:00:03. > :00:13.stay afloat. Just in time for yet another mass demonstration on
:00:13. > :00:15.
:00:15. > :00:20.Tonight on Newsnight Scotland, the Government is promoting private
:00:20. > :00:27.provision and social care, so should it be ruling it out for the
:00:27. > :00:33.NHS? We will ask the Health Secretary. That difference between
:00:33. > :00:37.the NHS in Scotland and England is widening, and a good thing, say
:00:37. > :00:40.many doctors, nurses and politicians. South of the Board of
:00:40. > :00:48.the coalition are pursuing controversial and expensive reforms
:00:48. > :00:54.but they SNP have eschewed radical change. But will that be good for
:00:54. > :00:57.patients? Could Scotland or ideas from our southern neighbours? And
:00:57. > :01:07.good private sector involvement an internal competition improve
:01:07. > :01:07.
:01:07. > :01:14.outcomes? Kier in Scotland there is a temptation to look with a fright
:01:14. > :01:19.at what is happening to the NHS in England. But should we be learning
:01:19. > :01:23.anything from the English situation?
:01:23. > :01:26.Some in Scotland think we should not be standing still. We like to
:01:26. > :01:29.pat ourselves on the back and say we have a better health and
:01:29. > :01:34.education system but is the health system really prepare for the train
:01:34. > :01:38.coming down the tracks? The challenge of an ageing population?
:01:38. > :01:43.Financial constraints? It is generally accepted that we spend
:01:43. > :01:46.more on health care in Scotland. That is explained away by at
:01:46. > :01:51.difficult geography with it is to hard to provide care over large
:01:51. > :01:56.rural areas. Also, deprivation and high levels of poor health. But I
:01:56. > :02:03.have done some mathematics. If you look at Trafford, Greater
:02:03. > :02:10.Manchester, that is very different now to parts of the NHS in Scotland.
:02:10. > :02:18.It costs, per person, 1450 announced it beat some body. Health
:02:18. > :02:25.care for one year, in Trafford. -- �1,450 to treat some body. In
:02:25. > :02:29.Glasgow, it is �2,166 per person. Is there really the difference that
:02:29. > :02:34.could justify it making it one third cheaper to to beat somebody
:02:34. > :02:41.in Manchester? People who favour competition within the NHS say that
:02:41. > :02:47.a cheaper costs in England are because of that competition.
:02:47. > :02:52.But then there are costs connected with reform.
:02:52. > :02:58.Yes, and the Westminster government freely admit it will cost �1.4
:02:58. > :03:03.billion. Most of that on redundancy packages for present management who
:03:03. > :03:11.hath to Cork, the IT costs, the set-up costs. But they claimed that
:03:11. > :03:16.will be offset by savings. �5 billion by 2015 in staff costs
:03:16. > :03:21.alone. Devolution allows government to arrange health policies that
:03:21. > :03:26.suit their own nations. The ultimate question is whether these
:03:26. > :03:36.policies produce better services and outcomes for patients. I have
:03:36. > :03:39.looked at some changes in England In the Somerset, a service for
:03:39. > :03:49.people with chronic breathing problems as run by the private
:03:49. > :03:57.
:03:57. > :04:04.health care from, -- company, BUPA. I cannot praise them enough. They
:04:04. > :04:11.have been wonderful. Our doctor was fine, no problem, but by the time
:04:11. > :04:14.we had been to him, he needed more medication. Whereas the ladies
:04:14. > :04:24.monitor him on a more regular basis and can stop something before it
:04:24. > :04:32.
:04:32. > :04:38.happens, they can warm ours. -- warmth -- warn us.
:04:38. > :04:48.There were teething problems but it has gone very well. The admission
:04:48. > :04:48.
:04:49. > :04:55.rate in Somerset has levelled off. In England, more than three and
:04:55. > :05:03.every 100 operations is carried out in the private sector. In Scotland,
:05:03. > :05:08.it is three per 1,000. It is estimated that in England �1 in
:05:08. > :05:16.every �20 of health spending goes out side took the NHS. In Scotland,
:05:16. > :05:21.that figure is not even recorded. Cornwall may share a Celtic
:05:21. > :05:30.language and aspirations of independence with the Scottish but
:05:30. > :05:37.the NHS there is a world away. Severe pain, does not sound like
:05:37. > :05:42.cardiac... This doctor is one of 10 and duty
:05:42. > :05:51.whip out of overs Cornwall GPC of this one along with a multinational
:05:51. > :06:00.private company. -- the out of hours surface. Even a child care
:06:00. > :06:10.services have been put out to tender. In April, there urgent care
:06:10. > :06:10.
:06:10. > :06:15.will take over the care of children like Josh. -- Virgin Care. With
:06:15. > :06:22.cerebral palsy, he relies on a raft of assistance. His father has
:06:22. > :06:25.misgivings. Ideally we should not notice any
:06:25. > :06:30.difference except the improvement but this is a commercial company
:06:30. > :06:37.who will want to make a profit. Do I want them making that profit out
:06:37. > :06:45.of my son? There has long been reluctance in
:06:45. > :06:50.Scotland to introduce competition to the NHS. Labour opposed it and
:06:51. > :07:00.Scott -- the SNP continued the policy, opposing any privatisation
:07:01. > :07:07.
:07:07. > :07:12.of the sector. When this patient was vast discharge from Scotland --
:07:12. > :07:16.hospital she had tears visiting four or five times a day. She asked
:07:16. > :07:24.for the money for her care to go directly into her bank account so
:07:24. > :07:34.she could think her own tiara for a longer period once a day. -- get
:07:34. > :07:34.
:07:34. > :07:40.her or one care if. I managed to get a tiny bit of
:07:40. > :07:46.gardening done with my carer and I felt like a normal human being.
:07:46. > :07:53.Debt is a whole difference of approach. I feel like I'm talking
:07:53. > :07:57.to someone who is more like a friend than a cave.
:07:57. > :08:01.Direct payments will soon become a right bylaw under keenly supported
:08:01. > :08:07.by the Scottish Government, allowing parents to bypass the
:08:07. > :08:16.state. -- patients. But, hang on, is that not the very same system
:08:16. > :08:26.the Government is fundamentally I am joined by the health secretary,
:08:26. > :08:32.
:08:33. > :08:38.Alex Neil. Thank you for joining us. Why can death -- Beth be given a
:08:38. > :08:46.budget for her home care but have no say about her medical care?
:08:46. > :08:52.Go that is not about privatisation or promoting private companies.
:08:52. > :08:57.Self directed support is about promoting choice in social care.
:08:57. > :09:06.Most of the people who have self- directed support are actually non-
:09:06. > :09:12.profit-making companies, like A needle. A fantastic charitable
:09:12. > :09:17.operation. The idea we are promoting privatisation is just not
:09:17. > :09:21.true. But the point is you are promoting
:09:21. > :09:25.choice and will increasingly have a system in which people with social
:09:25. > :09:30.care needs will be involved as partners in terms of dealing with
:09:30. > :09:37.their needs. Why, that been the philosophy and social care, can you
:09:37. > :09:42.not adopt the same philosophy in a medical care?
:09:42. > :09:44.Part of our agenda is the integration of adult health and
:09:44. > :09:50.social care. That will bring together health and social
:09:50. > :09:57.treatments that adult people get, particularly our senior citizens.
:09:58. > :10:03.The idea is that along with the of GP and health support work and
:10:03. > :10:08.social workers, they will be able to take part in decisions about
:10:08. > :10:13.what is the best package of care for them. So we are extending
:10:13. > :10:19.Choice in relation to health and social care.
:10:19. > :10:26.But whoever controls the Budget has the greater power. Why cannot then
:10:26. > :10:35.patients get some control over their medical budget? If that is
:10:35. > :10:40.something you thinking of doing, for whoever?
:10:40. > :10:49.Medical decisions must be informed by expert opinion such as GPs or
:10:49. > :10:58.consultants. So the scope for seeing total patient choice as...
:10:58. > :11:03.Nobody is suggesting that! In terms of the patient being
:11:03. > :11:07.involved with a GP or consultant, in deciding their future care, that
:11:07. > :11:12.is what we are promoting. One of the things we're keen to promote in
:11:12. > :11:20.the health service and social care system as at its choice and more
:11:20. > :11:25.active involvement for patients. -- extra choice.
:11:25. > :11:29.Well the patients, for instance, be able to go to a private hospital if
:11:29. > :11:36.they so choose as active participants? Or will be just have
:11:36. > :11:40.to take a hospital given to them by a health service.
:11:40. > :11:44.We will not fund private hospitals on anything like that kind of scale.
:11:44. > :11:51.We only use the private sector in exceptional circumstances and with
:11:51. > :11:54.very good reason. Firstly, there are relatively few private sector
:11:54. > :11:58.providers in Scotland relative to England, but more importantly, the
:11:59. > :12:04.level of care we can reach in the National Health Service in Scotland
:12:04. > :12:10.is far superior to what the private sector can provide. An example - an
:12:10. > :12:15.early decision of mine as health secretary was for a centre in
:12:15. > :12:20.Edinburgh which is an alternative to open heart surgery. Quite
:12:20. > :12:24.frankly, there is no way that the private sector, I believe, could
:12:24. > :12:29.provide the standard of care for coronary patients that the Health
:12:29. > :12:33.Service provides. A doctor quoted on the front of to day's Herald
:12:33. > :12:40.says that Kieran Scott and for heart patients is second to none in
:12:40. > :12:50.the United Kingdom. -- care in Scotland.
:12:50. > :12:52.
:12:53. > :12:55.What is the bad idea? -- big.
:12:56. > :13:00.Get you look at the traditional pattern of health when people went
:13:00. > :13:05.into hospital for a long stays, many of the procedures 20 years ago
:13:05. > :13:11.that would have taken 10 or 20 days can now be done by day surgery.
:13:12. > :13:18.Cable wish to be treated at home. An example, NHS Lanarkshire has a
:13:18. > :13:25.first-class programme for treating patients at home. They put in place
:13:25. > :13:35.a package of support and a health support package which is far better
:13:35. > :13:46.
:13:46. > :13:55.than UN Mrs Sally taking people to Is there anything you can learn
:13:55. > :13:59.from the English reforms? In all of our Ayer's Scotland it is
:14:00. > :14:09.already in the lead not just in the United Kingdom but also in the
:14:10. > :14:10.
:14:10. > :14:14.world. -- in all areas. Some headlines tomorrow, the
:14:14. > :14:21.European Commission sinking your alcohol minimum pricing plan. It is
:14:21. > :14:23.that true? That is certainly not true. Other
:14:23. > :14:27.countries have objected but the commission is looking at it and we
:14:27. > :14:31.will have a chance to respond to the observations made. It is news
:14:31. > :14:40.to me if they have ruled it out and back in the Daily Mail has got that
:14:40. > :14:47.one wrong. I very briefly, doctors feeling
:14:47. > :14:52.that you're not top up pensions? Clearly the stupid reforms being
:14:52. > :14:55.forced upon us from London do not make sense. The problem is that if
:14:55. > :14:58.we use public money in Scotland to people these additional
:14:58. > :15:04.contributions that money will then be deducted from ever budget from
:15:04. > :15:08.London. That could seriously affect front line services. There is a
:15:08. > :15:14.major problem there. We will continue to talk to the doctors to
:15:14. > :15:20.try and find a way through this. Thank you very much indeed for
:15:21. > :15:26.joining us. I enjoyed by Dr Forbes from
:15:26. > :15:31.Stirling University who has worked in both the NHS and private sector.
:15:31. > :15:37.-- I am joined by. What is the situation in Wales and Northern
:15:37. > :15:42.Ireland? The advent of devolution has
:15:42. > :15:46.allowed both administrations to develop their own health policies.
:15:46. > :15:49.They commit the sums of money that the desire to their own health
:15:49. > :15:55.systems and tackle priorities which may be different from the rest of
:15:56. > :16:01.the United Kingdom. In terms of competition, we have
:16:01. > :16:05.seen it in the English system since the 1990s in various forms. Through
:16:05. > :16:10.Tony Blair and now into the coalition government. But there is
:16:10. > :16:20.a cultural difference, isn't there? Between the way NHS is treated by
:16:20. > :16:22.
:16:22. > :16:26.politicians. Here in Scotland, Her absolutely. Conservative
:16:26. > :16:32.reforms of the 1980s and 90s were received in a lukewarm manner in
:16:32. > :16:37.Scotland. A Scotland has always had a desire to go down the road of
:16:37. > :16:41.improving social welfare policies, involving professions in the
:16:41. > :16:51.decision-making, involving the public. Collaboration has been the
:16:51. > :16:57.way since the late 1990s. Which works best?
:16:57. > :17:02.Looking at the over all outcomes there is not much of a difference.
:17:02. > :17:10.We saw Eleanor show that earlier. Life expectancy, in both countries,
:17:10. > :17:14.in terms of the system be used, similar.
:17:14. > :17:22.But at the outcomes are broadly similar is there an argument to be
:17:22. > :17:26.made about efficiency? Absolutely. The Glasgow -
:17:26. > :17:29.Manchester figures surprised me but you need to look in more detail
:17:29. > :17:33.like there is a difference. Always with competition there is an
:17:33. > :17:43.argument that providers will try to improve the way they deliver
:17:43. > :17:43.
:17:43. > :17:51.services. That brings costs down. Tomorrow's front pages, that daily
:17:51. > :17:57.Mail headline again, the European Union sinking SNP alcohol plans.
:17:57. > :18:01.But we're up on the Cabinet Secretary, it is news to him. -- we
:18:01. > :18:11.heard from. The Independent, another blow for the euro-zone as