when that lot—the Conservatives—were in charge.

David McLetchie (Conservative, Edinburgh Pentlands)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-1088)

Jack McConnell (Labour, Motherwell and Wishaw)

Among other issues that will be discussed, we will be congratulating the Minister for Health and Community Care on his announcement today about the Queen Mother's hospital in Glasgow.

David McLetchie (Conservative, Edinburgh Pentlands)

I am happy to join in those congratulations. It just goes to show that we get results in the Parliament when the Conservatives hold a debate on the subject of the national health service.

Last week, the First Minister said that there were far too many health boards in Scotland and that the artificial health board boundaries caused difficulties between health board areas. Can he explain to us how many boards he envisages there being in future? How big will they be? In what way will his lines on the map be any less artificial than the present ones? Is it not the case that the cuts in local hospital services, which we have been debating in Parliament today, have come about through the progressive centralisation of the NHS under this Government and that having fewer boards, which he advocates, means more cuts, which will simply rub salt into the wounds?

Jack McConnell (Labour, Motherwell and Wishaw)

No reduction in the number of health boards is proposed by the Executive, but there is a clear indication that the health boards have to start working together across boundaries to ensure that their decisions take account of the regional dimension, or else we will have to consider that option. There is a clear signal for the health boards that they need to do that.

I want to make absolutely clear, as I did in the chamber last week, that it is not that there are cuts in health service budgets or the level of service that is available across Scotland but that there are changes that are being proposed by the health boards. In some cases, those changes will be the right changes; in others, they will be the wrong ones. Where wrong changes have been made, the Minister for Health and Community Care will change them to ensure that the health boards do the right thing, as we have done today.

Across Scotland, there needs to be change in the health service. Technologies, skills and knowledge are available to us in the 21st century that were not available to us even in the last decade of the 20th century. We have to ensure that we can make best use of that knowledge, those skills and that equipment. We need to ensure that we have the right specialist centres and also that more and more care is provided on a local, decentralised basis. That is what is going on across Scotland. We are ensuring, decision by decision, that we get the right balance within a national strategy.

David McLetchie (Conservative, Edinburgh Pentlands)

The First Minister will have to get it right from one week to the next for the sake of consistency. He tells us today that there are no proposals for a reduction in the number of health boards. However, last week, he said to me:

"I am increasingly coming to the view that there are far too many health boards in Scotland".—[Official Report, 23 September 2004; c 10548.]

If he thinks that there are far too many health boards in Scotland, the logic would be that he wants there to be fewer, which would indicate that he is going to reduce the number. Could we perhaps get a little bit more consistency?

It is not only the Conservatives who think that the First Minister has been centralising the NHS in Scotland. Robin Cook has praised John Reid's paper, "Keeping the NHS Local—A New Direction of Travel", saying that it

"challenges many of the centralising assumptions behind health policy in Scotland"

and adding that

"the whole point of devolution was to keep decisions local."

However, that is not the First Minister's policy. When will he realise that his policy, as he outlined it this week and last week, is going further and further in the wrong direction and that we need a health service that is far more responsive to the needs of local communities than one that is delivered by the boards appointed by the Minister for Health and Community Care, who abolished the local trusts that were keeping local services going?

Will the First Minister acknowledge that the man who is right about the centralisation of the health service is Robin Cook and that the men who are wrong are the First Minister and the Minister for Health and Community Care?

Jack McConnell (Labour, Motherwell and Wishaw)

Not at all. Even if there were a case—as I suggested last week that there might increasingly appear to be—that there are too many health boards in Scotland, the health service in Scotland has suffered from many reorganisations, restructurings and increases in bureaucracy under the Conservatives and it is time to change that approach.

That is precisely why, in the five years for which the Parliament and the coalition Government have been in existence, we have seen a reduction of 15 per cent in the number of administrators and managers in the national health service and a consequent increase, by the same amount, in the number of ambulance staff. I mention that because the Conservatives were equally vocal about the changes that took place in Tayside back in the early days of the Parliament. We heard that there was to be centralisation as a result of changes in the configuration of hospitals there, but today members in all parts of the chamber hold up Tayside as an example of where we all want to be. There is a specialist service in Dundee, but there are also improved local services out in the community and ambulance personnel deliver life-saving treatments on the spot when someone has a heart attack rather than having to carry them into the city. Those are the sorts of changes that are required in a modern health service. Mr McLetchie must realise that we need not only increases in investment but reform to make sure that our health service delivers for all patients.

David McLetchie (Conservative, Edinburgh Pentlands)

I say to the First Minister that he is the one who wrecked and restructured the health service when he came into power. Does he seriously think that a Caithness health trust running the Caithness general hospital, which was built by a Conservative Government, would order women in Wick to travel 100 miles to Inverness to have their babies? That is what will happen under his proposals.

Jack McConnell (Labour, Motherwell and Wishaw)

The Conservatives should look back to May last year. In their manifesto, they said that fewer decisions should be made by politicians and more by clinicians in the NHS, but that is directly contradicted by the Conservative motion and by the point that Mr McLetchie makes. He wants a situation in which everything is run and decided here rather than our taking advice from those at a local level who want services to be improved. We are determined to back them when they are right, but when there is a division of opinion in the recommendations we will choose the right side on behalf of patients. We have done that today in relation to Glasgow and I am sure that we will do so again.

Tommy Sheridan (SSP, Glasgow)

To ask the First Minister how many Scots live in relative income poverty and what percentage of the total population this represents. (S2F-1108)

Jack McConnell (Labour, Motherwell and Wishaw)

Since 1997, the number of Scots who live in absolute poverty has reduced by 42 per cent and the number of Scots who live with relative low income has reduced by 8 per cent. The most recent figures on poverty were published on 30 March 2004 but they do not take full account of the new tax credit system and further benefit rises.

Tommy Sheridan (SSP, Glasgow)

As usual, the First Minister avoids the question that I ask. On Monday, he said that his vision was of "one Scotland". Is he embarrassed that, after seven years of new Labour in the UK and five years of the Labour-led Executive in Scotland, 570,000 adults and 320,000 children still live in poverty in a country as rich as ours? Why has the Government failed so many families?

Jack McConnell (Labour, Motherwell and Wishaw)

I have said before in the chamber, and I say again today, that there have been significant reductions in child poverty, pensioner poverty and adult poverty in the years of devolved government in Scotland. In that time, 210,000 children have been lifted from absolute poverty, 100,000 children have been lifted from relative income poverty and 170,000 pensioners have been lifted out of poverty too, but—and this is an important "but" for any elected representative to remember—that is not enough. We must continue our efforts and ensure that we invest in jobs, education, skills, regeneration and the opportunities that help people to come out of poverty and produce a working income for their families. We must not rest on the fact that we have made so much progress so far. We must continue our efforts to ensure that we can abolish child poverty in this country within a generation. We are well on our way to achieving that aim, but there is still an awful lot more to do.

Tommy Sheridan (SSP, Glasgow)

Is the First Minister aware that, even on the Executive's own doctored figures, poverty levels in Scotland are four times worse than in Denmark, five times worse than in Finland, seven times worse than in Norway and 10 times worse than in Sweden? If other small nations can reduce poverty and inequality to such radical levels, is it not the case that, until we have national independence with redistributive and socialist policies, the Executive will continue to abandon one in four pensioners, 570,000 adults and one in three kids in what is a deeply divided nation, not "one Scotland"?

Jack McConnell (Labour, Motherwell and Wishaw)

If Mr Sheridan's principled words were in any way reflected in his policies or in his actions, I would welcome them every time that he utters them in the chamber. If his warm words about poverty in Scotland meant anything in terms of the policies that he wants to pursue, they might mean something for those families in Scotland that still require assistance from us.

The truth is that not only would Mr Sheridan go as far as the Scottish nationalists in ensuring that Scotland's economy was weaker than it is today by ripping Scotland away from our markets and from the jobs that are created through our connections with the rest of the United Kingdom but, worse still, if he had that independent state, he would take the spending on education, health, child care, jobs, regeneration, housing and all the other priorities that we announced yesterday and use it to renationalise companies and do the sort of things that he wants to see because of his ideological and so-called principled position. He is wrong in his analysis. He may be right in his aims, but he is never going to get there.

Rhona Brankin (Labour, Midlothian)

To ask the First Minister how the Scottish Executive's spending review will help further and higher education colleges and universities meet their forthcoming challenges. (S2F-1095)

Jack McConnell (Labour, Motherwell and Wishaw)

As has been said by those who listened to it, including people from the universities, yesterday's budget announcement was outstanding news for Scotland's higher and further education sectors. Our annual investment in our colleges and universities will exceed £1.6 billion by 2007-08. That record level of investment will help to ensure that we have highly motivated, highly qualified staff who work in sustainable, 21st century buildings where they can develop world-class research and deliver high-quality learning and teaching to students not just from Scotland but from all over the world.

Rhona Brankin (Labour, Midlothian)

That is indeed the news that the further and higher education sectors have waited for.

As the First Minister will be aware, earlier today in Midlothian the Deputy First Minister launched the Edinburgh science triangle, which brings together universities and research institutes in the Edinburgh city region to create a world-class scientific cluster for Scotland. Does the First Minister share my belief in the importance of science in growing a modern, dynamic Scottish economy?

Jack McConnell (Labour, Motherwell and Wishaw)

It is very important for Scotland today that we do not try to compete with those economies elsewhere in the world in which wages and skills are significantly lower than they are here. We need to compete in the modern world on the basis of our talents, knowledge, ideas, innovations and, yes, our university and company research. Today's announcement by the Deputy First Minister on the Edinburgh science triangle is another step forward towards ensuring not only that we have world-class universities and companies here in Scotland but that they talk to one another and work together to deliver the jobs that will be so important for Scotland's future.

Alex Neil (Scottish National Party, Central Scotland)

To ask the First Minister what the up-to-date position is on his discussions with the Home Secretary in respect of the devolution of some immigration powers from the UK Government to the Scottish Executive. (S2F-1098)

Jack McConnell (Labour, Motherwell and Wishaw)

I am in regular discussions with the Home Secretary about ways in which he can support our fresh talent initiative. Indeed, he could not be more helpful in giving us that support.

Alex Neil (Scottish National Party, Central Scotland)

Thanks for that unpredictable reply.

In his speech to a fringe meeting on Sunday night in Brighton, the First Minister said:

"There needs to be more flexibility in UK immigration policy to allow Scotland to address its falling and ageing population."

What additional flexibilities does the First Minister believe are required, especially to increase the number of work permits and skilled immigrants to Scotland? What progress is he making with the Home Secretary on those two points? When does he hope to be able to announce progress on those matters, either in the papers or in the Parliament?

Jack McConnell (Labour, Motherwell and Wishaw)

I will make two points in response to Alex Neil's question. First, I am in discussion about these matters with the Home Secretary. As soon as there are decisions, I will be happy to announce them to Alex Neil personally, in the Parliament or elsewhere. It is important that we use the decisions that have already been made, which give our country, our universities and our companies a competitive edge in the international overseas student market by allocating specific visa provisions to Scotland. There is also scope for us to have an advantage in the work permit system and the other elements of managed migration that can benefit Scotland.

Secondly, it is important that we set the right tone and atmosphere for this debate. It is critically important that we send a signal not just in Scotland, that we want Scots to stay in their own country, or across the world, that we are welcoming of people from other races and cultures who come to Scotland, but inside the UK. The population figures announced this morning show that increasing numbers of people are coming from elsewhere in the UK to Scotland. The attitudes and atmosphere to which I refer will not be helped by a Conservative party that opposes fresh talent coming to Scotland. Mr McLetchie and one or two of his other colleagues who have been more positive about the population issue in the past should be ashamed of the comments that were made last weekend by Peter Duncan. If he is trying to stoke up racial hatred in advance of a general election, he is very wrong indeed.

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

The First Minister will be aware that NHS Highland recently hired two Polish consultants. They received no induction and days later they were sacked. Does he agree that it is crucial that, when we welcome people to our country, we give them the support and induction that will enable them to start work in the way in which they should?

Jack McConnell (Labour, Motherwell and Wishaw)

I am sure that Jamie Stone will understand that I have no wish to comment on individual cases or employers' decisions about the skills, abilities or attitudes of those whom they have employed. However, it is important that when people are here legitimately to work and to contribute to Scotland they should be given full support so that they can do so. That is why next month we will open a relocation advisory service that will give people advice on accommodation, employment, education for their children and all the other things that ensure that people realise that they can enjoy a great quality of life in Scotland if they choose to stay.

John Farquhar Munro (Liberal Democrat, Ross, Skye and Inverness West)

To ask the First Minister how the Scottish Executive will protect and promote the status of Gaelic. (S2F-1096)

Jack McConnell (Labour, Motherwell and Wishaw)

I congratulate John Farquhar Munro on his campaigning on this subject over many years. I am sure that he and many others in the chamber were pleased when this week we fulfilled our partnership commitment—a commitment by Labour and the Liberal Democrats in the Scottish Parliament—to introduce a Gaelic bill to the Parliament. The Gaelic Language (Scotland) Bill will promote the use of Gaelic and confirm that at long last Gaelic has official recognition in Scotland.

John Farquhar Munro (Liberal Democrat, Ross, Skye and Inverness West)

Like everyone else, I was delighted to witness the significant support for Gaelic language and culture that the introduction to the Parliament this week of the Gaelic Language (Scotland) Bill represents. I am sure that the majority of members will support the bill when it is debated in the Parliament.

Does the First Minister agree that the Government and the Executive should take a lead on Gaelic, so that local authorities and public agencies not only construct Gaelic plans under the terms of the bill but whole-heartedly embrace its spirit and provide a long-term future for Gaelic language and culture?

Jack McConnell (Labour, Motherwell and Wishaw)

In passing what I hope will be the Gaelic language (Scotland) act during the coming year, the Parliament will send a strong signal across Scotland that not only do we intend to implement the bill's provisions and expect local authorities and all other tiers of government to support them, but we expect every organisation in Scotland to embrace the idea that our ancient language is not dead and must not die. If we all work together, we can ensure that it not only survives but thrives in the years to come.

Jamie McGrigor (Conservative, Highlands and Islands)

Does the First Minister agree that the best way to promote Gaelic language and culture is through education and by giving them a higher profile in the media? What will the Executive do to fast track Gaelic teacher training? Will it promote a dedicated Gaelic television channel in Scotland?

Jack McConnell (Labour, Motherwell and Wishaw)

Additional resources were allocated in the budget, which was announced yesterday, both for Gaelic-medium education and, for the first time in many years, for Gaelic broadcasting. The minister responsible will announce the details of those soon.

Question Time — Scottish Executive — Enterprise, Lifelong Learning and Transport

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

To ask the Scottish Executive what the impact on productivity was last year of days lost to industry through ill health. (S2O-3459)

Jim Wallace (Liberal Democrat, Orkney Islands)

In 2003, the average number of working days lost due to ill health per worker was four, which was the equivalent of 2 per cent of the total number of scheduled working days. Although ill health is undoubtedly important for industry, its effect on productivity is somewhat complex and unclear. Executive policy focuses on the key drivers of productivity as identified in "The Framework for Economic Development in Scotland".

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

If the four days lost per employee is extrapolated, using a rule of thumb for the number of economically active employees in Scotland, the figure comes to 8 million days lost to the Scottish economy. That represents a major contributor to our productivity gap. This week's figures from the Federation of Small Businesses show that 93 per cent of Scottish businesses have fewer than 10 employees. Does the minister agree that days lost through ill health have a disproportionate effect on very small businesses, particularly in rural areas? Will he ensure that Scottish Enterprise works closely with national health service boards to ensure that productivity in relation to health is paramount in local economic strategies?

Jim Wallace (Liberal Democrat, Orkney Islands)

I congratulate Jeremy Purvis on his mental arithmetic and rule of thumb: his estimate was 8 million days lost and the data from the labour force survey show that 8.65 million days were lost, so his arithmetic is not bad. The serious point that he makes is that illness has a disproportionate effect on smaller businesses, especially those with fewer than 10 employees. However, as I indicated, the direct implications for productivity are not entirely clear, although, as reflected in "The Framework for Economic Development in Scotland", we recognise that health is an important driver of economic development.

Good health can be a significant boost for productivity, but ill health can mean costs on the economy through lost working time and lost output. That is why it is important that we should consider enterprise and productivity across a range of responsibilities. I take Jeremy Purvis's point. Perhaps community planning and local economic forums are good places for health interests and employment interests to have a dialogue and to stress the importance of a healthy working population for our economic output.

Stewart Maxwell (Scottish National Party, West of Scotland)

Bearing in mind the fact that smokers are off work between two and a half and six and a half days more on average than non-smokers, does the minister agree that a ban on smoking in public places—which would result in an immediate drop in the number of smokers and in the smoking rates among those who continue to smoke—would lead to an increase in productivity and efficiency for business because of the resultant reduction in ill health among workers?

Jim Wallace (Liberal Democrat, Orkney Islands)

I congratulate Stewart Maxwell on the way in which he has prosecuted that issue. As he knows, the Executive is consulting on the matter. We are nearing the end of the consultation and the responses will be analysed. Undoubtedly, the point that he makes is one of the factors that could and should be taken into account when decisions are reached.

Murdo Fraser (Conservative, Mid Scotland and Fife)

The minister will be aware that there is a higher level of sickness absence in the public sector, particularly in local authorities, than in private industry. Is he concerned by that? Will the Executive examine some of the reasons behind it, such as the work ethos among those who work in local authorities?

Jim Wallace (Liberal Democrat, Orkney Islands)

Murdo Fraser is right to point out that absence rates are greater in the public sector in Scotland, but the difference is small and the rates are still relatively low. In 2003, around 3.5 days per worker were lost through illness in the private sector, compared with around 5 days per worker in the public sector. In both cases, absence rates represent about 2 per cent of scheduled working days.

Alex Neil (Scottish National Party, Central Scotland)

To ask the Scottish Executive what action it is taking in respect of the governance of Glasgow Central College of Commerce. (S2O-3407)

Jim Wallace (Liberal Democrat, Orkney Islands)

I am encouraged that the Scottish Further Education Funding Council is taking forward with Glasgow Central College of Commerce's board of management an independent review of procedures at the college. It is vital that colleges have and can demonstrate effective governance and management arrangements in discharging their responsibilities for staff and public funds.

Alex Neil (Scottish National Party, Central Scotland)

I thank the minister for his helpful reply. Does he agree that, when an employment tribunal finds against a college board, it is the responsibility of the board, which is in charge of taxpayers' money, to abide by the spirit and the letter of the employment tribunal's decision?

Jim Wallace (Liberal Democrat, Orkney Islands)

It would be inappropriate to comment on the circumstances of individual cases, although, to be fair, Alex Neil did not mention a specific case. In general, I would expect any college that was the subject of an employment tribunal decision to implement that decision in good faith and with the minimum delay.

Sylvia Jackson (Labour, Stirling)

I will follow up Alex Neil's question. The minister knows that the Educational Institute of Scotland is concerned about the issue. As has been said, it is strange that something more positive has not resulted from the tribunal finding. Will the minister suggest a way in which to progress the matter or the bigger issue of the governance of colleges such as Glasgow Central College of Commerce?

Jim Wallace (Liberal Democrat, Orkney Islands)

As I said in my initial response to Alex Neil, the funding council is appointing an independent panel to review the governance and management arrangements at the college. I assure Sylvia Jackson and all members that the council will also review the college's disciplinary processes. The funding council's job is to ensure that colleges meet the highest standards of governance and management, which include having and following appropriate employment and disciplinary procedures. I will follow closely the outcome of the independent review.

Pauline McNeill (Labour, Glasgow Kelvin)

The minister will surely be aware of the concerns among all parties about the failure of a public institution to implement a tribunal decision, as Alex Neil mentioned—I welcome the minister's answer to him. If I assured the minister of the possibility of finding a way forward for the college, which is in my constituency, would he agree to meet me? I assure him that I will take a constructive approach.

Jim Wallace (Liberal Democrat, Orkney Islands)

I am certainly aware of the issue generally and of Pauline McNeill's close interest in it, given her constituency role. I am willing to meet her, because I know from experience that she usually comes to meetings armed with constructive ideas.

Trish Godman (Labour, West Renfrewshire)

Question 3 has been withdrawn.

Alex Fergusson (Conservative, Galloway and Upper Nithsdale)

To ask the Scottish Executive what representations it has made to the Department for Transport regarding the circumstances in which trans-European network funding would be applied for. (S2O-3476)

Nicol Stephen (Liberal Democrat, Aberdeen South)

The Scottish Executive is in regular contact with the Department for Transport on a range of issues, including trans-European networks.

Alex Fergusson (Conservative, Galloway and Upper Nithsdale)

I am grateful to the minister for his substantive answer. [ Laughter. ] I am interested that he finds my question amusing, but I thank him for what was a brief reply. In a recent written response to me, he kindly informed me that TEN funding could provide 50 per cent of the cost of studies. I ask him—I am happy even to implore him, if that is what it takes—to consider accessing that funding to undertake an in-depth study of the economic impact of a major upgrade of the A75 from Gretna to Stranraer instead of the welcome but nonetheless unsatisfactory measures that have been announced. Such a study could determine not only the beneficial impacts that such an upgrade would bring to the whole of south-west Scotland, but the benefits that would undoubtedly accrue to the central belt, where I am sure that he agrees the transport infrastructure is creaking at the seams.

Nicol Stephen (Liberal Democrat, Aberdeen South)

I am determined to see improvements to the A77 and the A75. We have a list of schemes that I discussed recently at Cairnryan when all the relevant interests were present. Those schemes have much support and we are determined to press ahead with them. The total funding for them is more than £40 million of Scottish Executive money.

Of course I want to examine other ways of funding projects. That is important for the profile of such international links, which take us from Scotland to Ireland but could take us from the Scandinavian and Baltic countries to the east coast of Scotland, across to the west coast and through to Ireland. The role of TEN funding could be important to that in the future. The maximum funding for the United Kingdom for such projects is 10 per cent but, as the member was right to say, up to 50 per cent funding is available for studies.

I am keen to consider the issue further and to examine ways in which we can raise its profile. In the meantime, there is absolutely nothing to prevent the local enterprise company, the local councils, the ferry companies and other interested parties from doing exactly as Alex Fergusson suggests and starting to prepare a study to emphasise the importance of the route. I see no reason why they would not wish to see that happen or why they would not wish to support such a study.

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

The minister is aware that the A82 is part of the trans-European network and that it is the main trunk road for the west of Scotland north of Glasgow. He is also aware that part of that road comprises a single track. Traffic is directed on to a single lane by traffic lights that are described as temporary, but that are now entering their fourth decade of good service—the minister is a mere youth in comparison. Does he agree that the stretch between Tarbet and Inverarnan is around four decades overdue for upgrading to normality? From his extensive international experience, part of which he shared with us in his previous answer, can he give one example of any other European nation in which part of the trans-European network comprises a single-track road?

Nicol Stephen (Liberal Democrat, Aberdeen South)

Fergus Ewing's starting premise is inaccurate, as the A82 is not on the list that I have of trans-European network routes in Europe.

Nicol Stephen (Liberal Democrat, Aberdeen South)

I presume that Fergus Ewing has suggested that it is on the list to ensure the competency of his question at question time this afternoon.

I have listened carefully to the points that have been made. We are carrying out a major study of the A82 and we intend to introduce more improvements to the route. I recently wrote to Fergus Ewing about the issue. Money is being invested in an improvement programme along the length of the route and there is a significant consultancy study, which is due to report next year. I have no doubt that, following that study, the Executive will put in place recommendations for the long-term improvement of the route.

I also listened carefully to what Alex Salmond said to his conference last week and the issue was certainly not one of the priorities that he or any member of the SNP identified. It rather sticks in the craw when I campaign for the Borders rail link and the upgrading of the A82 but neither campaign appears in the SNP's manifesto proposals.

Helen Eadie (Labour, Dunfermline East)

To ask the Scottish Executive what progress has been made on improving rail links to airports. (S2O-3501)