Scottish Parliament, 14 September 2006

440 contributions from 88 members. The official report.

Official Report 14 September 2006

Health

George Reid (None, Ochil)

Good morning. The first item of business is a debate on motion S2M-4784, in the name of Shona Robison, on health.

Shona Robison (Scottish National Party, Dundee East)

The debate is not about saying no to any change. It is not about refusing to recognise some of the real challenges that face our health service and it is not about rejecting the Kerr report. The debate is about Parliament sending out a clear message that it believes that the process involved in Lanarkshire Health Board deciding to downgrade accident and emergency services at Monklands hospital was fundamentally flawed and that that has resulted in a deeply flawed decision.

Monklands is one of the best performing A and E units in Scotland. It meets the four-hour waiting target in 94 per cent of cases and it is the most cost-effective unit: it has had the lowest cost per attendance and the lowest increase in cost over the past five years.

Only four years ago, the facility at Monklands received a £4 million investment and it has developed some effective and innovative ways of delivering its accident and emergency services, which is all to the benefit of patients. When I visited the unit I was struck by the dedication and loyalty of its staff. They are a credit to the health service, which makes the decision all the harder to understand.

The hospital serves some of the poorest communities in Scotland, which have some of the lowest levels of car ownership. That makes it difficult for people to jump in their car and travel to the proposed alternative sites, which will have a consequent effect on the ambulance service in the area. More than 17,000 emergency admissions were made to Monklands in 2005. The fact that many of those people will have to be transported across Lanarkshire by ambulance will put the ambulance service under enormous pressure.

The move will have serious knock-on consequences for the other Lanarkshire hospitals, which are already experiencing pressures. Monklands A and E is the busiest unit. Under this proposal it will join the second busiest unit, at Wishaw, which will result in huge pressure on the service.

In June the Scottish National Party released figures that showed that Wishaw general hospital was running at more than 20 per cent over capacity. It was designed to treat 50,000 people a year, but more than 61,000 patients passed through its doors last year. Furthermore, back in April it emerged that Wishaw's A and E department had clocked up one of the longest delays recorded in Scotland when a patient was held up for almost 20 hours. It is clear to me that further reducing A and E capacity in Lanarkshire will serve only to make the situation worse, which is why we believe that there is a case to be made for the retention of all three A and E departments.

The decision betrays a lack of joined-up thinking and planning and it will lead to added pressures on Glasgow royal infirmary and the new-build hospital at Larbert. Given that NHS Greater Glasgow and Clyde is in the middle of a beds review process, the decision will impact heavily on its estimations of what is required. Furthermore, the new hospital at Larbert, which might be expected to bear the burden of referrals from the Cumbernauld area, would need to expand by 20 per cent to do so effectively. The preferred bidder has already been selected for Larbert, based on the tender needs of NHS Forth Valley alone. Best value can no longer be guaranteed if the proposed A and E services need to expand, as the preferred bidder now has an effective monopoly on any change to the plans.

What about the process? In the new post-Kerr world, the bad practice of health boards consulting on plans when they had already made their mind up was supposed to be a thing of the past; there is a duty on health boards to consult properly. The Minister for Health and Community Care stated during the debate last year:

"I expect people to be consulted about the case for change, and the options for change, long before a preferred solution is reached."—[Official Report, 25 May 2005; c 17155.]

However, it seems that the bad old days are as much with us as they ever were. NHS Lanarkshire has had a preferred solution right from the start. The consultation process was a sham that sought to sell a predetermined option to an increasingly sceptical public. The decision is unacceptable to the people who use the hospital and is viewed with concern by many who work in it. It is high time that some democracy was put back into health boards. The SNP will do that by making health boards directly elected bodies.

Why did the set of so-called options put forward by the health board all lead in one direction: to the closure of Monklands A and E? As we all know, the reasons had little to do with clinical priorities and everything to do with finance. NHS Lanarkshire is running an £8.4 million deficit, which is the worst financial performance of any board in mainland Scotland. It is clear that that deficit has been one of the driving forces behind the decision.

The other key issue concerning finance is the fact that the other two Lanarkshire hospitals were built under the private finance initiative. The fact that managers are tied into the remaining 25 years or so of the PFI contract has grossly distorted the decision-making process. All things have not been equal when the options have been weighed up in this case.

The inherent inflexibility of the PFI contracts means that the hands of policymakers are tied for years to come. The Hairmyres contract alone runs to 350 pages and it governs everything from how many porters will be employed, to getting a light bulb changed. That squeezes out flexibility, abandons common sense and ensures that any proposal to reorder services around PFI facilities becomes from the outset an exercise in financial damage limitation.

All those factors are considered in private well before the issue that matters most: the good of the patient. All are considered before the conjuror's three-card trick that passes for a consultation even sees the light of day.

The decision is a bad one, which the Executive must re-examine and reverse. We have no problem with Karen Whitefield's amendment but, in order to get to vote on it, she and others who support her amendment will have to defeat the Executive amendment. Otherwise, her amendment will be pre-empted. I am sure that Karen Whitefield understands that point and will vote accordingly.

Today is an opportunity for Parliament to make a stand against bad decision making and the erosion of local services. I urge members to put the interests of patients first and foremost by supporting the motion in my name.

I move,

That the Parliament does not accept the case put forward for the downgrading of the accident and emergency unit at Monklands Hospital and calls on the Scottish Executive to re-examine its decision to approve this downgrading.

Lewis Macdonald (Labour, Aberdeen Central)

The debate is about how to modernise the national health service in Lanarkshire, how best to provide emergency services for patients and the future role of Monklands hospital. Those issues must be addressed in the context of our national policy for Scotland's NHS, on which, as Shona Robison indicated, members of this Parliament have already had a say.

As Shona Robison indicated, the publication of the Kerr report was broadly welcomed in the chamber last year. In October, members supported the Executive's response to that report, "Delivering for Health", by a substantial majority.

When we debated "Delivering for Health" there was widespread understanding of and agreement on the key principles on which we needed to base future services. Those include the need to shift the balance of care, so that we rely less on acute hospitals and provide more local services geared towards the management of long term conditions; the need to tackle health inequalities by anticipating and preventing problems, rather than waiting until a person is seriously ill; the need to streamline emergency care and provide the majority of such care in community casualty units while developing more specialised A and E departments that can concentrate on the most serious cases; and the need to separate planned from emergency care so that we can make the best use of facilities, cut down on cancellations and reduce waiting times for patients even further.

Donald Gorrie (Liberal Democrat, Central Scotland)

Will the minister give way?

Stewart Stevenson (Scottish National Party, Banff and Buchan)

Will the minister give way?

Lewis Macdonald (Labour, Aberdeen Central)

I will give way to Mr Gorrie.

Donald Gorrie (Liberal Democrat, Central Scotland)

Can the minister give an assurance on two points, which might help to ease local concern? First, could the Executive ask the audit authorities to examine the various figures that are being quoted about the costs of either keeping Monklands A and E department open or closing it, as compared to the other two hospitals? Secondly, can the Executive guarantee a much improved bus service to help patients and their relatives from the Monklands area who would have to continue to attend Wishaw general hospital and Hairmyres hospital after their initial A and E treatment?

Lewis Macdonald (Labour, Aberdeen Central)

I understand that Elaine Smith, whose constituency is in the area, has asked the Auditor General to consider the matter. His response is of course a matter for him, but if he chooses to take up her invitation all appropriate figures will be made available to him.

The answer to Mr Gorrie's second point, on transport, is yes; we will ensure transport provision.

Stewart Stevenson (Scottish National Party, Banff and Buchan)

The minister said that we should rely less on acute services and make more of local delivery. Will he comment on that in the context of maternity services in the NHS Grampian area, where the trend appears to be entirely in the opposite direction?

Lewis Macdonald (Labour, Aberdeen Central)

I will resist the temptation. No doubt Mr Stevenson will attend Mike Rumbles's members' business debate on maternity services in Aberdeenshire next week, when he will have another opportunity to ask me about the matter. In this debate we are discussing acute services—[ Interruption. ] We are discussing acute services in Lanarkshire, as Mr Stevenson and Mr Swinney know. It is clear that, throughout Scotland, NHS boards must embed the principles of "Delivering for Health" in the design and delivery of local services. As happens when there is any significant change in the way in which public services are delivered, we recognise that turning those principles into reality will involve hard choices that will sometimes be difficult for communities to accept. That is why I wanted to see for myself what was happening in Lanarkshire, so that I could understand the issues and choices.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

Communities would find decisions easier to accept if they thought that they had had meaningful involvement in the consultation process. Why did NHS Lanarkshire and the minister ignore the views of the thousands of people in Cumbernauld, Kilsyth, Coatbridge and Airdrie who signed petitions in support of the retention of A and E services at Monklands hospital?

Lewis Macdonald (Labour, Aberdeen Central)

I assure Cathie Craigie that I did not ignore those people's views—far from it. As I will explain, I have attempted to strengthen the proposals that relate to those parts of Lanarkshire, to ensure that people's concerns are fully reflected as we go forward.

When I visited hospitals in Lanarkshire in June, what struck me most was the poor quality of primary care in North Lanarkshire, which meant that many people were bypassing primary care and presenting directly to hospital A and E departments. People often presented to A and E very late in the development of a long-term condition, although their conditions would have been far better managed through early intervention by their general practitioners.

Like Mr Stevenson and other members, I use health services in NHS Grampian. On close examination of the services in Lanarkshire it was clear to me that there were areas in which significant improvement and modernisation was required. The test that I applied to NHS Lanarkshire's proposals was whether they would deliver the improvement and modernisation that is needed. I am conscious of NHS Lanarkshire's commitment to use the proposals in its document, "A Picture of Health", as the basis for a better quality health service than Lanarkshire has ever had before. I will hold the health board accountable for that commitment.

Alex Neil (Scottish National Party, Central Scotland)

During his consideration of the issues, why did the minister ignore the views of the tens of thousands of people in Lanarkshire who are utterly opposed to the board's daft proposal? Many of those people attended public meetings and at every meeting, people universally opposed the daft proposal.

Lewis Macdonald (Labour, Aberdeen Central)

Far from ignoring the views that were expressed at those meetings and elsewhere, I have taken those views into account in my response to the board's proposal. I have imposed a number of additional requirements that NHS Lanarkshire must put in place before it makes any change to A and E provision at Monklands hospital and elsewhere.

First, the necessary investments in primary care must be brought forward. I made it clear to the board that I expect early progress on new primary care premises, in Airdrie and in Coatbridge in particular. I am pleased to report that initial agreement on Airdrie resource centre has been reached, which is a necessary first step. We have brought forward capital funding to facilitate such developments.

I also made it clear that I expect the board to focus on reducing avoidable A and E admissions in the most deprived communities of North Lanarkshire, as part of the prevention 2010 initiative. I agreed to the early deployment of 43 additional paramedics and ambulance technicians by the Scottish Ambulance Service in Lanarkshire. I also required the provision of a shuttle bus service between the three Lanarkshire hospitals.

I made it clear to the board that necessary additional capacity at Hairmyres hospital and Wishaw general hospital, which Shona Robison mentioned, must be in place before any changes are made to the service at Monklands hospital and that the community casualty unit at Monklands should operate 24/7. I also required that community casualty units should be in place in Cumbernauld and Lanark. I also set expectations for regional planning by NHS Lanarkshire and other health boards in the west of Scotland.

Finally, in order to make crystal clear my expectation that Monklands hospital will continue to provide a full range of appropriate services as an integral part of NHS Lanarkshire, I announced that up to £100 million would be provided in the NHS Scotland capital programme, for the regeneration of Monklands hospital.

That programme of action requires NHS Lanarkshire to deliver measures to ensure that necessary improvements are in place before changes are made to A and E provision. The programme guarantees the future of Monklands hospital and provides the step change in improved health care that the people of Lanarkshire need and deserve.

I move amendment S2M-4784.2, to leave out from "does" to end and insert:

"reaffirms its support for Delivering for Health as the basis for service change in NHS Scotland; commends its commitment to shifting the balance of care to provide more safe and sustainable local services including the separation of scheduled and unscheduled care; notes the commitment of local communities to their health services and natural concerns when long-established services are changed, and remains committed to an NHS Scotland which responds to changes in the demands placed upon it."

Karen Whitefield (Labour, Airdrie and Shotts)

I welcome the opportunity to speak to the amendment in my name, not least because I want to speak out against the crass political opportunism of the Scottish National Party.

The SNP's approach to the reconfiguration of hospital services in Lanarkshire and throughout Scotland gives a new, rather desperate meaning to the term, "ambulance chasers". It saddens me that SNP politicians such as Shona Robison and Alex Neil treat the recent decision by NHS Lanarkshire as nothing more than an opportunity to score cheap political points.

Carolyn Leckie (SSP, Central Scotland)

Will the member give way?

Karen Whitefield (Labour, Airdrie and Shotts)

No. Only a year or so ago, the SNP acclaimed the recommendations in the Kerr report, but the party now appears to oppose some of the report's central tenets, such as the separation of planned and emergency surgery and the introduction of casualty units to take the strain away from A and E departments.

Sandra White (Scottish National Party, Glasgow)

Will the member give way?

Karen Whitefield (Labour, Airdrie and Shotts)

In the debate on "Delivering for Health" on 27 October 2005, Shona Robison said:

"The Scottish National Party welcomes the broad thrust of the Kerr report and the Executive's response to it."

She went on to say:

"We agree with Professor Kerr that there has to be a separation of scheduled and unscheduled care."—[Official Report, 27 October 2005; c 20035-37.]

Shona Robison (Scottish National Party, Dundee East)

Will the member give way?

Karen Whitefield (Labour, Airdrie and Shotts)

Sit down, Shona, you have had your chance and all you did was parrot my words—[ Interruption. ]

George Reid (None, Ochil)

Order. Let us get back to the core purpose of the debate.

Karen Whitefield (Labour, Airdrie and Shotts)

Alex Neil, in his press release on 28 March, said:

"In no way is ... the complete centralisation of planned care a positive thing."

Shona Robison shed crocodile tears this morning and she visited Monklands hospital yesterday—she did not even do me the courtesy of telling me that she was in my constituency—but where was she during the consultation? Alex Neil would show up at consultation meetings but he would not stay until the end, because he other things to do. He did not even bother to make a submission to the consultation. That is what passes for conviction politics in the SNP, but I have another name for it: contradiction politics. It is the politics of hypocrisy—[Interruption.] No matter how much SNP members shout, they will have to listen.

I understand and accept the need for change and modernisation in our health service. I welcome the minister's commitment to invest in Monklands hospital and to ensure that a shuttle bus service is put in place between Monklands hospital and the other two hospital sites. I welcome his commitment to have the Airdrie resource centre built as soon as possible and to recruit additional ambulance staff. I will hold the minister to his commitment that no changes will be made to A and E services in Lanarkshire until the necessary additional emergency care capacity is in place at Hairmyres hospital and Wishaw general hospital. Given the continuing capacity problems at the A and E departments at Hairmyres and Wishaw, I am not convinced that the minister's commitment can be delivered.

I make clear this fundamental point: the decision that NHS Lanarkshire took and that the minister endorsed is flawed and wrong. The decision to downgrade Monklands A and E is contrary to the core principles that Professor Kerr set out. The board and the minister have decided to downgrade Lanarkshire's most efficient and effective A and E department and to relocate the service within two hospitals that are struggling to cope with current demand. They have chosen to remove an accident and emergency department from the heart of a large community that has some of the worst health statistics in Scotland and suffers from some of the worst deprivation in the country. They have failed to take into account the serious effect that the decision will have on Wishaw, Hairmyres and Glasgow royal infirmary.

My constituents do not understand the decision and neither do I. That is why, with my colleagues Cathie Craigie, Elaine Smith and Donald Gorrie, I firmly believe that the wrong decision has been made on downgrading and I call on the minister to reverse his decision and maintain full accident and emergency services at Monklands hospital.

I move amendment S2M-4784.3, to leave out from "and calls on" to end and insert:

"supports the need to modernise our National Health Service as outlined in Delivering for Health; acknowledges the investment and commitment of the Scottish Executive to improve health services across the country, and calls on the Scottish Executive to reverse its decision to approve the downgrading of accident and emergency services at Monklands."

Nanette Milne (Conservative, North East Scotland)

The fact that I speak in support of the SNP's motion is a clear indication of concern across the parties about the continuing reconfiguration of NHS services in Scotland. The debate focuses on the concerns of people in Lanarkshire about the provision of accident and emergency services in their area, but it also opens up the issue of service redesign in the NHS. Communities throughout Scotland face major changes in provision, some of which are welcome and others of which provoke sustained anger and opposition of the kind that we have witnessed on the proposed closure of the accident and emergency unit at Monklands.

As a North East Scotland member, I am not familiar with the detailed geography of Lanarkshire, so I intend to speak in more general terms and leave the detail to my colleagues. Some months ago, I took part briefly in the debate on the Lanarkshire united health for all campaign, which was brought to the chamber by Carolyn Leckie. During that debate, it became clear not only that there was concern about the proposals to close the busiest accident and emergency unit in the most deprived part of Lanarkshire, but that there was fury that the consultation that was under way at the time did not even allow consideration of the status quo.

At that time, there was cross-party support from local members—Elaine Smith, Cathie Craigie, Karen Whitefield, Margaret Mitchell, Carolyn Leckie and Alex Neil—who all made their concerns and opposition to the closure of the Monklands accident and emergency unit clear to the minister. They did not do that lightly and they had significant backing from medical opinion in the area. Then the announcement came that the Monklands unit was to close.

More recently, I sat in on a similar debate about NHS hospital provision in the Borders. Again, there was cross-party support that was backed up by medical opinion and a strong case for the retention of services was put to the minister. The announcement that Coldstream and Jedburgh cottage hospitals face closure came weeks later.

In Grampian, we have a continuing campaign against the health board's decision to close the midwife-led maternity units in Fraserburgh and Aboyne and to focus instead on community midwifery. Again, there has been major community involvement and cross-party support and, next week, there will be a debate on the subject in the name of Mike Rumbles. In that case, campaigners felt that the consultation process was merely cosmetic and, in their support, the Scottish health council initiated further consultation. NHS Grampian's proposals are currently with the minister, and we await the outcome with interest.

There is also massive opposition to proposed changes in the accident and emergency services in Ayrshire. I have no doubt that John Scott will deal with that when he speaks later on.

There clearly have to be changes in NHS provision to meet the demands of modern health care, and health boards throughout the country are having to redefine their services. Some older and cherished hospital buildings may have to go because they are no longer fit for purpose, and people will mourn their loss. However, if there is serious concern about proposed changes, if whole communities genuinely feel that consultation is not meaningful and if responsible elected members across the parties are totally supportive of local opinion, ministers must be wary of taking decisions that go against that opinion.

Consultation is all very well but, if the weight of public opinion is set aside at the end of it, the public will rapidly become even more cynical and disillusioned than they are at present. The public perception of the health service is that it is becoming far too centralised. People are extremely worried about the loss of facilities close to home and, far from feeling that they are involved in service redesign, they feel that they are simply being ignored and brushed aside. Monklands seems to me to be a classic example of that and, to use the terms of the motion, I urge the Scottish Executive to re-examine its decision to approve that closure.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

As has rightly been said, the debate takes place in the context of the Kerr report. It is helpful to have on record Shona Robison's opening remarks on that report, which, to be fair, were a repetition of what the SNP said when the Parliament debated it and "Delivering for Health". As the minister said, the Kerr report was accepted by the Parliament.

Shona Robison (Scottish National Party, Dundee East)

I have no problem with repeating what I said about the Kerr report. I understand it as backing the provision of local services. If Euan Robson interprets it somewhat differently, I am afraid that we have different interpretations of what Kerr said.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

I do not dissent from the point that Shona Robison made—that the report is about delivering more services locally. Of course, it is also about service redesign, and Kerr envisages change; we cannot escape that conclusion. In fact, I would go so far as to say that redesign of services would take place even if there had been no Kerr report and the subsequent Executive response. We know full well that there are a number of buildings in the NHS that are no longer fit for purpose. We know full well that there is major population change in some communities, which means that services have to be redesigned, and there are also changes in medical practice. It is right that more local services should be more locally delivered and that there should be an emphasis on anticipatory care. Indeed, as specialism develops, there will be more specialised A and E departments, which will mean that there will have to be fewer of the highly specialised departments than in the past.

The consultation process in Lanarkshire is said to have been flawed. I have experienced in my constituency a consultation process that was said to be flawed. There is a common denominator in some of the consultations: a strong suspicion in the local community that the relevant board has made up its mind beforehand. If a board is minded to decide in one direction or another, it would be far better for it to say so up front. The consultation would then be about what the board wanted to do, the other options that were available and the reasons that the board had chosen one option rather than another. The Scottish health council, which has been set up to monitor such consultations, must make that clear.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

The Grampian consultation has been mentioned. There is nothing wrong with that consultation; it has been really good and effective and has engaged the local community. The point is not that the consultation process is wrong, but that the board pays no attention to the results of the consultation. That is the problem.

Euan Robson (Liberal Democrat, Roxburgh and Berwickshire)

That is precisely the point that I am trying to get at. There have been exhaustive consultations, endless meetings and endless documents but—let us come to the point—the board has made up its mind in advance. However, if it had said at the outset what its proposal was, rather than saying that no conclusion had been drawn and that the consultation was open, consultees would be clear about what they were dealing with. I defer to Mike Rumbles's greater experience of the Grampian consultation.

I would be grateful if the minister would clarify whether the deliberations took account of the Monklands closure's potential knock-on effect on other authorities' accident and emergency units.

We have had a lot of discussion about the Monklands unit being one of three accident and emergency units in Lanarkshire, but Lanarkshire is not an island. There are other, neighbouring health authorities and I would be interested to know precisely what was said in the deliberations about the knock-on effect in Forth Valley, Glasgow and further afield. If it is the case that there will be serious implications elsewhere, there is a duty on the Executive to recognise that and, perhaps, intervene in the form of investment. The minister can deal with that in his summing up.

I welcome the investment that has been made in the community, the transport infrastructure, the shuttle bus service, the additional ambulance staff and the additional capacity that has been put in place. I also welcome the £100 million regeneration money for the hospital. That is a significant sum of money in anyone's language.

I believe that the Auditor General should have a look at these figures. It would be helpful if the minister were to express more enthusiasm for that. If, at the end of the day, the figures are seen to be robust, that is fine and we can proceed on a sound basis. If they are not, there are implications.

Sandra White (Scottish National Party, Glasgow)

I was absolutely appalled by Karen Whitefield's rant. It merits no reply from me. The people of Lanarkshire can reply to her; I have no time to do so today.

With all due respect, I say to the minister that his amendment is one of the most insipid that I have ever seen. It does nothing to alleviate the fears of the people of Lanarkshire about the downgrading and eventual closure of Monklands.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

Will the member take an intervention?

Sandra White (Scottish National Party, Glasgow)

No; I was not allowed to intervene earlier.

As Euan Robson said, this Government has continually avoided dealing with the impact of the downgrading of Monklands A and E unit on other areas, particularly on Glasgow royal infirmary. The decision to downgrade Monklands was taken without any studies being conducted into the effect that the decision would have on Glasgow. That is worrying, particularly as Glasgow is downgrading to a position in which it will have only two full A and E units. NHS Lanarkshire said that, during the consultation, it was able to tell patients what hospital they would go to in order to avoid overcrowding other hospitals. However, anyone who is in an emergency will go to the nearest hospital, which, for people in the area that we are discussing, is Glasgow royal infirmary. They will not be guided by lectures from the health board. One of my worries about the proposal with regard to Monklands is the impact that that will have on Glasgow and other areas. We must have a real debate on this issue so that we may re-examine the decisions that have been taken and—I hope—overturn them.

I said that Glasgow was downgrading to a position in which it will have only two full A and E units. It is also downgrading Victoria and Stobhill as well. That will take place in 2009. The redevelopment of Glasgow royal infirmary is not anticipated to take place until 2013. The decisions that are being made will put even more strain on our services in Glasgow and the wider area. The GRI is currently operating at 80 per cent of its capacity and Victoria and Stobhill will also have to cope with an influx of patients if Monklands closes down. Currently, Victoria deals with more cases than the GRI does, and Monklands deals with about the same amount of cases as the GRI. It does not take an expert to work out that a disaster is about to happen. I pointed that out to the minister in a question that I put to him on 4 May this year. Before Monklands hospital was opened, the GRI was running at 150 per cent of its capacity. We cannot possibly go back to that situation.

The "Delivering for Health" document, which has been mentioned, is all very well, but Glasgow royal infirmary cannot cope with the extra influx. I am not scaremongering when I say that lives will be put at risk if something is not done about the situation.

I find it incomprehensible that one of the most major impacts of the downgrading of Monklands—the effect that that will have on surrounding areas—was not mentioned until a week before the consultation closed. That makes me wonder whether there is a legal ground for challenging the health board's decision.

The minister has to consider the situation seriously. The views of the Scottish health council and the bodies that I would call quangos that this Government has set up are being taken into account. However, surely the public should have the final say. They are the ones who will suffer as a result of a bad decision being made.

The figures for the money that was spent by the health board on the hospitals—£56 a head at Monklands, £70 at Wishaw and £72 at Hairmyres—show that Monklands was the cheapest to run. Why, then, was a decision taken to close it down?

I ask the minister to address, in his summing up, the issue of the admissibility, or inadmissibility, of the consultation, given the fact that the major issue of the impact that the downgrading of Monklands would have on the rest of Scotland was not mentioned until a week before the end of the consultation.

Janis Hughes (Labour, Glasgow Rutherglen)

I welcome the opportunity to speak in this debate mainly because I think that it is important to put the record straight with regard to the SNP's record on health.

As the Deputy Minister for Health and Community Care said, when we debated "Delivering for Health" last year, there was agreement in this chamber on its key principles. Indeed, when we debated the same issue earlier this year, Mr Swinney, speaking on behalf of the SNP, said:

"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."—[Official Report, 18 May 2006; c 25747.]

Alex Neil (Scottish National Party, Central Scotland)

Will the member give way?

Janis Hughes (Labour, Glasgow Rutherglen)

I do not think that Mr Neil disagrees with his colleague. In any case, he will have a chance to make a speech soon.

I took Mr Swinney's words to mean that he is not averse to change. Indeed, we have heard from Ms Robison this morning that the SNP's motion is not about rejecting change. However, funnily enough, when change was proposed in Glasgow, the SNP objected to it as well, as we have heard from Sandra White.

Achieving change often means making difficult decisions. Having been through the acute service review in Glasgow some years ago, I understand only too well how emotive an issue this can be. In general, people like what they are used to and we have not been good at providing information in advance of any proposed change to explain why it is necessary and how it will benefit people.

I believe that the Kerr report helped a great deal with that, as it went a long way towards explaining why change is not always a bad thing. Change is often driven by necessity, and I do not believe that anyone on the Labour benches campaigned for the status quo on health provision in Lanarkshire, as Karen Whitefield said. Unlike some others in this chamber, we understand the serious point that change must happen and do not simply use it for political opportunism.

Month after month, the First Minister is challenged in this chamber on the issue of waiting times. Health spending is at an all-time high and investment in staff and diagnostic equipment is unprecedented. However, money alone will not deliver the improvement in delivery that the Opposition calls for.

John Swinburne (SSCUP, Central Scotland)

Will the member give way?

Janis Hughes (Labour, Glasgow Rutherglen)

No, I will carry on.

Changing the way in which we deliver health care to streamline the patient journey, establishing community casualty units where those with minor injuries and ailments will not have to wait for hours before being attended to, separating planned and emergency care so that cancellation of surgery will not cause the distress that it so often causes at present, introducing one-stop shops for care, so that assessment, diagnosis and treatment can be carried out on the same day—these are the things that will improve our health provision and make a difference to people's lives.

If this debate today is important, why are we devoting only half a morning to it? If the SNP is committed to the health of the people of Lanarkshire—and we have heard its members speak a lot about that in recent days—surely the party could have given all its time to the issue this morning. Instead, it has chosen to use a local situation for political gain. People will make up their own minds about that. Labour's record on health shows our commitment to the people of Scotland. Perhaps it would be better if the SNP told us what it would do better, instead of just criticising other people's decisions.

Jean Turner (Independent, Strathkelvin and Bearsden)

It is clear that all politicians defend hospitals and support campaigners. They all want to keep their hospitals open and we all know that change has to take place. I have worked in the NHS for 35 years and change constantly took place throughout that time, so I am used to it.

We have to be clear about what is best for the patient. We should never close a service or decide to shut something down until there is something better to put in its place. We must ensure that what is being provided is at least as good as what was there before, if not better.

Elaine Smith (Labour, Coatbridge and Chryston)

Will the member give way?

Jean Turner (Independent, Strathkelvin and Bearsden)

I am sorry, but I have only four minutes and I have a lot of points to cover.

The service that is provided has to be accessible. Transport is essential. The proposal that we are discussing will have an impact on Glasgow. The Health Committee heard that it is easier for the people who currently go to Monklands to get transport to that hospital than it is for them to get to other hospitals. I do not know whether a shuttle bus will suffice.

What we have heard confirms my suspicion that overcapacity is a serious problem. No hospital should run at more than 80 to 85 per cent capacity. If they do, they run into difficulties, such as infection. At present, there is not enough capacity in our system—for example, we are putting into general wards people who should not be in those wards. The other day, I heard about somebody who had had a serious plastic surgery operation. They had a problem, were admitted to Glasgow royal infirmary but ended up in an ordinary ward. That is tantamount to disaster. The minister should listen to the people and to the consultants and others who work in the service. It is simply bad practice to run a hospital at over its capacity.

We have had innovative change. Stobhill hospital was cost effective and made lots of innovative changes, but that does not save hospitals. What comes into the equation is money. Health boards have to find the money for public-private partnerships before they find money for services elsewhere. I agree that Hairmyres should increase in size, because the Southern general will be the only general hospital in the south of Glasgow, from which Hairmyres is at the opposite end. There will be no services to the people in Newton Mearns. Lots of people, including people in my constituency, have already decided that they will go to the royal infirmary rather than through the tunnel to the Southern general.

We have managed to keep Stobhill's casualty department open despite the fact that Tim Davidson, who is the chap in charge of the NHS in Lanarkshire, wanted to accelerate the closure of the department. If he had done that, he would have changed the status of the general hospital and left himself without a hospital that he very much needs at the moment.

The minister is right to say that the consultation was okay, but what is the point of consultation if nobody is listening, if nobody takes things on board and if, financially, the only option is to spend the money in one direction? The minister is being dishonest with the people. He should not have consultation at all. The situation was summed up for me at one of the consultation sessions when a health board member in my group said, "It's so good to have you all here to consult. I think our problem has been that we haven't got our message across to you." I say to the minister that many of the people who live in Lanarkshire and greater Glasgow and Clyde may be deprived in some ways—in economic matters—but they are not stupid and they understand what the health boards are doing. They understand the need to have services close to home.

We cannot do everything in primary care. It is cheaper and better to do things in primary care, but we need to put in the services so that those things can be done. It is not safe to prevent staff from admitting people to hospital to cut down on accident and emergency admissions because that puts pressure on clinicians. The minister must rethink. We should not close anything until we have provided something better.

George Reid (None, Ochil)

I call Margaret Mitchell, to be followed by Carolyn Leckie.

Margaret Mitchell (Conservative, Central Scotland)

At the MSP briefing prior to the launch of the consultation "A Picture of Health", NHS Lanarkshire included as one of the options to be consulted upon the retention of all three accident and emergency departments, although it was made clear that that was not the board's favoured configuration. Subsequently, retention of the status quo was not included as an option when the consultation was launched, because it was becoming obvious, even at that early stage, that the status quo was the favoured option of the vast majority of people—and, crucially, users of the service in Lanarkshire.

Rather than keeping the option and persuading people by the power of its arguments, the board dropped the option and, in so doing, rendered the consultation nothing more than a marketing exercise and an attempt to sell a pre-determined option. For that reason alone, the minister should re-examine the decision to approve closure. The option to retain all three accident and emergency departments was not included in the formal consultation, yet the fact of the matter is that, at every public meeting, the public wanted to discuss that option.

The board's arguments for closure do not stack up. The assertion that it would not be financially viable to retain the departments fails to take into consideration the fact that a fully equipped, modern accident and emergency department at Monklands hospital would attract patients from Glasgow, where, as has already been stated, the five departments are to be reduced to two. I am disappointed that the board has failed to be proactive in that regard.

The claim that it would not be possible to attract appropriate clinicians to staff the three departments is simply not true. The necessary training could be put in place now to ensure that clinicians are available, and they would most certainly be attracted to a modern and well-equipped department.

Duncan McNeil (Labour, Greenock and Inverclyde)

Does the member believe that consultants should be forced to work every weekend?

Margaret Mitchell (Conservative, Central Scotland)

That is, frankly, a pathetic excuse. I believe that we can put through enough consultants now if there is the political will to do it.

The assertion that a better standard of care would be delivered by retaining two accident and emergency departments and one elective department is irresponsible, for the following reasons. In the event of closure of the accident and emergency department at Monklands, there are no direct public transport links from communities such as those in Cumbernauld, Chryston, Stepps, Moodiesburn, Gartcosh, Kirkintilloch and Lenzie to the nearest accident and emergency department, which would be in Wishaw. It is not certain that the required public transport improvements can be delivered and the board acknowledges that, hence its fallback position to provide inter-hospital shuttle buses. That would be expensive and the board admits that it would take funding away from patient care.

Furthermore, anyone, from BBC camera crews to individual commuters, who has tried to negotiate the Shawhead flyover or the East Kilbride expressway an hour either side of peak travel times in the morning or evening knows that they will have a lengthy wait in the traffic, which is almost certain to be gridlocked. Despite that, a full traffic impact assessment has still not been carried out, yet it seems that the minister has unquestioningly accepted the health board's assurances about projected travel times for blue-light ambulance services.

Time constraints do not permit me to go into more detail, but it is already glaringly obvious that the case for closure has most definitely not been made and that closure should not be approved. Even at this eleventh hour, it is not too late for common sense to prevail and for Labour and Liberal Democrat coalition members to reject the closure decision. All that is required is the political will.

Carolyn Leckie (SSP, Central Scotland)

There has been a lot of competition during the summer for the title of the biggest villain in the Parliament, but I think that Lewis Macdonald pipped it at the end of the summer with his decision to endorse NHS Lanarkshire's decision to downgrade services in Lanarkshire. We should remember that this is not just about accident and emergency services—I will come back to that.

The minister would have been far more inclined to support the public—who are well-informed, by the way—if his Labour Party colleagues had managed to unite themselves across Lanarkshire, never mind uniting with other parties to defend services for everybody in Lanarkshire. We have the farcical situation of Labour Party members in East Kilbride defending Hairmyres hospital and Labour Party members in the Monklands area defending Monklands hospital. They are not honest enough to say that they support the NHS's proposals and it could not be made public that they accept that there should be only two accident and emergency departments in Lanarkshire. They have a completely dishonest position.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

Will the member give way?

Carolyn Leckie (SSP, Central Scotland)

No, I will not. Speak to your pal.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

On a point of order, Presiding Officer, the member has accused members of being dishonest. It is right that those members whom she is accusing have the opportunity to put her right and to show her dishonesty in the chamber this morning.

Murray Tosh (Conservative, West of Scotland)

Your means of doing so is to offer to intervene, which you did, and that was declined. I am sorry. That is the end of it.

Carolyn Leckie (SSP, Central Scotland)

I think that everybody knows the facts about the Labour Party positions in various constituencies. The public know the facts and they will remind Labour members of that in May 2007.

The debate is not just about accident and emergency services. There are a lot of issues. I met the minister and I have been involved in the Lanarkshire health united campaign, whose position is the status quo plus.

The issues are about the geographical separation of elective and emergency services, which does not have clinical research support. I am worried about the impact of that on the education and experience levels and the skill mix and so on of hospital staff over several years. As the minister knows, evidence is coming out from England about geographical separation and the impact that it has on the quality of care.

From the beginning of the consultation, the main issue has been about PFI and the constraints that it places on the health board and the flexibility of its budget. We know that Monklands is the only public hospital with enough land left for flexibility. It could be sold—no doubt for housing development.

John Swinburne (SSCUP, Central Scotland)

Will the member give way?

Carolyn Leckie (SSP, Central Scotland)

I cannot; I am sorry.

Murray Tosh (Conservative, West of Scotland)

The member is in her final minute.

Carolyn Leckie (SSP, Central Scotland)

When we look to the future, I predict that, unless the minister reverses the decision, the trends of PFI will show that the decrease in capacity that we have already suffered in Lanarkshire will get worse, the decrease in the proportion of the budget spent on staffing will get worse and the ability of hospitals in Lanarkshire to cater for the demands placed on them will lessen. The people of Lanarkshire, particularly those who are most vulnerable, will have decreased—not increased—access to services.

The democratic deficit in this process is worrying and should send a warning to all the parties in the chamber: do not patronise the public by saying that they do not understand. A well-informed public is completely at odds with the health board, Government bodies and political parties. The public will vote with their feet. They have to be given democratic input into the decision on how their health service is configured. If that is not done, the current MSPs will be booted out.

Murray Tosh (Conservative, West of Scotland)

Given that the Presiding Officer called Ms Leckie, I honoured that commitment, but I am unable to call anyone else in the open part of the debate. I express my regrets for that, but I must now go to the closing speeches.

Elaine Smith (Labour, Coatbridge and Chryston)

It has been an interesting—if short—debate. To answer Sandra White's point, we would have had a better chance of a real debate if it had been a wee bit longer. Perhaps the SNP should have participated properly in NHS Lanarkshire's consultation process.

Unfortunately, there has been a lot of brinksmanship and political posturing this morning. Carolyn Leckie demonstrated some of that. Calling members of the Labour Party dishonest was utterly disgraceful. She then showed political opportunism by mentioning elections, because that is really what it is all about for her; for members on our benches, it is about health in Lanarkshire.

A key theme in the chamber is that all members are in favour of talking about change, but they are not in favour of any change at all when it comes down to it. Last October, when we voted on the Scottish Executive's action plan, "Delivering for Health", which has been widely mentioned, our vote was based on the service change proposals of the Kerr report. According to the motion, we were attempting

"to provide more safe and sustainable local services,"

for our constituents,

"to tackle health inequalities ... in our most deprived communities ... to benefit people wherever they live"

and to pursue "greater quality and productivity" in the NHS in Scotland. That is what we voted on, and Janis Hughes outlined some of the positive changes that came after we voted on the Kerr report.

However, we did not sanction the potentially fatal blow that has recently been dealt to Monklands general hospital, which is the busiest, most efficient and most effective hospital in Lanarkshire, serving areas that have some of the worst health and deprivation records in Europe. I was interested to hear that a lot of Shona Robison's speech was comprised of what Karen Whitefield, Cathie Craigie and I have said in the past. She could have said something new, but she said nothing new at all.

I agree with Carolyn Leckie on one point. We did not agree to the blatant asset stripping of the only NHS-owned hospital in Lanarkshire by a health board that is intent on justifying the exorbitant guaranteed incomes that it pays to its PFI partners. We did not vote on that.

Last October, we would almost certainly have rejected such a fundamental change to service provision, the result of which could mean that the most deprived communities in Lanarkshire become further isolated and socially excluded in relation to access to local emergency care. That shift of provision has been decided without proper access to detailed service planning, outline or full business cases, comprehensive research or costings. The minister's amendment says that the Executive wants an

"NHS Scotland which responds to changes in the demands placed upon it."

We have to be clear that downgrading Monklands hospital does not do that. The fact that Monklands faces that downgrading is a disgrace. It undermines the very principles of the Kerr report and "Delivering for Health". We have said that since the beginning.

This is fundamentally the wrong decision for the people of Lanarkshire. The overarching aims of "Delivering for Health" are right, and I acknowledge the commitment to invest in the area. However, the minister's decision to support NHS Lanarkshire's plans to downgrade Monklands is based on biased, flawed and insufficient information provided to him by the board. Further, NHS Lanarkshire has utterly failed in its responsibility to consult service users, because it presided over a lavish public relations exercise in which it told the people of Lanarkshire what it was going to do; it did not ask them. Even more shameful, the exercise was distilled into a six-month period, so a critical decision that will impact on Lanarkshire and, as Euan Robson said, on Forth Valley, Glasgow and wider areas for generations to come has been rushed through without adequate scrutiny and planning and in the absence of a rational evidence base.

As mentioned, the minister knows that I have asked the Auditor General for Scotland to review the decision. The minister also knows that Karen Whitefield, Cathie Craigie and I have asked for an independent review, in the absence of which we have little choice but to call for a reversal of the decision. It should never have been made and we want the minister to reverse the decision and to take decisive action to guarantee the long-term future of Monklands hospital.

Margaret Smith (Liberal Democrat, Edinburgh West)

From the contributions made in the chamber today, it is quite clear that this is a very difficult issue, particularly for local members. I feel their pain and difficulty. It is more than a decade since the closure of the accident and emergency department at the Western general hospital in my constituency and people still write to me trying to get it reopened, but the world has moved on.

It is worth remembering many of the issues and drivers behind the need to redesign services. Workforce issues have evolved over time, such as the training required by junior doctors, the critical mass of patients that is needed for clinicians to build up levels of expertise and for risk to be assessed, the introduction of the working time directive and changes in demographics. There are a number of drivers behind the decisions that are being taken, not only in Lanarkshire but across the country.

There is also the policy background of the Kerr report, which many speakers have discussed today. The Kerr report is a fundamental document but it takes a broad-brush approach and is open to interpretation, which is always important. Each individual case should be considered on its own merits and set of circumstances. From what the minister said, it is quite clear that he has taken on board many of the issues in Lanarkshire. I note the comments that he made about the need to invest in primary care. Janis Hughes was right. Change is always difficult. It is not always wrong and it is not always right, but it is always difficult.

The minister has been given lots of advice during this interesting debate. I particularly enjoyed the advice that he got from Carolyn Leckie, who gave him and Labour MSPs a bit of a lecture about unity and speaking with one voice. That was quite interesting.

The important comment in the minister's speech was the assurance that he gave about making no changes to accident and emergency provision until there is extra capacity at Wishaw and Hairmyres. Jean Turner made the point that people would feel much happier about change if they felt that changes were already happening on the ground before the old services were done away with. We really have to take that on board as we take Kerr forward.

Elaine Smith (Labour, Coatbridge and Chryston)

Is it Margaret Smith's interpretation of what the minister said that no change will take place at Monklands hospital until such times as those provisions are firmly in place?

Margaret Smith (Liberal Democrat, Edinburgh West)

We will be able to hear that from the minister himself, but that is a question on which we would like clarification.

There has been a substantial investment of £100 million in Monklands, but one of the most important points that the minister made was about additional paramedics, which Margaret Mitchell talked about. Because of the centralisation of services at the new Edinburgh royal infirmary on the other side of Edinburgh, I have talked to NHS Lothian about the length of time that it takes people to get to a hospital. An important issue now is the length of time that it takes a paramedic to get to a patient. That is when health care starts. We need to ensure not only that there are enough paramedics but that they have the equipment that they need.

Margaret Mitchell (Conservative, Central Scotland)

Will the member give way?

Margaret Smith (Liberal Democrat, Edinburgh West)

I cannot.

Transport has been mentioned by several members. I appreciate the point that the minister made about the provision of shuttle buses, but transport issues are important and cannot be lost sight of.

I end on the need for proper consultation and proper information. As local members, we are often bombarded with lots of information from clinicians who tell us lots of different things about these situations. We are lay people, not clinicians, so we always find it difficult to get to the bottom of the issue. I agree that further consideration needs to be given to the financial matters that Elaine Smith, Donald Gorrie and others mentioned. Perhaps the minister in his summing up can address those points about PFI. A more general point about which the Health Committee has had concerns for many years is that, going forward, we need to reform the way in which we consult on these matters. Otherwise, the public will lose faith completely in the NHS.

John Scott (Conservative, Ayr)

In today's debate on the proposed closure of the accident and emergency unit at Monklands, we have seen the Parliament operating at its best by holding the Government to account. We have seen members from all parties and all political views unite to express their concerns to the Liberal-Labour coalition about what they regard as flawed Government policy.

Entertainingly, we have heard Karen Whitefield both support and condemn her Government's policy in one paragraph of her speech. I suppose that we must reflect on Churchill's comment that consistency is the hobgoblin of small minds.

No one disputes the need to develop specialist services and centres of excellence in the west of Scotland, such as we have with cancer treatment at the Beatson, head injuries at the Southern general and heart surgery at Clydebank. That is accepted in the debate, as Shona Robison said in her opening remarks. However, where most people separate from Labour-Liberal coalition policy is in applying the concept of centralisation to A and E units. Nanette Milne, Sandra White and Jean Turner all made that point.

Health care professionals, including ambulancemen, paramedics, nurses and consultant staff all over the country, are telling planners that the policy will cost lives. That is what planners are being told in Lanarkshire, Glasgow, Ayrshire and elsewhere, as Sandra White also mentioned.

Regrettably, the people who will suffer most come from the areas of greatest deprivation. It is not a pretty sight to see a Labour-Liberal coalition Government disadvantaging most the communities that elected it to look after their health care needs. Shona Robison, Cathie Craigie, Margaret Mitchell, Carolyn Leckie and Elaine Smith all made that point in their remarks.

Consultation processes in Lanarkshire and Ayrshire have been a meaningless sham. The clearly expressed views of the public have been ignored and it is apparent that decisions were taken before the consultation process even began. Nowhere did that happen more than in Ayrshire and Lanarkshire, as Nanette Milne, Euan Robson and Jean Turner all highlighted.

John Swinburne (SSCUP, Central Scotland)

Will the member give way?

John Scott (Conservative, Ayr)

No.

The Government is in danger of dogmatically following an inappropriate policy of centralisation of A and E services and ignoring the views of patients, medical staff and many of its erstwhile political colleagues. Politicians of all parties—including, most tellingly of the Government's own—have opposed the minister's view. Among those with the highest profile who have opposed the plans are John Reid, Robin Cook, Sandra Osborne and Brian Donohoe. Carolyn Leckie was correct to point that out.

Almost all the proposed closures of A and E units across the country are claimed to be justified in part by the fear that sufficient consultants may not be found to staff our hospitals in future. However, that is not a sustainable argument. Quite simply, if we trained more junior doctors in Scotland—and did so in our hospitals rather than just in universities—we would have more consultants available when we need them. The recent failure to address what is a workforce planning issue should not be used to close A and E units across the country today. I tell the minister that this is a solvable problem and it needs to be addressed forthwith.

Finding the key people to run any enterprise is always a business risk, but our Government is throwing in the towel long before a significant problem even exists. The can-do attitude that is so evident in Scots elsewhere in the world needs to be instilled into our Liberal-Labour coalition Government and its NHS planners. They need to deliver the health care services that people across Scotland rightly demand.

I hope that the minister will reflect on views that have been expressed in the chamber today before it is too late for our A and E units in Monklands and Ayr. He must reconsider whether the path that he is pursuing is in the best interests of patients throughout Scotland.

Lewis Macdonald (Labour, Aberdeen Central)

At the heart of the debate is the critical question of what members believed that the Parliament voted for when it supported "Delivering for Health".

Shona Robison said that the SNP supports the principles of the Kerr report, but the Kerr report is very clear about the fact that the way in which unscheduled care is currently delivered is unsustainable without reform. To maintain local services, we must

"develop ... community casualty units ... staffed by multidisciplinary teams to provide much of our urgent care needs 24 hours a day"

and create new centralised specialised emergency services.

Shona Robison (Scottish National Party, Dundee East)

In our submission to the Kerr committee, we were very clear that we regarded A and E not as a specialist service but as a core service that must be delivered locally. For minor injuries units, the best model is the one that currently operates at Monklands hospital, where the minor injuries unit works alongside the A and E unit to reduce pressure on the A and E services.

Lewis Macdonald (Labour, Aberdeen Central)

I am glad that Shona Robison has seen the operation of the separation of scheduled and unscheduled care at Monklands hospital. We want to build on the effectiveness of that separation and take it forward. Indeed, the Kerr report states that, for the delivery of emergency care,

"A potentially generalisable model already exists in NHS Grampian",

where Aberdeen royal infirmary is linked to local hospitals but provides focused A and E services for some 500,000 people. The Kerr report does not support the SNP position that such changes are okay in theory but that Lanarkshire does not need to change the way in which it provides emergency services.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

In correspondence, the minister has told my colleagues and me that no changes will be made to A and E services in Lanarkshire until all necessary additional emergency care capacity is in place. Today, he said that no change "should" be made. That is a big difference. Will he clarify what he means?

Lewis Macdonald (Labour, Aberdeen Central)

I understand the point that Cathie Craigie makes, which was also made by Jean Turner. The commitment that I have given, which I give again today, is that the new services that I have instructed the board to deliver will be in place before there are changes to the provision of A and E services. Clearly, all of that is subject, as it always must be, to issues of clinical safety but, with that proviso, I make that clear commitment, which I have imposed on the board. I give the commitment to Parliament today that we will bring forward the additional primary care investments. We will bring forward the investment to improve capacity at Hairmyres and Wishaw and we will bring forward that £100 million of investment in future provision at Monklands before we get to the point at which the configuration of A and E services at Monklands and the other hospitals is changed. Those are important and clear commitments.

We recognise the central significance of deprivation and the clear connections between social and economic deprivation and poor health.

John Swinburne (SSCUP, Central Scotland)

rose—

Lewis Macdonald (Labour, Aberdeen Central)

I give way to Mr Swinburne.

John Swinburne (SSCUP, Central Scotland)

After about nine attempts, I am glad that my intervention has been accepted. Basically, Lanarkshire NHS Board is bankrupt. It has £818 million hanging round its neck like a millstone. Hairmyres hospital cost £67 million and Wishaw hospital cost £100 million, but the repayments will cost £1,080 million under this beautiful, pie-in-the-sky PFI/PPP deal.

Murray Tosh (Conservative, West of Scotland)

Minister, you must watch your time.

Lewis Macdonald (Labour, Aberdeen Central)

Mr Swinburne gives me the opportunity to respond to points that were made in the debate about the financial figures, which are an important issue. I am satisfied that the financial issues have been properly addressed in the process and I am satisfied that the sums add up.

Murray Tosh (Conservative, West of Scotland)

You have one minute.

Lewis Macdonald (Labour, Aberdeen Central)

It is fundamentally wrong to say that the changes are driven by cost; they are driven by the interests and needs of patients. I am happy to address the specific concerns that have been raised by local members, but it is critical to recognise that the purpose of the proposals, which ministers have endorsed with additional requirements, is to improve the quality of patient care. That alone is the driver of the changes and that alone was the deciding consideration for ministers' approval of the proposals.

Elaine Smith (Labour, Coatbridge and Chryston)

Will the minister give way?

Lewis Macdonald (Labour, Aberdeen Central)

I am afraid that time does not allow me to accept a further intervention.

Elaine Smith (Labour, Coatbridge and Chryston)

I wanted to ask about those future commitments—

Murray Tosh (Conservative, West of Scotland)

No, the minister does not have time to accept an intervention.

Lewis Macdonald (Labour, Aberdeen Central)

I am happy to re-emphasise the point that I made in response to Cathie Craigie's intervention about my commitment to ensure that the services are in place to deliver the quality of care that people in Lanarkshire are entitled to expect and that these proposals, with our additional requirements, will deliver for the people of Lanarkshire.

Murray Tosh (Conservative, West of Scotland)

I call Alex Neil to wind up the debate. You have the luxury of seven minutes, Mr Neil.

Alex Neil (Scottish National Party, Central Scotland)

Thank you, Presiding Officer. It is probably the chamber that has the luxury of my seven minutes.

I will deal first with the Kerr report. It is consistent to be generally in favour of the principles of the Kerr report and—to quote Karen Whitefield—to say that this decision on Monklands flies in the face of the Kerr report. To hide behind the Kerr report, as the minister is trying to do, as justification for this dangerous and daft decision is nonsense. This is not about the implementation of the Kerr report; this is about the implications of PFI at Hairmyres and Wishaw. PFI is coming back to bite the Labour Party where it hurts.

Lewis Macdonald (Labour, Aberdeen Central)

I would be interested to hear how Mr Neil believes that the Kerr report should be applied in relation to emergency services in Lanarkshire.

Alex Neil (Scottish National Party, Central Scotland)

I have always made it clear, in my submission and at every meeting that I have had with the health board and others—[ Interruption. ]

Murray Tosh (Conservative, West of Scotland)

Order.

Alex Neil (Scottish National Party, Central Scotland)

Unlike Karen Whitefield and others, I did not sell the pass on day one; I argued that Lanarkshire needs three accident and emergency units. Every Labour politician argued against that, with the honourable exception of Tom Clarke MP, who agrees publicly with me, Margaret Mitchell, Carolyn Leckie and others that somewhere with Lanarkshire's population and deprivation requires three A and E units. Those who immediately caved in and said that the number should be reduced to two sold the pass at that point, as it was then a case of divide and rule.

In East Kilbride, the Labour folk came to the meetings saying, "We've got to have Hairmyres." Then, the next night, in Airdrie, Karen Whitefield would be there with John Reid saying, "We've got to keep Monklands open." In Wishaw, although we did not see the First Minister, he sent his troops to say, "We've got to keep Wishaw open." The reality is that A and E is a core service. If the unit at Monklands is closed, that will endanger life and limb.

At the moment, in the health service in Lanarkshire on a typical Saturday night, there are so many people at the A and E units in Wishaw and Hairmyres that they have to be referred to Monklands. If the A and E unit at Monklands is not there, where will those people go? Will they go into Glasgow and make another journey to another A and E unit? Will they go to Stirling or Falkirk—or, eventually, to Larbert—even given the distance that that would involve? In a recent maternity case, a woman was sent from Wishaw to Dundee because Wishaw did not have sufficient capacity.

Christine May (Labour, Central Fife)

Can Alex Neil tell us the basis for his assertion that the loss of an accident and emergency unit would cost lives—not in minor accident or trauma cases but in serious medical cases? I believe that the evidence shows that paramedic and ambulance support is more important.

Alex Neil (Scottish National Party, Central Scotland)

That is not the evidence. I am sure that even Karen Whitefield would accept that if someone in Airdrie had a heart attack, a stroke, an asthmatic attack or an attack of meningitis, by the time that they got to Hairmyres or Wishaw—especially at certain times of the day—at best, their position would be severely worse and, at worst, their life could be in danger. The transport infrastructure in Lanarkshire is such that, if the A and E unit at Monklands closed, the time that it would take for someone in Airdrie or Coatbridge to get to another accident and emergency unit would mean that, in some cases, lives would be in danger. That is what we are dealing with. That is why the debate is far too important for members to be scoring petty points about the timing of debates. There are substantive issues that need to be addressed.

Margaret Smith (Liberal Democrat, Edinburgh West)

Does Alex Neil welcome the minister's assurances about the number of paramedics? Does he agree that, as I said in my speech, we should ensure that paramedics have the tools that they need and linkages back to A and E departments so that the necessary care can be given eight or 10 minutes after someone has suffered a heart attack, not half an hour later, when they get to a hospital?

Alex Neil (Scottish National Party, Central Scotland)

There are two issues. First, we received an assurance four years ago that there would be no threat to the A and E unit at Monklands. Any assurances from the Executive or NHS Lanarkshire are not worth the paper that they are written on. Secondly, the support that Margaret Smith says should be provided to paramedics should be provided irrespective of what happens to the A and E unit at Monklands. Those facilities should be in place anyway.

When the debate started, we were told that the driving force behind the proposed closure was the shortage of consultants in Lanarkshire and the inability of NHS Lanarkshire to attract consultants. It is ironic that around £100,000 of health board money was spent on hiring outside public relations consultants to try to sell the case to the people of Lanarkshire. Had that £100,000 been spent on recruiting NHS consultants, we might not be in the current position.

When it came to the final decision, contrary to what the minister said, the key factor at the board meeting was not the shortage of consultants nor the clinical reasons that have been given; it was all to do with finance. Because two of the hospitals are PFI hospitals, even if they do not have any patients, the health board still has to pay up the money for them to the private contractor. That is the real reason why Monklands A and E unit is closing.

The litmus test of whether members are genuine or just playing politics will come when the matter is put to the vote tonight. If they vote for the Executive amendment to the SNP motion, nobody in Lanarkshire will believe them in May next year.

Access to Higher Education

Murray Tosh (Conservative, West of Scotland)

The next item of business is a debate on motion S2M-4788, in the name of Fiona Hyslop, on access to higher education.

Fiona Hyslop (Scottish National Party, Lothians)

All of us in the chamber will recognise the opportunities that access to higher education can bring. Many of us will have been the first in our families to have gone to university. Since I went to university in the 1980s, at the age of 17, there has been an expansion in the number of young people who go to university. However, the Government wants to claim as its own successes in the expansion of access to higher education that were achieved before it came to power.

Today, the Scottish National Party can reveal figures that show that, despite there being 2,000 more 17-year-old Scots in the population than there were in 2001, 2,000 fewer of them are going to university now than were five years ago. When Labour came to power, 46.6 per cent of young people in Scotland were going into higher education. Now, marginally fewer—46.4 per cent—are doing so according to the Executive's latest figures in its "Age Participation Index for Scotland 2004-05". We can debate whether the figure is too high or whether it is sustainable, but we cannot argue—as the Government tries to—that the figure has gone up.

Allan Wilson (Labour, Cunninghame North)

Does Fiona Hyslop dispute the simple fact that university access has increased by 12 per cent since 1990?

Fiona Hyslop (Scottish National Party, Lothians)

If the minister had listened to the start of my speech, he would have heard me say that there was an increase in student numbers in the 1990s. However, the increase began in 1990, not when Labour came to power. The Executive claims, in its glossy documents, that the increase was down to the Labour Government, but it was not.

Just as the school performance of the bottom 25 per cent of pupils is flatlining, and just as pupils' attainment below higher level is flatlining, so the Government's performance in higher education is flatlining. The fact that a Labour document claims that student numbers have gone up and that access to higher education has increased under Labour from 40 per cent to 50 per cent, although it has not, shows us that the Government does not have a grasp of the fact that it is flatlining in its education performance. It is no wonder that Jack McConnell wants to introduce another arithmetic examination—he must want to check dodgy Labour claims. If he is responsible for this matter, we will be left with the bizarre sight of a mathematics teacher who cannot count.

The SNP believes that those from deprived backgrounds should have wider access to higher education. The Government says that it believes the same but, since 2002, it has managed to increase the number of students from deprived backgrounds in higher education only from 1,630 to 1,665. That grand total of 30 people is hardly anything to write home about—or even enough to put in an amendment. After nine years of Labour and seven years of Labour and Liberal Democrat rule, we should be seeing some results.

There is a debate to be had about participation levels in higher education. I think that the target of about 50 per cent is about right, given that other countries are competing for knowledge economy jobs in a fast-changing world where one's ability to learn tomorrow is as important as what one knows today. I should point out that the current 46 per cent participation rate includes people taking higher national certificate and higher national diploma college courses, which is probably why the rate was so high when Labour came to power after the Tories. Anyone who attacks such levels should consider that point.

Christine May (Labour, Central Fife)

Will the member give way?

Fiona Hyslop (Scottish National Party, Lothians)

No—I want to carry on.

The 50 per cent participation rate is made up primarily of people from the middle class. Perhaps many of those people might find more personal fulfilment if they pursued other opportunities instead of automatically drifting to universities. If everyone is to fulfil their potential, we need the brightest people in deprived communities to form more of that 50 per cent.

If the Government has increased neither the absolute numbers at universities nor the number of people from deprived areas going to universities, what has it done? Well, the state has created a mountain of debt that hangs like a millstone round the neck of students and graduates in their 20s and 30s and is a drag on the economy. In 1999, the average student debt was £2,500. Since then, that amount has been ratcheted up to an average £11,000 today, and it is rising even further as a result of back-end endowment fees that are added on at graduation.

Debt and the fear of debt put off exactly the sort of students from deprived backgrounds whom we want to get into university. Although the United Kingdom figure for university applications has risen, there has been a dip in the number of applications from Scots, particularly from over-25-year-olds with financial and family commitments. As a result, there are compelling education and social justice reasons to tackle the student loans situation, although the public finance and economic arguments, which my colleagues will set out during the debate, are just as important. The point is that the student loans and graduate debt system in this country is inefficient, expensive and a drain on the public purse.

Murdo Fraser (Conservative, Mid Scotland and Fife)

What would be the annual cost of replacing the current student loans scheme with grants for all?

Fiona Hyslop (Scottish National Party, Lothians)

I am about to discuss that. It would cost £100 million.

The Conservatives have published figures showing that across the UK the public purse is shelling out £1 billion a year to subsidise the interest on loans, even though it has been estimated that 30 per cent of them will never be repaid. In Scotland alone, the cost of interest subsidies is £100 million. That figure does not even take into account the loans that Labour sold off in 1997. Scots have paid out more than £25 million—and indeed are still paying—to subsidise loans that have been sold off to banks in America and from which they will see no income. Even though they were based on a seven-year repayment model, loans are taking 13 years to repay.

The situation is so bad that, according to the Government's accounts, it has already written off £500 million of the debt. Indeed, the difference between the book value of the debt and its fair value shows that the Government itself expects not to get back a third of it. The Government says that the debt amounts to £1.4 billion, but it needs to look at its own accounts.

There is a serious concern about the growing debt culture in this country and whether individuals or the economy can sustain such debt. The Bank of England has warned that student fees in England will increase inflation. The SNP wants an education system based on the ability to learn, not the ability to pay. As a result, we want to stop the fundamentally flawed, expensive and unsustainable rip-off of the public purse that is the student loans system. It is clear that, in that respect, the public finance arguments are as compelling as the access to education arguments.

Parents and grandparents want their children and grandchildren to have the life chances that they never had, but they are horrified by the level of debt in which those children and grandchildren find themselves. Scotland in the 21st century needs a Government that is bold and imaginative, not tired and flatlining. It is time for a change to get the Parliament and the country moving. I say to the Labour and Liberal Democrat Government: move over, so that Scotland can move on.

I move,

That the Parliament recognises the opportunities made available to young people accessing higher education in Scotland and the importance to the Scottish economy of having a highly educated workforce; notes with concern, however, that debt and the fear of debt are having an adverse affect on Scots applying to universities; believes that access to university should be based on the ability to learn, not the ability to pay, and calls for replacement of the current expensive and inefficient student loans system by a fairer grant system and for the problem of student loan graduate debt, which is a drag on the economy, to be addressed.

Allan Wilson (Labour, Cunninghame North)

I notice that we are still waiting for an answer to Murdo Fraser's question, but no doubt that will come during the debate.

I am happy to speak on behalf of the Executive in this debate on higher education. If I had to choose an area in which the Executive's record is indisputably strong, I would find it difficult to come up with a better example than higher education. I can at least thank the nats for that.

We have achieved something that many thought was impossible. We have helped our universities to preserve their international competitiveness while maintaining our policy of protecting the interests of Scottish students by not introducing top-up fees—or indeed any other fee.

The Executive has proven its commitment to further and higher education by investing strategically in our colleges and universities. Over the period of the current spending review, our investment will have increased in real terms by 23 per cent to more than £1.6 billion in the next financial year. That money goes directly into our institutions to cover the costs of maintaining our internationally renowned higher education sector and world-class colleges. We have allocated significant investment in research and teaching and, for the first time in decades, estates have been improved. Indeed, no one can enter a university campus without seeing the benefits of our capital expenditure programme.

Ms Hyslop's speech contained so many foxes that I find it difficult to decide which one to shoot first.

Murdo Fraser (Conservative, Mid Scotland and Fife)

But the Executive has banned fox hunting.

Allan Wilson (Labour, Cunninghame North)

I think that Mr Fraser will find that we are still allowed to shoot them.

That investment has funded significant growth in the sectors. In the 1960s, when opportunities to participate in higher education were limited, the participation rate in higher education was about one in six. That figure is now closer to one in two. Since devolution alone, the number of Scots entering degree-level studies has increased by 12 per cent.

At the same time, our institutions are becoming more and more accessible. It is an undeniable fact that more people from disadvantaged backgrounds now have the opportunity to enter higher education and are reaping the benefits of it. Since 2001-02, the number of students from low-participation neighbourhoods entering degree level study has increased by 18 per cent.

None of that suggests that students are being put off higher education by the prospect of student loans. In fact, it is clear that most young people recognise higher education's economic and social benefits, which is why they are prepared to invest in their future.

Continuing that growth and maintaining those opportunities are essential if Scotland is to meet the undoubted pressures of globalisation. Education and lifelong learning will contribute hugely to our future by providing a flexible, highly skilled workforce as well as the social benefits that accrue from wider participation in higher education.

However, such an objective does not come cheaply. By the final year of the current spending review period, our annual combined investment in our universities, colleges and students will stand at £2 billion.

Not that we have heard anything about them so far this morning, but I must say that the SNP proposals on student funding are fundamentally flawed. For a start, they are flawed financially. Far from costing £100 million, the full package floated by Nicola Sturgeon, who I notice has not been able to stay for the rest of the debate, would cost in the region of £1.7 billion.

Fiona Hyslop (Scottish National Party, Lothians)

The Executive has already written off a third of the debt and the current annual repayment income on the existing debt is only £29 million. Does the minister consider that to be a satisfactory state of affairs for public finance?

Allan Wilson (Labour, Cunninghame North)

I do not deny that writing off student loan debt, replacing loans with grants and abolishing the graduate endowment—

Jim Mather (Scottish National Party, Highlands and Islands)

So the Executive has written the debt off.

Allan Wilson (Labour, Cunninghame North)

Of course we will write off bad debt.

In addition to writing off the existing debt, the SNP would have to write off the payments that previous graduates have already made to the cost of their loans. That amounts to £300 million. The total cost of the SNP proposal is not £100 million but £1.7 billion.

However, the proposals are flawed not only financially, but in principle. Student loans have been in existence for almost two decades, in which time participation has doubled. As I have said, there have never been more people from the most disadvantaged groups in higher education. The SNP proposal would not increase our already high participation rates, extend the benefits of higher education to those from the most disadvantaged backgrounds, support world-class teaching in our universities or help our institutions to provide students and staff with world-class facilities.

I will leave it at that, Presiding Officer, and return to the other issues in winding up.

I move amendment S2M-4788.2, to leave out from "recognises" to end and insert:

"applauds the substantial growth of investment and participation in the higher education sector in Scotland in the last seven years, the growing opportunities made available to young people and others wishing to access higher education in Scotland, the increase in participation rates in higher education of those from disadvantaged backgrounds over the same period and the vital importance of having a skilled and highly educated workforce to the Scottish economy; welcomes the facts that 72,000 students have benefited from young student bursaries since the reintroduction of student grants in 2001, that Scottish students have had their fees abolished by the Scottish Executive and that the Executive continues to oppose top-up fees, but notes with concern that the £1.7 billion costs of replacing all student loans with grants and writing off student debt threatens the continued success and expansion of higher education institutions and diverts effort and resources from encouraging wider participation from under-represented groups."

Murdo Fraser (Conservative, Mid Scotland and Fife)

I have two thank yous to say to the SNP this morning. The first thank you is to Fiona Hyslop for giving us the opportunity to discuss the important issue of student debt. In so doing, I draw attention to my entry in the register of members' interests, which states that I am a member of the board of management of Dundee University Students Association.

The SNP is right to say that we have a difficulty with growing levels of student debt. I do not intend, in the short time available, to rehearse all the statistics, but we just need to look at the level of bankruptcies to see the extent of the problem. In 1997, only 31 graduates declared themselves bankrupt. In 2004, that figure was 1,541—a huge increase—despite the fact that student loans are exempt from bankruptcy, so those students must have acquired debts in other ways. No one would sensibly advise students to go down the bankruptcy road, but the sad fact is that some see it as the easiest way out of their problems.

It is clear that the current arrangements are not working. Our party has previously set out proposals to address the situation. We have to realise that the problem is not students borrowing under the student loans scheme, but rather students borrowing in more expensive ways by using, for example, unsecured bank overdrafts or, worse still, credit cards. Our solution is to extend the current student loans scheme and allow much larger sums to be borrowed, but at commercial rates of interest. That would still be cheaper for students than unsecured bank overdrafts and credit card borrowing, which are the areas of real concern as far as student debt is concerned.

Allan Wilson (Labour, Cunninghame North)

As Murdo Fraser is probably aware, there is no evidence that significant numbers are running up commercial debts. We have evidence that 84 per cent of higher education students' borrowings are through the Student Loans Company, so how could they borrow commercially at a lower rate than they do from the Student Loans Company? Is not what Murdo Fraser proposes that they should pay more to commercial lenders?

Murdo Fraser (Conservative, Mid Scotland and Fife)

The problem is that there are many students for whom the student loan is insufficient, so they have to borrow money elsewhere. Under such a scheme as we propose, they would pay a lower rate of interest than the rate that they pay to those other lenders.

I want to say a second thank you to Fiona Hyslop and her party for their extraordinary generosity this morning. The SNP proposes to scrap the student loans scheme and replace it with a scheme of grants, which it claims would cost £100 million a year, but we have not yet heard justification for those figures. Have we heard from the SNP where the extra £100 million—or however much it will be—will come from? No, we have not. However, Fiona Hyslop's generosity does not end there, because the SNP proposes to go further than that and write off the existing debt to the Student Loans Company of all Scottish-domiciled students, of whom there are 300,000. The latest figures from the Student Loans Company, which are for 2004, show the value of those outstanding loans as £1.47 billion. Even what is called the fair value—what the company thinks it can recover—has been assessed at £990 million, and that is going up year on year. So there we have another spending commitment, another splendid act of generosity, on the part of the SNP on behalf of the Scottish taxpayer, requiring a cool £1 billion-plus to write off all student debt.

Murray Tosh (Conservative, West of Scotland)

You have one minute left, Mr Fraser.

Murdo Fraser (Conservative, Mid Scotland and Fife)

I could say that such generosity is unprecedented but, given some of the other spending commitments that we have had from the SNP over the past three weeks, that would not be a fair comment. I am surprised that Mr Mather has not fallen off his chair at the thought of all the tax increases he will have to put through to fund that largesse.

Fiona Hyslop's generosity does not stop even there, because she proposes to go still further. The SNP is also going to pay the fees of all English students studying in Scotland. Has the SNP even costed that pledge? Has it thought about the implications of a flood of English students coming north to Scotland to study here, displacing Scottish students? Has it thought of the millions that that would cost? No.

The issue of student debt and the future of higher education is serious, and the questions about it require serious answers. Our party has put forward a serious package of proposals to help to address the problems. What is on offer from the SNP is not serious, credible or affordable.

Murray Tosh (Conservative, West of Scotland)

You must close now.

Murdo Fraser (Conservative, Mid Scotland and Fife)

It is an attempt to play to the student gallery, with no prospect of delivery. From a party that aspired to—

Murray Tosh (Conservative, West of Scotland)

No. You must take my word for it. You must close.

Amendment S2M-4788.3 moved:

"leave out from 'with concern' to end and insert 'the growing levels of student debt and bankruptcies among graduates; believes that an extension to the current student loans scheme with larger non-means-tested loans available at low commercial rates of interest would reduce student reliance on unsecured bank overdrafts and credit card borrowings and provide additional funds for higher education, and calls on the Scottish Executive to introduce such a scheme in preference to the current unsatisfactory arrangements and unrealistic and unaffordable proposals to replace loans with grants.'"—[Murdo Fraser.]

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

Fiona Hyslop insinuates—indeed, she tells us—that tuition fees have not been abolished but have simply been deferred in the form of the graduate endowment, but she should listen to the hundreds of thousands of Scottish university students who have not had to pay a single penny of tuition fees over the past six years.

David McLetchie (Conservative, Edinburgh Pentlands)

Not yet.

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

That is a fair point, but I think that the students would disagree strongly with Fiona Hyslop. My own three children have been to university and would be the first to agree with what I say.

The Parliament legislated for the graduate endowment to increase the amount of money that is available to support the most disadvantaged students in Scotland in meeting their living costs. However, Fiona Hyslop and other members are content to mislead anyone who bothers to listen by telling them that the graduate endowment is a tuition fee. The endowment would not cover even a third of the cost of an average Scottish degree, so that claim simply does not add up. It has been implied that there are no grants, but there evidently are, because more than 50,000 Scottish students were awarded a grant or bursary in 2004-05. The deal for Scottish students is superior to the deal for students in the rest of the UK for those reasons, and the English and Welsh are the first to tell us so.

I turn to the SNP's latest student finance policy. Fiona Hyslop hopes to pay off the full cumulative debt of Scottish graduates who have student loans, replace borrowed loans with free grants and abolish the student endowment, the cost of which we have heard will be only £100 million. It has been amply demonstrated by Allan Wilson and Murdo Fraser that that is absolute nonsense and that the question must be revisited. Conjuring with money does not work. Jim Mather is great at presenting us with his fiscal fairy, but this one ain't gonna wash. I issue a third challenge to the SNP to put flesh on the bones, because what has been said so far will not do.

Which other budget will the money come from? Will it come from the universities budget? Will our institutions face a spending cut? Could there be a cut in their competitiveness, as Murdo Fraser has suggested? To tell the truth, I am not aware what the SNP has pledged to our universities at all.

Murdo Fraser (Conservative, Mid Scotland and Fife)

Nothing.

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

That may well be the case.

What of the proposal for grants, not loans? Is Fiona Hyslop aware that the poorest students currently have grants, not loans? Whom does her policy ultimately benefit? A key question is whether the grants that she proposes are to be means tested and, if they are, what will be left for those students who do not qualify for them but who want a little extra support if they cannot get a low-interest loan. Will they have to turn to the commercial providers, to which Murdo Fraser referred?

We are talking about paying off the debts of current and former students in Scotland. The nationalists' £100 million would not cover even 5 per cent of that debt. How long would the process really take? Where would the money come from? Would there be job losses at the Glasgow-based Student Loans Company? Those questions need to be answered.

The SNP has also said that it wants to make all education in Scotland free to all students. Here is the killer question: will the SNP pay the fees of English students? Will English students get grants, not loans? What about people who study part time? Students want to hear more than sound bites and conjecture from the SNP. They want no more of Jim Mather's "Jim'll Fix It" fiscal fairy. They want proper answers. I warn the SNP not to place a bid when it cannot pay up. That would be a cruel joke on our young people.

Adam Ingram (Scottish National Party, South of Scotland)

The Executive parties show little sign of having grasped the strength of the SNP's arguments in favour of reforming student support and widening access to higher education. The minister was at it again this morning, claiming that the SNP policy to abolish student loans and restore maintenance grants would cost the public purse billions of pounds extra.

I shall try to keep things simple for the minister, Jamie Stone and other members. Let us look at the relative costs of paying out loans rather than grants. The average grant level that the SNP proposes will be equal to the average loan currently paid out to students. There is no difference there, but surely foregoing loan repayments will mean that expenditure on student support will rocket? Well, no actually. That is because we will no longer need to pay out the current subsidy to keep loan interest down to no more than the rate of inflation. Last year, the Executive ingathered £29 million in loan repayments, but paid out exactly the same in interest subsidy.

If we take into account the £5 million that it cost last year to run the Student Loans Company, which we will abolish, a grant system will cost the public purse £5 million less than the existing loan system.

Christine May (Labour, Central Fife)

Will the member take an intervention?

Adam Ingram (Scottish National Party, South of Scotland)

No, I do not have time.

Those figures are robust and stand up to scrutiny. Indeed, our Conservative friends across the chamber have also twigged that the self-sustaining loan system that they envisaged back in the early 1990s, when it was introduced by Ken Clarke, has not come to pass.

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

rose—

Adam Ingram (Scottish National Party, South of Scotland)

Sit down, please.

Rather than remove the burden of loan debt from students, the Conservatives propose to cut public spending by privatising loans and removing the interest subsidy. We reject that approach because it would compound the difficulties that modern students face in getting rid of the debt that they incur in procuring a degree education.

Allan Wilson (Labour, Cunninghame North)

Will the member give way?

Adam Ingram (Scottish National Party, South of Scotland)

I am sorry, minister, but I have only two minutes left.

We believe that society as a whole benefits from an educated citizenry and that higher education should be paid for through general taxation. If, indeed, graduates reap the reward of having higher incomes than non-graduates, they will pay back much more in higher taxes, providing that we maintain a progressive tax system.

When Ken Clarke abolished grants and introduced loans, he posed the famous question: why should the bus driver have to pay for the lawyer's education? I find that an illuminating question, in the sense that it clearly betrayed the mindset of the British elite. It clearly had not crossed Mr Clarke's mind that the lawyer in question could be the bus driver's son or daughter. The seamless transition from Tory to new Labour preserved that mindset and we have subsequently seen the imposition of tuition fees and top-up fees, which have heaped the costs of acquiring a degree on to students and their families.

Our Liberal Democrat friends across the chamber will claim that they have mitigated the worst excesses of the policy developments by insisting that the Executive goes down the graduate endowment route instead. However, they cannot deny that such a policy still increases the burden of student debt and acts as a disincentive to students from poorer backgrounds entering higher education at all.

The Liberal Democrats' colleagues down south share our concerns. I could not have put it better than did the Lib Dems' English education spokesperson, Sarah Teather, who said:

"It's extremely sad to think that there are intelligent young people out there who achieved good grades yesterday but won't be applying to university because of the cost."

She also said that when school leavers choose whether to go to university they are now more concerned about their ability to manage their debt than their ability to study.

I appeal to our Liberal Democrat colleagues that it is surely time to ditch that unholy alliance with Labour that so discomforts their principles. They should be looking forward to making common cause with like-minded people.

Wendy Alexander (Labour, Paisley North)

It is refreshing to have the chance to debate SNP policy. I wanted to do the party justice, so I had a look at its website. It has a promise today by the SNP's deputy leader under the headline:

"SNP makes 'free education' pledge".

The article states:

"graduates will not start their working lives ... burdened by debt."

So, what is that level of debt? Well, the SNP website tells us that it is £18,700 for each graduate. I have to say that both Ms Sturgeon and Ms Hyslop used a rather more conservative figure on television and in the chamber when they stated that the average graduate debt is £11,000.

Let us stick with the conservative figure of £11,000, forget all the past students and the historic debt, and just focus on the pledge of free education for today's students. What would it cost? There are 271,000 students in higher education. For some reason, the SNP is not concerned about further education students. Let us start with higher education.

Fiona Hyslop (Scottish National Party, Lothians)

I have particular concerns about the further education figures, which is why I am concerned that the numbers going into higher education—which includes universities and further education colleges—have flatlined under this Government, despite its claim that the numbers have increased.

Wendy Alexander (Labour, Paisley North)

Well, let us stick with higher education. The average debt of £11,000 for 271,000 students comes to a total of around £3 billion. Therefore, to meet the pledge of free education, the SNP proposes either to divert half the national health service budget in Scotland to those destined already to be the richest half of Scottish society, or it does not really mean to meet the pledge at all.

Actually, if we look at the small print that goes beyond the dishonest political posturing, we find that the promise is not for £3 billion and free education but for £100 million. That would be enough to clear the £11,000 debt of one in 25 Scottish students. Is the SNP suggesting that student unions should run a lucky dip to find the one in 25 who will have a free education? If we included further education students, one in 50 will benefit from the lucky dip.

What we have here is a piece of gesture politics, but it does tell us something about the SNP's political priorities. For the SNP, it is tough luck for the one in two students who do not go to university and for those whose modern apprenticeships are financed by Scottish Enterprise, the budget of which the SNP wants to halve. It is also tough luck for all council tenants, who are surely a more deserving case for the writing-off of historical debt in order to build affordable homes. They are surely more deserving than people such as Ms Sturgeon, who might herself have historical student debt imprudently left around. It is also tough luck for all those Scots who believe that our future depends on the strength of our universities, because most of the funding for universities in Scotland comes not from the Executive's core grants but from United Kingdom research councils, UK foundations such as the Wellcome Trust, and UK companies, many of which would be jeopardised under the SNP.

I said last week that I thought "Big Spender" was the SNP's recurring theme tune. There certainly seems to have been no change over the past week. If the SNP wants to be taken seriously, it must stop trying to buy votes, stop peddling free education for all when it means nothing of the kind and start engaging in a serious debate about how we widen access to Scottish universities.

Mark Ballard (Green, Lothians)

I draw members' attention to my entry in the register of members' interests about my role as the rector of the University of Edinburgh.

I think that everybody in the chamber agrees that higher education is vital to the future of Scotland and that we need more young Scots to fulfil their maximum educational potential and go into higher education. I think that we all recognise the need for a smart, successful and sustainable Scotland. This debate is welcome, because it addresses one of the fundamental issues in the debate about higher education—who will pay for it?

Over the past 20 years, the burden of debt for students has increased and it has distorted access to higher education for young people. It has changed how people access higher education and how they approach it. When I graduated from the University of Edinburgh in 1994, I had £2,100 of student loan debt, which I found easy to repay over the following three years. However, according to figures from the National Union of Students, students leave higher education today with more than £20,000 of debt. We must recognise that that has a huge impact on students' approach to higher education. As Fiona Hyslop said, that burden affects not only the ability of the most debt-averse students to go into tertiary education but their choices when they do go into tertiary education, because they recognise that a huge burden of debt will hang over their heads.

Allan Wilson (Labour, Cunninghame North)

Can Mr Ballard quantify exactly what that impact has been, given that the number of students gaining access to universities has doubled since 1990? In Scotland, access has increased by 12 per cent since 2000 and access by students from disadvantaged backgrounds has increased by 18 per cent over the same period.

Mark Ballard (Green, Lothians)

I think that Fiona Hyslop answered the minister's question in her opening speech.

We have also seen a massive increase in the number of students who drop out of university. Debt is one of the key reasons why students decide not to continue their tertiary education.

We must be realistic about the amount of support that we offer students in the current system. At the moment, a student will get just over £4,000 in loan or in loan plus the young students bursary. For the average student in Edinburgh, rent and bills come to about £95 a week, which completely wipes out their loan and their young students bursary. We must recognise that we do not give students enough support.

Edinburgh University Students Association has just produced its education manifesto for the 2007 elections. Jamie Stone talked about listening to students. If members want to listen to students, they should read what students and student associations are saying, which is that students are not getting enough support and should be provided with better support. Students are not receiving enough help through concessionary fares, there is a lack of support for mature students and the cost of visas for international students has doubled. That is all part of the Executive's policy of heaping more debt and greater financial burdens on students.

If we want higher education to be the pride of Scotland and we want people to make the right choices in higher education, we as a society must support students rather than expect them to bear an ever greater burden of debt. That is why I will be supporting the SNP motion tonight.

Brian Adam (Scottish National Party, Aberdeen North)

I want to raise an issue that affects a specific group of students—part-time students. Not only is debt mounting for students in general—partly because of the graduate endowment, which is nothing short of a back-end tuition fee, and partly because of loans—but part-time students are being positively discriminated against. There is no enforcement of the Executive's policy that part-time students ought to pay pro rata, in spite of the fact that the issue has been raised regularly in the Parliament. As far as I am aware, the review of the present arrangements has not yet reported back.

Earlier this year, my colleague Alasdair Morgan asked the First Minister about funding for part-time students. Mr McConnell acknowledged that it was up to universities to set their own rates for such students, but said that a review was under way. In his concluding remarks, perhaps the minister could tell us how far that review has got and whether the existing, grossly unfair arrangements for part-time students will be rectified before this session of Parliament concludes.

In response to a letter from me about fee levels for part-time students, the university at which one of my constituents is enrolled as a part-time student said:

"we also take into consideration market forces."

That might be the kind of policy that members of new Labour, as worthy successors to the Tories, favour, but I thought that such a proposal would be anathema across the board in the Scottish Parliament. I do not want to find out that that is not the case.

Christine May (Labour, Central Fife)

Is the member able to confirm whether part-time students are covered by the SNP's pledge on free education? If they are, where is that costed in the figure of £100 million?

Brian Adam (Scottish National Party, Aberdeen North)

Along with a number of her colleagues—especially those in the Executive—Christine May is obsessed with the £100 million. She should give some thought to the loans situation. There is a major difference between repayment of a capital sum and repayment of a capital sum plus the interest on it. There is confusion even in the mind of a former Minister for Enterprise and Lifelong Learning about how long it will take to pay off the capital and the interest, how that will be done and how often payments will be made. The Deputy Minister for Enterprise and Lifelong Learning has implied that we have promised to repay the total sum in one year, which would mean that the £100 million would not be adequate.

Allan Wilson (Labour, Cunninghame North)

Will the member give way?

Trish Godman (Labour, West Renfrewshire)

Mr Adam, you are in your final minute.

Brian Adam (Scottish National Party, Aberdeen North)

No, thank you. I am responding to a specific point and I am in my final minute.

I am deeply disappointed that ministers and former ministers are unable to grasp the fundamental economic issues that are at stake or, as I suspect is the case, are being deliberately misleading. To service debt, one must pay it off, and one can do that over a period of time.

Wendy Alexander (Labour, Paisley North)

Will the member give way?

Brian Adam (Scottish National Party, Aberdeen North)

No, thank you.

Originally, the Executive might well have wanted students to pay off their debt within seven years—it looks as if that period could now be 13 years—but if a Government decides to consolidate that debt, it can choose over what period to make that repayment.

Allan Wilson (Labour, Cunninghame North)

Will the member give way?

Brian Adam (Scottish National Party, Aberdeen North)

No, thank you.

We have made a commitment to provide £100 million a year, which will service that debt and the capital repayment. All students who are domiciled in Scotland will be covered by the £100 million.

Mary Mulligan (Labour, Linlithgow)

I am always pleased to debate education issues. I agree with the SNP motion's recognition of the opportunities that education provides for a more fulfilling life, but that is where I part company with its sentiments.

I admit that, as a student, I would have argued that to ask students to contribute financially to their time at university was wrong because it would deter young people—particularly those from less affluent backgrounds—from taking up places at university. I am sure that many other members are in the same position. However, I must now accept—as must today's students—the reality of the situation.

When loans were introduced in 1990, there were around 138,000 students, but by 2004-05 that figure had doubled to 276,000. I admit that the increase in the number of students from low-income families has been less. I will come back to that.

Fiona Hyslop (Scottish National Party, Lothians)

Will the member give way?

Mary Mulligan (Labour, Linlithgow)

In a minute.

I cannot give all the reasons why my original feelings on the matter have been shown to be wrong. One reason is perhaps that, as the SNP's deputy leader Nicola Sturgeon has admitted, parents and young people now recognise that a university education benefits the individual concerned. The increase in the number of students is a fact and it flies in the face of the SNP's assertion.

Along with many other members, I would like to hear more about how the SNP thinks that it could pay for the promises it has made. It seems to me that the SNP's absent leader Alex Salmond has decided that next May's elections are crucial to his future, so the SNP has spent the summer making promises that it does not know how to fund.

Let us consider how much it would cost to replace student loans by a fairer grant system and to address graduate debt. It would cost at least £1.7 billion to write off student loans. Who would pay for that? Would it be hard-working families, who would have to pay higher taxes, or would it be young people who have chosen to go to work? The SNP motion ignores the 360,000 people who go on to further education, although I know that my colleague Christine May will not.

Let us compare those uncosted promises with what Labour has delivered. We have abolished tuition fees, reintroduced student grants for the poorest students—there is sensible targeting for those who are most in need—and increased funding to Scotland's world-class universities. Almost 50 per cent of young people in Scotland are now in higher education, which is the highest figure in the UK.

What really distresses me about the SNP's position is that in trying to grab a headline on student grants, it has failed to look at the bigger picture. The fact that fewer young people from poorer backgrounds go on to higher education is not just to do with money. We must consider how we can help them. Is there a lack of confidence? Can we do more to encourage those young people while they are at school? Can we work with their parents to explain the benefits that higher education can bring? We must address the issue in another way. The SNP is shirking that task.

I look forward to many more debates on the huge subject of education, which offers great opportunities to everyone who becomes involved in it. I hope that the SNP will get in touch with the real issues, such as future investment in our universities, which face the challenge of variable fees elsewhere. We must think about how universities can continue to progress their research abilities and their links with industry. We need to consider drop-out rates and the additional pressures—including financial—that are being placed on young people as a result of the need to obtain further qualifications once they have obtained their first degrees. Education is crucial, and we should be taking it seriously, not just grabbing at soundbites.

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

There is no doubt that rising student debt is a real and important issue. There is also a moral obligation us as legislators, in that we should not be saddling our future taxpayers with such levels of debt. I do not agree with Wendy Alexander when she says that we should not subsidise the richest people in society—that is not the issue. We have a system in our society called income tax: the more money one earns, the more one pays back to society. We are investing in our future—we should not be saddling people with huge amounts of debt.

Bristow Muldoon (Labour, Livingston)

Will the member give way?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

No—unfortunately, I have only three minutes.

That said, we should congratulate the Scottish Executive on its measures so far. Over the years it has, in real terms, helped to alleviate the problems of student debt.

Fiona Hyslop (Scottish National Party, Lothians)

Will the member give way?

Mike Rumbles (Liberal Democrat, West Aberdeenshire and Kincardine)

I cannot. I have only three minutes.

We have restored grants to the poorest students through the graduate endowment scheme. That is the point of the scheme; we have a better system than that in England.

I have two sons, one of whom is at university in Scotland and another who is looking to go to university next year, also in Scotland. Why do both of them want to study in Scotland? It is not because of any pressure from me. They know that when they leave university, their graduate endowment debt will be £2,000 and that, if they went south of the border, it would be at least £9,000. That is because of what we have done in the Scottish Parliament. I make the partisan point that, had it been left to the Labour Party, we would not have the graduate endowment. One has only to look south of the border: they have fees, they are sticking with fees and they are going to have top-up fees. That is wrong. There has been a real Lib-Dem input to what the Executive has done in Scotland.

That said, there remains a large measure of unfinished business. I would like us to tackle student debt even more than we have done. I was pleased to hear my party leader make it clear last year that he would prefer to see the Scottish Executive, and not our students, pay the graduate endowment in full. There is nothing wrong with the graduate endowment; it is a good scheme. The legislation makes it clear that it is designed to give grants to our poorest students. However, the problem with the scheme is that current students are expected to pay into it. In the first session of Parliament, we made the compromise that led to the scheme. By the time we reach the third session, I hope that we can do something to put that right.

Christine May (Labour, Central Fife)

I am surprised that there are not more members in the room rolling up for the great SNP giveaway. Not only would the SNP give away money from Scottish funds, it would deny Scotland the student loans funding that currently comes to us from the Treasury.

We have created a post-18 education system that allows people to learn. We have increased participation not only among school leavers, but by increasing the numbers of mature students and returners to learning in postgraduate and diploma courses, thereby upskilling our workforce.

I am disappointed that the SNP made so little reference to the important role that the college sector plays in higher education courses and in offering courses that lead to further qualifications. Is the SNP seriously saying that a higher national certificate that a single mum from Methil achieves is less important or relevant than a degree that someone else achieves from the University of St Andrews, the University of Edinburgh or any other university? That is exactly what it is saying.

Our colleges are flexible and cost-efficient providers of higher education. They do that for increasing numbers of students from disadvantaged backgrounds, thereby increasing the participation rate of students from those backgrounds in higher education. Our colleges are locally based, which means that travel—which is a significant cost for many students—is not the issue that it can be in respect of participation in university education.

Of course, post-18 funding for education is not only about supporting students; it is about supporting our institutions to be the best and about supporting their record of leading the UK in gaining research funding. That is what helps to increase the numbers of international students who come to study in Scotland. A recent British Council report showed that over 80 per cent of international students cited the quality of education, the quality of teaching staff, the facilities in Scotland and Scotland itself as major factors in attracting them here and in what they enjoy.

I have some questions for the SNP in my last seconds. They are questions that the SNP has not addressed and which turn the SNP's policy on its head. Why should the funding that we are putting in place for those who are not in education, employment or training be jeopardised in order to write off the debt of those who will be the highest earners in the country? Why is the SNP not saying that it will not write off all student debt, just some of it? The SNP plans to write off only the student loan debt—indeed, the Conservatives have a point when they talk in their amendment about the other expensive debt that students come out of education with. What about apprentices? What about the situation in countries that we aspire to emulate and whose economies are doing better than ours? Those countries have a mixed system of loan and grant. Their systems work; ours will work, too.

Iain Smith (Liberal Democrat, North East Fife)

I apologise for not being able to stay for the rest of the debate. I have to attend a visit by Bell Baxter high school in the education centre.

Sadly, the debate has been less about student debt than it has been about arithmetic. I will come on to that later. First, I want to stress the positives. Scottish students have benefited from devolution. Thanks to the Liberal Democrats, they pay no fees and those from the poorest backgrounds have gained access to substantial grants. Scottish students graduate with significantly less debt than do their English counterparts. At the University of St Andrews, which is now one of the 10 top universities in the UK and number one in Scotland, 10 per cent of applicants now receive bursaries. That shows that students from disadvantaged backgrounds are accessing that institution. There has also been an increase in the number of Scottish applicants to the university. All of those things are positive gains that are thanks to the Liberal Democrats in the partnership Government in Scotland.

I turn to the Opposition. We have not heard much about the Tories' amendment this morning. Let us look at their proposal. The Tories propose to solve the problem of student debt first by allowing students to borrow more and, secondly, by charging them higher interest. That seems to be it.

What about the SNP? I turn to its arithmetic. The problem for the SNP is that its sums do not add up. In effect, the SNP is saying that it can write off existing debt at no cost.

In "Grants Not Loans: Supporting Students—Fair, Just and Enterprising", which Fiona Hyslop published in August 2004, she said:

"Perhaps the simplest way of thinking about this would be to consider how it would work if this was a person-to-person loan. If you lend £10 to a friend with the implicit expectation that this will be repaid but later decide not to accept the repayment, you are not having to pay out another £10 to cover the money already loaned, but you have to forgo your 'asset'."

So, that is it—nice and simple. I will go to my bank tomorrow and say that I do not have to pay off my mortgage because the bank has already given me the money and it does not need it back. It is another example of Mather maginomics—more of the fiscal fairy dust that we get from the SNP. The debt will just fall down the SNP's funding gap.

Let me just talk a little about the SNP funding gap. In "Scotland In Surplus", which the SNP published in July, the SNP indicated that Scotland would have £4.3 billion surplus. On 7 August, Alex Salmond said that the SNP had, of course, based its figures on a world oil price of $65 and that, as the price had increased to $70 since April, the surplus had risen to £5.3 billion. I checked the world oil price this morning, and it is now down to $63 a barrel. In less than a month, the SNP has lost £1.4 billion of its alleged surplus. That is hardly a way to run an economy. It is Mather maginomics and it does not add up—[Interruption.]

Trish Godman (Labour, West Renfrewshire)

Order.

Iain Smith (Liberal Democrat, North East Fife)

The only thing that is bigger than the SNP's funding gap is its credibility gap.

However, members should not worry if the SNP's student funding policy does not add up; there will be another one along in a minute. The SNP has had nine policies in the past nine years. In 1997, the SNP was calling to replace student loans with 100 per cent grants. In 1998, it accepted that it could not fund that commitment and dropped the proposal. In its election manifesto in 1999, it pledged to make a grant of £500 to the poorest 20,000 students. By 2000, the amount pledged had gone up to £1,500 for 66 per cent of the student population. By 2001, it was Cubie plus, whatever that was—nobody could really work out what it meant, including the SNP.

By 2003, the SNP did not really have any policy at all. There were no costings, no specifics and no ideas in the SNP's 2003 election manifesto. In 2004, the SNP made up for that with all sorts of bizarre ideas. To cap it all, it supported the proposal of higher fees for English students studying medicine in Scotland. There was, of course, a U-turn on that policy in 2005. Now, in 2006, the SNP is going to pay off all graduate debt, abolish graduate endowments, give out loans for free and fund all English students to come here and study in Scotland for free—all for £100 million. Parliament is not fooled, and the students of Scotland will not be fooled either.

David McLetchie (Conservative, Edinburgh Pentlands)

Today's SNP-sponsored debate allows us to reflect in nostalgic fashion on the way things were: a world in which there were no tuition fees; a world in which there were student grants; a world in which there was a massive and sustained increase in the number of young people going into higher education, from 70,000 to 240,000; a world in which the number of universities in Scotland increased from eight to 13. In short, we can reflect on the halcyon days of Conservative Government.

Can it be that it was all so simple then? Yes. If we had the chance, would we do it all again? Yes, we would. But could we? Could we do it in relation to student support? It would probably be very difficult to replicate the way things were in 1997. Even at that time, the financial strains within higher education were beginning to show, and the Conservative Government established the Dearing and Garrick committees to review higher education funding and student support.

Sadly, we do not know what a Conservative Government would have done with those committees' recommendations, but we certainly know what happened when the Labour Government received their reports: out went grants and in came fees. Although, in a classic piece of Liberal Democrat duplicity and sophistry, it is now called a "graduate endowment", we still in truth have a form of fees in an accumulated debt, which is repayable on graduation at a marginal tax rate of 9p in the pound.

The Scottish National Party wants to take us back to the way we were. In principle, and if it is affordable, that is not a bad thing. I was the beneficiary of such a system—I paid no fees during my four years of studying law at the University of Edinburgh. My father was not one of Adam Ingram's bus drivers, but I qualified for a grant that enabled me, when it was supplemented by income from vacation jobs, to graduate without the burden of debt that weighs heavily on so many young people today, a fact that we must accept.

The plain fact is that the SNP's policy is simply not affordable. Its members say that they can take us back to a world in which there are generous grants, no fees, no loans, no graduate endowment and a massive £1 billion accumulated debt write-off. They expect us to believe not only that that is one of their priorities, but that it can be financed out of the Scottish block grant. Having promised the earth to students and graduates, the SNP then trots out Mr Mather—a cross between a bank manager and a business guru—to tell us that, at one and the same time, the SNP will cut business taxes. Its policy simply does not add up and it is simply not credible. I congratulate Wendy Alexander and Iain Smith on their contributions to the debate—they should go into business as demolition contractors.

The SNP's policy would divert valuable resources from the task of educating our young people to that of maintaining them. It ignores the fact that, notwithstanding the changes that were made to student support in 1998, the number of people in higher education has continued to increase. The policies that the SNP has outlined today are the sort of policies that Labour politicians used to advocate before they got into Government and learned to count. The SNP has never learned to count. Today, it has shown that it never will. It remains a party of incorrigible spendthrifts.

Allan Wilson (Labour, Cunninghame North)

I suppose that I should declare an interest. I have a son who is at university. Interestingly, he is the first in his family to attend a higher education institution.

I wish to address what David McLetchie had to say and address a question that was posed by Mark Ballard, Wendy Alexander, Mary Mulligan, Mike Rumbles and other members about who would pay for this latest SNP folly. The grim truth of the SNP's position is that it would mean that Scotland's modest-earning and hard-working families would pay to send Scotland's better-off teenagers to university. As David McLetchie said, that was the case back in the halcyon days of so-called free education. It was only the numbers that were involved then that made that a comparatively good thing. The reason why the SNP has no numbers in its motion is that the numbers are now the moral issue.

If we go back 40 years—I am perhaps doing David McLetchie a disservice—to the grants system, one in six Scots youngsters left school and went on to higher education in the 1960s. If we strip out the better-off people, who were then dominating higher education, only one in 12 ordinary working families sent their youngsters to uni at that time. In the 1960s, for every one ordinary working family whose offspring went through a university gate, another 11 working families were paying the taxes that paid the grant. Even then, it was probably the middle classes who were the true beneficiaries of the system. It was clear, however, that those 11 families were relatively content to pay the taxes because they knew that, one day, their kid might also go to university, as mine does now. Today, the figure is one in two or thereabouts. The universities are now full of ordinary working families' offspring.

Everyone has the ability to learn, whether they go to university or not, but university access is not universal.

Fiona Hyslop (Scottish National Party, Lothians)

Does the minister agree that, when Labour came to power, only 8 per cent of university entrants came from deprived backgrounds and that the figure has gone up only to 8.6 per cent? There is a huge challenge left unmet.

Allan Wilson (Labour, Cunninghame North)

Of course there is a challenge to meet—I am telling the SNP how to do it. We have increased access for young people from disadvantaged backgrounds by 18 per cent in five years. That is why it would not be fair to heap all the cost of higher education on the half of the population—or thereabouts—whose sons and daughters will never see the inside of a university but who nevertheless make an equally valuable contribution to our economy by learning vocational skills, going into employment and creating the wealth that enables us to run world-class institutions, as well as running our service industries.

There has been a lot of hype about the SNP's first 100 days and what it would do in the unlikely event that it ever had the opportunity to manipulate the levers of power. We now know what it would do: it would abandon the policies that would have got it there in the first place. Fifty days ago, Nicola Sturgeon told the Scottish people—by news release—that she would reinstate so-called free education: she would get rid of the graduate endowment, and abolish student loans and replace them with grants. She would also write off existing graduate debt from student loans. That suggests a number of questions today, only 50 days on. If those commitments are good enough for the SNP's press releases, why are they not good enough for its parliamentary motion? If the SNP is promising free education for all, why on earth does it not say so in its motion? If the SNP is not promising free education for all, why did it issue a press release saying that it was?

SNP members seem to work on the principle that if they can fool enough of the people for a few more months, they might get away with it. They seem to have fooled the Greens, but trying to deceive young people into believing that they are going to get or be offered something that they are not in fact going to be offered is, dare I say it, a pretty low trick.

Let us get this on the record once and for all. Does the SNP stand by the promises in its press release? If it does, the rest of us could get on with the serious business of costing those promises. I can tell the SNP now that they would cost £1.7 billion. We currently pay grants, bursaries and fees. The Treasury in effect pays the loans. The SNP might save £80 million in write-off subsidy, but it would have to pay the additional £150 million that it would cost to transfer loans into grants and write off the historic debt.

Has the SNP cynically sought to mislead the young people of Scotland and their parents with its hype and spin or with sleight of hand? It has to answer those questions today—I now give the SNP the floor to do so.

Jim Mather (Scottish National Party, Highlands and Islands)

This has been a useful debate. It has flushed out the scare tactics of unionism and has proved that unionism weds people to the idiots' guide to the free market. It makes them fail to see education in the full context of our economic well being and limits them to a zero-sum mentality. On top of that, unionism seems to make people unable to tell the difference between debit and credit and between capital and revenue—everything is conflated into a scare scenario.

In seeking to bring clarity and common sense to the debate, I look to Ian Bell who, in The Herald on 17 June, asked since when education was ever free. His contention, like ours, is that if we had an efficient and fair tax system, our education could be paid through taxes. That would go really well. Mr Bell, unlike Jamie Stone, knows that one can change the term "fee" to "endowment" and still end up with a debt that further inhibits participation in university education for deprived kids.

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

Will the member take an intervention?

Jim Mather (Scottish National Party, Highlands and Islands)

Mr Stone should sit down. The canards are about to be shot. Like us, Ian Bell argues that loading youngsters with debt in the prime of their lives offers them a perverse incentive. Like us, he knows that skilled graduates in a properly run and vibrant economy will more than pay their way in the tax system and will start businesses and generate effervescence and vibrancy in our economy.

Where are we today? This week the chairmen of Scottish Enterprise and the Confederation of British Industry Scotland called for higher levels of economic growth, telling us implicitly that the current rate is not good enough and that we have to do something different. Is this Executive of ours so wedded to loans and inefficient management of financial and human resources that it now acknowledges that it cannot run efficient systems or generate economic growth? The Executive is retaining the current system because it no longer believes that it can retain our best and brightest people.

Allan Wilson (Labour, Cunninghame North)

Will the member take an intervention?

Jim Mather (Scottish National Party, Highlands and Islands)

The minister has laid enough canards for me to shoot down. I will just crack on.

Let us consider the unintended consequences of the loans policy. The doubts that have been cast on the SNP's probity come from the idiots' guide to the free market. Adam Ingram defended our probity wonderfully and robustly. On top of the unintended consequences of the loans policy, we face the cost of fewer capable youngsters from lower-income backgrounds getting into university. There has been a marked increase in part-time work and bankruptcy among those young people: Murdo Fraser's solution is to bring in the free market, to let them borrow more and then to unleash higher rates of interest on them. That means that home ownership, marriage, families and business start-ups will be delayed and migration will accelerate, all of which will depress our economy. Wendy Alexander's speech was another argument that does not withstand audit.

Murdo Fraser (Conservative, Mid Scotland and Fife)

Throughout the debate, various costings of the SNP policy have been postulated: £1 billion, £1.7 billion and £3 billion from Wendy Alexander. How much does the SNP think the policy will cost and where will the money come from?

Jim Mather (Scottish National Party, Highlands and Islands)

It will cost £100 million per annum. Murdo Fraser should look at our website and our aspiration to move this country off 1.6 or 1.7 per cent to 3.5 per cent economic growth, which is now subscribed to by Melfort Campbell and John Ward, both of whom are putting themselves on the right side of history, unlike the Tories.

Allan Wilson (Labour, Cunninghame North)

rose—

Wendy Alexander (Labour, Paisley North)

rose—

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

rose—

Jim Mather (Scottish National Party, Highlands and Islands)

Members can all sit down. They have flown their canards—now let us see them shot down. Jamie Stone should be ashamed of himself because, in essence, the policy that is in place has a perverse and duplicating effect on his constituency and the rest of the Highlands and Islands. More and more people who are further away from universities and are on lower incomes are caught in the trap.

Christine May (Labour, Central Fife)

rose—

Jim Mather (Scottish National Party, Highlands and Islands)

Members can sit down. I am listening to none of them.

We contend that Scotland should reinstate free education, recognise that educated people pay more taxes and not slavishly follow America. America is not right about everything. We are in danger of making education totally commercial. That is confirmed when we see how, in the classless United States of America, potential wealth increasingly dictates life chances and educational choices. We do not want that in our Scotland.

The reality is that we can build economic muscle and we should all be looking to challenge the retention statistics of Scottish graduates. I talked to representatives of Scottish Financial Enterprise—two chief executives ago—who told me that they reckoned that at least 40 per cent of our graduates leave Scotland. That figure increases in respect of the better universities and the more advanced courses.

When I asked Professor Jim Love of the University of Strathclyde what percentage of his economics graduates leave to follow their long-term careers outside Scotland, he said 70 to 80 per cent of them do, which is a shocking statistic.

The case has been made. Scotland's economy needs its graduates: they have to stay here. The SNP policy will provide for that. I support the motion.

Question Time — Scottish Executive — General Questions

Irene Oldfather (Labour, Cunninghame South)

To ask the Scottish Executive what importance it places on maintaining nutrition and hygiene standards in care homes. (S2O-10505)

Lewis Macdonald (Labour, Aberdeen Central)

The Scottish Executive places the highest importance on maintaining nutrition and hygiene standards in care homes. The national care standards for care homes specifically address the issues of nutrition, hygiene and infection control and are taken into account in the inspection and regulation of care homes by the Scottish Commission for the Regulation of Care.

Irene Oldfather (Labour, Cunninghame South)

I acknowledge the progress that has been made. However, does the minister agree that an information campaign to heighten awareness of the importance of good hygiene and nutrition in nursing and residential homes would ensure that residents and their families know what standards to expect? Will he give me an assurance that he will work with the care commission to ensure that there is appropriate staff training in those areas and rigorous audit, so that our elderly people can receive and their families can be assured of the highest standards of care?

Lewis Macdonald (Labour, Aberdeen Central)

I completely accept the important points that Irene Oldfather makes. I am pleased to report that in recent months the care commission has worked in collaboration with NHS Education for Scotland to assist providers to understand their obligations in relation to care homes. Work has also been done with the Royal College of Nursing, which has a number of members working in the sector. Further such work is planned with providers.

I accept Irene Oldfather's point that it is important that residents and their families are aware of these matters and I will consider carefully whether there is anything that we ought to be doing, or encouraging the care commission to do, in that regard. The national care standards require that providers have a staff development strategy and effective annual training in place for all staff, which is the right way to proceed in that area.

John Swinburne (SSCUP, Central Scotland)

What solution does the minister suggest to the problem of the pensioner in care who faces a bill of £1,174 per annum for heating and cooking her food?

Lewis Macdonald (Labour, Aberdeen Central)

Mr Swinburne will be aware that the Regulation of Care (Scotland) Act 2001 does not relate to that directly, but the provisions of the Community Care and Health (Scotland) Act 2002 on personal and nursing care do. The 2002 act makes it clear that the hotel costs that residents face are legitimate. However, one of the things that any family will want to consider before making a decision about placement in a care home is the fees regime that is in place.

John Swinney (Scottish National Party, North Tayside)

To ask the Scottish Executive what progress is being made on improving road safety on the A9 north of Perth. (S2O-10472)

Tavish Scott (Liberal Democrat, Shetland Islands)

A wide range of improvements are being progressed for the A9 north of Perth including: grade separation at Ballinluig and Bankfoot; a dual-carriageway extension at Crubenmore; provision of a three-lane section at Kincraig; junction improvements at Kindallachan and Inveralmond; an alignment improvement at Helmsdale; and overtaking opportunities at Moy, Slochd and Carrbridge. A number of safety-related studies are also under way.

John Swinney (Scottish National Party, North Tayside)

I welcome the various measures that are being taken to improve safety. When in 2007 will work on site commence on the upgrades of the Bankfoot and Ballinluig junctions? What is the minister's response to my calls and the calls of, among others, the Confederation of British Industry Scotland and the Scottish Council for Development and Industry for consideration to be given—as part of the strategic projects review and the national transport strategy—to making the A9 into a dual carriageway to improve road safety?

Tavish Scott (Liberal Democrat, Shetland Islands)

I am happy to write to Mr Swinney in the next few days to give him the dates on which we expect work on the junctions at Bankfoot and Ballinluig to start.

I understand the points that have been made about the entire route, which is why the strategic projects review will provide an objective analysis of it. That is in addition to the current study of the route between Perth and Pitlochry. We will ensure that that work is done timeously so that appropriate decisions can be taken as quickly as possible on that important route between the capital of the Highlands and Perth.

Janis Hughes (Labour, Glasgow Rutherglen)

To ask the Scottish Executive how it will respond to the cancer costs study carried out by Macmillan Cancer Support. (S2O-10489)

Lewis Macdonald (Labour, Aberdeen Central)

We recognise the additional anxieties and difficulties that are faced by people with serious illnesses such as cancer, and we take seriously the points that the report has made.

We have circulated guidance to national health service boards to ensure that patients are made aware of the two existing national schemes that allow for the reimbursement of travelling expenses for patients who are attending hospital for treatment and of escort expenses, where an escort is medically necessary. In 2004, we issued revised guidance to NHS boards that made it clear that they should make available sufficient car parking spaces and concessionary rates for patients who attend hospital regularly, for example for dialysis or radiotherapy.

Janis Hughes (Labour, Glasgow Rutherglen)

I am pleased that the minister has issued guidance on the schemes that are in existence. As he may be aware, patients in Scotland who travel to hospital for cancer care endure an average of 37 trips and costs of £395 during the course of their treatment. Will he consider extending the current schemes to assist those patients?

Lewis Macdonald (Labour, Aberdeen Central)

In addition to the statutory position under those schemes, boards currently have discretion to consider on a case-by-case basis whether a patient should receive further reimbursement or travelling expenses. That is the right approach. It is important that boards are aware, and make patients aware, of the support that can be accessed. I am happy to consider any alternative suggestions for promoting the schemes that could improve eligible patients' access to them.

Sandra White (Scottish National Party, Glasgow)

The minister mentioned guidance to NHS boards, but that is simply guidance. Does he agree that many hospitals have blatantly ignored it? Will the Executive introduce statutory powers to enforce its guidelines and thereby end the anomaly that exists and the disgraceful situation in which cancer patients have to pay parking and transport fees?

Lewis Macdonald (Labour, Aberdeen Central)

No.

Cathie Craigie (Labour, Cumbernauld and Kilsyth)

I thank the minister for his willingness to discuss the matter and am sure that he will agree that there are many hidden costs for cancer patients. For families, there are not only the emotional costs, but the worry and cost that result from having to travel to hospital. Many day-care patients stay there for a long time—indeed, they can stay for the whole day—but finding parking close to hospitals can be impossible. People have other things on their mind than claiming expenses. Will the minister meet me and some of my colleagues to discuss the Macmillan campaign, which seeks to raise the profile of the issue?

Lewis Macdonald (Labour, Aberdeen Central)

As I said in response to Janis Hughes's question, I am certainly prepared to consider other ways of promoting the schemes. I do not accept Sandra White's point that hospitals are blatantly ignoring the guidance. I have no evidence that they are doing so. If such evidence exists, I want to know about it. [ Interruption. ]

I hear members making additional suggestions from sedentary positions. If those members have anything coherent to say, they should make the appropriate information available to me.

We want to ensure that hospitals and health boards throughout the country follow the guidance, but we must also recognise the reality. The ability of patients to park close to large general hospitals in urban areas in particular must be protected, and that is often best done by a charging scheme that will deter fly parkers and those who ought not to be there. However, I would be happy to discuss the matter further, as Cathie Craigie has requested, because we want to ensure that whatever schemes are in place, the interests of patients who require access to hospitals come first.

Karen Whitefield (Labour, Airdrie and Shotts)

To ask the Scottish Executive what monitoring has been carried out of the implementation of the free concessionary bus travel scheme. (S2O-10507)

Tavish Scott (Liberal Democrat, Shetland Islands)

Transport Scotland carries out various forms of monitoring, ranging from monitoring of the number of cards that have been issued, their category of eligibility and the accuracy of the records that are held.

Karen Whitefield (Labour, Airdrie and Shotts)

Is the minister aware of the concerns of my elderly constituents? When some of them have used their bus passes, they have been told that they must go to the end of the queue until paying passengers are seated. Does he agree that such behaviour and the charging of booking fees is unacceptable, especially as fares have been paid by the Scottish Executive? Will he take steps to ensure that such practice ceases immediately?

Tavish Scott (Liberal Democrat, Shetland Islands)

I would be happy to look into the cases that Karen Whitefield has mentioned and to ensure that Transport Scotland contacts her so that they are properly considered. It would certainly be unacceptable for elderly people with concessionary passes to be bumped to the end of the queue in the circumstances that Karen Whitefield has described. Of course, she will be aware of the difference between elderly passengers who have the card and other fare-paying passengers who have pre-booked seats, but I will certainly take up the matter and ensure that Transport Scotland looks into matters that are causing considerable and understandable concern.

Roseanna Cunningham (Scottish National Party, Perth)

I associate myself with Karen Whitefield's concerns and suspect that her constituents' problems are being replicated throughout Scotland.

Is the minister aware that there are still serious difficulties with people getting their bus passes in the first place? As recently as this week, I spoke to an 80-year-old constituent of mine who has still failed to get a concessionary bus pass after four attempts. On at least two occasions, her pass was returned with a picture of a man on it, despite the fact that she sent in her own picture. Will the minister take serious steps to ensure that the card agency that issues the cards does its job properly?

Tavish Scott (Liberal Democrat, Shetland Islands)

I would be happy to take up the case that Roseanna Cunningham has mentioned, which I hope she has brought to the attention of Transport Scotland. After question time, I will check whether she has done so. We have said time and time again that Transport Scotland is available to sort out problems. If she has raised the matter with it and the issue has not been solved, that is not good enough. I will check whether she has raised the matter with that body at all.

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

The elderly have widely applauded the implementation of the free concessionary bus travel scheme, but in Caithness, in my constituency, the necessary work has not been done to buses to make them easier for disabled people to access—in fact, many disabled people simply cannot access them. Therefore, they are missing out on this laudable scheme. Will the minister assure me that the issue will be looked into as a matter of urgency? [ Interruption. ]

Tavish Scott (Liberal Democrat, Shetland Islands)

Scottish National Party members are an excitable lot today. I hope that they support the scheme, although it is clear that there are questions about the SNP's support for any policy that would help the elderly.

I would be happy to consider the serious issues that Mr Stone has raised, which I can see are of no importance to the SNP whatever. We are discussing with the bus companies significant matters to do with bus design and disabled access, particularly in relation to coaches that go on longer journeys. We will continue that work and see that the bus operators provide the types of bus that are needed to provide a better service for the constituents whom Mr Stone represents.

Christine May (Labour, Central Fife)

To ask the Scottish Executive what support is being given to the renewable energy sector. (S2O-10494)

Nicol Stephen (Liberal Democrat, Aberdeen South)

Earlier this year, I announced more than £20 million of extra support for the development of renewable energy. We have also committed around £16 million to the Scottish community and householder renewables initiative, more than £3 million for the European Marine Energy Centre in Orkney and £3 million to Talisman Energy for the development of the Beatrice offshore wind farm. That money is in addition to the significant support for renewable energy through the renewables obligation system.

Christine May (Labour, Central Fife)

The use of the Sigma sustainable energies fund for renewable energy projects in the east of Scotland to support the Pelamis marine energy project has brought great benefits to my constituency, which I welcome. The minister referred to support for other forms of renewable energy. Is he aware of the proposal by Tullis Russell Papermakers in Markinch, in my constituency, to replace its coal-fired power plant with a 100 per cent biomass fuel plant? Will he confirm that there is Executive support for biomass renewable energy projects? Will he agree to meet me to discuss the Tullis Russell proposal and perhaps accept an invitation to visit the plant?