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Written report of BMA Scotland Hustings

Tuesday 20 March 2007

In the run up to the Scottish Parliament Elections, the BMA in Scotland hosted a health hustings at its Edinburgh offices on March 20. This event gave BMA members the opportunity to hear the health policies being put forward by the main political parties and to take part in an open debate.

The event was chaired by Dr Peter Terry, chairman of the BMA’s Scottish Council, speakers were:
Andy Kerr MSP (Labour)
Shona Robison MSP (SNP)
Euan Robson MSP (Lib Dem)
Dr Nanette Milne MSP (Conservative)
Dr Eleanor Scott MSP (Green)
Charlie McCarthy (Scottish Socialist Party)

Dr Peter Terry, Chairman of BMA Scotland, welcomed all speakers and invited them each to give a five minute introduction to highlight their key health policies for the next election.

Labour
Andy Kerr highlighted some of the successes of the Labour led Executive in Scotland and spoke of the priorities for the next four years. He said that:

• It was a challenging and exciting time for the health service in Scotland.
• The Kerr report provided an opportunity for new way of looking at health in Scotland.
• Health inequalities are at the top of the Labour Party agenda, along with shifting the balance of care.
• Labour had increased investment in public sector resources to increase productivity and expand the workforce.
• Labour believe that key for the future was to invest in people and skills.

A link will be provided when the Labout manifesto is published.

SNP
Shona Robison thanked NHS staff for their hard work and highlighted and outlined the SNP’s vision for Scotland is to improve the heath of the nation:

• SNP will extend the Emergency Workers legislation to cover all staff as part of plans to keep workers safe.
• They will increase NHS capacity; however they added that PFI should be brought to an end.
• They would provide guaranteed waiting times based on individual clinical need.
• They would provide incentives for local hospitals, recognising the workforce need for such a strategy.
• Preventing ill health is a priority for the SNP. For example, tackling binge drinking, offer MOTs to all aged over 40, and work in the field of mental health.

A link to the SNP manifesto will be provided when published.

Liberal Democrat
Euan Robson thanked the BMA for organising the event and highlighted that:

• As part of its commitment to shifting care into the community, the Liberal Democrats would create 100 new local health centres in Scotland.
• Tackling violent behaviour toward healthcare staff is a priority for the Party.
• Workforce planning is needed and should be taken forward in closer dialogue with doctors.
• Scotland’s smoking legislation is good but they agree that the pressure to reduce smoking in Scotland should be maintained. He said that we need to keep the pressure up by tackling the recruitment of young smokers, in particular female smokers and smoking by pregnant women. He added that it would be useful to effectively enforce minimum age level to buy tobacco in advance of increasing the age to 18.
• Healthy eating is important but it should not just be dealt with in primary schools but throughout all education years.

A link will be provided when the Liberal Democrat manifesto is published.

Conservatives
Nanette Milne highlighted that:

• It is a crucial time for NHS in Scotland, particularly in relation to the ongoing staff shortages.
• Juniors are facing enormous changes in training and the Conservatives recognise the need to address problems in discussion with doctors.
• The Conservatives support and are totally committed to the NHS.
• They believe that patients should be more involved with their NHS and would give them more control and choice.
• The Conservatives propose to take power away from politicians and give it to doctors and other healthcare professionals working in the service.

Conservative's manifesto.

Green
Eleanor Scott highlighted that:

• The Green Party is committed to an NHS free at point of need
• Prevention of ill heath and management of chronic disease are priorities in Scotland.
• The Party believes there is a better way than PFI to fund new hospitals.
• Obesity, mental health problems, sexual health are all areas of public health that need attention.
• Health impact assessments should be introduced for all areas of policy.

Green's manifesto.

SSP
Charlie McCarthy highlighted that:

• The SSP opposes privatisation of the health service.
• Free school meals are the best way to eradicate poverty and improve the diet of Scotland’s children.
• The Socialists want to stop people profiting from illness i.e. through– PFI/PPP.
• A publicly funded pharmaceutical company that would generate no profit should be established to keep drug costs down.
• They believe that putting patients before profit is key for the NHS.

A link will be provided when the SSP manifesto is published.

Question 1:
Dr Graeme Eunson, SPR in Paediatrics Lothian and Chairman of the BMA's Scottish Junior Doctor Committee, said that reforms to medical training (Modernising Medical Careers MMC) was the biggest issue facing future careers of junior doctors adding that the public and junior doctors had lost faith and confidence in the application process (MTAS). Do you agree that the only solution is to interview all eligible applicants to restore this lost confidence? Are you committed to expanding the medical workforce to provide a GP/consultant delivered service?

The Greens, SNP and the Conservatives all agreed there should be a solution to MTAS and agreed with the suggestion to interview all eligible applicants. Labour and the Lib Dems were keen to wait to see the result of the Department of Health’s review. Charlie McCarthy (SSP) questioned the need for MMC as, in his opinion, the old system was better and wondered where the motivation was for doctors since there was such a small chance of becoming a consultant. His party would be happy to continue with a consultant/GP led service.

Nanette Milne (Cons) underlined the need to train people with a view for the future needs of Scotland. She said that there is a current shortage of GPs and an ageing workforce, so there is a clear need to plan ahead.

Andy Kerr (Lab) said that he understood the concerns of juniors. He said that he had every confidence in NHS Education for Scotland and the Chief Medical Officer Harry Burns to do what is best for Scotland. He added that access to medical training had always been competitive and he did not expect ‘mass unemployment’ in Scotland that some had been predicting. He said that he would take advice from the CMO before making a decision on whether or not to interview all applicants. In response to the second part of the question, Mr Kerr said that there was currently a clear shift in healthcare and that there should be a balance between acute and primary care service provision. His aim would be to train healthcare workers in line with that plan.

Shona Robison (SNP) said workforce planning had been historically poor and that more progress needs to be made. Euan Robson (Lib Dem) highlighted that Scotland should have the number of consultants required to provide the healthcare it needs. Workforce planning needs to be improved, he added.

Eleanor Scott (Green) stated that the problems of MTAS were largely due to IT problems. She said that in the NHS, IT always seemed to go wrong and if the process regarding junior doctor applications is fixable then they should do so, if not, then she suggested a return to the old application process.

Question 2:
Dr John Garner, Lothian GP asked if the panel supported employed or independent contractors in general practice.

Andy Kerr (Lab), Euan Robson (Lib Dem), Shona Robison (SNP), Eleanor Scott (Green) and Nanette Milne (Cons) were content with the current mixed economy of both salaried and independent contractors. Kerr (Lab) said that a balance should be struck and that a big shift could destabilise the health service. Euan Robson (Lib Dem) commented on the problems with dentists and Shona Robison (SNP) highlighted concerns surrounding out of hours and said that whatever system delivered the best deal for patients was most important. She suggested that a salaried service should be provided in areas that need attention. Charlie McCarthy (SSP) stated that the SSP was against any form of private contracting within the NHS and said that all health workers should receive a fair day’s wage for a fair day’s work.

Question 3:
Professor Peter Brunt, Royal College of Physicians Edinburgh, highlighted the high number of deaths from alcohol in Scotland and asked what the panel would do about the pricing of alcohol?

All panel members agreed that pricing was one part of a complex range of issues that needed to be tackled to reduce alcohol misuse in Scotland. Shona Robison (SNP) highlighted there was still a long way to go with regards to off-sales and suggested using licensing powers to negotiate with supermarkets, who she felt should take some responsibility. Euan Robson (Lib Dem) suggested that restrictions on alcohol with high sugar content, which were marketed towards the young should be a priority. Eleanor Scott (Green) claimed that part of Scotland’s problem with alcohol was linked to its unhealthy relationship with food. Andy Kerr (Lab) said that not all high alcohol drinks were cheap, highlighting Buckfast as a case in point and suggested that a system which differentiated between low taxes for low alcohol and higher taxes for products with high alcohol content could be worth exploring. All parties agreed that education and enforcement of age restrictions were important. Nanette Milne (Cons) suggested planning was required and Charlie McCarthy (SSP) stated that doctors should be listened to on this issue.

Question 4:
Dr Sally Winning, Staff Grade Psychiatrist in Aberdeen and Chairman of the BMA’s Scottish Staff and Associate Specialist (SAS) Committee, asked if the panel agreed with Harry Burns (CMO) that there was no appetite to introduce a sub consultant grade in Scotland?

Andy Kerr (Lab) stated that there were no plans to introduce this grade in Scotland. He added that he receives good advice from the CMO and would think twice about going against his recommendations. Nanette Milne (Cons) heralded the great service that SAS grades provide and she would therefore think twice before getting rid of this grade. Charlie McCarthy (SSP) stated that in some instances there is little if any difference between consultant and SAS grades and questioned why this should be the case. Shona Robison (SNP) suggested that there was scope to help SAS doctors become consultants and also agreed with Harry Burns. Euan Robson (Lib Dem) said he would need to be convinced of the merit of introducing a sub consultant grade and that in his view, a blanket approach does not seem appropriate. Eleanor Scott (Green) said that workforce planning was essential – if Scotland needs consultants then it should employ consultants, not try to get them on the cheap.

Question 5:
Dr Dean Marshall, GP Midlothian and Chairman of the BMA’s Scottish GP committee, asked what the panel’s views are on private providers competing for services in primary care. Should there be a level playing field or incentives for private providers to enter the market?

Charlie McCarthy (SSP) and Eleanor Scott (Green) spoke out against private providers within the NHS and the SSP added that if Carolyn Leckie (current SSP spokesperson for Heath) is re-elected, she would be lodging a members bill to stop private providers from being allowed to compete for business within the NHS. Andy Kerr (Lab) supports the traditional model but commented on the recent situation in Harthill where a private company had put in a bid to run a practice. He added that he was glad the contract had been awarded to a GP. Shona Robison (SNP), Nanette Milne (Cons) and Euan Robson (Lib Dems) all agreed that if traditional provider is not available in certain circumstances, then private providers should be able to provide the care. One example given was specialist addiction services.

Question 6 Dr Peter Terry asked the speakers if they did not get elected in May and had to work as a doctor instead, which specialty would they choose?

Charlie McCarthy (SSP) stated that he is a nurse currently and if he is not able to do that after May he must have done something wrong so it was unlikely that the medical profession would have him! Nanette Milne (Cons), Andy Kerr (Labour) and Shona Robison (SNP) all chose public health, however Shona Robison also stated mental health would be a challenging and rewarding area of work. Euan Robson (Lib Dem) who had formerly worked as a teacher, chose paediatrics and Eleanor Scott (Greens) chose public health or an A&E minor injury unit.

Dr Peter Terry closed the meeting by thanking all the speakers and members for attending.