10/03/2016 Scotland 2016

The Scottish Government's plans for the NHS are called into question.

The public spending watchdog issues a scathing verdict

on the Scottish Government's plans

We'll hear from the Health Secretary.

And praise for Scotland's record on the environment

from no less than the UN's Head of Climate Change.

A lack of leadership by the Scottish Government

is preventing the NHS from making the changes which are needed

if it's to cope with an older, sicker population.

That's the finding of a scathing report

by the public spending watchdog, Audit Scotland.

It found that the current ways of working are unsustainable,

especially in the face of tougher public spending budgets.

In a moment, we'll hear from the Health Secretary.

Getting us out of hospital and back into our own homes. It has been the

aim of successive governments including this SNP administration.

What it has done differently is set a deadline called the 2020 Vision,

described as the most substantial NHS reform in a generation. But this

Audit Scotland report says it is endangered by a lack of leadership.

We think the Scottish Government can do more to put the plan in place to

support its vision, which has been around since 2010, and progress

is not fast enough to see it completed and running by 2020 as

originally envisaged, so plans are bought from Government, and equally

more people and health boards and councillors could make sure they are

testing out what is working from the changes they are making. The

Government plan is to integrate health and social care allowing more

averse to be cared for in or as close as possible to our own homes

instead of being admitted to hospital. It means large parts of

health and council spending are being merged when staff are under

increasing pressure. Nurses around the country are aware of the need to

make changes. They are struggling and they understand that within

their boards, local authorities and councils that Chief Executive 's

have hard choices because the budgets are tough and they know

savings are being made. They also know that there are changes in

practice they could make. The NHS is stuck between two models of care. It

is currently focused on the here and now, short-term and drug target

driven with treatment in big expense of hospitals like this one. By 2020

it is supposed to be about preventative and community-based

care. But with so much cash tied up in resources like this can it afford

to make those changes? Money is just one pressure point. The third of GPs

are over 50 and by 2034 the number of Scots over 85 will have doubled.

The Scottish Government says it is investing an extra quarter of ?1

billion in the budget for health and social care. Opposition parties say

it may be too little too late. It shows we are facing a perfect storm

of reduced real terms funding, of an increasing, ageing population, of

extra pressures on the workforce, also emphasising the fact that we

are going to be forecast to lose many GPs. I think it is a bit of a

mess. I hope it works but I have serious doubts, and it is clear from

the Audit Scotland report that they have doubts about the progress made,

the rate is slow and the budgets are critical to the delivery. If we are

going to have any prospect of securing an NHS in public hands,

free at the point of need and delivery, on a sustainable base

going into the future, somebody needs to show real leadership now in

order to agree the plan to secure that, and I think Audit Scotland are

expressing concern about the leadership of the Government.

Changing the NHS is like turning around and World Bank. It cannot be

rushed but needs steering, and as pressure mounts on the system is

time beginning to run out? Just before we came on air I spoke

to the Health Secretary Shona Robison from our studio. A lack of

vision, Al-Aqsa of leadership? This report cannot have been comfortable

read -- a lack of leadership, that could not have been comfortable

reading for youth. I have been in this job a year now and during that

time I have spent more time meeting local partnerships and speaking to

them, making sure the national arrangements are in place, making

sure the funding is in place, so a lot has been done to provide that

national leadership, the framework and the money, but there is always

more that can be done. We always look

closely at Audit Scotland reports and the recommendations they make.

If there is more we can do nationally, then we will do. The

report is pretty clear, it says the Scottish Government needs to provide

stronger leadership. This is halfway through the plan, and that is what

they are saying at this stage. Well, I would say that the partnerships I

meet on a regular basis, I meet many of them, and they are ready to hit

the ground running on the 1st of April. We have had some partnerships

further down the line than others, but of course that is always the

case, and we have supported those partnerships that need to do more to

ensure they can hit the ground running on the 1st of April. We are

providing ?250 million of additional resources for social care from the

1st of April. We have provided 300 million in the Integrated Care Plan

and we are providing support around Best practice and the roll of best

practice, and we have provided a lot of support, but as I said there was

always more we can do, we want to do more and we will look at the report

closely. Quite a bit more. Audit Scotland says there is limited

evidence of transformational change on the scale required to meet the

objective of 2020 Vision. This is not your opponents, this is the

public spending watchdog saying this. And of course we look closely

at the reports, but the partnerships only formally come into being on the

1st of April, so they have only had a shadow year, they only hit the

ground running on the 1st of April, and of course we have given them

extensive new resources to work with to ensure they can meet the

challenges, and we have just published a national chronicle

strategy to provide a good framework for health and care services to

follow, and there are good examples of good practice, which Audit

Scotland... They also say change is small-scale and not widespread

enough. Well, changed does take time but it is happening and if you look

across Scotland attacked -- Scotland the tackling of delayed discharge is

happening. We are already seeing results even in the Shadow year

before the partnerships are formally constituted from the 1st of April. I

accept there is more to be done. I said last year when Audit Scotland

produced a similar report that we needed to up the pace of change and

deliver the 2020 Vision faster. This report says you haven't managed to

do that. ?250 million of resources will help crank up the speed of that

change. The report also considers funding and says the level of

investment required to keep pace with demand is not sustainable in

the current financial climate. Well, the ?250 million for social care is

one of the biggest transfers of resources we have seen... And that

is for a single year? It is recurring, it will continue. 250

million a year going forward so over four years, ?1 billion of

investment. That was a decision we took because we know we have to

transfer more resources from acute services into primary and community

services and social care, and we needed to up the pace on that.

That is why that is one of the biggest transfers of resources we

have seen, but I can ever remember, and we need to make sure, though,

that that money works, but it delivers new services on the ground,

and of course it will deliver the living wage for social care workers

as well. So all that taken together, I think the pace of change from this

year on will crank up, and it needs to and I have said that previously.

There was good news today, that Scottish emergency departments are

treating people more quickly than anywhere else in the UK, but doesn't

that just highlight the pressure you have to keep channelling funds into

acute services to meet accident and emergency targets or other targets

like that? Is it simply too difficult to shift the funding

required to make this transformational change by 2020? It

is a challenging thing to do, and of course we need to keep acute

services going as well because people will continue to need

accident and emergency and the acute services we provide, but we can

provide those more effectively and efficiently in the national

Chronicle strategy, which lays out the blueprint for the next ten or 15

years of how that will happen -- National clinical strategy. But we

need to see the development of clinical health services including

clinical services because we know if we do that we will see less people

turning up at accident and emergency or admitted to hospital and see

people getting home more quickly. That is why we made the decision to

allocate half the resources to help that would go through the NHS to

social care. That was a decision we made because we know that is where

we need to be able to keep people out of hospital and that is where

the investment needs to be made. I am sure you can understand on a

report card like this more than halfway through this supposed

change, people will be concerned. I confident, can you guarantee you

will have the services you are expecting by 2020? We will make more

progress than we have made to date by 2020. We need to up the Pope pace

of change. That is why the strategy is a comprehensive blueprint for the

next 15 years setting out what needs to happen, and that is about as

focusing on primary, community and social care services, keeping people

out of hospital, reorganising the way acute services are delivered,

better regional planning services, all that will need to happen at a

pace we haven't seen before, which will be challenging but in the

national leadership I will provide alongside the Government, we will

make sure we give the right policies, frameworks and resources

that are there to make sure that happens. Shona Robison in Dundee,

thank you very much for joining us. She's the woman who helped forge

an historic global deal on climate change

in Paris in December. Today, the Costa Rican diplomat

Christiana Figueres was in Holyrood, where she met the First Minister,

Nicola Sturgeon. Scotland's own

climate change targets were at the top

of the agenda. Our environment correspondent,

David Miller, to talk about the record

of the Scottish and the prospect of

a Trump Presidency. The Paris Agreement is adopted.

CHEERING. Paris, December 2015, and after the chaos and confusion of the

Copenhagen climate talks six years earlier, a global deal is finally

struck. Firmly at the helm, Christiana Figueres, in her role as

executive secretary of the United Nations framework Convention on

climate change. Charismatic, passionate and determined, this is a

woman who helped achieve what many said would prove impossible. I

wanted to know what were her hopes and fears post Paris. Can I begin by

asking you about the post-Paris world, the conference in Paris was

met with a very positive response internationally. Exhilaration, I

would say! Your words, but a real positivity. Given the scale of the

challenge, the vast political backdrop, 100 and countries, what

contribution can Scotland hope to make. Only some countries have

presented their plans and we expect the rest to be able to do that in

due time. But Scotland is actually, yes, a small emitter, but very

important in its leadership. I come from a very small country that is

also a small emitter but has taken a leadership role. In the case of

Scotland, the fact that in 2009 you already took on climate change and

took what was then considered and ambitious target, and Scotland is

already at 38%, presents a good example of the fact that once we

have a target and we focus and bring together private sector ingenuity,

financing and policy, that we can meet and exceed targets.

What you have to look at is watered in the direction of travel. The

direction of travel is the one that is important and it is very

understandable that there will be periods in which any economy is

meeting and exceeding and periods during which any economy is actually

lagging behind. I am not so concerned about if I say... About

the ebbs and flows. What I think is much more important is what is the

undercurrent. What is the direction of travel? That is fundamentally

very sound. And there is a huge political commitment to continue

this. So I am not so concerned about the little ebbs and flows. What I

look at is underneath what is the direction?

You have spoken of Scottish leadership, is the UK's leading on

the international stage in the way you would like to see? UK definitely

lead... Past tense? It laid in Paris and lead throughout the six years

that I had the honour of being there and I am grateful this has occurred

throughout several governments in the UK. There has never been a

question about the international leadership of the UK. When you

devolve that then inside the UK, of course we know that there is

currently the discussion about what are we doing about incentives for

renewables, incentives for energy efficiency. And that is still an

ongoing conversation and one... So is the UK talking the talk but

failing to walk the walk? I would not put it that way. Because, at the

international level, the pacing and the timing is that we deal with are

much longer. And I have no doubt that the UK as a whole remains

committed to those long-term targets, and to the long-term path.

I have no doubt about that. A global problem which will require a global

solution, clearly, that is a given. In light of that, how do you view

the prospect of a Donald Trump Presidency? Honestly, that is a

concern. That is a concern. The fact is that I hear from everyone who is

commenting on the US campaign elections that nobody really knows

if Trump were to be the candidate, and then a few steps there, elected

as President what he would actually do. I do not think we should fall

into the simplistic assumption that we already know today what he would

do on climate change, for example, because from everything that I hear,

it really is quite unpredictable what he would do. His language seems

resolute. He clearly is not a believer. He says that about many

things but here is the important thing about this, two things. First,

74% of the US electorate understands that climate change is a Colin, that

it is man and woman made and that we have to do something about it. --

climate change is car ring. On the popular base, there is read a lot of

support and there has been for the remarkable leadership that President

Obama has been displaying. Point number one. Point number two, the

fact is that US industry is benefited not by looking to the

technologies of the past but by looking to the technologies of the

future. And I cannot imagine that any US president next year would

want to be OK with the fact that China is currently the number-1 of

solar panels in the world, the number two producer of wind

turbines. Is that OK for US industry? Does the US industry

actually... It has a huge potential to both have breakthrough renewable

energy technologies, as we have seen from the initiative that Bill Gates

and many of his high wealth friends put money into and committed money

in Paris to help breakthrough technologies, but overall there is a

huge export market, because we are moving to a low carbon economy, no

matter what. That is unstoppable by now. That is the demand that is

where the cutting edge technologies are coming from. That is the kind of

energy that will be demanded. So I cannot imagine that any US

government would feel satisfied with giving up a leadership role that

they can quite easily have. Finally, let me ask, given the complexity and

scale of the challenge, the controversy, how do you cope? How do

you go to these huge, incredibly detailed, controversial, complex

international negotiations and think," I can somehow pilot my way

through this?" First of all, it is not that I can pilot, we can pilot.

It really is very much a collective effort. But actually, my question is

the opposite. What option do we have? It is unacceptable to leave

developing countries behind. It is unacceptable to condemn vulnerable

populations to eternal poverty because we would never be able to

catch up. And it is frankly stupid not to make the kinds of investments

that would produce prosperity and benefit for all. It is just... It is

a no-brainer. Thank you very much. Thank you.

David Miller speaking to the UN's Head of Climate Change

Joining me now to talk about that and some of the day's other news

are the journalists Pennie Taylor and Dominic Hynde.

Some interesting comments they are from her, particularly on the

prospect of a Trump Presidency. Dominik, you're just back from New

York covering the election. What did you make of her comments? She is

right to say that a Donald Trump Presidency would be hard to read at

this stage. I think there is a lot of time to go before we get anywhere

near the White House. There is also a cautionary element to what she

says, in that Trump has been quite vocally pro-fossil fuels, has said

that climate change targets hold back American industry. The thing to

understand about American politics and the environment, it is not about

the environment, it is about a cultural war between the

pro-environment real liberal class and what the American right sees as

normal people and the interests of America. It is interesting that she

was bringing up China in a provocative way, to say, America, do

you want China to lead the way? Indeed. One thing that is becoming

evident is that as more and more countries shift to a more

sustainable economic model, or at least talk about it, America feels

incredibly, increasingly old-fashioned. A Trump Presidency,

or a Clint -- Clinton presidency, who has been pro-oil, would seem

anachronistic. She was warm about our record in Scotland. Yes, but I

was getting the impression that although we will not meet our

interim targets and although there are plans to cut 10% from the budget

in Scotland for climate change and she was being encouraging. I think

it was diplomatic language. It is basically saying you're doing very

well, chaps, but you have a lot further to go. That is patently

true. She is a motivational diplomat, I think. She did say at

the end of the day that she felt it was a direction of travel that was

important for Scotland. It is the direction of travel but climate

change is getting worse and worse of all time. In Scotland, although the

figures on renewable energy production are very impressive, when

you break down the data, you see that in Scotland originally nothing

has been done to tackle emissions from household heating and

transport, which are largely fossil -based style. The government in

Scotland have started building roads that are forecast to increase

emissions from transport. So I think there are hard questions that need

to be asked about the long-term strategy. I am hoping she is doing

that had closed doors when she is meeting senior people in the

Scottish Government today. OK, let's move on to top story this evening,

the damning report on the Scottish Government's progress on implement

in its plans for more health care in the community. This is what the

Auditor General had to say. The real challenge is that the vision is very

clear but the change that is happening on the ground in

communities across Scotland are still quite small scale and not

widespread enough to really provide the services that are needed to help

older people stay in their own homes as long as possible. It was a pretty

damning report, was it not? It was. It was the latest in a series of

pretty damning reports about progress on this agenda and I have

to say, what I am hearing on the ground, certainly, echoes those

sentiments. Yesterday I was hearing from a man that runs a social

enterprise where they are trying to run a successful project to keep out

of people out of hospital. He does not know where the money is coming

from to see him through into next week. So whilst lots of money, and

there is a real intention from the government to make a difference to

this, it is in the middle I am hearing it is not happening. The

money is not trickling through. It is getting stuck somewhere. Somebody

has to work out why and where it is getting stuck, and unstick it quick.

Is it acute services, is that your suspicion? Obviously, we have got to

keep going with acute services as they stand. There are building

blocks in place. The government has produced a very good national

clinical strategy that gives strong indications about what we need to

do. But it is going to be very uncomfortable. Politically

uncomfortable and uncomfortable for individuals in communities, because

it means changing the way we have been used to acute services

operating. If we are going to free up resources to put them into the

immunity, to keep people well, it is necessary. If we agree that matters,

we have all got to be addressing what it will take to do that. We so

figures out today about waiting times in Accident Emergency.

Scotland was better than the rest of the UK. Still not hitting the

target. What government is going to shift funds away from hitting both

kind of target is to try to make this work? No government. Those are

the headline figures that win elections, that people talk about

and voters will see. They are not going to change that. The real

question is you either injured hundreds of millions of pounds more

into the health service. It is not clear or that ends up. Or you make

structural reforms that mean you can better track and target where it is

needed. You have got to make the changes would likely have to be made

was that we are doing things in the wrong way at the moment. We know

what the ambitions are. It is how we are going to get there. And I

imagine that after this next election, it is incredibly urgent

that we address those issues as a country, as a society. We heard the

Health Secretary say more needs to be done. That of an understatement?

Definitely. She can say that but it does not mean that much. We have an

election coming up. After that, we may see a change of direction. They

will not make any big decisions before that. Just before we go, we

hear that one of Scotland's richest men is to charge people to get into

del Keith Kent apart after 7pm in the evening. A minimum of ?10. Is

that a bit cheeky? I think it is obscene. It is ?10 for an adult. It

is ?20 for a dog walker and ?20 for a family. In the summer, if people

do not get one... This country Park is basically the park for the time.

It is a bit like saying you would charge ?10 for people to get into

Kelvingrove Park or Holyrood Park. I do not know how you can even

conceive of that. He says it is to improve security and safety in the

evenings. In a park that big, if you want to break in, you can break in.

It seems like he is trying to sell a real ticket for the countryside. It

seems grossly unfair. A family pass will cost ?20. It is quite a lot in

a time of austerity. It is a great deal of money and maybe he just

wants to keep certain people out of his part but hopefully the weeks

will claim over the wolf and go in anyway.

It is his land, he can do what they wants. There is a tiny clothes and

Scottish land legislation when it was drafted in the first Scottish

Parliament. Because he was charging before it existed, he is allowed to

do this. Nobody else in Scotland would be allowed to, and I think

that is interesting. There we must leave it. Thank you so much for

coming in. That's it for tonight

and for this week. I'm back again

on Monday, usual time. On Easter week 1916, a band of Irish

rebels seized control of Dublin. For six days they held out against

the might of the British Empire. Three of the rebels who held Dublin

city that week were my uncles I'm going to re-trace my uncles'

steps. It's as close as we can hope to get

to creation, to the beginning

of the universe itself. Not just for the sake of being

something