Scottish Parliament, 18 May 2006

352 contributions from 76 members. The official report.

Official Report 18 May 2006

National Health Service (Future Needs)

George Reid (None, Ochil)

Good morning. The first item of business is a debate on the implications of the Kerr report for the future needs of the national health service. I call Margo MacDonald to open the debate.

Margo MacDonald (Independent, Lothians)

Good morning to you, Presiding Officer, and to those members who have got here in time. As one would expect from business in the independents' allocation of time, this morning's debate will not be used to bash Lewis Macdonald or to allow Lewis Macdonald to bash anybody else. We have had enough bashing without thought in here, so we will be thinking instead about the implications of Professor David Kerr's report for the NHS in Scotland.

I believe the report to be a good analysis of the principal requirements of the NHS in the 21st century. When it was published, some commentators talked down the importance and quality of "Building a Health Service Fit for the Future". Some said that we had heard most of the report's observations and recommendations before, which seemed to me to be a case of "Never mind the quality, feel the width." Of course, it is true that we have heard clinicians, academics and health workers in general expounding the need for a particular specialism to be located in one hospital because that is the only way in which the necessary throughput of patients can be achieved to enable surgical teams to develop their expertise to the highest level possible. However, the Kerr report is the first of its kind to remind us implicitly but quite firmly and consistently that there will be trade-offs in the redesign of health services delivery systems.

To paraphrase Professor Kerr, if patients want to be admitted to hospital as soon as possible after diagnosis, within the timescale intimated to them, and to leave after as short a stay as is compatible with a good recovery, they—that is us—will have to take more responsibility for their own health, fitness and sense of well-being. In principle, that seems a fair enough trade-off to me, but such a refocused approach will not just swing into place without the appropriate planning procedures or without excellent communication of ideas and objectives to health workers and their potential patients, before policies are signed and sealed. There must also be practical demonstrations from the Executive of how trade-offs can work in the interests of all parts of the Scottish community.

It is important that the Executive should take the lead in demonstrating that. To give an example of what I mean by the Executive taking the lead in changing our perceptions about how the NHS can best nurture good health, as opposed to cure bad health, I commend Andy Kerr for his attendance at and support for the launch of the Long-Term Conditions Alliance Scotland a couple of days ago. That new charity comprises voluntary organisations that have been campaigning for years on single conditions, representing people who live with diabetes, epilepsy, asthma, post-polio syndrome, lymphoedema, the after-effects of stroke, colitis, Parkinson's disease and many other conditions, some of which are life-threatening and some of which are not but which, nevertheless, are extremely debilitating and, if not managed properly, can easily act as catalysts for the development of other conditions and illnesses, including mental illness, resulting in misery for the sufferer and additional cost to the NHS.

The minister has wisely pump-primed that new charity because if it is to contribute to the redesign of services as a genuine partner with health boards and social work and housing departments, it will need the money to engage staff who are equal to the task. Thought and energy are required to maximise the return on the resources committed by the Executive and the money raised by the various charities in the umbrella alliance of long-term conditions campaigns. I know, as I am sure other members will, of umpteen campaigning groups and charities that are forced to spend a disproportionate amount of their time and energy on fundraising. Although I am not advancing a case for throwing even more money at organisations such as the Long-Term Conditions Alliance Scotland—because I am well aware that we are now spending twice what we were spending when the Parliament came into being—I urge the minister to get together now with the voluntary organisations that might be expected to underpin the collective care in the community of people with the sort of conditions that I have referred to and to deliver much of the information and education that will enable sufferers to manage their conditions and achieve their personal optimum level of good health. It is a waste of the expertise of sufferers, their carers and the volunteers who support them—to say nothing of the diminished quality of support for sufferers of long-term conditions—if too much time is spent on trying to raise money. There is a balance to be struck and I do not think that we have got it quite right.

In Edinburgh, there is a prototype of the sort of provision that utilises the energy and imagination of volunteers and appropriate services. The Minister for Health and Community Care has visited the Fala Court health initiative with me. I hope that Lewis Macdonald has heard of it, and he is welcome to visit it too. That sort of service points to the future of achieving what the Kerr report says we should be attempting to achieve for the NHS.

John Swinney (Scottish National Party, North Tayside)

At the heart of the conclusions of the Kerr report are the aspirations of promoting local access to services and balancing local delivery with the need to have centres of excellence that provide high-quality, modern, specialist care. I do not think that that is a definition that anyone could disagree with if they believe in a health service that respects the desire of individuals to be treated as close to home as possible but which is clinically safe. Although the Kerr report gave a great deal of thought to the balance between locally available health services and the need for some specialist care to be delivered in a limited number of locations, it did not give definitive guidance on which services should be located at a local or a specialist location.

That is now the issue that bedevils a number of health boards as they try to use the conclusions of the Kerr report to justify the centralisation of services in the community, because it is easy to argue in different circumstances and in different parts of the country that one specific service should be locally based and another should be at a more central location. In certain parts of the country, the public are being asked to support the centralisation of certain health services that have been made available locally by health boards, with the Kerr report being used as justification. That is exactly the type of lazy management that the Government has been prepared to accept from health boards around the country. Members of the public are being asked to accept a route to centralisation by Executive-appointed health boards that is being resisted by numerous members of this Parliament, many of whom support the Executive. The situation is so serious that the Home Secretary, among his many other problems and challenges to date, has had to take to the streets to defend local health services from the centralising acts of a health board appointed by Labour ministers in the Scottish Executive.

In my view, those members of Parliament and members of the public are right to challenge the centralising tendencies of the health boards.

Lewis Macdonald (Labour, Aberdeen Central)

Do Mr Swinney's general comments on the import of the Kerr report mean that his party would never support the specialisation of services or the delivery of specialised services at a prime site?

John Swinney (Scottish National Party, North Tayside)

I made it clear in my opening remarks that anybody who believes that we should have a health service that is clinically safe must accept that there will be specialisation at certain locations. The issue that concerns me is the use of the Kerr report as an excuse for centralisation by lazy health boards. I will go on to say more about the health board in my locality, which is a good example of a health board that is resisting the temptation to centralise, but in the course of my remarks I will illustrate to the minister exactly what I mean by lazy health boards that use the Kerr report as an excuse. I believe that the decisions to centralise have been driven more by a desire to save money and to avoid changing the medical profession's working practices than by a desire to deliver the optimum service to patients within the resources available.

I represent a constituency that has had to put up with a lazy health board that is prepared to take decisions on that basis. Thankfully, that has changed since the appointment of Peter Bates as chairman of NHS Tayside. When I was elected to Parliament, NHS Tayside was running down Stracathro hospital. My colleague Andrew Welsh and I repeatedly said that it would be a death by 1,000 cuts for that hospital. The drive was to centralise services at Ninewells hospital in Dundee and to reduce levels of service for patients in Angus. After a huge and broadly supported local campaign we changed the mind of NHS Tayside. The board listened, it thought out of the box and it challenged working practices in the medical profession. Today, more patients than ever before are being treated at Stracathro hospital. There is to be an expansion of services and patients can barely get near the hospital for the queue of Government ministers visiting to see how it can be done.

Perth royal infirmary faced similar threats. The health board removed consultant-led maternity care and tried to initiate a process of removing other key services. The community resisted and the health board came up with a virtual acute hospital model, which was achieved by linking Ninewells hospital and Perth royal infirmary. The objective was to expand the services available in Perth by changing working practices. We will hold the health board to that objective.

In the context of the local delivery of care, my colleague Christine Grahame will address the threat to local cottage hospitals in the Borders. The health board in my area has maintained and is investing in a range of cottage hospitals at Blairgowrie, Aberfeldy and Pitlochry. It sees cottage hospitals as providing a valuable level of care a step down, which can take the strain off acute hospitals. Why do boards in other parts of the country not see such hospitals as the valuable assets that they are?

The one gripe that I have about the centralisation of services relates to the out-of-hours service. The minister will be aware of my concerns about what is happening in the very remote areas of my constituency, where the fact that GP practices are being allowed to opt out is resulting in a diminished level of out-of-hours care. That is an example of the centralisation of services in rural areas; many other examples in more urban communities also concern many members. It is right to resist centralisation, to challenge health boards and to seek to get the right balance between local and specialist care, which many health boards have failed to do.

Nanette Milne (Conservative, North East Scotland)

The Kerr report reflects a consensus in Scotland that the national health service needs to change, but the question is how it should change.

The report recognises that most patient care is best provided at local level. Primary care services should supply the care and support needed to enable patients to cope with their chronic health problems at home or in their local communities and should encourage them to take responsibility for their own health. Such an approach reduces demand for secondary care and relieves pressure on hospital and specialist services.

Most people want the focus to be on local care. It is accepted that there are compelling arguments for highly specialised services to be available in a few centres of excellence, but there is a clear demand for as much health care as is reasonably practical to be provided locally.

However, if local delivery is to work, it will involve a great deal of workforce planning. People will have to get used to being seen by the practice team and not only by their GP; many allied health professionals may be involved in the care of a patient.

Recruitment is already a problem. GPs are hard to come by in some parts of Scotland. There are global shortages of specialists in a number of clinical areas, and there will be an escalating need for already scarce specialist nurses and various allied health professionals. There will be a need to train generalists as well as specialists and GPs are being encouraged to develop special skills, for example in orthopaedics, dermatology and minor surgery.

Health boards are taking their first steps towards change. They are not all doing it at the same pace or in the same way. There are tensions between boards that are trying to rationalise services through amalgamation and centralisation and patients who want to retain their familiar local facilities.

Kerr says that the NHS in Scotland can meet the challenge of change by building a new relationship of partnership and trust with the public, but that is already being threatened by the proposed closure or downgrading of local hospitals. People do not accept that having to travel to a distant accident and emergency department because their local facility has gone represents progress.

The mums in Aboyne in Aberdeenshire will fight to the end to keep their midwife-run maternity unit, because they value the care that they receive in their community. Rather than accept closure because the local delivery rate is low, they want actively to promote their unit, as was done successfully at the Montrose unit in Angus, which is now a thriving unit that nobody would dream of closing. People want the local hospital to diversify and perhaps to provide chemotherapy, care for the elderly or minor surgery, but not at the cost of losing the maternity unit.

Compromises must be made. Not every facility can be available everywhere, but local input and co-operation are vital if Kerr's proposals are to be implemented successfully.

There is not time in such a short debate to deal with all the current issues of concern. The establishment and operation of the new community health partnerships seem to be variable, according to anecdotal evidence. Some CHPs appear to be working better than others. I would welcome an update on the matter from the minister.

There are still concerns that, whatever the minister has said to the contrary, the centralisation of specialist services will lead to the downgrading of units such as Aberdeen's neurosurgical unit.

As John Swinney said, in many areas there are serious problems with out-of-hours provision of primary care. The care that patients desire is often not available. Workforce issues are far from being resolved.

I want a health service in Scotland that is clearly focused on the needs of patients and is accountable to them, in which the primary care team, led by GPs—who are best placed to advise patients—determines, in conjunction with patients, their journey of care within the NHS. The service would cease to be a monopoly provider, which is centrally driven and developed according to directives and targets. Instead, it would become a service that reacts to the needs and demands of its patients. If the NHS is to work in the real interests of patients, power must be given to them and to the professionals rather than to politicians. Sadly, we are a long way from achieving that.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

The Scottish Liberal Democrats welcomed the publication of the Kerr report. In years to come, it will be remembered as a significant landmark in the history of the NHS in Scotland. The Executive's response, "Delivering for Health", set the agenda for implementing the Kerr report. "Delivering for Health" is set against the background of the near doubling of the NHS budget from £4.6 billion in 1999 to £8.8 billion in 2005. The effective use of that large increase in the budget is critical to achieving the vision set out in the Kerr report and "Delivering for Health". It is critical because it is unlikely that the next six years will see another such increase in the NHS budget.

"Delivering for Health" set out four main priorities for reshaping the NHS: to make it as local as possible; to achieve systematic support for people with long-term conditions; to reduce health inequalities; and to actively manage hospital admissions.

On the first—making the NHS as local or as close to home as we can—we must ensure that NHS boards and local authorities take a new approach to infrastructure and buildings. It is self-evident that not every town and village can have one of everything. However, shared facilities and the delivery of health services in community settings allow services to be provided close to home. There are good examples throughout Scotland of shared facilities. There are new or improved buildings where community health services are delivered alongside social work and social care, and from where allied voluntary bodies offer their expertise in the community.

David Davidson (Conservative, North East Scotland)

The model of sharing premises for care raises another issue, which is that patients can fall between two budgets. Can the member suggest a solution to that problem?

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

It is interesting that Mr Swinney talked about health boards being lazy. That may be his experience in his area, but I think that it is more about mindset. The point is to ensure that people understand that there are huge benefits to be had from sharing facilities and, where necessary, pooling the labour force in social care and health services. There is a great deal to do.

I will return to my theme, which is that there is no reason why the NHS should not go beyond that and—where it is sensible to do so—share facilities with the private sector. For example, where we need to replace or renovate a community hospital and there is scant local nursing home provision, there is clearly an impetus for having a shared facility. Indeed, I advocated exactly that in my constituency, where in Coldstream and Jedburgh the community hospitals are in need of renewal and nursing home provision is lacking and needed. There are clear opportunities to develop an innovative approach.

John Swinney (Scottish National Party, North Tayside)

Will the member give way?

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

Yes.

John Swinney (Scottish National Party, North Tayside)

In supporting Mr Robson's line of argument, I suggest that he might want to investigate a proposal in Pitlochry in my constituency to construct, for the first time ever, a GP practice, a local community hospital and nursing home provision on a single new site. That is a welcome model of how to proceed.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

That is precisely the kind of innovative solution that many local health and social work professionals would advocate and which I am sure can provide answers for the future. There is no doubt that sharing facilities leads to much more and better local services.

Margo MacDonald (Independent, Lothians)

I am part of a group of people in Edinburgh who are trying to bring together medical GP services, associated complementary services, social work services and all the things that we have talked about and which the Kerr report talks about. I hope that Euan Robson agrees with me that we must address the point that David Davidson raised, which is that funding streams often get in the way of good ideas.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

The Executive could assist with funding streams by ensuring that innovative approaches are promoted.

We are not good at sharing best practice in Scotland. Mr Swinney mentioned an example of good practice and there are others in Ayrshire and Lanarkshire. I believe that if we were better at sharing good practice—in which there is a role for the Executive—we could ensure that the vision in the Kerr report is brought to reality.

On long-term care, we must take into account important workforce development in certain areas. I believe that there are greater opportunities to share training and to dovetail social care and health care skills to provide a more effective service for people in Scotland.

John Swinburne (SSCUP, Central Scotland)

There is no doubt that in future the Kerr report will be regarded as a turning point for the better in the long history of the NHS in Scotland. In many ways, the report is visionary and, as such, it has caused controversy and debate in many areas of the NHS. The attempts at rationalisation are probably the most contentious issue currently in the NHS in Scotland. Many people regard that approach as missing the first dominant issue that Professor Kerr identified in the foreword to the report—addressed to the Minister for Health and Community Care, Andy Kerr, on 15 May 2005—which was

"Maintaining high quality services locally".

In many areas, such as Lanarkshire, the local health boards seem to have missed that important point.

Lanarkshire NHS Board's cost-saving decision on which accident and emergency unit to retain certainly cuts across the principle of maintaining high-quality services locally. However, I am confident that in the final analysis our minister, Andy Kerr, will show the wisdom of Solomon and will come up with a solution that will allay the fears of the people of Lanarkshire. That will possibly be done by retaining the A and E units in Wishaw, East Kilbride and Monklands. It has not been shown that anything less than the existing set-up would be as good. Not retaining those units would mean that high-quality local services would not be maintained, which would be against the spirit and the intention of the Kerr report.

Care in the community is a key element of the Kerr report. I wish the minister every success in that area because it involves treating people in their own homes, wherever possible. Obviously, that will mean a massive increase in the number of ancillary workers who are required. Care in the community services would alleviate the sad situation of elderly people who live alone all too often being placed in care homes and then being shocked to find that their home has been sold to pay for their residential care. To have their homes stolen by an uncaring state is no way to treat hard-working senior citizens who have contributed to the welfare of our country all their lives. That intolerable situation cannot be allowed to continue. We should remember that the NHS was set up to care for all from the cradle to the grave and not from the cradle to the care home.

Despite that major glitch, are things improving in the NHS in Scotland? The simple answer is a definite yes and the proof of that is the increasing life expectancy across the country, except for in a couple of black spots where it is attributable to basic deprivation. Statisticians forecast that by the end of the century more than 1 million people in the country will be over 100 years old. Longevity is the ultimate measure of the success of the NHS. That pleases me because it will increase my party's scope to increase its membership.

The Kerr report is a consensual document. As I have stated before, health should be taken out of the political arena and every party should propose its positive ideas. They should do so not for party-political gain, which happens too often in this place, but for the overall good of the NHS and for the ultimate good health of the people of Scotland.

That is why the Scottish Senior Citizens Unity Party will invariably support Andy Kerr as he strives to improve the health of Scotland's population. He is being attacked on the issue of targets by the media and by MSPs from other parties. However, targets are set with the best of intentions. They are laudable and it is superb when they are achieved. Instead of the usual yah-boo confrontation in this place, let us hear in the future—and starting from today—constructive ideas being advanced by all those who claim that they could do better.

Eleanor Scott (Green, Highlands and Islands)

First, I declare an interest: I am a member of the British Medical Association.

I very much welcome this debate and do so, perhaps slightly unusually, not primarily for the chance to express my point of view but to hear what the minister will say. When the Kerr report was published almost exactly a year ago there was a cross-party welcome for it. There was a feeling that here was a way of taking forward the NHS and that the report's recommendations would be implemented rather than just sit on a shelf as previous reports had done, such as the report on the acute services review. Rather than debate the report's merits, which we are pretty much agreed on, we want to hear that progress is being made towards implementing the report's recommendations.

In answer to a question on 25 May last year, the minister said:

"I am happy to support the proposal for a network of rural hospitals and the education and training infrastructure that will support it".—[Official Report, 25 May 2005; c 17165.]

I would very much welcome an update on progress towards that because for those of us who represent rural areas the idea of rural general hospitals was one of the most welcome things in the report. It was regarded as an answer to what we had been asking for all this time: an area between the highly specialised centres, which we all agree are necessary for some conditions, and delivering care as near to people as possible.

The report also mentioned community hospitals. When we debated the Kerr report when it came out, I was not clear whether the minister envisaged that as simply a rebranding of existing cottage hospitals or an expanded network of community hospitals. I am still not clear about that and I would like an update on the matter. On the technological side of bringing medicine closer to the people, I would like an update on our progress on telemedicine, which is important in remote and rural areas.

We have all agreed that local delivery is the right approach and that an appropriate network of professionals should support it. We are talking about not just doctors but specialist nurses and specialist allied health professionals. I still think that there are not enough specialist nurses for epilepsy, asthma, diabetes and so on. Such professionals are much valued by the patients who are lucky enough to have access to them, but they are grossly overstretched.

I will give a local example of that—we are all trotting out such examples. The cystic fibrosis physiotherapist who covers the whole of the Highlands, Western Isles and west Grampian area works 25 hours a week. When the post was established in 1988, her caseload was 27 but, because people with cystic fibrosis now live a lot longer, it is now 46. That professional, whose work is hugely necessary in treating cystic fibrosis and keeping people with it healthy, is trying to cover an area the size of Belgium on 25 hours a week. Financial constraints mean that the health board cannot increase her hours. I do not believe that that is acceptable. It is just one example; I am sure that members have others.

A pledge was made to engage early with local people about what was being delivered. I would like to know whether that is happening, what has changed in how the NHS engages with communities and how far-reaching the engagement is. Some people will share my reservations about some of the target-driven approaches in the NHS. I have heard that in Highland, where there is a shortage of orthodontists, the locum orthodontists are being encouraged to make senior referrals to keep to the waiting-time targets for such referrals rather than for initiating treatment. The permanent post-holders will come back to a huge backlog of patients who need treatment, which has been piling up because the locums have not been treating them. I belong to a party that often insists that the Executive should set targets in certain areas but, although targets can be valuable in some areas, they can have a distorting effect in others.

I do not have time to cover health inequalities and the need for good demographic information.

One of the points in the Kerr report—and the Executive's response to it—was that good case finding might prevent some acute admissions. That is fine up to a point, but it is dangerous to assume that we will not need acute beds as a result, in the same way as it would be unsafe to assume that because people are living longer and staying healthy longer, local authorities might not have to provide residential care.

On health promotion, I draw to members' attention a motion that I lodged just after the new year. It was an excellent motion—some members might remember it and some might have signed up—because the words were not mine but the BMA's. The motion says a lot about what we need to do to build a healthy Scotland, which is not just about delivering health care. It states:

"That the Parliament agrees with Dr Peter Terry, chairman of the British Medical Association in Scotland, that a long-term public health strategy can be effective only if there is a co-ordinated approach across all ministerial portfolios; notes that decisions taken in other policy areas have a significant bearing on public health; agrees on the need to develop synergistic policies and cross-departmental co-operation, and calls on the Scottish Executive to introduce a system of routine health impact assessments to be applied to all policies and legislation."

That is crucial. We assess the impact of all legislation on equal opportunities and human rights; we should also consider its impact on health.

I will finish with a statistic that members might have noticed on the excellent play display in the garden lobby. For every 80 acres of golf course in Scotland, there is 1 acre of children's play area. We are not really building a Scotland in which it is possible to grow up healthy. We should consider not just health delivery, but the kind of Scotland that we have.

Mary Mulligan (Labour, Linlithgow)

I welcome this opportunity to discuss the challenges that we face in providing the health service that people in Scotland will need in the future.

We spend a disproportionate amount of time discussing hospitals, given that 90 per cent of health care is delivered in a community setting. I crave members' indulgence, because I want to discuss a local building that is causing concern. Perhaps we should give more consideration to the range of services that are delivered in GP surgeries and health centres. In Linlithgow, there are two strong pressures on the health centre. First, there are increasing patient numbers, given the growing population that has resulted from new housing. Secondly, there is a desire to offer a wider range of preventive health services within the health centre. I have attended yoga classes for babies and support groups for people with multiple sclerosis—I am sure that other members have done such things in their constituencies. Those are small examples of what goes on within the health centre, which means that it is outgrowing its existing premises. However, given the developments that are taking place in the town, it is difficult to find a site for a new facility. Options are being considered, but they will cost money and they need to be fit for purpose.

I acknowledge the substantial funding of £50 million that the Executive has made available for new, modern health centres. However, many people are competing for those funds and I hope that the minister understands that a growing population cannot wait—people need the service now.

As I said, the health service should be seen as more than buildings. The Kerr report stated clearly that the health improvement agenda was crucial. We need to establish good eating habits, which can be learned at home and supplemented in schools. We need to keep active, whether by exercising at the local gym or walking more regularly—even if we just walk around the shops. We need to care for our mental health, perhaps by having a job that we enjoy, which raises our self-esteem, or by socialising with family and friends. All those measures can help us to stay healthy and none of them requires a hospital or a health centre. However, the Scottish Executive has a role to play, which Eleanor Scott mentioned, in joining up the services that we provide to ensure that there is a framework within which to deliver them.

When health problems arise, we need a range of health staff to meet our needs. Much of our previous discussion has concentrated on doctors and consultants in particular, and the figures are encouraging. In answer to a question from the Scottish National Party health spokesperson, the minister was able to confirm that the number of consultants in the Lothian NHS Board area rose from 536 in 1997 to 685 in 2005. However, the figures also need to show consultants' specialties. The national workforce planning framework will be essential to ensure full coverage of all specialties.

The Kerr report acknowledged the role of other health workers and the wider roles that could and should be developing for them. I found the Royal College of Nursing's briefing for the debate interesting and agree that nurses could and should play a wider role in the community in health education and preventive health, and that their skills in more complex areas should be developed. Other allied health professionals can also offer support. Podiatrists, physiotherapists and occupational therapists provide services in local, and even home, settings. They can support older people with physical and mental health problems, which keeps them out of our hospitals.

I welcome the development of community health partnerships. The CHP in West Lothian, although still relatively new, is already having an impact in joining up services. The buck can no longer be passed between social care and health care. That is particularly important in addressing the needs of an older population, who, with minimal support, could remain in their own homes for longer, which the majority of them say that they wish to do. New technology is also helping people to stay in their homes, so we need to continue to invest in it.

Given the variety of health professionals who work in the community, I would be interested to know how far we have moved in developing protocols to allow health workers other than GPs to take self-referrals and, if necessary, to refer cases back to GPs.

I am sorry that we do not have more time for the debate, because I think that it will play an important part in developing a new, modern system that will address people's needs, not just through hospitals and doctors, but through a range of health facilities and professionals who work in our communities.

Sandra White (Scottish National Party, Glasgow)

Like Eleanor Scott, I want to know what has happened since the Kerr report was published a year ago. I remind members of some of the report's recommendations, which were that high-quality services should be maintained locally; that local needs and expectations should be met; that options for change should be developed with people, not for them; and—this one is close to my heart—that the Scottish Executive should review its guidance on public consultation, with a view to promoting best practice.

A number of weeks ago, NHS Greater Glasgow and Clyde held a workshop about the new sick kids hospital, which I and others were not told about. However, being the type of person that I am, I found out about it and managed to go along. In light of my experience, perhaps the Executive should review its guidance on public consultation.

On the maintenance of local high-quality services, I point out that Glasgow has gone from having five accident and emergency departments to having only two. Given the threat to Monklands hospital, which I mentioned last week, and the state of the services in Argyll and Clyde, I have to ask what kind of local services we can expect in Glasgow. When people have to travel three quarters of the way around Glasgow and beyond to get to what should be local services, I do not think that local needs and expectations are being met. How would having only two maternity hospitals in Glasgow meet local needs and expectations? It is proposed that the new site for maternity and sick kids' services should be at the Southern general hospital, but it is in dire need of modernisation. Operating theatres are closing down there because of modernisation. Maternity wards are being closed because they need refurbished and fixed—they are falling down. How can people be comfortable with that situation? I would like the minister to look into that particular issue.

Margo MacDonald and Eleanor Scott mentioned the training of staff. That is an important point. I recognise the fact that staff have to be trained to do outreach work. However, at the NHS Greater Glasgow and Clyde meeting that I referred to, certain fears were raised regarding specialised paediatric nurses. Obviously, if facilities are closing, parents will themselves diagnose their children, deciding whether to take them to the sick kids hospital across the river, an ambulatory care and diagnostic centre or local services—of course, we should bear in mind the fact that the ACADs and local services will not be open at night.

When I asked a question about the specialist training of paediatric nurses, I was told that that was being looked at. It is an important point and I would like the minister to tell us whether the Executive has any figures regarding the training of staff. Like Mary Mulligan, I think that the Kerr report's recommendations in that regard were important. We do not seem to have any monitoring or evaluation of any of those aspects of the Kerr report.

The Kerr report mentioned the fact that we have to look after people in deprived areas. However, I do not see any more outreach work being done in the deprived areas that I represent, such as Drumchapel. There is no evidence of extra nurses, doctors and health workers being able to do outreach work in those areas. I would like the minister to tell us whether there are any updated figures on outreach work or recommendations about how we can get the health professionals to work in the areas that I mentioned, so that people there get the services that they deserve.

The Kerr report says that services should be localised to meet people's needs. I do not believe that closing down three hospitals and having only two maternity hospitals is meeting people's local needs in Glasgow. I would like the minister to revisit that issue.

Duncan McNeil (Labour, Greenock and Inverclyde)

Although I do not want to focus on them, it is worth noting the issues that brought about the Kerr report. Issues such as the European working time directive, consultants' specialisms and subspecialisms, junior doctors' hours and training and accreditation have brought us politicians to a point at which, like it or not, we have to make decisions to ensure that a much-loved, respected and valued institution continues in a modern form in Scotland.

Although it is not a panacea, Professor Kerr's report gives us a course of treatment for the ills that affect today's national health service and offers a way forward that could revolutionise the health service and make it more responsive, effective and efficient.

The key innovation in Kerr's report is the idea that services should be designed to suit need and that there should not be Berlin wall-style health board boundaries. As I have argued repeatedly, the case for designing services to meet need is strengthened by the fact that quality health services still tend to be most readily available to those who need them least. We are still beset by the strange one-size-fits-all approach. Out-of-date funding formulas and notional equal access to general practitioners has resulted in healthy, affluent areas having the same concentration of doctors as do the poorest pockets of public health. That results in poor sick people having less time with GPs; being less likely to be referred to a consultant; being more likely to be seen in an overburdened, single-doctor practice; being more likely to be seen by a younger doctor who has never been in a deprived community before in his life; and being more likely to die younger. The report of the Kerr subgroup on health inequalities confirms that that approach has seen the gap between rich and poor grow rather than shrink.

Margo MacDonald (Independent, Lothians)

I do not disagree with a word that Duncan McNeil has said. However, does he agree that it is not the health service's policies or strategies that have brought about the situation that he describes, but the economic situation? If we are talking about tackling the inequalities in health, we must address that as well.

Duncan McNeil (Labour, Greenock and Inverclyde)

Yes, but today we are discussing the health service's role. If we wanted, we could discuss the community regeneration fund, the central heating programme, the warm deal and the massive investment that there has been in early years and other stages of education. We are making progress in that regard but, this morning, we are discussing the responsibilities of the health service with regard to that agenda. That is why I slightly disagree with the British Medical Association, which promotes the interests of consultant doctors in relation to subspecialisms, reduced hours and less contact with patients. The BMA lectures us about our responsibilities, but it needs to face up to its own responsibilities.

Last month, I had the opportunity to put some of those points to the chief medical officer for Scotland, Dr Harry Burns, who was attending a meeting of the Health Committee to discuss the Kerr subgroup's findings. To his credit—this underlines how the debate has matured and moved on—Dr Burns said:

"If we are to tackle the increased prevalence of disease in deprived communities, we must match that increased prevalence with an increased number of GPs."—[Official Report, Health Committee, 18 April 2006; c 2725.]

Implementing the Kerr report properly means giving most help to those most in need and using resources to maximum effect. However, if we are serious about doing that, bold choices must be made. We cannot continue to pour money into making the healthiest healthier while my constituents are dying in their 60s—indeed, too many of them do not even make it that far. This week, members will have seen figures highlighting the persistently poor infant mortality rates in some deprived areas.

Further—and this will be difficult for some people to hear because of the positions that they have held—implementing the Kerr report properly requires us to address the complete disgrace that is the Arbuthnott formula. I understand that the work on the review of the Arbuthnott formula has been delayed—given the sensitivity around the issue of redistribution, I suppose that that is not too surprising. I await the outcome of those discussions with interest.

I repeat: if we are serious about tackling health inequalities in Scotland, bold decisions need to be taken.

Dennis Canavan (Independent, Falkirk West)

Earlier this week, NHS Forth Valley made an important announcement about plans for a new hospital in Larbert. That modern, state-of-the-art hospital will cost £300 million and will have about 800 in-patient and day-patient spaces, providing a range of acute services for people in the health board's area.

I warmly welcome the fact that the plans are on schedule for work on the site to begin early next year and for the new hospital to open in 2009. The design of the hospital looks good and it will be located in an excellent environment, in the spacious grounds of the former Royal Scottish national hospital.

However, I am not happy about certain aspects of the health board's announcement. I am concerned about the fact that many of the employees in the new hospital, including porters, catering staff and cleaning staff, will be employed by a private company rather than by NHS Forth Valley. At present, the dedicated NHS employees in those positions give such a quality of service that they have won national awards for catering and cleaning standards. I fail to see how a private company won the contract for that work unless it is intent on cutting wages or cutting the number of employees. That could threaten the standard of patient care, which is dependent on staff morale and the employees' team spirit.

I am also concerned about the apparent assumption that the new hospital will be a private finance initiative project. Last Friday, I and some parliamentary colleagues met board members and officials of NHS Forth Valley. We were told that a decision on the method of funding the hospital will not be taken until later this year, yet according to the press release that the health board issued on Tuesday of this week, Mr Richard Weston, the managing director of Equion, said:

"We are delighted to have been awarded this project, which is the largest PFI hospital in Scotland."

That company or consortium—whatever we call it—has a dodgy track record in PFI projects, including alleged profiteering from the refinancing of a hospital south of the border. Past experience shows that PFI does not represent best value for money. The number and cost of PFI projects could be a millstone around the necks of future generations of taxpayers for many years.

The NHS was founded to serve the needs of the people, not to line the pockets of profiteers. Yes, we need new, modern hospitals for the 21st century, but surely there is a better way of financing the building programme in the interests of patients, NHS employees and taxpayers. I therefore urge the Scottish Executive to think again.

Helen Eadie (Labour, Dunfermline East)

I begin by reminding members how many people work for the health service throughout the United Kingdom. I believe that it has more than 1 million employees. For our ministers, both at the United Kingdom level and here in Scotland, managing the process must be like turning the Titanic around on a sixpence.

As my colleague Mary Mulligan said, 90 per cent of health care is delivered at the primary care level. The challenge is to move health care services even further into primary care rather than simply continuing to think that services can only be delivered in hospitals. I remind Sandra White, in particular, of that point. Her mindset seems to be that we can deliver services only in the hospital environment. There are some essential services that must be delivered in hospitals, but we must open our minds to ways in which we can deliver more services in local communities.

I welcome Margo MacDonald's comments on the Long-Term Conditions Alliance Scotland. Like her and other members, I have worked with a number of organisations—including the Skin Care Campaign and organisations that are concerned with musculoskeletal conditions, rheumatology and osteoporosis—and tried to help them to highlight chronic conditions. We need to pay more attention to those organisations' concerns. That challenge is in the Kerr report and it also comes across in the briefings that were sent to us by the Royal College of Nursing and Age Concern. In dealing with chronic conditions, demographic changes are the biggest challenge. We need to think about how the reform of prescription charges is going to pan out, given that the minister's consultation on the matter is coming to an end.

Eleanor Scott said that we should focus on the delivery of services rather than simply debating the Kerr report. I will highlight a few things that are happening in Fife. When I picked up a publication from the National Rheumatoid Arthritis Society recently—I promise that I had no hand in preparing it—I was delighted to learn that it cited Fife NHS Board as the best example of good practice in the UK. The board was commended for the way in which it delivers rheumatoid arthritis services much closer to people in the community. I am sure that the minister and others will also be delighted to hear that. We need to think about taking more services out of the hospital environment and into local communities. Throughout Fife, the aim has been to deliver services as close as possible to people's homes.

Another example of good practice that was highlighted in the Kerr report is the Leith medical centre, which is a model urban community hospital that could be replicated elsewhere. In my constituency, at Dalgety Bay and Inverkeithing, I have what is perhaps the biggest general practitioner practice in Scotland, which is striving to deliver services more locally, outwith the hospital environment. Simple procedures for which people previously had to go to hospital are now carried out locally.

There is yet more progress—I am not ashamed of mentioning all these examples of good practice. In the Kerr report, the workforce planning inquiry and elsewhere we heard about how many of our students were ending up in Manchester rather than here in Scotland. A lot of our students were lost to Scotland forever because they were trained in Manchester, but I am delighted that we now have a really good set-up. Medical students no longer automatically go to Manchester but are trained in our own backyard at the Randolph Wemyss memorial hospital in the Buckhaven and Methil area.

Fife is in the vanguard of delivering digital imaging services. When people go for X-ray treatment they can now access the service not just locally, in Fife, but—

Margo MacDonald (Independent, Lothians)

I accept that Fife is fabulous, but given that there are GP surgeries, walk-in services at hospitals and complementary services, how are the funding streams straightened out?

Helen Eadie (Labour, Dunfermline East)

In Fife, we are addressing that problem. The social work department and the health board have a joint approach and a joint agenda for the future in Fife. They are tackling the issue of the funding streams. I was interested to hear what is happening in other areas. It seems so straightforward. We get the people who have the budgets, sit them down and tackle the issues. There is a lot to learn from the Fife example.

Technology is vital. I do not often cite things that have been done by members on the Opposition benches, but yesterday I attended a very good briefing that Shona Robison—who is not here this morning—organised on a new machine for cancer treatment called CyberKnife. Apparently, there is not a single CyberKnife machine in the UK, even though there are such machines in the Netherlands and throughout Europe. I am told that the best example of their use is in northern Italy. I appeal to Scottish and UK ministers to seek a briefing on CyberKnife. However, I am delighted that Ninewells hospital in Dundee is leading the way on new photodynamic therapy treatments for cancer.

Coming back to Fife, our catering service has been returned in house and is no longer provided by external contractors. It is tremendous that we have that in-house service.

Eleanor Scott made a good point about play improving people's health. There are more swimming pools in Paris than in the whole of Scotland. Joined-up working by the Scottish Executive is essential. We need many more swimming pools because the therapy of being in a swimming pool is superb for elderly people, people with mobility problems and people with chronic conditions. I am sure that Dennis Canavan, as convener of the cross-party group on sports, would agree that we need a great expansion in the number of swimming pools throughout Scotland.

Adam Ingram (Scottish National Party, South of Scotland)

In my contributions to previous debates on the Kerr report, I acknowledged that most, if not all, of us can agree with the prescription that Kerr gives us for the reconfiguration of the NHS in Scotland. We want to move away from a reactive system that is geared up to provide a crisis intervention service to a system that prevents medical crises from arising in the first place. The provision of continuing care in the community will be the key to such a transformation, particularly for the growing number and proportion of elderly patients.

How we get from where we are to where we want to go is fraught with difficulties, not least of which is the poor performance of health boards in making the case for change and bringing patient and public opinion with them as they develop proposals. The Kerr report highlights the need to meet patient expectations and build public trust, but the public is losing confidence in the NHS because of creeping centralisation and specialisation. People are willing to travel for highly specialised surgery, but they want core services, such as accident and emergency services, to be close to home. A and E units are the safety nets in a crisis intervention system and their proposed closure is bound to cause public alarm.

The consultation exercise on NHS Ayrshire and Arran's review of emergency and unscheduled care presented only variations of a preferred option, all of which entailed the closure of Ayr hospital's specialised A and E unit. NHS Ayrshire and Arran's approach offered a model of how not to conduct a consultation exercise, although the board claimed to have followed to the letter the Executive's guidelines on public consultation. If that was so, the guidelines are deeply defective and utterly fail to ensure public engagement with the change process. Even if one accepts the need to centralise specialised A and E services, what justification can there be for not presenting an option for centralisation of such services at Ayr hospital, which was deemed feasible in the options appraisal exercise? Given Ayrshire's geography, that option would minimise inconvenience to the public. I urge the minister to consider the mess that NHS Ayrshire and Arran has made of the public consultation. The matter must be revisited if we are to restore a semblance of public confidence that the future of the NHS is in safe hands.

The minister should focus on how to deliver community-based services before he approves radical surgery to specialised A and E units. If public support for the direction of travel that Kerr advocates is to be generated, the Executive must take time to build capacity for home care for the elderly, community casualty units and the extra specialist staff that the NHS needs. The minister should not allow health boards to force him to make hasty decisions for which a heavy political price must surely be paid.

David Davidson (Conservative, North East Scotland)

The debate has been interesting, because members have promoted ideas and set challenges for the Executive, which I think was Margo MacDonald's intention when she started her speech. She said that people must take personal responsibility for their health, because they are on a lifetime's journey. However, if people are to do that, they must have education. Parents must understand how to educate their children so that they are tooled up to assume that responsibility.

I am worried about long-term alliances, because we had a little difficulty with the Scottish cancer coalition. The coalition was a great idea and most MSPs turned up for its launch, but it has been pretty quiet on the ground and I wonder whether it enjoys much independence. There must be a joined-up approach to using the voluntary sector to supplement or develop services, which might mean that the voluntary sector should be given contracts to do its work. Such an approach might enable standards to be set but would require reasonable funding.

John Swinney, who is today's substitute striker for the Scottish National Party, mentioned a couple of interesting issues, of which clinical safety was the most important, because clinical safety should be the basis on which services are designed. In that regard, A and E services should be designed on the basis not of geography but of the time that it takes to reach a unit. The odds of someone to the north of Stirling who is in a critical condition getting an ambulance all the way to Larbert in time are pretty remote. We must ensure that A and E planning takes account of the emergency nature of A and E.

John Swinney talked about the misuse of centralisation. The minister appoints health board chairs, so a variation in performance is very much at the minister's door and should be dealt with by him.

Nanette Milne talked about workforce planning and recruitment and retention. She said that we need clinical generalists, which is a matter that Dr Jean Turner has raised in the past.

We support CHPs, but they must be regarded as joined-up organisations and not just a group of people who sit round a table, each with their own budget. As I said to Euan Robson, what happens if a patient falls between two budgets? We must be brave and amalgamate budgets, to eliminate the nonsense of double handling and ensure that patients do not fall through the gap.

When Malcolm Chisholm was the Minister for Health and Community Care, I told him that the debate should be about who can do what, rather than who does what. We must consider upskilling different health professionals. Susan Deacon supported an increased role for pharmacists. Specialist nurses can also take on increased roles, because most nurses have degrees that include a specialism. Such nurses are an important asset, because doctors do not have to do everything.

We must ensure that we have a good network of local general hospitals, which are key to the whole approach—that is a major theme of the Kerr report. If there is to be specialisation, we must decide what should be specialised, where specialised services should be available and to what standards such services should operate.

Margo MacDonald (Independent, Lothians)

Adam Ingram said that it will take time to change the attitudes of the public and patients to the redesign of services, so the minister should not quickly chop off services with which people are familiar. Does David Davidson agree?

David Davidson (Conservative, North East Scotland)

Yes. However, the key to that is consideration of what we mean by consultation. If we want the public to come on board and play their part, ministers and health boards must listen and there must be reasonable consultation.

In the case of Ayr hospital's A and E unit, in which John Scott has been heavily involved, some 55,000 people signed a petition and 5,000 went on a march, which indicates people's anger and frustration that, despite the consultation, apparently nobody had paid a blind bit of notice to their angst. Similar situations have arisen in relation to maternity services at Aboyne hospital and Fraserburgh hospital. There is disunity between thinking in the health service and public opinion and we must bridge the gap. That will require leadership.

Eleanor Scott talked about removing silos. During many debates in the Scottish Parliament, people have talked at length about the roles of education, social work and health services, yet the ministers with those portfolios seem to operate in silos—I say "seem" because that is the perception; if joint working is going on behind the scenes, we should tell the public about it.

Like other members, I attended yesterday's presentation on the CyberKnife. We should consider such innovations, but they cost money.

Duncan McNeil was right to talk about the support that is offered to different parts of society. Health inequalities exist, but much can be dealt with by education and a will to move away from a sticking-plaster service towards an approach that is based on health promotion and disease prevention.

The independent MSPs asked for ideas and I am sure that many people have ideas. We do not use statistics properly. Because we do not gather or make available the right statistics, we do not do proper forward planning on staffing and other matters. If we do not plan, our approach can only be piecemeal.

If we are to move forward, we must take the public with us. There is a place for the consumer and the potential consumer in the redesign of health services, which affect everyone's family. I welcome the tone of the debate. We must ensure that we plan efficient, focused services that can be delivered. The public must feel that they have ownership of such services.

Christine Grahame (Scottish National Party, South of Scotland)

This has been an interesting debate. My remarks will jump around a bit because I want to deal with what several members have said.

I could not agree more with what Margo MacDonald said about people taking more responsibility for their fitness and health. However, in Penicuik, for example, the leisure centre is under threat of closure. That example links into what has been said about silo mentalities. Last night, a meeting was attended by 150 people—young and elderly—who were desperate to keep the centre open. The centre helps to keep them fit, keep them out of trouble and keep their minds alert. Such things are happening on the ground as a result of local authority cuts. The Parliament provides substantial budgets to local authorities, so members must consider such matters. Local authorities are making cuts, leisure centres are being closed and there will be an impact on the health programme. Cross-cutting work is therefore not happening.

I will deal with John Swinney's interesting remarks later. I will visit the Tayside model—I wish that I had done so before—and take Borders NHS Board representatives with me. The ethos at Hay Lodge hospital in Peebles is to combine a GP unit, nursing beds and a cottage hospital, but it is a pity that such an approach is not taken elsewhere. I will touch on what is happening in Jedburgh and Coldstream later.

Euan Robson, Margo MacDonald, David Davidson, Helen Eadie and others mentioned issues to do with silo mentalities. I do not know how the cycle can be broken, although we have all said that doing so would be common sense. Social work departments, health boards and local authorities defend their budgets, but people who have been assessed as being able to return to their communities are stuck in hospital beds that they cannot leave because social work departments do not have enough money to allow them to do so. By the time those departments have money, people become more institutionalised, have to be reassessed and end up back at the end of a queue. Human misery and costs result. We have been saying that for seven years.

Mary Mulligan (Labour, Linlithgow)

Does Christine Grahame welcome the approach of the CHP in West Lothian, which has brought together council and health board funding? One officer is responsible for overseeing matters, so no one can say that something is not their responsibility, and people are not kept in hospitals when that is inappropriate.

Christine Grahame (Scottish National Party, South of Scotland)

I welcome progress that is made anywhere. I cannot speak about what happens in the Lothians, but that approach is not being taken elsewhere—it is certainly not being taken in the Borders, where there is still competition for budgets. There is a patchy approach.

I am sorry that I got lost with John Swinburne's remarks on septuagenarians. I do not know whether he was directing them at me, although I do not think that he was.

I agree with Eleanor Scott. There are issues to do with having a target-driven approach, which distorts requirements on the ground—health professionals, too, are conceding that.

I got lost with Mary Mulligan's images of babies in the lotus position. I thought that they could adopt that position anyway.

Sandra White referred to an important point that the Kerr report makes. The report states that we must

"develop options for change with people, not for them, starting from the patient experience and engaging the public early on to develop solutions rather than have them respond to pre-determined plans conceived by the professionals."

I am afraid that the experience of many people who have gone to NHS board meetings is that the latter approach has been taken. They get the feeling that decisions have been made, that consultation is cosmetic and that people are not going with the grain of public feeling.

Helen Eadie (Labour, Dunfermline East)

Does the member agree that consultation does not necessarily mean saying yes to everything and that part of the problem is how to track changes and make transparent to the public what changes there have been as a consequence of consultations? To my knowledge, that has never been done.

Christine Grahame (Scottish National Party, South of Scotland)

That is another issue. However, in respect of the Borders, I knew ages ago that the hospitals in Jedburgh and Coldstream were set for closure and that the NHS board was simply working out how to present the case. That is the reality. People are not silly—everyone else involved knew that too. Such an approach is not in the spirit of the Kerr report and does not deliver what people want. I agree that people cannot have everything that they want, but if we go with the grain and listen to people, we will find that they sometimes have jolly good ideas about what should happen in their communities.

Duncan McNeil rightly talked about issues that have impacted on costs to the health service. Contractual and legal imperatives, whether we like them or not, have had an impact on costs. However, I say to him that the changes to health delivery in Scotland across the various levels should be clinically driven and driven by the various levels of treatment that are required and not by costs. That is a huge issue, as we are designing an NHS service for the next decade and more.

I completely agree with what Adam Ingram said about the poor performance of health boards, and I will knock Borders NHS Board again in that context. Adam Ingram picked up on the location of accident and emergency services. We agree with David Davidson that time is the issue. I refer to the golden hour. A person who is travelling to Ayr hospital for accident and emergency treatment may have to travel a long way. If the accident and emergency department is moved somewhere else, another half hour could be added to that person's journey. The critical golden hour in which lives can be saved represents the test for accident and emergency services.

Margo MacDonald (Independent, Lothians)

I think that all members want as many accident and emergency departments as possible so that people are given a feeling of comfort, but providing such services in rural areas is not possible in the way that it is in urban areas. In that context, the training of paramedic staff—who are the first people to reach patients—is all the more important and must be considered alongside the siting of accident and emergency units.

Christine Grahame (Scottish National Party, South of Scotland)

I have no difficulty with first responders, but the issue is having the appropriate level of treatment at the local level. It is not an either/or situation.

I want to compare the Tayside model with what has happened in the Borders. As Euan Robson and I know, 700 people marched in Jedburgh and 700 people marched in Coldstream, not necessarily to save a building but to save an appropriate service, particularly for elderly people in respite care or convalescing or people with chronic conditions such as asthma—I see that Euan Robson agrees with me. Those communities have made a proposal to have combined services, which will be on the minister's desk. In fact, GPs in Jedburgh had a model built up years ago in which there were social services and housing all within the GP complex and a cottage hospital.

In England, 100 cottage hospitals have been reprieved because people see the value of the level of treatment that they involve at the local level. People can travel to such hospitals, which can be right beside their houses. In areas such as the Borders, people, including elderly people, will have to get buses that do not yet exist—travel issues have not been resolved—or drive in their cars to visit elderly relatives. No wonder people feel how they do. It would be common sense to retain such hospitals. England—God bless it—has led the way in keeping cottage hospitals open, keeping people out of general hospitals and keeping beds free so that people are treated at the appropriate level. I hope that when the proposal in question lands on the minister's desk, he will reject Borders NHS Board's proposals on closing cottage hospitals.

Lewis Macdonald (Labour, Aberdeen Central)

There are many challenges ahead in responding to the Kerr report and in delivering on the change in focus of the NHS in Scotland, which we laid out in "Delivering for Health" last October. I welcome the proposition from Margo MacDonald and John Swinburne that the debate should not focus on the negative but emphasise the positive, and I want to respond in that spirit.

Of course, the challenge is not only for ministers or the NHS—it is for all of us. As Mary Mulligan said, if we are to deliver the type of health care that Kerr envisaged, we must move away from the overwhelming emphasis on acute care delivered in hospitals to in-patients that characterised the NHS's first 50 years, and towards a wider emphasis on delivering care to people through improving health across the board.

Margo MacDonald asked about our willingness to work with voluntary sector organisations that represent people with long-term conditions. We very much support such work. For example, we are working with Asthma UK Scotland on plans and clinical standards for children with asthma; we are working with Epilepsy Scotland on the development of managed clinical networks—we have recently provided funding to it; we are working with Voices of Experience, or VOX, to give voice to users of mental health services; and we are working closely with Diabetes UK to refresh the Scottish diabetes framework. We regard the voluntary sector, which represents and talks to and for users of the services, as a key partner in a number of ways.

Several members have mentioned the secondary care sector. The Kerr principles lay out a national framework for service change. That framework does not provide excuses for easy decision making; rather, it sets criteria against which changes must be designed and justified. That is a process that all parties should welcome. The real laziness is in saying that, in spite of those principles, change should always be opposed. We cannot accept the principle of specialisation where it is needed and yet find no case for ever changing anything in real terms.

Christine Grahame (Scottish National Party, South of Scotland)

At what point in the debate did anybody say that?

Lewis Macdonald (Labour, Aberdeen Central)

At what point in the debate did I suggest that that had been said? Let me be clear. There are principles according to which service changes must be justified, and I reject the proposition that no changes should ever happen. Services should be delivered as locally as possible, but they should be as specialised as is necessary. That is why, since the debate last October, we have carried out further work to establish which services need to be concentrated in fewer centres. I emphasise the fact that the default position is the local provision of services.

Several members have referred to the need for proper consultation. The Scottish health council was established last year to act on behalf of ministers in ensuring that the proper processes for public consultation are followed. That is the assurance that we have. The members who referred to those processes will be aware of that and will know that the Scottish health council's views are considered by local health boards when they are making their recommendations as well as by ministers once those recommendations have been brought forward.

The emphasis under the Kerr report will be on keeping people healthy for as long as possible. Improving the health of Scotland in the longer term requires effective action, such as the ban on smoking in public places and our proposals on the promotion of better nutrition in schools. It also requires us to address the issues to do with inequality that were raised by Duncan McNeil. The prevention 2010 pilot projects will have a key role in developing new models of anticipatory care to increase the rate of health improvement in our most deprived communities through the provision of enhanced primary care services and through picking up early what otherwise might turn into serious long-term conditions.

When people develop a long-term condition, we want to slow its progress as much as we can, to reduce complications and to help people to cope with that condition. As I said at the outset, we also want to work with users and carers, who know more than anybody about the nature of those conditions and what it is like to live with them. That is a key task for the Long-Term Conditions Alliance Scotland, whose launch Andy Kerr supported a couple of days ago. When the disease process cannot be halted, people should have the best possible care as locally as possible. Our review of community nursing and the development of the rehabilitation framework underpin that aim.

Our work on neurosciences has shown that even specialised services must have a strong base in the community. That is why we need to see our neurosurgical units as part of a neurosciences service for the whole of Scotland, which involves developing a local tier that is designed to give people the ready access that they want to neurological opinion.

The services that people get must be personal and should be integrated so that all health care and other care that people receive work together. The community health partnerships are the key agencies in delivering that, and schemes of establishment for those have now been approved in most areas. Through the CHP development group, we will continue to support those developments. Likewise, the funding that we are providing for primary care premises is designed to encourage the co-location of services wherever that is possible.

David Davidson (Conservative, North East Scotland)

On the subject of the CHP development group, is any work being done to establish where services should be combined into one organisation with one budget, rather than having an agreement to share money?

Lewis Macdonald (Labour, Aberdeen Central)

The joint future programme that is going forward as we speak is very much about encouraging the alignment of budgets and the sharing of premises. Indeed, in some local areas it has involved joint appointments of staff by health and local authority services. That provides us with the right direction forward in those areas.

We have developed a long-term conditions toolkit for CHPs to use in working with people who have long-term conditions. We also recognise the need to support those people in our communities who have complex needs. That involves developing services that focus on the patient and ensure that all the relevant professionals are able to provide the necessary service.

We are taking forward the delivering for health programme and we are delivering on a whole range of issues, including many issues that have been raised today on which there is no time to respond. That approach is central to the development of public services in Scotland. We want to focus on people as people rather than as patients or carers, and we want to provide services that are personal and address all those people's needs. As I said at the outset, the emphasis must be on the positive aspects, recognising that the more successful we are in maintaining people's lives, the more people will live with long-term conditions. We need to work across the board to ensure that people can enjoy the best quality of life in those circumstances.

Jean Turner (Independent, Strathkelvin and Bearsden)

I thank the minister for what he has said. It is obvious that we are all singing from the same hymn sheet. We all want to put people first and we should be grateful that Professor David Kerr was asked to produce his report, as he stopped the juggernaut that was, for years, the only plan to solve every problem in the Scottish health service—the centralisation of services in Inverness, Aberdeen, Dundee, Edinburgh and Glasgow. That would not suit our geography or our population. John Swinney emphasised the different requirements in different parts of his constituency and the importance of establishing a balance between the need for centres of excellence and the need for local access.

As a former general practitioner—members will know that that is my professional background—I know for certain that 90 per cent of health care work is done in general practice. That is where most general practitioners, nurses and allied health professionals want it to be done. However, buildings can create difficulties in certain areas. I worked in a health centre that was built in 1982 but which by 1990 was not fit for purpose. Medicine moves on and there must always be changes.

Another point to emphasise is that people do not understand exactly what general practitioners and primary care professionals do. Many of the things that people think are new in general practice have already been done. We have been running clinics for chronic conditions such as asthma and cardiovascular disease. If we want to put more into general practice, we must take on board what Nanette Milne said about workforce planning. It is essential that we have a bigger workforce. I know that there is a huge wage bill, but we need specialist nurses for diabetes, lupus and psoriasis and to provide allied arthritic care. I would like to hear that more specialist nurses are being trained who will enter the workforce further down the line. There seem to be a lot of qualified people out there who could be doing a more wonderful job for the patient.

The most precious thing that a health care professional can give a patient is time. In order to think and make the right diagnosis, everybody needs time. Patients love that and will be prepared to wait weeks to see the same doctor. Providing many different professionals does not always solve the problem for the patient. We should listen to the patient.

John Swinburne mentioned deprivation. It is accepted that there are more hospital emergencies in areas of deprivation. If GPs do not have time to think about how they wish to place their patients, there will be more hospital emergencies.

It has always been the case that 80 to 85 per cent of the work of a large major hospital is done in the out-patient department. We welcome all the ambulatory care and diagnostic units that there are around, especially in our city, but in effect they will doing everything that can be done in a day unit and I think that that will involve split-site working, despite the intention of the European working time directive to put all the doctors into one hospital—or three. There will be hospital units in which out-patient work will be done and there will be split-site working. The doctors will therefore have to consider rotating as they did in Glasgow to keep the casualty department open.

There is a general misconception that A and E departments deal only with accident and emergency cases; people do not think about trauma. A lot of the changes that have taken place have been due to the desire to have combined accident and emergency departments and trauma units. That is why the number of trauma units has been reduced in Glasgow and elsewhere. We know that we can get people to trauma units by helicopter, but it is much better to stabilise people near to where their accident happened and then transfer them. Some cases will require a helicopter, but they are very expensive and the skies will be buzzing with them if everyone has to get to the trauma unit as fast as possible.

The Government is doing a lot of good work on prevention through its work on healthy eating in schools and encouraging children to play in the playground—that exhibition about children and play in the garden lobby was wonderful. As Eleanor Scott said, it is astonishing that there are 80 acres of golf course to 1 acre of playground. The swimming pools that used to be all around our cities were all closed because they were all neglected. The Victorians were pretty great at knowing what we needed, even though we had other problems, all those years ago. Many swimming pools were closed and we have had to build news ones, but we do not have enough. Aquatherapy is important.

We also need more physiotherapists and allied health professionals. When we are making any changes, we should consider that change should not be for its own sake; it should provide at least the same service or a better one. I would like us all to consider that.

We sit in front of a mace on which are written the words "wisdom, justice, compassion, integrity". When he accepted the mace from the Queen, Donald Dewar said

"Timeless values. Honourable aspirations for this new forum of democracy, born on the cusp of a new century.

We are fallible. We will make mistakes. But we will never lose sight of what brought us here: the striving to do right by the people of Scotland; to respect their priorities; to better their lot; and to contribute to the commonweal."

We all have that in our hearts and I think that the Scottish Executive has it in its heart. However, it needs to listen to more frontline managers, perhaps get rid of some targets, do more monitoring, and think and plan ahead.

Crown Appointments

Trish Godman (Labour, West Renfrewshire)

The next item of business is a debate on motion S2M-4380, in the name of Donald Gorrie, on behalf of the Procedures Committee, on its second report in 2006, on procedures relating to Crown appointments.

Donald Gorrie (Liberal Democrat, Central Scotland)

Thank you. I am happy to be moving the motion on behalf of the Procedures Committee.

I emphasise that the committee was asked to look at a very narrow aspect of the commissioners and their role—their reappointment. Since then, other committees and groups have become interested in the cost of the commissioners, whether we need so many, their remits and so on. The committee had nothing to do with any of that. Our report is only a small part of the overall picture. However, because of those other interests we will not press any of our recommendations, other than those on the standing orders. We will lay our recommendations on the table and push for them at the right time during the overall discussion.

The changes to standing orders on which members are being asked to vote are relatively minor. They will tidy up the system of reappointment and lay down rules that will enable the Scottish Parliamentary Corporate Body to bring whatever reappointment system is adopted to Parliament to be voted on. The same rules on the length of debates, majorities and so on will apply to appointments and reappointments.

We propose to delete two rules because they already exist in the Scotland Act 1998 or in the Scottish Parliamentary Standards Commissioner Act 2002. We do not see any point in having a standing order that just replicates a bit of an act. Whatever views members have on other aspects of the commissioners, I hope that the proposed new standing orders will receive general support.

For our report, we were asked to consider a number of different issues, the first of which was how to reappoint commissioners. Taking the approach of the Eurovision song contest, I say that the third and least popular proposition was that we just pat the incumbent on the head and tell them to carry on. That proposition received nul points.

Coming in second was the proposition that we rerun the initial competition. If a commissioner wanted to be reappointed, they would have to fight for their place against allcomers. That proposition was supported by Bruce McFee, who no doubt will speak with vigour and eloquence on the subject.

The remaining six members of the committee supported what we might call the middle road—a reappointment process that rigorously scrutinised how the incumbent had performed through a proper grilling by the SPCB. The difficulty is that if the commissioner's strength lies in the fact that they are entirely independent, how do we evaluate how well they have done? We grappled with that question for a long time and came to the conclusion that we should have an assessor who is knowledgeable about the commissioner's work to advise the SPCB on how the person had performed against the job specification and the legislation that set up their position. The assessor would not judge individual cases, but they would judge how well a person had performed in managing their operation, and they would provide advice to guide the SPCB's vigorous grilling of the commissioner. Six members of the committee thought that that was the best way forward, and I hope that it will be pursued.

Alasdair Morgan (Scottish National Party, South of Scotland)

I do not know if I missed this point in the committee's report, but I cannot recall reading it: if a commissioner's reappointment is going to be turned down because they have received an unsatisfactory performance report, should not their bosses have warned them during their four or five years of tenure that their performance was becoming unsatisfactory, to give them a chance to remedy it? That is what would happen with a normal position. People do not suddenly get told that their performance is unsatisfactory and they are going to be dismissed. How do we get round that particular employment law problem?

Donald Gorrie (Liberal Democrat, Central Scotland)

That is an important point, and I should have mentioned it. The committee discussed and agreed that more use should be made of the annual report that the commissioner is supposed to make. The relevant committee would question the commissioner on their annual report and obvious dissatisfaction would be made apparent. That would address Mr Morgan's point. I think that the report covers the issue but, if it does not, it is certainly one of the points on which we were keen.

We have tried to find what we think is a sensible route. It is difficult to attract very good people to these arduous jobs that might last for only four or five years. It would be easier to attract people to the jobs if they knew that, as long as they were performing well, they would get eight, nine or 10 years in the post. That had to be balanced against an open competition.

Bruce McFee (Scottish National Party, West of Scotland)

Donald Gorrie assumes that even if the person is doing a good job and is the most suitable candidate, they would not be reappointed in an open competition, but presumably they would get the job for a second term if they were the best person for it.

Donald Gorrie (Liberal Democrat, Central Scotland)

Somebody even better might apply. The person in post might do well, but there might be somebody who the appointing committee feels is even better. There are difficulties in any approach to this issue, but the committee feels that its proposition is the fairest.

I will deal briefly with other points that the committee was asked to consider. We are totally against third-term reappointments, unless in very exceptional circumstances. On the removal of Crown appointees, the committee feels that the existing rules are adequate and that we do not need more of them. However, we made one minor point about voting thresholds: they are marginally different for different commissioners and they should be tidied up.

Margo MacDonald (Independent, Lothians)

Just before Donald Gorrie summarises, will he tell us where the consumer's voice comes into this? At the moment, it appears as if we are Pooh-Bah and we do it all, yet there is supposed to be an ombudsman who responds to public complaints.

Donald Gorrie (Liberal Democrat, Central Scotland)

We are keen that they should be able to respond to public complaints without coming under pressure from us, but I do not think that there is any way of having a sort of plebiscite on whether a person should be reappointed. The situation would be dominated by two or three people who were not satisfied with a particular decision.

I want to make one other point about independence. Some rules allow the Parliament or the SPCB to give directions on the form and content of the annual reports of commissioner-type people. The committee feels that those rules should not be in place. They should be changed in due course and, until they are, the Parliament and the SPCB should not press the point. The independence of commissioners is key.

Members are not voting on such issues today, but I am presenting the Procedures Committee's report to Parliament. I hope that members will support the suggested changes to standing orders.

I move,

That the Parliament notes the Procedures Committee's 2nd Report 2006 (Session 2), Procedures relating to Crown appointments (SP Paper 515) and agrees that the changes to Standing Orders set out in Annexe A to the report be made with effect from 19 May 2006.

Bruce McFee (Scottish National Party, West of Scotland)

As Donald Gorrie suggests, the Procedures Committee's report was wide-ranging and it has been narrowed down to one proposal on changes to standing orders on the reappointment of Crown appointees.

I am aware of the Finance Committee's report on the accountability and governance of commissioners, and of the clear impacts that it had on the Procedures Committee's inquiry and report because of the crossover points. I hear the different views on how this Parliament should ensure that commissioners and ombudsmen are performing their duties well and stewarding public money properly. It is correct that we have a debate. However, the Procedures Committee's report accepts that such assessments should be a continuing process rather than a single event towards the end of a commissioner's term of office. Of course, we must always ensure that a commissioner's independence is not infringed. Those issues will take time to digest before recommendations can be made.

One issue of which I am certain is that the assessment process—whatever form it takes—should not prevent this Parliament from ensuring that it has the best available person for the job. Unfortunately, the proposed changes to standing orders will prevent that. They will, at a stroke, hand to the SPCB the ability to refuse to advertise a position, to refuse to seek or accept applications, to permit only one individual to apply—namely the present postholder—and to abolish competitive interviews. At the end of the process, everyone will express their surprise when the present postholder is reappointed.

There is no doubt about what will happen: the closed process will be followed by the SPCB. Time and again, the SPCB has told us that that is what it wants to do. It wants a non-competitive administrative process to reappoint commissioners. That is exactly the process that it used in the one opportunity that it had: there was a non-competitive interview.

During our inquiry, the Procedures Committee was never told about the drivers for change or about why we must adopt a closed-doors, non-competitive, shoo-in procedure. First we were told that the reason was cost. Then we were told that it was not cost but expertise and continuity—only for us to discover that, if the existing postholder possessed the appropriate level of expertise and other attributes, they could go forward to a competitive interview. Then we were told that a five-year term would deter people from applying in the first instance. Not a single scrap of evidence was provided to support any claim.

However, thanks to Donald Gorrie today, we now know why we need a non-competitive, closed-list, one-application-only procedure: it is in case there might be somebody "even better" for the job. What a wonderful principle on which to base reappointments to posts—"For God's sake, don't open it up to competition, because we might get somebody who's even better." Not a single scrap of evidence was provided to the committee to demonstrate why a change to a non-competitive administrative reappointment process was required, or why such a process was more desirable than an open and competitive process. We were told that cost might be a reason—it could be around £20,000 for the full process—but I submit that that is nothing compared with the millions of pounds that are spent by commissioners and ombudsmen.

A principle must be upheld any time this Parliament makes an appointment or reappointment: the best candidate must get the job. That principle will be sacrificed if the proposed changes to standing orders are accepted. Not only will it leave us open to charges of offering jobs for the boys and girls, it will confirm that things are not done differently here and that, in the brave, new Scotland, positions are protected and challenge is not permitted.

Reappointments should be honest, open and competitive and should be aimed at driving up standards, not at accepting mediocrity simply because we do not want to rock the boat.

Alex Johnstone (Conservative, North East Scotland)

Bruce is a hard act to follow. Throughout this whole process, he has been persistent in taking his isolated line.

Bruce McFee (Scottish National Party, West of Scotland)

Will the member take an intervention?

Alex Johnstone (Conservative, North East Scotland)

A very brief one.

Bruce McFee (Scottish National Party, West of Scotland)

Does the member agree with Donald Gorrie that we do not want to open up the reappointment process to competitive interview because there might be somebody even better?

Alex Johnstone (Conservative, North East Scotland)

No, I do not, and I do not think that that is what Donald Gorrie meant either.

Throughout the process, Bruce McFee, representing the Scottish National Party, has taken the view that we have been discussing some kind of automatic reappointment, but never at any stage did the committee believe it was talking about that. The request for us to consider possibilities for the process of reappointment for a second and possibly a third term was reasonable. Having considered the possibilities, we believed that it was reasonable that, if the right person was in the job and was doing a good job, they should expect to have a route by which they could be reappointed for a second term.

Bruce McFee (Scottish National Party, West of Scotland)

Will the member take an intervention?

Alex Johnstone (Conservative, North East Scotland)

No, not at the moment.

We went on to decide that third-term reappointment was inappropriate and that, in order to deal with any difficulties in appointing a replacement at the end of the second term, there should perhaps be limitations on the time of the second term, to allow some flexibility.

The one concern that the committee got bogged down in reflects the very point that Bruce McFee is most concerned about—that is, how we assess the quality of the person who is in the job so that we can decide whether it is appropriate for them to continue. That is the issue on which the committee found itself slightly at odds with the SPCB representatives who gave evidence. Yes, it is essential that the performance of incumbents is rigorously assessed, but how do we decide whether they have done the job appropriately and well, and how do we decide whether they are worthy of entering the reappointment process?

The corporate body seemed to think that it was in a position to make that assessment, and it may well be qualified to do so, but we disagreed, because there must be a truly unbiased, independent and non-political way of determining the performance of office-holders. We all know that we will disagree with decisions that they make, often for fundamentally political reasons. That should never be a reason for us to object to their holding their jobs. The competence and independence of those people is key, which is why we came to the rather clumsy but inevitable conclusion that an assessor has to be involved in the process. Although the corporate body resisted that idea, we have insisted that someone should have that role.

I turn to some of the other proposals. As Donald Gorrie said, a number of suggestions emerged as a result of the committee handling the SPCB's request. We have indicated that, at some time in the future, primary legislation might be necessary to end the possibility of reappointment for a third term; to standardise the procedures relating to the removal of postholders and the reasons for such removal; and to take away the power to direct the Scottish public services ombudsman on the nature of reports. Perhaps there should be independence on that.

Bruce McFee (Scottish National Party, West of Scotland)

Will the member give way?

Alex Johnstone (Conservative, North East Scotland)

No.

I am keen to hear the views of members and the Executive on whether the Executive could introduce legislation to deal with those matters or whether a committee bill—which would enable the committee to make decisions about how to proceed—is likely to be necessary. I await their responses with interest.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

I am pleased to take part in the debate. I suppose that it is unusual for a committee member to acknowledge that the Executive will not accept all the committee's recommendations. As both the convener of our committee and Alex Johnstone mentioned, we hope to be able to address that situation later in the session by introducing a committee bill to deal with some of the issues that we uncovered in the course of our inquiry into the reappointment of Crown appointees.

As other members have said, some time ago the Presiding Officer asked the committee to examine the issue in detail. Bruce McFee said that the reappointment process should be open, honest and above board, but I do not agree; it must be open, honest and above board. There is no room for any doubt. The process must also be seen to be open and honest by members of the Parliament, the public and the office-holders concerned.

Bruce McFee (Scottish National Party, West of Scotland)

Will the member give way on that issue?

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

I will move on. [ Interruption. ]

Murray Tosh (Conservative, West of Scotland)

Order. Mr McFee, the member who is holding the floor is not giving way.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

Thank you for your protection, Presiding Officer.

The committee was asked to consider the possibility of crown appointees being reappointed and the introduction of procedures to deal with that. It was also asked to determine whether standing orders could be amended to specify the special circumstances under which it would be possible to reappoint some Crown appointees for a third term and whether a parliamentary mechanism could be introduced to facilitate the removal from office of Crown appointees. Those are all important issues.

As well as taking evidence, committee members brought their experience as parliamentarians to bear on how matters should proceed. We felt strongly that reappointment should not take place automatically and that an office-holder should be able to demonstrate that they have carried out their job confidently and ably and in a way in which we would have wanted it to be done.

Bruce McFee (Scottish National Party, West of Scotland)

According to the letter from Margaret Curran that was distributed yesterday, the Executive does not accept the requirement for a second assessment. If a commissioner who is up for reappointment receives a good assessment that says that he has done his job well, on what possible grounds could that individual fail the subsequent interview?

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

We will have to wait for an answer on that and talk the matter through. In our report, we mention that there must be a mechanism to allow someone to be removed from post, as well as a way of measuring how an individual has carried out their job.

I hope that the Executive will find time in the parliamentary timetable to deal with those issues, because it is important that we get the process right. Although the present number of Crown appointees is manageable and the existing legislation can cope, we must ensure that we adopt a uniform approach to all Crown appointees terms of office and to how they can be reappointed or removed from office. I hope that the Executive will welcome the adoption of such an approach as being in the interests of the good management of its organisation, of the Parliament and of public office-holders, who are accountable to the people of Scotland.

The Procedures Committee has given the matter a great deal of detailed consideration. We believe that it is important to put in place a mechanism that allows us to deal with the necessary processes in the coming months, which are galloping towards us. We should agree to the motion in the name of Donald Gorrie, which seeks to put in place an administrative mechanism that will ensure the good and smooth running of the Parliament.

John Scott (Conservative, Ayr)

On behalf of the SPCB, I thank the Procedures Committee for undertaking such a comprehensive review of Crown appointees who are nominated by the Parliament. Throughout the committee's inquiry, the SPCB provided written and oral evidence and we are grateful to the committee for allowing us to do so.

The SPCB invited the Procedures Committee to consider changes to standing orders that would allow reappointments to be made and would clarify the special circumstances under which it would be possible for an office-holder to be reappointed for a third term, if that was desirable. The committee was also asked to assess the extension of standing orders to allow for the removal of those office-holders who are not already covered.

In general, the SPCB welcomes the recommendations in the committee's report and we will consider how we can give effect to most of them as soon as possible. In particular, we welcome the conclusion that the Parliament should adopt a largely administrative reappointment process, as part of which office-holders would be subject to a panel interview conducted by the SPCB. It is already the case that an assessor is appointed to oversee any interview process to ensure the probity of reappointment proceedings.

We note the committee's recommendations that, prior to interview, an independent assessor should be appointed to undertake an appraisal of the office-holder's performance against a published set of criteria and that a report should be sent to the SPCB. We are considering the mechanics of introducing an appraisal process because we acknowledge that by introducing one not only would the SPCB be provided with an independent and comprehensive picture of the officer-holder's term in office, but the Parliament would have added confidence in the reappointment process.

Bruce McFee (Scottish National Party, West of Scotland)

The member will be aware of Margaret Curran's letter, which states the views of the Executive. Doubt is expressed about whether it is necessary to have two assessments, which is a requirement that some members of the committee have hung their whole case on. After an assessment has been carried out and the SPCB has received a report that says that a commissioner is doing their job reasonably well, how could they fail a subsequent interview? On what grounds could that individual's reappointment be turned down?

John Scott (Conservative, Ayr)

I am afraid that I am not aware of the letter. That is a matter of regret. If I may, I will move on.

Given the provision in all the enabling legislation for the SPCB to appoint an acting office-holder, we note the committee's recommendation that third-term appointments should not be made.

The committee also recommended that second-term reappointments should, as part of standard practice, be limited to four years. Although we will give serious consideration to that recommendation, our view is that we require the flexibility to be able to offer a shorter term in certain circumstances. For example, an office-holder might advise us that, for personal reasons, they wish to remain in post for only a further three years.

The committee has invited views on whether it should formally propose a committee bill to give effect to its recommendations for legislative change. The SPCB views that as desirable. In particular, we welcome the proposal to regularise the position of all office-holders in relation to removal from office and the provision of specific grounds for removal.

We are aware that the Finance Committee is undertaking an inquiry into the costs and accountability of commissioners and ombudsmen, on which I will give evidence to the committee in June. That inquiry might highlight other changes that need to be made to the enabling legislation, so it might be prudent to await its conclusions before we further consider whether the Procedures Committee should lodge a committee bill.

The SPCB welcomes the Procedures Committee's proposed changes to the standing orders to provide for reappointments, and, for consistency, to delete rules 3.12 and 3A.2, which provide for the removal of office-holders. We welcome the proposal that the Parliament should instead rely on statutory provisions for the appointment and reappointment of all office-holders.

David McLetchie (Conservative, Edinburgh Pentlands)

The Procedures Committee is to be commended for undertaking its comprehensive review of the subject and for its identification of gaps and inconsistencies in the relevant legislation and standing orders.

I do not take issue with the recommendation that the SPCB should take the leading role in determining whether various office-holders should be recommended to the Parliament for reappointment for a second term. However, in paragraph 14 of the report, I note that the committee considered the option of reconvening the original selection panel, but discarded it in favour of the SPCB fulfilling the role. The committee did that because

"some or all of the members of the original Selection Panel may have moved post or left the Parliament altogether."

In that context, it is worth while making the observation that turnover in the membership of the Scottish Parliamentary Corporate Body is not exactly unknown. Indeed, not only do none of the original five members of the corporate body still serve in that capacity, but Sir David Steel and my friend John Young are no longer members of the Parliament. That said, I believe that the members of the SPCB can bring the necessary qualities to the role in question, the determining factor of which is not continuity of personnel but the ability to build corporate expertise over time and to demonstrate a degree of independence of judgment.

I was intrigued by the discussion of the performance assessments that independent assessors might undertake when the question of reappointment arises. In particular, I was intrigued to note the recommendation in paragraph 21 that the performance assessment should not be published. Of course, any objection to the proposal may impose an intriguing dilemma for at least one of the office-holders whose reappointment may be under consideration.

The committee should be commended for its review of the maximum term that the various appointees can serve. I whole-heartedly endorse its recommendation that that should be rationalised and that a two-term limit should be set on all appointments. In that respect, the proposed committee bill to amend the various statutes would mirror the 22nd amendment to the constitution of the United States of America that was ratified in 1951. British Prime Ministers may aspire to go on and on, but presidents of the United States cannot do so. In my judgment, the US model is a better constitutional model for us to follow in the case of all our appointees.

We support the motion.

Margaret Curran (Labour, Glasgow Baillieston)

I congratulate Mr McLetchie on livening up the debate. I will pass no comment on the longevity of certain office-holders in British political life.

I thank the Procedures Committee very much for its report and take this opportunity to emphasise the committee's contribution to the running of the Parliament. In my post, I am often in discussion with the Procedures Committee—usually our discussion is consensual, although I get the odd challenge from time to time. The Parliament is moving towards ensuring that we create parliamentary processes that fundamentally work. That is in the interest of members. The Procedures Committee, of course, champions that approach. The committee discharges its work effectively; this morning's debate is part of that.

The report makes recommendations on the reappointment and removal of Crown appointees and other ancillary changes in that regard. Those are primarily matters for the Parliament, given that it controls the governance of the posts, but the Executive has an interest in the matter. We sponsored the legislation that established the Scottish public services ombudsman—I need to think of a way of saying ombudsperson without it sounding clumsy—the Scottish information commissioner and the commissioner for public appointments in Scotland. It is clear that the Executive has a policy interest in the matter.

Of course and more generally, as members, we have an interest in the good governance of public bodies to ensure that value for money is achieved for taxpayers, from whom the money ultimately comes. Often, what is associated with the commissioners is the expenditure of public moneys, for which we are all accountable. The Executive welcomes the opportunity to contribute to the debate.

I acknowledge my appreciation of the Procedures Committee for taking on board the wider points that I made in response to its inquiry. I think that we are all aware of the broader interest in the Parliament in the effectiveness, governance and accountability of the commissioners. That interest is cross-party and widespread; indeed, it has been the subject of debate in a number of avenues in the Parliament. Accountability and governance in relation to commissioners and similar appointments is the subject of a current Finance Committee inquiry. In addition, with the agreement of the Parliament, the Scottish Commissioner for Human Rights Bill will lead to the appointment of a commissioner for human rights. The Justice 1 Committee has a strong interest in that bill. I appreciate the wording in the amendments to our standing orders that the Procedures Committee proposes in that regard.

From my discussions with colleagues, I am aware of the strong consensus in favour of having coherent frameworks for governance and clear structures around accountability for the various commissioners and other appointments with which we are involved. It is important that the Parliament holds that broader debate. I welcome the approach to those broader issues that the Procedures Committee has taken in its report.

The Procedures Committee was tasked with offering a view on how best the Parliament should handle nominations for the reappointment of Crown appointees. In its report, the committee focused on the importance of establishing transparent procedures that would incorporate an assessment of an office-holder's performance of the relevant function to date. The Executive welcomes the committee's approach in recognising the need to establish the appropriate mechanisms to support the statutory obligations that are placed on the Parliament but which also preserve the independence of the office-holders. That point was emphasised in the debate.

Although the Executive respects, and in certain cases has promoted legislation to support, the independence of Crown appointees, there is obviously a requirement for the Parliament to have procedures under which the performance of those who hold positions of independence can be considered as objectively as possible. Clearly, that is unavoidable when there is a need to ensure the integrity of public functions and, of course, the best use of public funds. The committee's response addresses those issues and recognises the challenges and difficulties that need to be overcome.

Clearly, the arrangements that need to be put in place will differ from those that the Executive uses routinely for its appointees. The role of the Parliament's Crown appointees is substantially different and requires an approach that underlines their degree of independence and takes account of the way in which they undertake their respective functions. Appraisal arrangements must reflect in principle and in practice that relationship, which is often different for the Parliament.

However, we are pleased that, as a starting point, the committee took account of the requirements that are placed on the Executive in relation to reappointments. Our general view is that the proposals for assessing the performance of commissioners and the reappointment procedures are sensible in principle. We probably go along with the SPCB's concerns about whether involving two assessors in the reappointment procedures is proportionate or practical. Perhaps a single assessor could undertake the tasks. However, that issue is not critical and it certainly does not jeopardise the Executive's support for the committee's proposals.

We note that the report recognises the independence of Crown appointees. We approve of the emphasis on that and of the recommendation that the criteria against which an office-holder's performance is measured should be made public. That recommendation aims to make clear the basis on which suitability is assessed and to avoid the accusation that decisions by an office-holder have impinged on their chance of being reappointed.

The Executive is happy to support the committee's motion and looks forward to considering the remaining recommendations in due course. I will take advice on legislative timetables. It would be wrong of me to make a legislative commitment now and to provide time for that, because many issues need to be factored in. However, I am happy to discuss that with the committee's convener and other appropriate people.

Murray Tosh (Conservative, West of Scotland)

I call Karen Gillon to wind up the debate for the committee. You have just over 13 minutes for your speech.

Karen Gillon (Labour, Clydesdale)

Aye, okay. Thank—you—very—much—Presiding—Officer. [ Laughter. ] It is not funny. Why do I always get the job of winding up? Donald Gorrie will do it next time.

Bruce McFee (Scottish National Party, West of Scotland)

I can help the member with an intervention.

Karen Gillon (Labour, Clydesdale)

I am happy to take an intervention—as many as members like.

Bruce McFee (Scottish National Party, West of Scotland)

As Donald Gorrie is a Liberal, my intervention may open a door to Karen Gillon. Does she agree with his assumption that one problem of opening the reappointment procedure to competition is that someone who is even better for the post might be found? Is it valid for the Scottish Parliament not to open reappointments to competitive interview simply because somebody who is better for the job might be found?

Karen Gillon (Labour, Clydesdale)

I promise to answer those questions after I have given the gist of my speech.

I thank all members who have spoken in the debate, which has been interesting. Alasdair Morgan made a fair point about appraisal. It is important for the Parliament continually to appraise the roles and responsibilities of people whom we appoint. That is a difficult job that we must perform while maintaining the postholder's independence. I hope that if somebody went way off the line, the Parliament would pass a motion of no confidence and that person would be removed from the post.

Bruce McFee has maintained his position throughout the committee's consideration of the subject. I have some sympathy with the points that he has made about having a competitive process. Under the non-competitive process, the SPCB must first assess whether the postholder is doing the job as we set it out. The SPCB always has the option of saying no and of opening the post to competition. The non-competitive process is cheaper and simpler when there is no good case for looking beyond the postholder, but it keeps options open when there is a case for doing that.

Bruce McFee (Scottish National Party, West of Scotland)

rose—

Karen Gillon (Labour, Clydesdale)

I will proceed with my point.

I understand the point that Bruce McFee makes about the view of my colleague Mr Gorrie. Sometimes, I disagree with the positions that the committee's convener takes in his various capacities. My response is that I hope that we have the best person in the job in the first place. Finding that person is the role of the initial interview and selection process. Continuity in such posts over two terms has benefits. Postholders need time to get into their job, to make contacts, to build relationships and to develop their team of staff. Having continuity over two terms of office allows a good-quality postholder the time in their second term to build on the experience and expertise that they gained in their first term.

Bruce McFee (Scottish National Party, West of Scotland)

rose—

Karen Gillon (Labour, Clydesdale)

I will take an intervention in a minute.

If we are serious about appointing to posts the best people—the people whom we want to take such positions—we must offer them at least the option of having eight years in the post, if they are doing a good job. If we do not offer that, the quality of applicants for posts will be lower, because the posts will offer no job security. Bruce McFee knows that as the holder of a four-year fixed-term position that is reviewed under an open selection process. Some would say that that is why he will not go through that open selection process at the end of his four-year term. Postholders are given a role and responsibilities. If they fulfil them, they must have surety that they will be able to have their post for eight years.

Bruce McFee (Scottish National Party, West of Scotland)

Perhaps a good argument has been made for non-competitive interview.

Does Karen Gillon accept that if an individual is doing the job that they are supposed to do, existing legislation offers every possibility that they can be reappointed for a second term as she desires? Will she answer the following question, which I have asked three other members who made the same proposal as she has? If a sitting candidate is given a good assessment and they have a non-competitive interview, on what grounds can they fail that interview?

Karen Gillon (Labour, Clydesdale)

I could have a great assessment but answer a question at my interview about how I intend to do my job in the next four years by suddenly changing my position. I could say, "Actually, I think what we've done in the past four years was a lot of rubbish and we should do this instead." If that diverged completely from what had been done, we could say that somebody should not be reappointed. If it emerged in the interview process that a person was flawed—if they made a racist, sexist or homophobic remark—that would give the corporate body reason to consider whether that person should be reappointed.

Bruce McFee (Scottish National Party, West of Scotland)

The member is struggling.

Karen Gillon (Labour, Clydesdale)

I am not struggling. We must ask whether we want a full competitive interview process. I do not want such a process, which would not be in the best interests of the commissioners' posts. My personal view is that Scotland has far too many commissioners. The Finance Committee's inquiry should consider whether we have too many commissioners, whether duplication is taking place and whether there is room for considering existing roles and responsibilities. Before we establish any more commissioners, we should consider whether they are needed or whether other people could undertake the proposed roles.

David McLetchie made a fair point about selection panels. I accept his suggestion that we should seek to build up expertise in the corporate body. Perhaps the report's wording was not as clear as it could have been. The question that faced the committee was whether we should recall an initial selection panel after four years or whether a more appropriate body in the Parliament could undertake that panel's role. If the first interview panel was recalled and it involved people who were no longer MSPs, they would no longer be accountable to the Parliament, so committee members felt on balance that it would be inappropriate for those people to be members of a reselection panel.

The corporate body's personnel might change in four years, but it is still the corporate body of the Parliament and it still has roles and responsibilities. Its members are accountable to the Parliament and are elected by the Parliament. That is why we felt that as the reappointments process operates—several reappointments will be due—the most appropriate body for the task was the corporate body, whose members are elected on a free vote of the Parliament.

John Scott (Conservative, Ayr)

Does Karen Gillon accept that, to take on board the Procedures Committee's points, introducing an annual appraisal—as she has suggested—will go a long way towards satisfying everybody's desire for office-holders to do their jobs as best they can in the Parliament's view?

Karen Gillon (Labour, Clydesdale)

We have been grappling with this matter of reappointing for some time, as we always seem to do in the Procedures Committee. We do not like to do anything—and I mean anything—quickly.

David McLetchie (Conservative, Edinburgh Pentlands)

Even speaking.

Karen Gillon (Labour, Clydesdale)

I am trying to speak very slowly.

Having an annual appraisal process will help, but it is important for the way in which people perform their functions that there is a level of independence. I have been present when a person's character has been ripped to shreds on the floor of the Parliament. That person did his job, I think, completely without fear or favour to any party, yet he had to sit and listen to Mr McFee's colleagues ripping apart his character here in the chamber for no apparent reason. That illustrates one of the principal reasons why we must be careful how we appraise people and how we go through the reappointments process.

Commissioners and the Parliament are in a no-win position, whatever we do. If we choose to appoint somebody, the accusation will be levelled that they are just our poodle; if we choose not to reappoint a person, the accusation will be levelled that we are getting rid of them just because they did something that we did not like. We have a free press in Scotland, which can hold the Parliament to account. We have parliamentary committees that pride themselves on taking their job seriously and on carrying out their responsibilities.

It is important that there are relationships between the commissioners and the appropriate committees, so that annual reports can be considered and so that committees can consider what issues to pursue and what legislation might need to be changed. We can consider whether there are issues on which we might need to challenge the Executive. Are there ways in which the job of the commissioner in question could be improved or developed? The Parliament will have to take such decisions. It is a matter of doing so properly while maintaining the postholder's independence. The Parliament has to be very clear on that.

John Scott (Conservative, Ayr)

Will the member note the current position in legislation, whereby appointees cannot take up office in public life again for three years? That issue has not been introduced into the debate. However, it means that the candidates of a suitable quality whom we might seek will put themselves in an inhibiting position when they first apply, especially if they have only one term in office. They might be excluded from taking up many positions for three years thereafter.

Karen Gillon (Labour, Clydesdale)

Mr Scott makes a very fair point. Despite my well-known reservations about commissioners, I am exceptionally keen to ensure that, when we choose to appoint them, we get the best people for the job. Mr Scott's point about people then not being able to do another job in public life is a fair one, as I said. If somebody has been doing a job and there is nothing in the way that they have done that job or in their interview that suggests that they have acted inappropriately; if the corporate body makes an assessment of that; if an appraisal of their job skills is made; if an independent assessment is made of their interview; and if all that is seen to be fair and accountable, that person should be given the opportunity to retain their post for eight years. That is entirely appropriate and we should accept it. That is the right way for us to proceed. Having said that, I respect those who hold a different point of view.

Donald Gorrie (Liberal Democrat, Central Scotland)

Will the deputy convener reassure Mr McFee—perhaps I should have done so in my opening speech—that the proposed standing order changes will in no way inhibit his proposition from going through in due course, if that is the decision that is taken? It is not necessary for him to vote against the proposed standing order changes today. They merely tidy up the arrangements, whichever way we decide to deal with reappointments in due course.

Karen Gillon (Labour, Clydesdale)

Far be it from me to prescribe to Mr McFee the way in which he should vote. If the corporate body believes that an open selection process is appropriate for a particular job, I hope that it could implement that within the rules. I support the motion in Mr Gorrie's name and I urge the Parliament to support it at decision time.

Question Time — Scottish Executive — General Questions

Linda Fabiani (Scottish National Party, Central Scotland)

To ask the Scottish Executive whether it will join in the thanks to the senior school pupils from all over Scotland who participated in the youth forum on Europe in the Parliament on 7 and 8 May 2006 and whether it recognises the importance of youth contributions to the debate about our country's future. (S2O-9866)

George Lyon (Liberal Democrat, Argyll and Bute)

I thank Linda Fabiani for this opportunity to put on record my congratulations and thanks on behalf of the Scottish Executive to the senior school pupils from Bell Baxter high school, Earlston high school, Greenock academy, Holyrood secondary school, Linlithgow academy, Mintlaw academy, Nairn academy and Strathaven academy, and to the other young Europeans, for their contributions to the our voice on Europe event. I was extremely impressed by the high quality of their contributions to the debate on the future of Europe.

Linda Fabiani (Scottish National Party, Central Scotland)

In recognising the importance of youth contributions, will the minister and the Executive reflect on the concern that was unanimously expressed by the youth contributors last week that the lack of emphasis on language training in our country is potentially damaging to our future? Ailsa Wallace of Mintlaw academy encapsulated the issue:

"However at the moment the Scottish education system's commitment to teaching two foreign languages has been undermined by the decisions of the Scottish executive."

Will the minister, in the spirit of youth participation, undertake to meet youth representatives who took part in last week's gathering to discuss the matter further?

George Lyon (Liberal Democrat, Argyll and Bute)

We are happy to meet. I gave a commitment at the forum that all the contributions were being listened to. Scottish Executive officials were there recording the views that were expressed, and we gave an undertaking to respond to them and to take away with us the ideas and issues that were raised. Among the issues raised in the pupils' presentations to the youth forum were, first, that there is a widespread ignorance of all things to do with Europe. Secondly, there was the importance of Europe to Scotland and to this institution, the Scottish Parliament, given that Europe drives much of the legislative programme that we implement here. Thirdly, there was the importance of Europe's impact on daily life. Whether it is to do with the health service, ferries or water quality, the European Union is an extremely important institution. I was pleased that the youth forum showed a willingness to engage further in the debate on how to improve integration and to make its views known to the European Commission and the other European institutions.

Mary Mulligan (Labour, Linlithgow)

I was delighted to join the young people and teachers of Linlithgow academy at the youth forum on Europe. Their enthusiasm for playing an active role in Europe, which has already been referred to, was inspiring. How will the Scottish Executive ensure that all schools keep their young people informed of the opportunities that the European Union can offer them in various aspects of their lives?

George Lyon (Liberal Democrat, Argyll and Bute)

As I said in response to Linda Fabiani, Executive officials attended the forum and took a note of all the views that were raised. I understand that the Scottish Parliament will be writing up a report on the event, which it will send as a response to the European Commission's plan D for democracy, dialogue and debate. The views that are expressed will help with the Scottish Executive's conclusions on its building a bridge between Europe and its citizens project, which examines how European institutions can better engage with their citizens.

A further event will be linked with the building a bridge between Europe and its citizens project. Commissioner Margot Wallström will be in Scotland. She and the First Minister will host an event at which children from throughout Scotland, including those who took part in the youth forum here in the Parliament, will be invited to come along and ask questions directly of both the First Minister and Commissioner Wallström. I hope that that event will prove to be just as good as the one that we held here in the Parliament.

Pauline McNeill (Labour, Glasgow Kelvin)

To ask the Scottish Executive what assurances can be given that children removed from substance-abusing families are placed in nurturing family environments. (S2O-9892)

Robert Brown (Liberal Democrat, Glasgow)

When a child becomes looked after, the local authority has a duty to safeguard and promote the child's welfare. For many children, that will mean being placed with foster families, for others it will mean being placed with other relatives, and for a small number a children's home or unit will be in their best interests.

Pauline McNeill (Labour, Glasgow Kelvin)

The report, "Hidden Harm—Next Steps: Supporting Children—Working with Parents", is one of the most important pieces of research that the Executive has done to date, because of the focus on children and the inference that we will take firmer action to remove children from substance-abusing families, at least for a while, to protect the family and, more important, the child. What assurances can the minister give me that children will not just be taken out of families and put into care? What monitoring will the Executive do to ensure that those children will have an environment that will keep them safe and secure and that attempts to normalise their childhood? What resources is the Executive prepared to put in to implement the "Hidden Harm" report, including meeting the need, to which the minister has referred, to attract more foster families and foster carers?

Robert Brown (Liberal Democrat, Glasgow)

The many questions in Pauline McNeill's supplementary were all important. It is important to remember that the central issue is the best interests of the child, and what is best for the individual child will vary according to circumstances. The primary duty under the Children (Scotland) Act 1995 is to safeguard and promote the welfare of children in need. It is obviously important to keep families together where that is possible, and one of the priorities that emerged from the "Hidden Harm" document and from many other studies was to do with the importance of retaining family links and of supporting families to become drug free. We should remember, however, that drug abuse by parents is a major risk factor for children, and we have to balance how such issues are handled.

As far as monitoring is concerned, that is a matter for all the relevant professionals. In the legislation, the administrative actions and the letters that have gone out from the Scottish Executive, we have been at pains to make it clear to everyone that it is everyone's job to ensure that the children are all right. We will be legislating later in the year to provide new powers to compel agencies to share information and to build on that.

Significant resources are being allocated to the general area of caring for children in such circumstances, through grant-aided expenditure support for local authorities and through a variety of other funding mechanisms. Pauline McNeill will be aware that a fund of £12 million over two years has been made available to support the recruitment and retention of foster parents, because it is important that wider choices should be available. There are pressures on the number of foster parents, as we are all aware, and Pauline McNeill will be aware of the activity that is taking place to tackle those pressures, particularly in Glasgow, where there is a great need to bring in some of that money, together with the local authority's money, to mount a major campaign to recruit foster carers in the city.

Fiona Hyslop (Scottish National Party, Lothians)

The Parliament's Education Committee heard yesterday from Glasgow City Council that, increasingly, many of the children removed from substance-abusing families are babies in the zero-to-two age group who have themselves suffered because of substance abuse. Can the minister reassure me that any families taking in such children will have continuing care and support, because many of those children will have health and learning difficulties for some years to come as they grow up?

Robert Brown (Liberal Democrat, Glasgow)

Fiona Hyslop is absolutely right. Against the background of that difficult problem, there is an increasing emphasis on early intervention at the right time, to avoid families getting into a position where children are damaged in the long term by those early difficulties. The issue is linked to the question of having enough foster places for those children, as I mentioned before, and to the question of the input into individual families. Some families can be supported, because it is not by any means the case that all drug-abusing families are unsuitable for bringing up children. However, families need support, monitoring and backing, and it is important that we are able to make decisions at the right time and in the right way, and that a wide range of possibilities is open to us. It is not a simple issue. A whole series of issues are being brought together in dealing with funding, support and the professional duties on the authorities.

John Swinburne (SSCUP, Central Scotland)

What assurance can the minister give regarding kinship carers, given the disparity across the country from one council to another? Of the 32 councils, some do very well and pay kinship carers the same amount as is paid in a fostering allowance, while others give absolutely nothing. Can he assure me that where, with the approval of social workers, children are placed with kinship carers, those children will be financially cared for?

Robert Brown (Liberal Democrat, Glasgow)

John Swinburne raises another important point. The wider family is a huge resource when it comes to looking after the interests of children. The issue is complex because of the different situations that can exist.

Mr Swinburne will be aware that we are doing two things in this connection. First, the Minister for Education and Young People announced in March that a fostering strategy was to be developed. The matter is currently being taken forward. Secondly, we are taking powers in the Adoption and Children (Scotland) Bill to provide for a national scheme of fostering allowances. Kinship support will be considered as part of that exercise.

Patrick Harvie (Green, Glasgow)

To ask the Scottish Executive how congestion and vehicle emissions will be reduced if the target for stabilising the volume of road traffic is removed. (S2O-9850)

Tavish Scott (Liberal Democrat, Shetland Islands)

The recent publication of "Changing Our Ways: Scotland's Climate Change Programme" demonstrates the commitment of the Scottish ministers to tackling emissions and climate change and to developing further carbon savings. Evidence suggests that road traffic levels are still rising. We are considering the 2021 target, its underpinning environmental and economic aims and the best way to achieve them as part of the consultation on the development of the national transport strategy, which was launched on 20 April 2006.

Patrick Harvie (Green, Glasgow)

The shifting of the goalposts is a regular problem in this policy area. Does the minister recall the words of John Prescott when he came into office? He stated:

"I will have failed if in five years time there are not ... far fewer journeys by car."

Would not the Scottish Executive, by abandoning its existing target, similarly shift the goalposts? How can the Scottish public be confident that any new criteria of failure will not be abandoned or redefined in future?

Tavish Scott (Liberal Democrat, Shetland Islands)

I am not responsible for John Prescott. That is probably a good thing for us both.

A consultation is taking place on the national transport strategy, so it is unfair and incorrect of Mr Harvie to say that any target has been abandoned. The purpose of the national transport strategy consultation is to assess those matters. I am sure that Mr Harvie will want to contribute to the consultation. The issue is serious and I recognise the seriousness of the points that he raises. I am sure that he also recognises the work that we are doing on the target to have biofuels constitute 5 per cent of the fuels on sale on garage forecourts by 2010. If we can achieve that target—I hope that we can not only achieve it but do considerably better—it would be equivalent to saving a million tonnes of carbon emissions produced by road transport. We cannot ignore the realities of our transport system and the contribution that transport makes to emissions. That is why we must place those matters in the context of the overall climate change programme.

Roseanna Cunningham (Scottish National Party, Perth)

Recent written questions to the minister indicate that traffic flows on long stretches of road in my constituency are counted by a single traffic counter. That would not seem to allow the minister to establish the frequency and extent of commuter traffic between significant settlements, for example along the Perth to Stirling stretch of the A9. If he cannot do that, how can he decide on future public transport requirements? It will, of course, be necessary to do so if we are to reduce emissions in future.

Tavish Scott (Liberal Democrat, Shetland Islands)

I am happy to investigate specific issues that members have in relation to the methodology that we have adopted on traffic counting, the evidence that is necessary to inform investment in our roads infrastructure and the comparators that we use when we consider public transport improvements.

Alex Johnstone (Conservative, North East Scotland)

Does the minister agree that one man's increased traffic volume is another man's economic development and that the best way for Scotland to tackle emissions and road traffic is to improve the road network to bring an end to bottlenecks and traffic jams so that we can get on with building the economy?

Tavish Scott (Liberal Democrat, Shetland Islands)

I am sure that Mr Johnstone accepts that we are improving the road network. It is because of this devolved Government and this coalition Government's work that we are investing solidly in local road improvements—in collaboration with local government—and in the trunk road network.

I am sure that Mr Johnstone would also want to be fair and reflect that transport has an environmental consequence. We need to consider carefully the consequences, not necessarily for Mr Johnstone or me, but for future generations. That is an important factor. The national transport strategy, which is being taken forward in a national consultation, must be put in the context of the climate change programme that I mentioned.

Jim Mather (Scottish National Party, Highlands and Islands)

To ask the Scottish Executive what changes it has requested in the operational and financial management and performance and financial reporting of Scottish Enterprise in response to the recent overspend. (S2O-9821)

Nicol Stephen (Liberal Democrat, Aberdeen South)

The Scottish Executive receives regular resource budgeting reports from Scottish Enterprise as part of the current operational and financial management arrangements. The Executive has asked for those reports to be extended and to identify more clearly issues of concern. In preparing the reports, Scottish Enterprise will itself have better information following implementation of the KPMG recommendations. For example, KPMG suggested a number of ways in which financial analysis could be improved. It also recommended that Scottish Enterprise maintain a firmer grasp of likely non-cash costs throughout the year by reporting as part of its monthly management accounts and by the production of quarterly balance sheets.

Jim Mather (Scottish National Party, Highlands and Islands)

I thank the minister for that answer. In the interests of openness, can Parliament now see a full, comparative, time-series report that shows the resources that were applied to every programme and recipient in 2004-05 and 2005-06, in order to ascertain what is continuing and what is being discontinued?

Nicol Stephen (Liberal Democrat, Aberdeen South)

The detail of its budget is largely a matter for Scottish Enterprise, although I will continue to take a close interest, as no doubt will all MSPs, in the impact of the budget and operational plan for 2006-07. The Scottish Enterprise board approved the budget last Friday. The operating plan will be submitted to me, as Minister for Enterprise and Lifelong Learning, and I understand that Scottish Enterprise has agreed to submit the operating plan to the Enterprise and Culture Committee, too, which seems to me to be appropriate. I am sure that all in the chamber will continue to be closely involved in the developments at Scottish Enterprise.

Murdo Fraser (Conservative, Mid Scotland and Fife)

I wonder whether the minister is now in a position to tell us—he could not tell us last week—from where in his budget the additional £45 million for Scottish Enterprise is coming. In other words, which other budgets will be cut?

Nicol Stephen (Liberal Democrat, Aberdeen South)

No budgets will be cut and it is important that that is emphasised and made clear. The additional cover that was provided was found from previous underspends in the Enterprise, Transport and Lifelong Learning Department and will be found this year from tight management of the department's operational budget. That will clearly involve reduced flexibility as the year goes on. I should emphasise, however, that the department has a budget of over £5 billion and it seems to me to be entirely achievable and manageable to deliver the additional investment that we are putting into Scottish Enterprise. I repeat that that investment is resource cover—non-cash cover—apart from the additional £5 million that Scottish Enterprise will raise from additional receipts.

Karen Gillon (Labour, Clydesdale)

Does the minister accept that in constituencies such as mine, which has a backlog of £40 million of non-rural roads expenditure, the ability to find the amount of money that has been found in the Scottish Executive's budget for Scottish Enterprise causes wonder about why that money was not spent on non-rural roads, which spending is a commitment in the Executive's partnership agreement?

Nicol Stephen (Liberal Democrat, Aberdeen South)

Those are important judgments for ministers to make. Of course, I realise that there will always be competing priorities in Government. It was clear at one point, just a few weeks ago, what the scale of the cuts that were likely to be imposed by Scottish Enterprise would be if ministers did not take action. The cuts would have been across a range of projects at the local level, including training programmes, modern apprenticeships and the business gateway. There was an outcry about the extent of the cuts that would have been implemented at local level. I though that it was appropriate to take action.

Charlie Gordon (Labour, Glasgow Cathcart)

To ask the Scottish Executive whether fear of crime is measured regularly in Scotland. (S2O-9878)

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

Fear of crime is measured regularly, in both the Scottish crime and victimisation survey and the Scottish household survey.

Charlie Gordon (Labour, Glasgow Cathcart)

I am grateful for that answer. Does the minister share my view that one of the best ways to reduce fear of crime and thus to improve people's quality of life is to have uniformed police officers on foot patrol? Will she encourage chief constables to make more use of that operational response to fear of crime and, indeed, to crime itself?

Cathy Jamieson (Labour, Carrick, Cumnock and Doon Valley)

It is important that communities have confidence in the police services that are provided. There is no doubt that police visibility, backed up by community wardens, is important. I hope that initiatives such as the one that we announced this week for 1,000 additional metal detectors to tackle knife crime will enable the public to be reassured that the police are there and ready to act.

George Reid (None, Ochil)

Before questions to the First Minister, members will want to join me in welcoming to the chamber Pascal Couchepin, Switzerland's Minister for Home Affairs, who is in Edinburgh to open Switzerland's new consulate general. [ Applause. ]

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 they will discuss. (S2F-2296)

Jack McConnell (Labour, Motherwell and Wishaw)

I have no immediate plans to meet the Prime Minister.

Nicola Sturgeon (Scottish National Party, Glasgow)

I remind the First Minister that Tony Blair said this week that without new nuclear power stations there will be a dramatic gap in our targets to reduce carbon emissions and we will become heavily dependent on foreign gas. However, the Sustainable Development Commission, which was set up to advise the Government, has said that in its expert opinion we can meet our carbon targets and our energy needs without new nuclear power.

What is the First Minister's view on the necessity for new nuclear power stations?

Jack McConnell (Labour, Motherwell and Wishaw)

There are two necessities. One is the necessity to ensure that we have a solution to nuclear waste and that that solution is sustainable. Secondly, there is an absolute necessity to have an intelligent debate about this.

As I have said in a different kind of chamber on a number of occasions in recent weeks, on the one hand we have to deal with the nuclear waste issue, which those who advocate more nuclear power stations in Scotland need to address; on the other, given that more than a third of the electricity generated in Scotland comes from nuclear, those who say that there is no case at all for nuclear power in Scotland have to say how we should fill that gap.

We need to have an intelligent debate in Scotland—that is the absolute necessity.

Nicola Sturgeon (Scottish National Party, Glasgow)

I know that the question, "What will replace existing nuclear capacity?" has to be answered, but I did not ask the First Minister to repose that question; I asked him what he thinks the answer is.

What side of the debate is the First Minister on? I do not agree with Tony Blair on the issue, but at least he has nailed his colours to the mast. Tony Blair said that new nuclear power is necessary and that not to take a decision on it "now"—not in the future, but now—would be a "serious dereliction of duty." Does the First Minister agree with the Prime Minister—yes or no?

Jack McConnell (Labour, Motherwell and Wishaw)

I am quite happy to explain which side of the debate I am on. I am on the side of electricity consumers and business in Scotland now and into the future. I believe that what they want us to do is not consider additional new nuclear power stations in Scotland without having resolved the issue of nuclear waste, because of the impact it has on future generations. That is absolutely vital as far as I am concerned.

However, on the other side of the coin, I think that it is important that we address the energy gap that would be created if we simply ended the role of nuclear in Scotland without having an answer to the replacements that might be required. Therefore, it is vital that we consider the facts and the evidence and ensure that the decisions that are made about the future of electricity generation in Scotland are based on the needs of consumers, the needs of Scottish business and the need for a decent environment in Scotland for generations to come.

Nicola Sturgeon (Scottish National Party, Glasgow)

It seems that the First Minister is on both sides of the debate. Is not that the mebbes aye, mebbes no approach to leadership? Where I agree with Tony Blair is that to dodge the issue, hide behind a form of words, show no leadership whatever, as the First Minister is doing, is a serious dereliction of duty.

Is not it the case that we know where Tony Blair stands? As of this morning, we know where Gordon Brown stands. He will back nuclear, too. We know that here in this Parliament, the Scottish National Party, the Greens and the Liberals oppose new nuclear power stations, because there are better alternatives. Is not it reasonable for the Scottish people to ask and be told what side of the fence their First Minister is on?

When the Prime Minister says that nuclear is a necessary part of the mix and that we must make a decision on that now, not in the future, does the First Minister agree with him or not?

Jack McConnell (Labour, Motherwell and Wishaw)

There is only a certain number of times that I can answer the same question with exactly the same answer, but I will do so again. It would be an absolute dereliction of duty if I ruled out options for the future for Scotland. I believe that it is important that, as part of this debate on the future energy policy of Scotland on electricity generation, we say that we need to address the fact that, if there were no nuclear power stations in Scotland, that gap would have to be addressed in some other way. The Scottish National Party, perhaps more than any other party in this chamber, fails to address that issue. That is because of its contradictory position on renewables, never mind its position on nuclear or other forms of energy.

However, it would also be a dereliction of duty on my part if I approved, or encourage ministers to approve, new nuclear power stations in Scotland without a resolution to the nuclear waste issue. I believe strongly that nuclear waste has an impact not just on people today but on future generations. It is an issue that we in Scotland need to address because we have to be part of the solution, not just part of the problem. Unlike the nationalists, who abdicate this duty, we have to acknowledge that we in Scotland have a duty to deal with that issue in order to protect future generations and to ensure that energy policy and decisions on new power stations are made in the most sensible and reasonable way.

Nicola Sturgeon (Scottish National Party, Glasgow)

In the Prime Minister's words, not mine, the dereliction of duty is to dodge the issue and dodging the issue is what the First Minister is doing. Why will the First Minister not show some real leadership? Why will he not follow the advice of the Sustainable Development Commission, which was set up to advise him, and rule out the distraction of a heated nuclear debate and, instead, concentrate on the alternative sources of energy that we need to replace dirty, expensive, unsafe nuclear power? Would not that be showing real political leadership?

Jack McConnell (Labour, Motherwell and Wishaw)

I do not think that it is political leadership to rule out options. Further, I do not think that it is political leadership to advocate a solution—I assume that that is what Ms Sturgeon was doing when she mentioned renewables—and then consistently join SNP members across the country in opposing wind farms and other forms of renewable energy generation. The difference between policy and action on the part of the SNP becomes all too apparent.

We need a consistent energy policy. We need to get that from business organisations, consumers and environmental groups. I believe that to achieve a consistent energy policy, we have to address two issues. First, the nuclear waste issue must be dealt with before we consider new nuclear power stations. Secondly, if we are, at some point, not to consider having new nuclear power stations, we have to address the gap that that would create in Scottish electricity generation. The SNP addresses neither of those issues. It abdicates responsibility for them. In both cases, that is a real failure of leadership.

Annabel Goldie (Conservative, West of Scotland)

To ask the First Minister what issues will be discussed at the next meeting of the Scottish Executive's Cabinet. (S2F-2297)

Jack McConnell (Labour, Motherwell and Wishaw)

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

Annabel Goldie (Conservative, West of Scotland)

As the First Minister and his Liberal Democrat colleagues in the Scottish Executive are so keen on newspaper advertising, can he tell me how much of the £3.7 million of taxpayers' money that has been spent on advertising in the past 20 months was used to inform patients in Scotland that, under European Union regulations, they are entitled to seek treatment in other European countries, paid for by the national health service?

Jack McConnell (Labour, Motherwell and Wishaw)

I do not know, but I suspect that very little of that money was spent in that way. There are far higher priorities for public information campaigns in Scotland. For example, campaigns on road safety and public health are an absolute necessity. Further, the events of the past two weeks have shown clearly that campaigns on sexual health and sexual education for young people and their parents, to ensure that young people take more responsibility for their lives, are also essential. Those should be the priorities for public information campaigns, not what Miss Goldie outlines.

Annabel Goldie (Conservative, West of Scotland)

I hope that the patients in Scotland who are suffering and in pain while they wait for treatment listened closely to the First Minister's answer. The entitlement about which the First Minister knows so little is exercised by applying for something called a form E112. Most people in Scotland have never heard of the facility. I have a constituent who was totally ignorant of the procedure and his general practitioner also seemed unaware of it. My constituent confirmed that it was never brought to his attention by his local hospital.

Presumably, the scheme is designed to be in the interests of patients who need treatment that is not available or cannot be provided quickly enough in this country. Why is the First Minister so shy about telling people in Scotland about their right?

Jack McConnell (Labour, Motherwell and Wishaw)

Obviously, I am not sure off the top of my head exactly what communications there have been between the health service nationally and individual GPs about the procedures that they should follow to inform their patients of that particular option and form.

However, I can tell Annabel Goldie that in a speech to health service professionals in Dundee in—I think—February 2003, and consistently since then in speeches, articles, communications and debates in the chamber, we have made it absolutely clear that if health boards do not meet the targets that we set for individual treatments, and patients or their GPs want to choose other locations either in Scotland or elsewhere in the UK or Europe, they have the right to do so and we will ensure that that guarantee is met. That has been crystal clear since at least early 2003, if not significantly longer, and it remains our position today, but I am happy to ensure that Annabel Goldie is informed about the individual communications and advice that is given to GPs to ensure that they are aware of the procedures that they have to follow.

Annabel Goldie (Conservative, West of Scotland)

I am certainly reassured by the First Minister's commitment to support the EU regulation, but I have to say that it must be one of the best-kept secrets in Scotland. It is an entitlement for all NHS patients in Scotland. For the benefit of those who, as we speak, are in pain and incapacitated because of undue delays in treatment, will the First Minister today stand up for patients' rights and broadcast more publicly the availability of the entitlement?

Jack McConnell (Labour, Motherwell and Wishaw)

As I said, I am happy to look into what communications have taken place and what guidance is available to individual GPs and patients and to ensure that it is as clear as it can be. However, I stress that our absolute priority for the health service in Scotland is to ensure that people can have treatments in Scotland within the guaranteed waiting times that they have been given.

The guaranteed waiting times, which were met on 31 December last year for both out-patients and in-patients, are being reduced this year. We look forward to seeing the health statistics next week, which we hope will show further improvements. We will also ensure that we work towards the guaranteed waiting times that we have set for the end of 2007, because that is a far better option for people in Scotland than having to travel overseas.

George Reid (None, Ochil)

I will take two constituency questions.

Margaret Smith (Liberal Democrat, Edinburgh West)

Will the First Minister tell us how much the Scottish Executive's decision to relocate sportscotland jobs from Edinburgh will cost, which budget the money will come from, and whether funds will be taken from front-line sports services and bid preparations to pay for it? Will he also tell us whether the relocation satisfies the terms of the Scottish Sports Council's royal charter and confirm that, because of the charter, it was the management of sportscotland, rather than ministers, who had the ultimate power to make the decision?

Jack McConnell (Labour, Motherwell and Wishaw)

The Minister for Tourism, Culture and Sport was to make an announcement about the matter today. I am not sure whether that is in the public domain yet, with all the details. I am happy for her to outline all those details. However, I can guarantee that the financing of any relocation will not lead to a diminution of the amount of money that is available for sports in Scotland. Our commitment to sports activity, facilities and education in Scotland remains absolute. The relocation of sportscotland's headquarters is designed to ensure that there is an improvement in that work throughout Scotland, not a diminution.

Duncan McNeil (Labour, Greenock and Inverclyde)

The First Minister will be aware of this week's press reports that highlighted the high rates of infant mortality in my constituency. He will also be aware that, in Scotland, each year, 300 babies are born addicted to heroin. Does the First Minister agree that that terrifying picture of modern Scotland is unacceptable? Will he assure the Parliament that he will consider every available option to turn the situation around?

Jack McConnell (Labour, Motherwell and Wishaw)

First, I recognise the strong views that Duncan McNeil holds on the matter because of his strong commitment to improving the lives of adults and children in his constituency. I welcome his contribution to the debate, although obviously we are not committed to at least one proposal that he has made in the past seven days.

I strongly suggest that we need to take a reasonable but radical approach to the issue. Last Monday, Cathy Jamieson and I met a number of mothers who were or had been addicts. I met a five-year-old youngster who had been born with an addiction because of his mother's addiction. That youngster is lively, healthy and making progress, which is a good thing and is partly because his mother has been helped away from her addiction by good rehabilitation.

There are issues about good rehabilitation and supporting youngsters in their development, which might be delayed, but there is also an issue about ensuring that youngsters are not born into such situations in the first place. Therefore, we need an open and radical debate about how we deal with the issue and we should not close down options or attack people for making radical suggestions when their intentions are very well meaning indeed.

Campbell Martin (Independent, West of Scotland)

To ask the First Minister whether the Scottish Executive's Cabinet has discussed the recommendations of the Steel commission report, "Moving to Federalism—A New Settlement for Scotland", and what the outcome was of any such discussions. (S2F-2309)

Jack McConnell (Labour, Motherwell and Wishaw)

I think that when the report was initially published it might have been mentioned in an information report before Cabinet, but we have not discussed the matter at Cabinet.

Campbell Martin (Independent, West of Scotland)

Does the First Minister accept that the conclusions and recommendations of the Steel commission report indicate that even within the Executive parties there is a strong feeling that the powers of the Scottish Parliament are incomplete? Does he accept that in the Parliament and throughout Scotland there is strong support for an increase in the powers of the Parliament, up to and including full sovereign powers?

I think that all members accept that the Executive and the Parliament are ambitious for Scotland. Does the First Minister think that we can achieve our ambitions without there being any enhancement of the current powers of the Parliament?

Jack McConnell (Labour, Motherwell and Wishaw)

As I think I have said in the Parliament on a number of occasions, I welcome the Steel commission's contribution to the debate.

I want to focus on the particular points that Campbell Martin made. There is a debate to be had on the matter, which I welcome. Indeed, I would welcome more honesty from some parties about their position, because it would be healthy for us to have that discussion. However, it is absolutely wrong to portray the advocacy of an entirely independent Scottish state, which is very much the position of Campbell Martin and his former colleagues in the Scottish National Party, as the gradual securing of more powers for the Scottish Parliament. Let us have an honest debate on the matter, in which the SNP, Campbell Martin and others tell us what the impact of a separate state in Scotland would be on our currency, our army—[Interruption.] I hear complaining from the SNP benches, so I give an example. Over the past few years the SNP ran a campaign to save the British regiments, but this week Christine Grahame complained that the regiments are recruiting in Scottish schools. The SNP points this way and it points that way, on regiments, on fiscal powers, on interest rates, on the currency and on every other issue.

I recognise Campbell Martin's sincerity, honesty and absolute consistency on the issue and I admire him for those qualities, which I suspect are the main reason why he is no longer a member of the SNP. I wish that the SNP was as consistent and honest as Campbell Martin is—I look forward to having the debate when that happens.

Campbell Martin (Independent, West of Scotland)

That was almost praise—I do not know whether I liked it.

The First Minister knows that I no longer have any party political affiliation. I genuinely ask such questions because we need to learn from seven years of devolution and think about where we are and where we go from here.

Does the First Minister agree that it will ultimately be for the people of Scotland to decide, through a Scottish general election, what level of enhancement to the powers of the Parliament there should be, and that if they vote for full sovereign powers—or independence, as some of us like to call it—nothing should be put in the way of their democratically expressed will? Does he think that that decision would still have to be endorsed in a referendum?

The First Minister expressed a desire for honesty. Can we have an honest debate in the Executive's time in the chamber on where we should go in building the Parliament's powers?

Jack McConnell (Labour, Motherwell and Wishaw)

I will happily consider the suggestion that there should be a debate in the chamber on an independent Scotland. I am sure that such a debate would be a pleasure. It would be interesting to try to eke out the SNP's ideas on independence.

Campbell Martin has made a valid point. I agree that the people of Scotland should ultimately decide what Scotland's constitutional position should be, but the matter has been resolved for the moment by the referendum in 1997, in which a massive majority voted in favour of the establishment of the Parliament and its current powers. I would welcome a debate on what the future might hold for Scotland and would be happy to participate in it, but say to colleagues that we must get on with the business of using the powers that we currently have and making the settlement work.

Scott Barrie (Labour, Dunfermline West)

To ask the First Minister what provisions are in place to ensure that child care nurseries meet statutory hygiene requirements. (S2F-2304)

Jack McConnell (Labour, Motherwell and Wishaw)

Under the Regulation of Care (Scotland) Act 2001, all nursery services must be registered with the Scottish Commission for the Regulation of Care. Ministers have made various regulations under the act and have set national care standards that registered services are expected to meet. The care commission regulates service providers against the act and the regulations, taking account of the standards. It has a range of powers under the act, including the power to make recommendations and/or requirements in respect of a provider, to place conditions on a registration, to use formal improvement notices and, ultimately, to close a service if doing so is warranted.

Scott Barrie (Labour, Dunfermline West)

I am sure that all members will welcome the news that those who have been affected by the E coli outbreak in my constituency are continuing to improve.

In the light of the First Minister's answer and the answer that he gave me last week, does he agree to consider how recommendations or concerns that the care commission and Her Majesty's Inspectorate of Education have highlighted are acted on? In particular, does he agree that time delays between any inspection that has taken place and the publication of the subsequent report should not be allowed to compromise areas of concern? Should the care commission and local authorities be more aware of any deficiencies that are identified and ensure that they are immediately acted on?

Jack McConnell (Labour, Motherwell and Wishaw)

Obviously, I am conscious of Scott Barrie's constituency interest in the matter and his representations and questions to ministers in recent weeks. I am sure that all of us are thinking about the children who are involved and their families.

I want to make two points. First, we should support the care commission in ensuring that appropriate action is taken as a result of the incidents that have occurred and that lessons are learned from them for the individual establishments and the company that is involved.

Secondly, on those who are involved in drafting reports, the action plans that those reports create and the speed of the process, I am certain that the care commission, as well as ministers, will want to review matters as they develop and ensure that any lessons that are learned are acted on as quickly as possible.

Christine Grahame (Scottish National Party, South of Scotland)

To ask the First Minister what plans the Scottish Executive has to improve parental education in light of recently published figures on the number of underage pregnancies. (S2F-2310)

Jack McConnell (Labour, Motherwell and Wishaw)

Parents and all carers play an important role in explaining responsible sexual behaviour to children. Parents are supported through sure start Scotland and other programmes, and schools provide a range of life skills courses to young people.

Christine Grahame (Scottish National Party, South of Scotland)

I thank the First Minister for that answer. I have obtained recent figures that reveal that six children in Scotland had conceived at the age of 12. Is the First Minister aware of that? I speak as one former school teacher and current politician to another. I think that we agree that teachers, educators and politicians cannot undertake change on their own. I think that the First Minister has also said that good parenting provides an important role model to children learning personal responsibility.

Will he therefore advise the chamber whether he agrees that teaching parenting skills should be a priority in social education and integral to sex education, so that Scottish children do not continue to have children? Will he also take the opportunity to make it clear to me that he has not endorsed Duncan McNeil's proposal—I think that he called it a radical proposal—for the chemical sterilisation of methadone users? I find that proposal both crass and sexist.

Duncan McNeil (Labour, Greenock and Inverclyde)

On a point of order, Presiding Officer. I ask Christine Grahame to withdraw that remark. I never said in any statement in the chamber, publicly or anywhere what she just described. I ask her to withdraw her remark and to apologise unreservedly.

George Reid (None, Ochil)

I will reflect on that and come back to it before we close, Mr McNeil.

Jack McConnell (Labour, Motherwell and Wishaw)

I have three points to make in response to Christine Grahame. First, I have made clear my position on Duncan McNeil's contribution to the debate. The issues that he identifies are important, and the measured way in which he made his radical proposal means that it deserves debate and attention. We need to consider a variety of radical options that might help to reduce the problems that are caused in those circumstances.

I have two points to make about parenting. First, some high-quality parenting education is already going on in our schools. However, it is not enough. It is clear to me that youngsters in Scotland—where extended families no longer exist in communities as they once did and where many of the affected youngsters no longer have parents who are good role models in this modern age—need to be able to learn some of those skills in the classroom. That said, we must not blame schools for parental failings. There is an issue about parental responsibility for the youngsters and ensuring that parents take more responsibility for the behaviour, actions and attitudes of their children.

Secondly, there is a role for grandparents in the community, in the school and in the home. I have made that suggestion on two or three occasions with different connections. Scottish grandparents could be encouraged to play a more significant role in developing the expectations and attitudes of young people in Scotland and in determining the actions that those young people pursue.

I would like us to ensure, in all that we do on this, not only that we work with parents to improve their skills and their actions as role models and with children to ensure that they grow up with the skills to become better parents, but that we engage with grandparents, who I think have a significant role to play in helping families to develop in what is, at times, a very disjointed and dysfunctional society.

Nanette Milne (Conservative, North East Scotland)

In the light of the recent passing of the Scottish Schools (Parental Involvement) Bill, which abolished the provision in section 9(2) of the School Boards (Scotland) Act 1988 that gave school boards the right to approve spending on teaching materials, what assurances can the First Minister give me that parents will be encouraged to take more responsibility for their children's sexual health education by allowing them appropriate influence over the materials relating to sex and relationships education that are used in teaching their children?

Jack McConnell (Labour, Motherwell and Wishaw)

I thank Nanette Milne for that question, as it gives me a chance to clarify the position. Under the guidelines that we have set out, parents must be involved in—not just have the option—the development of sex education programmes in our schools. The changes to the school boards should make no difference whatever to that. In fact, it should be possible, because of the bill that was passed last week, to ensure that parents are more involved in those activities in schools, as the participation of parents should improve as a result of the bill.

I want to clear up two other myths in this debate. The first is the myth that there is no commitment in our sex education programme or our sexual health strategy to marriage as an important part of our society, although it is only one of many relationships. The second myth is that there is no encouragement of abstinence among young people so that they do not make choices that could be detrimental to the rest of their lives.

The Executive's sexual health strategy makes it absolutely clear that marriage remains a key part of our national life and that abstinence until a mature, loving relationship is established is an approach that we support. If we are going to move Scotland on, it would be helpful if we could agree that those two elements are in place and consider practical ways of getting that message across rather than try to deny it.

Phil Gallie (Conservative, South of Scotland)

To ask the First Minister whether he has discussed the European convention on human rights with the new Home Secretary. (S2F-2299)

Jack McConnell (Labour, Motherwell and Wishaw)

Yes, I have.

Phil Gallie (Conservative, South of Scotland)

I am delighted but not surprised, given the fact that the First Minister is a neighbour of the new Home Secretary. Does the First Minister agree with Mr Reid that, as I warned in the early days of this Parliament, the ECHR has become a charter for the criminally inclined? Does the First Minister recognise the shambles that has been made of our bail laws, such that a vicious criminal who knifed someone can be released on eight bail orders? Does he recognise that prisoners are compensated with hard-earned taxpayers' money because prison conditions do not come up to hotel standards?

When next he meets the Home Secretary, who is the member of Parliament for Airdrie and Shotts, will the First Minister insist that when he legislates to reduce the impact of the ECHR on English constituents, Mr Reid will consider amending the Scotland Act 1998 to take care of his Scottish constituents?

Jack McConnell (Labour, Motherwell and Wishaw)

It is sometimes tempting to dismiss the turn of phrase, but those are serious issues and I want to address them seriously.

First, the Human Rights Act 1998 is United Kingdom legislation. It has an impact on the whole UK and we will therefore clearly be involved in discussions with the Home Office and the Department for Constitutional Affairs during the review of its operation as announced in recent days.

Secondly, the establishment of a series of rights in our law in relation to the ECHR took place a very long time ago and it was supported by Conservative Governments, so let us not deny that. The establishment of rights in our law in Scotland and across the UK is important for the 21st century, but it is also important that the provision of those rights does not create a culture that will lead to victims, witnesses or potential victims of crime having no rights, or perceiving that they have no rights. In the operation of the law, it is important to ensure that people are properly protected and that public safety is paramount.

I will give Phil Gallie an example. The way in which our courts were implementing the new laws was perceived to be having an impact on public safety, even if it was not doing so in reality, so we had to tighten up the law on bail. We are doing that. There will be changes that ensure that any judge who gives bail also gives their reasons for doing so. The changes will also put on the face of Scots law the conditions in which bail can be refused. There will also be changes to practice and procedures to ensure that information is more speedily exchanged so that those who are being considered for bail go in front of people who have full information available to them.

Those changes are important and they are being made in light of practical experience of the Human Rights Act 1998. I am sure that other changes will need to be considered in the years to come. My absolute priority will be to strike a balance between the rights of individuals—particularly the rights of law-abiding, decent individuals—and the rights of the victims and witnesses of crime, and to ensure that public safety and concern for the public are at the heart of our criminal justice system.

George Reid (None, Ochil)

I revert to the point of order raised by Duncan McNeil. Members will appreciate that it is difficult for me to come to a judgment when I do not have specific details or the extracts in front of me.

However, I remind all members that, under rule 7.3, they are required to behave and conduct themselves in a courteous and respectful manner, particularly when attributing direct quotations to other members. I ask Christine Grahame to reflect on whether her description of Duncan McNeil's remarks was, in her view, fair, accurate and consistent with rule 7.3.

Question Time — Scottish Executive — Health and Community Care

Alasdair Morrison (Labour, Western Isles)

To ask the Scottish Executive how it expects national health service boards to provide support for specialist palliative care across Scotland. (S2O-9894)

Lewis Macdonald (Labour, Aberdeen Central)

We expect NHS boards to have in place a palliative care strategy for their area and, in that context, to fund 50 per cent of the agreed annual running costs of voluntary sector hospices that provide palliative care.

Alasdair Morrison (Labour, Western Isles)

Does Lewis Macdonald agree that it is unacceptable that the Western Isles NHS Board has failed to agree and put in place a service level agreement for medical cover at the Bethesda hospice in Stornoway? Does he agree that it is far from acceptable that many of the letters on the matter that the Bethesda management have sent to the NHS board since January have not even been acknowledged? Further, does he agree that we need a degree of tolerance and common sense to prevail in the regulation of facilities such as Bethesda, which is a four-bed hospice in the Western Isles? Will he support me in trying to put in place a system that will allow the continuation beyond the end of this month of specialist palliative care in the one and only hospice in the outer Hebrides, avoiding the closure of what is an excellent and highly regarded facility?

Lewis Macdonald (Labour, Aberdeen Central)

It is important to ensure the provision of palliative care to people as close to their communities as possible, although any hospice provision must meet the appropriate statutory requirements. In the circumstances that Alasdair Morrison described, I expect payments to continue under the previous year's service level agreement until a new agreement is in place. I certainly expect the management of Bethesda and the health board to engage in constructive dialogue to resolve the issues.

Rob Gibson (Scottish National Party, Highlands and Islands)

We welcome the support for the Bethesda hospice. I understand that, once again, services are being put in doubt because of the Western Isles NHS Board's financial situation. We hope that ministers will acknowledge that. A positive outcome could be achieved through a new arrangement under which care homes would upgrade their services to provide palliative care. Does the minister have that in mind as a future option for the Bethesda hospice?

Lewis Macdonald (Labour, Aberdeen Central)

As I said, the expectation is that NHS boards throughout Scotland will support voluntary sector hospices. We acknowledge that hospices provide a significant service that is particularly sensitive to patients and their families. We want that to continue, which I expect to happen in the case of the combined care home and hospice facility that Alasdair Morrison asked about and in other cases. However, the statutory requirements must be complied with, including the requirement for the Scottish Commission for the Regulation of Care to inspect homes biannually. We must also ensure that the standards of medical support and provision are appropriate for the circumstances.

Des McNulty (Labour, Clydebank and Milngavie)

I draw to the minister's attention the extent to which fundraising is required to maintain our hospices. The largest hospice in Scotland, St Margaret's, is in my constituency. Although it receives substantial support from Greater Glasgow and Clyde NHS Board, I would welcome proper negotiations around solidifying the level of support from boards and, ultimately, the Executive. I would like to discuss that with the minister.

Lewis Macdonald (Labour, Aberdeen Central)

I am happy to meet Des McNulty to discuss issues that he wants to raise in connection with the hospice that he mentioned, but it is important to understand the basis on which negotiations of the type that he mentions could take place. The hospice movement does not seek full funding from health boards, because it appreciates and values its independence. That independence is delivered and protected by the funding arrangement, under which we expect health boards throughout Scotland to provide funding in the order of 50 per cent.

John Swinburne (SSCUP, Central Scotland)

To ask the Scottish Executive what timescale it has set to implement the recommendations on care in the community, set out in the Kerr report, to allow older people to remain in their own homes rather than in residential care. (S2O-9820)

Lewis Macdonald (Labour, Aberdeen Central)

When we published "Delivering for Health", our response to the Kerr report, in October 2005, we made it clear that we envisaged implementation over the next 10 years. We will publish proposals in the next few weeks for a rehabilitation framework to support services for older people and those with long-term conditions. The chief medical officer will shortly begin to draw together existing work on identifying the frailest people in our communities, in order to provide co-ordinated care that will allow them to remain independent in their own homes for as long as possible. We expect work on the integrated care that they need to be completed and implemented by all health boards before the end of next year.

John Swinburne (SSCUP, Central Scotland)

Does the minister agree that there will require to be a considerable increase in the provision of home helps and meals-on-wheels, nursing and ancillary staff to give proper care to all those who can and should be treated in their own home? Other disciplines, such as physiotherapy and chiropody, should also be made available. The major benefit of that would be that people would be allowed to remain in familiar surroundings, instead of going into residential care, which all too often entails their homes being sold. In the final analysis—

Murray Tosh (Conservative, West of Scotland)

Mr Swinburne, you are not here to provide a final analysis. You have asked a question. Do you have a further question to ask?

John Swinburne (SSCUP, Central Scotland)

I am nearly finished.

Murray Tosh (Conservative, West of Scotland)

I do not want you to finish what you are saying. I want you to ask a question.

John Swinburne (SSCUP, Central Scotland)

Does the minister agree that, in the final analysis, where required, the availability of palliative care in the home would be the final piece in the complex jigsaw of care in the community?

Lewis Macdonald (Labour, Aberdeen Central)

John Swinburne raised number of points, and I support the principle underlying his question. We want people to stay in their own homes for as long as possible, and we recognise that the implication of that is that we will provide the services—either directly or, more commonly, through a partnership between health boards and local authorities—that will enable people to do so. The issue of palliative care at home is a difficult and complicated one; it is not always an appropriate form of care or the best way in which people should spend their final days, but, where it is appropriate, we would want to make it possible.

Des McNulty (Labour, Clydebank and Milngavie)

To ask the Scottish Executive whether it is aware of the work being undertaken by Clydebank Asbestos Group in conjunction with West Dunbartonshire Council to address the health needs of mesothelioma patients. (S2O-9893)

Lewis Macdonald (Labour, Aberdeen Central)

Yes, not least because of the constructive meeting earlier this week involving those groups, Des McNulty and Hugh Henry, at which justice issues arising from that work were discussed.

Des McNulty (Labour, Clydebank and Milngavie)

I hope that my proposal for a bill will get a lot of support.

The progressive partnership that has been established between Macmillan Cancer Support and West Dunbartonshire Council has assisted hundreds of cancer patients and carers in the past 12 months. Will the minister agree to hear a presentation by the partners on an initiative that the Convention of Scottish Local Authorities is keen to see rolled out throughout Scotland? I ask him for an assurance that Alimta, which is the only licensed treatment for mesothelioma patients and which has been shown not only to increase quality of life but to extend life, will continue to be available to Scottish patients.

Lewis Macdonald (Labour, Aberdeen Central)

The bill to which Des McNulty referred relates to issues that require to be resolved. That was acknowledged by Hugh Henry when he met Des McNulty earlier this week.

I would be interested in any lessons that we can learn from work that is being done in West Dunbartonshire on support for patients in the circumstances that Des McNulty described.

As far as Alimta is concerned, the consultation that is being held by the National Institute for Clinical Excellence is just that: a consultation. It is not NICE's final view. It is important to stress that patients who are already receiving Alimta will continue to do so, whatever the final conclusions of the NICE consultation.

Jean Turner (Independent, Strathkelvin and Bearsden)

To ask the Scottish Executive what the advantages are of the four-hour target established for casualty and accident and emergency departments, which means that staff must process patients from registration to discharge or admission within that timescale. (S2O-9840)

Andy Kerr (Labour, East Kilbride)

The four-hour target is about ensuring that patients get the treatment they need as quickly as possible—in other words, a high-quality, responsive service for patients using emergency services. The Health Department, through the centre for change and innovation, is supporting national health service boards to ensure that the target can be met by the due date of the end of 2007. The target applies not only to patients attending all accident and emergency departments but to patients attending community casualty and minor injuries units and acute receiving and assessment units across Scotland. I believe that the target is welcomed by patients and will be achieved by NHS Scotland.

Jean Turner (Independent, Strathkelvin and Bearsden)

Some patients, especially those who had 12-hour waits last month, would probably not see the advantages. ISD Scotland figures show that the lack of beds is the commonest cause for long waits in casualty departments. Stobhill hospital has an added problem, due to the loss of wards there in preparation for the new ambulatory care and diagnostic unit. It has not had extra winter beds or—

Murray Tosh (Conservative, West of Scotland)

Dr Turner, you must ask a question.