27/09/2012 Newsnight Scotland

stay afloat. Just in time for yet another mass demonstration on

Tonight on Newsnight Scotland, the Government is promoting private

provision and social care, so should it be ruling it out for the

NHS? We will ask the Health Secretary. That difference between

the NHS in Scotland and England is widening, and a good thing, say

many doctors, nurses and politicians. South of the Board of

the coalition are pursuing controversial and expensive reforms

but they SNP have eschewed radical change. But will that be good for

patients? Could Scotland or ideas from our southern neighbours? And

good private sector involvement an internal competition improve

outcomes? Kier in Scotland there is a temptation to look with a fright

at what is happening to the NHS in England. But should we be learning

anything from the English situation?

Some in Scotland think we should not be standing still. We like to

pat ourselves on the back and say we have a better health and

education system but is the health system really prepare for the train

coming down the tracks? The challenge of an ageing population?

Financial constraints? It is generally accepted that we spend

more on health care in Scotland. That is explained away by at

difficult geography with it is to hard to provide care over large

rural areas. Also, deprivation and high levels of poor health. But I

have done some mathematics. If you look at Trafford, Greater

Manchester, that is very different now to parts of the NHS in Scotland.

It costs, per person, 1450 announced it beat some body. Health

care for one year, in Trafford. -- �1,450 to treat some body. In

Glasgow, it is �2,166 per person. Is there really the difference that

could justify it making it one third cheaper to to beat somebody

in Manchester? People who favour competition within the NHS say that

a cheaper costs in England are because of that competition.

But then there are costs connected with reform.

Yes, and the Westminster government freely admit it will cost �1.4

billion. Most of that on redundancy packages for present management who

hath to Cork, the IT costs, the set-up costs. But they claimed that

will be offset by savings. �5 billion by 2015 in staff costs

alone. Devolution allows government to arrange health policies that

suit their own nations. The ultimate question is whether these

policies produce better services and outcomes for patients. I have

looked at some changes in England In the Somerset, a service for

people with chronic breathing problems as run by the private

health care from, -- company, BUPA. I cannot praise them enough. They

have been wonderful. Our doctor was fine, no problem, but by the time

we had been to him, he needed more medication. Whereas the ladies

monitor him on a more regular basis and can stop something before it

happens, they can warm ours. -- warmth -- warn us.

There were teething problems but it has gone very well. The admission

rate in Somerset has levelled off. In England, more than three and

every 100 operations is carried out in the private sector. In Scotland,

it is three per 1,000. It is estimated that in England �1 in

every �20 of health spending goes out side took the NHS. In Scotland,

that figure is not even recorded. Cornwall may share a Celtic

language and aspirations of independence with the Scottish but

the NHS there is a world away. Severe pain, does not sound like

cardiac... This doctor is one of 10 and duty

whip out of overs Cornwall GPC of this one along with a multinational

private company. -- the out of hours surface. Even a child care

services have been put out to tender. In April, there urgent care

will take over the care of children like Josh. -- Virgin Care. With

cerebral palsy, he relies on a raft of assistance. His father has

misgivings. Ideally we should not notice any

difference except the improvement but this is a commercial company

who will want to make a profit. Do I want them making that profit out

of my son? There has long been reluctance in

Scotland to introduce competition to the NHS. Labour opposed it and

Scott -- the SNP continued the policy, opposing any privatisation

of the sector. When this patient was vast discharge from Scotland --

hospital she had tears visiting four or five times a day. She asked

for the money for her care to go directly into her bank account so

she could think her own tiara for a longer period once a day. -- get

her or one care if. I managed to get a tiny bit of

gardening done with my carer and I felt like a normal human being.

Debt is a whole difference of approach. I feel like I'm talking

to someone who is more like a friend than a cave.

Direct payments will soon become a right bylaw under keenly supported

by the Scottish Government, allowing parents to bypass the

state. -- patients. But, hang on, is that not the very same system

the Government is fundamentally I am joined by the health secretary,

Alex Neil. Thank you for joining us. Why can death -- Beth be given a

budget for her home care but have no say about her medical care?

Go that is not about privatisation or promoting private companies.

Self directed support is about promoting choice in social care.

Most of the people who have self- directed support are actually non-

profit-making companies, like A needle. A fantastic charitable

operation. The idea we are promoting privatisation is just not

true. But the point is you are promoting

choice and will increasingly have a system in which people with social

care needs will be involved as partners in terms of dealing with

their needs. Why, that been the philosophy and social care, can you

not adopt the same philosophy in a medical care?

Part of our agenda is the integration of adult health and

social care. That will bring together health and social

treatments that adult people get, particularly our senior citizens.

The idea is that along with the of GP and health support work and

social workers, they will be able to take part in decisions about

what is the best package of care for them. So we are extending

Choice in relation to health and social care.

But whoever controls the Budget has the greater power. Why cannot then

patients get some control over their medical budget? If that is

something you thinking of doing, for whoever?

Medical decisions must be informed by expert opinion such as GPs or

consultants. So the scope for seeing total patient choice as...

Nobody is suggesting that! In terms of the patient being

involved with a GP or consultant, in deciding their future care, that

is what we are promoting. One of the things we're keen to promote in

the health service and social care system as at its choice and more

active involvement for patients. -- extra choice.

Well the patients, for instance, be able to go to a private hospital if

they so choose as active participants? Or will be just have

to take a hospital given to them by a health service.

We will not fund private hospitals on anything like that kind of scale.

We only use the private sector in exceptional circumstances and with

very good reason. Firstly, there are relatively few private sector

providers in Scotland relative to England, but more importantly, the

level of care we can reach in the National Health Service in Scotland

is far superior to what the private sector can provide. An example - an

early decision of mine as health secretary was for a centre in

Edinburgh which is an alternative to open heart surgery. Quite

frankly, there is no way that the private sector, I believe, could

provide the standard of care for coronary patients that the Health

Service provides. A doctor quoted on the front of to day's Herald

says that Kieran Scott and for heart patients is second to none in

the United Kingdom. -- care in Scotland.

What is the bad idea? -- big.

Get you look at the traditional pattern of health when people went

into hospital for a long stays, many of the procedures 20 years ago

that would have taken 10 or 20 days can now be done by day surgery.

Cable wish to be treated at home. An example, NHS Lanarkshire has a

first-class programme for treating patients at home. They put in place

a package of support and a health support package which is far better

than UN Mrs Sally taking people to Is there anything you can learn

from the English reforms? In all of our Ayer's Scotland it is

already in the lead not just in the United Kingdom but also in the

world. -- in all areas. Some headlines tomorrow, the

European Commission sinking your alcohol minimum pricing plan. It is

that true? That is certainly not true. Other

countries have objected but the commission is looking at it and we

will have a chance to respond to the observations made. It is news

to me if they have ruled it out and back in the Daily Mail has got that

one wrong. I very briefly, doctors feeling

that you're not top up pensions? Clearly the stupid reforms being

forced upon us from London do not make sense. The problem is that if

we use public money in Scotland to people these additional

contributions that money will then be deducted from ever budget from

London. That could seriously affect front line services. There is a

major problem there. We will continue to talk to the doctors to

try and find a way through this. Thank you very much indeed for

joining us. I enjoyed by Dr Forbes from

Stirling University who has worked in both the NHS and private sector.

-- I am joined by. What is the situation in Wales and Northern

Ireland? The advent of devolution has

allowed both administrations to develop their own health policies.

They commit the sums of money that the desire to their own health

systems and tackle priorities which may be different from the rest of

the United Kingdom. In terms of competition, we have

seen it in the English system since the 1990s in various forms. Through

Tony Blair and now into the coalition government. But there is

a cultural difference, isn't there? Between the way NHS is treated by

politicians. Here in Scotland, Her absolutely. Conservative

reforms of the 1980s and 90s were received in a lukewarm manner in

Scotland. A Scotland has always had a desire to go down the road of

improving social welfare policies, involving professions in the

decision-making, involving the public. Collaboration has been the

way since the late 1990s. Which works best?

Looking at the over all outcomes there is not much of a difference.

We saw Eleanor show that earlier. Life expectancy, in both countries,

in terms of the system be used, similar.

But at the outcomes are broadly similar is there an argument to be

made about efficiency? Absolutely. The Glasgow -

Manchester figures surprised me but you need to look in more detail

like there is a difference. Always with competition there is an

argument that providers will try to improve the way they deliver

services. That brings costs down. Tomorrow's front pages, that daily

Mail headline again, the European Union sinking SNP alcohol plans.

But we're up on the Cabinet Secretary, it is news to him. -- we

heard from. The Independent, another blow for the euro-zone as