Health

Angus Robertson Excerpts

Monday 9th June 2014 Commons Chamber

[Angus Robertson (Moray) (SNP)]

It is an honour to follow the hon. Member for Burnley (Gordon Birtwistle). The House was listening raptly to a speech full of humanity and compassion. I pay tribute, too, to the right hon. Member for Cynon Valley (Ann Clwyd), who read out a lot of examples of what everyone will agree was shocking treatment. I genuinely hope that Ministers listened closely to those speakers and to many others who have made important points.

In the limited time available, I should like to draw attention to the obvious point that this is the last Queen’s Speech before the historic and exciting independence referendum in Scotland on 18 September. It is worth making the point that this Queen’s Speech and Westminster governance—the choices that the Government have introduced—can and should be seen through that prism. There are 100 days left before people in Scotland are able to determine whether we should become a normal country making all the normal decisions that successful democracies make.

Today, we have been encouraged to speak about health, so I was pleased to find a recent international health watchdog report issued only a few days ago in Canada, which said:

“Imagine a land where a patients’ charter of rights and responsibilities is in place that includes wait-time guarantees; over 90% of patients requiring elective care are treated within 18 weeks from referral by a family physician to start of treatment/procedure including all diagnostic testing and specialist consultations. Over 98% of in-patient procedures and day-surgery cases are treated within 12 weeks of agreement to treat. Over 90% of patients are seen within four hours in the emergency department (i.e., admitted, transferred or discharged). Citizens can access the most appropriate member of their primary care team within 48 hours. Up-to-date statistics and reports on wait times and health system performance indicators are publicly available. In addition to providing timely access, this land has been successful in improving other dimensions of quality of care (e.g., significantly reducing levels of hospital acquired infections, reducing the level of inappropriate care), and performance in all of these dimensions is being tracked through the measurement and reporting of performance targets available for use by patients, providers and system managers alike. Fortunately, this land already exists—Scotland.”

That report was issued only a few days ago by the physicians watchdog in Canada.

I pay tribute, as did the Health Secretary, to the work of health professionals, who make a tremendous difference to people in the NHS system in England and, no doubt, to the NHS system in Wales and Northern Ireland. I pay tribute to all of them, and in particular to those who work in NHS Scotland. I am proud of the difference that the Scottish National party Government have made since taking power in 2007. Staffing has increased under the SNP by more than 6.7%.

[Tom Blenkinsop]

Will the hon. Gentleman give way?

--- Later in debate ---

[Angus Robertson]

I have very little time, and I would like to make progress. The Government in Scotland have protected the front-line NHS budget—Labour said that they would not—and there is high patient satisfaction in the NHS. Obviously, there is always much to do, but 87% of people are fairly or very satisfied with local health services, which is an increase of 7%. We have seen the abolition of prescription charges in Scotland, which is extremely welcome. Prescriptions still need to be paid for in England, and I encourage the UK Government to consider following the example of the Scottish Government. A Scottish patient on a low income saves £7.85 per prescription, compared with a similar patient in England, and people with long-term conditions save £104 per annum compared with a patient in England, where there is provision for a pre-payment certificate.

Free prescriptions are not the only advantage. Free personal care, which was championed by the former Labour First Minister in Scotland, Henry McLeish, has been introduced, and there is pride across the political spectrum in Scotland about that. Free personal care for the elderly improves the lives of over 77,000 older vulnerable people in Scotland, where personal care is free for people over 65 who need it. That kind of service would be beneficial for the kind of constituents about whom the hon. Member for Burnley talked so movingly. Of course, patients in England are not entitled to free personal care.

Those are examples of better decision making and better outcomes, because in Scotland we have the ability in our Parliament and through our Government to pursue the policies that we wish to pursue, as opposed to those that are pursued by Governments whom we have not elected, such as those pursuing privatisation in the NHS in England. There is a concern about protecting budgets in Scotland against further cuts from Westminster and the austerity agenda that it is driving, which is why people are now talking about full financial responsibility. I looked closely at the Queen’s Speech to see how that might take place: all three UK parties have now said that they wish to see the transfer of further powers, notwithstanding the fact that only a few years ago there was a line in the sand. There were to be no more transfers but, lo and behold, when the SNP won with an absolute majority and a referendum was in sight, suddenly everyone was in favour of more powers. However, there were no specific proposals in the Queen’s Speech—reinforcement of the reality, if anyone needed it, that to have the powers to make a difference in people’s lives and build on the successes of devolution, we have to vote yes.

I would wish the Queen’s Speech to include a series of measures that were not included: building and enlarging free child care; abolishing the bedroom tax; halting the further roll-out of universal credit and personal independence payments to create a fairer welfare system; simplification of the tax system to reduce compliance costs; negotiation of the removal of Trident nuclear weapons from Scotland; protecting the value of the state pension and putting more money into the pockets of pensioners; supporting enterprise in the economy by increasing personal tax allowances; making sure that the minimum wage increases at least in line with inflation; the creation of an oil fund so that we do not see the wasting of that natural resource, which can be there for future generations; and negotiating directly with the European Union to get a better deal for farmers and fishing communities. The list goes on. Those are all measures that could have been in a Queen’s Speech in Scotland if Scotland were in charge of all the normal powers that normal democracies are in charge of.

This Queen’s Speech was totally empty of any of those proposals—proposals popular with the electorate in Scotland, proposals that can be brought forward if we use the power that is in our hands on 18 September. Between 7 am and 10 pm on that day the people of Scotland will have the power of Scotland in their hands. The simple choice for them will be whether we keep it or hand it back. I will be voting yes and I believe the majority of people in Scotland will do so too.

[Dr Phillip Lee (Bracknell) (Con)]

I shall take this opportunity in what is nominally the health debate on the Queen’s Speech to speak more broadly about the national health service. I welcome the fact that there is not much in the Queen’s Speech on health policy, because what we have done already under this Government needs to bed down.

I have always tried to build cross-party consensus in the Chamber. At no point have I sought to make any party political points in relation to health care, primarily because, as a clinician who still practises in the health service and who has an extensive network of friends from medical school who are all approaching consultancy, I have been aware of the challenges that the NHS faces and have therefore always believed that there needs to be an understanding across the Benches for us to find the appropriate solutions.

We need to get a grip of the NHS challenges that we face. Significant changes are afoot in our society—changes in attitude and behaviour, and patients’ expectations change as each generation passes away. A stoic wartime generation is being replaced by arguably much softer ones. Their experience of pain and their approach to suffering are different, in my clinical experience. Each generation is becoming more and more obese. As I have already said, the society we live in is ageing. There have been some poignant contributions to this debate. That is fine and I share the concerns, but let us not kid ourselves: more than 20% of the population is now aged over 60. The proportion of people paying tax compared with the proportion of people who have retired is diminishing. We cannot lose sight of that reality, and we need to recognise that change is inevitable.

There are some welcome advances in medicine—in drugs, technology and the application of that technology to the care of patients—but these have invariably been expensive. The National Institute for Health and Care Excellence does a pretty good job of the cost-benefit analysis, but we are now saying no to drugs that enhance people’s lives. We need to reflect on that.

The NHS was introduced in 1948 by Nye Bevan, who represented a constituency that I sought and, funnily enough, failed to take in 2005. At that time, the budget was £437 million, the equivalent of £9 billion in current money. We are approaching or may have touched above £110 billion per year. He said that there would be an initial expense when he introduced the service and that costs would then fall as the population became healthier. I am sorry—Mr Bevan might have been right to introduce the service, but he was wrong in thinking that the costs of that service would diminish with time. Clearly, they have not.

What is there to do? I would say there are four things. First, we need to find a way of reducing demand on the services. This morning I attended an induction as I am about to start working at an urgent care centre in my constituency. It was striking to note who was coming through the door. The demand is great and it is growing, and we need to deal with it.

Secondly, we must improve the physical structures in the system. Our hospitals are 19th and 20th-century buildings and we are trying, and at times failing, to deliver 21st-century care in those environments. We need to improve them and to do it fast. In order to secure an appropriate plan for our nation, I suggest that we need some sort of cross-party committee and cross-party understanding of where those acute hospitals will be in the future. We will have fewer of them, but we will have more community-based hospitals delivering chronic care. Let us not forget that over 80% of the NHS budget is now spent on chronic care. We need to make sure that that care is delivered closer to patients’ homes.

In the future we will have telemedicine, which will deliver care in patients’ homes. This is the reality. It is already being piloted in Scotland, with some very good outcomes.

[Angus Robertson]

indicated assent.

[Dr Lee]

We need to recognise that, but with that will come changes in hospital infrastructure and, yes, extremely difficult politics. We have heard about the difficult politics in south-west London, west London and elsewhere. That will be replicated irrespective of who wins next year’s election. The problem is here and now and we need to deal with it. All parties should put skin in the game and make a decision on where those hospitals should be.

The third element is funding. This is the most emotive topic to discuss. Colleagues on the Labour Benches have proposed co-payments. From those on the Government Benches, there have been suggestions of health accounts and supplementary insurance schemes. There is a plethora of ways of funding health care—one only has to look abroad. In Norway people pay to see their GP; in Denmark they pay for their drugs at cost; in Germany there are supplementary insurance schemes; in France there are means tests, and the list goes on.

I have not 100% decided what I think would be the right thing in future in this country, but the debate is needed. I cannot see how we can go above 10% of GDP on health care spending and balance the books across the whole of Government. Perhaps there are people who think we should spend north of 10% on that—fine—and approaching almost 20% on welfare if we include pensions. We are approaching £1 billion a day expenditure on these two areas. I do not think that is sustainable, but I know that if it is to change we need a cross-party debate on the matter. It is not easy.

Finally, the political cycle does not help. We have heard how it helped the hon. Member for Burnley (Gordon Birtwistle) get elected at the last election, and I am sure this will be replicated on both sides of the House in future. There is no avoiding it. I have walked the walk in my constituency: I stood at the last election calling for the closure of my local hospital, because I know that if we consolidate services in my region, we get better outcomes. People live who otherwise would not live. People suffer less. I did not think it was appropriate for a clinician who had worked in the region in which he was seeking to represent a constituency to say otherwise. I thought it appropriate that I stood on that. I continue to stand on it and I continue to stand for the consolidation of acute services in my region and for chronic care to be offered locally to people.

In conclusion, this country is very privileged to inherit a health care system that is pretty good. It is approaching first class by global standards, but it is a legacy that we must protect. Our grandparents have given it to us and we need to protect it in future, which means that we need to be open-minded about the changes required. I think the solutions will come from more than one political party and more than one expert group, but the time is now and we all need to work together.