:00:00. > :00:00.The countdown to the Holyrood election continues and tonight, for
:00:00. > :00:12.From prescription charges to GP shortages, we have an invited studio
:00:13. > :00:15.audience champing at the bit to ask senior politicians the questions
:00:16. > :00:19.about health policy that really matter to them.
:00:20. > :00:23.For the Liberal Democrats, we have Christine Jardine.
:00:24. > :00:28.Jackson Carlaw for the Conservatives.
:00:29. > :01:01.Hello and welcome to this special debate on health.
:01:02. > :01:04.Let's get straight into questions from the audience, the first of
:01:05. > :01:10.Hello, Lynne, what would you like to ask the panel?
:01:11. > :01:16.Prescription charges should be means-tested, do you agree?
:01:17. > :01:25.Good question to start off with. Shona Robison, what do you think,
:01:26. > :01:30.shouldn't people who can afford to pay for prescriptions? No, we think
:01:31. > :01:34.prescription charges were a tax on ill-health. When I sat on the Health
:01:35. > :01:38.Committee we looked at this in a lot of detail. It was a very unfair
:01:39. > :01:42.system. You had some people with chronic conditions, who were exempt,
:01:43. > :01:46.many others who weren't exempt. Cancer patients had to pay for their
:01:47. > :01:49.drugs as well, if they weren't exempt in other categories. That was
:01:50. > :01:54.wrong. We looked at a system of whether you could make everybody
:01:55. > :01:59.with a chronic condition exempt, but were then left with so few people
:02:00. > :02:02.that the administration costs of operating a system for a small
:02:03. > :02:06.number of people didn't make any sense. The decision was made,
:02:07. > :02:11.rightly, to abolish prescription charges. It is a very important part
:02:12. > :02:16.of keeping people well, particularly people who have long-term conditions
:02:17. > :02:21.and require those medications to keep them well. So we will certainly
:02:22. > :02:25.maintain free prescriptions going forward. Jackson Carlaw, an
:02:26. > :02:30.important part of keeping people well? This is a difficult policy
:02:31. > :02:35.that the Scottish Conservatives have decided to embrace, which is to
:02:36. > :02:39.reintroduce prescription charges. I want to explain why. I don't know
:02:40. > :03:01.how many watched last night the news and there
:03:02. > :03:05.how many watched last night the news paracetamol. We are living in a
:03:06. > :03:10.golden age of new pharmaceutical breakthroughs for diseases which
:03:11. > :03:19.many of you have put into tins and now we are seeing new drugs coming
:03:20. > :03:21.forward for them. They can improve the quality of
:03:22. > :05:09.life. While others are They can improve the quality of
:05:10. > :05:12.prescriptions and that was not if you had one item to pay for, but
:05:13. > :05:18.perhaps several. We recognised that it's a tax on ill-health. We would
:05:19. > :05:23.keep prescriptions free. I have to take issue with Jackson. He is
:05:24. > :05:26.introducing a hidden tax here. The issue of specialist drugs is
:05:27. > :05:31.something that is dealt with separately. The amount he would save
:05:32. > :05:36.on prescription charges wouldn't begin to touch some of the costs of
:05:37. > :05:41.these specialist drugs. And therefore I think whilst the
:05:42. > :05:45.approval process for the muscular dystrophy drug that was talked
:05:46. > :05:48.about, I was have severe issues with, I do think he's mixing two
:05:49. > :05:53.things up and that is unhelpful to the debate. Christine Jardine, where
:05:54. > :05:59.do the Lib Dems stand on prescription charges? We wouldn't
:06:00. > :06:02.reintroduce them because it is a Conservative "stealth tax." They are
:06:03. > :06:07.talking about it to bring Scotland into line with policy in London.
:06:08. > :06:12.Where they are introducing the "stealth tax," it would be ?8 per
:06:13. > :06:19.item. It would also be extremely costly to look at a complicated way
:06:20. > :06:22.of either means-testing, or working to salaries, and that money would be
:06:23. > :06:29.much better spent investing in the services which are currently
:06:30. > :06:35.underfunded and vital. Mental health - we would like to double the budget
:06:36. > :06:39.of mental healthcare for children and young people. We would like to
:06:40. > :06:43.increase the budget for primary healthcare. We won't be able to do
:06:44. > :06:46.that if we have a costly system of working out who should and who
:06:47. > :06:52.shouldn't pay prescription charges. We are where we are, and we
:06:53. > :06:56.shouldn't take on the extra expense of trying to revert it this quickly.
:06:57. > :07:02.Lynne, what is your view on this? Yes, they all have their own points.
:07:03. > :07:06.How can you sanction a GP prescribing paracetamol when you can
:07:07. > :07:12.buy it for 23 pence in a shop? Many people possibly have an issue with
:07:13. > :07:17.that. The answer to that is to invest in public health education,
:07:18. > :07:23.so the people are aware that it is the first port of call, and it
:07:24. > :07:28.should be the pharmacist and trust people, who as Jackson says, not to
:07:29. > :07:32.abuse the system, to buy their drugs when they can and to leave the
:07:33. > :07:36.prescriptions for those who might need them more. Shona Robison, what
:07:37. > :07:41.is your response? It is important to recognise that for some people who
:07:42. > :07:44.are prescribed paracetamol, they are prescribed it in doses that you
:07:45. > :07:48.can't get over the counter because they are using it for chronic pain
:07:49. > :07:51.conditions. It is not as straightforward as going in and
:07:52. > :07:54.getting a packet of paracetamol, these are in quite high doses that
:07:55. > :07:57.you would not be able to get over the counter because of conditions
:07:58. > :08:00.like chronic pain. That is an important element of this. Anyone
:08:01. > :08:07.else from the audience have a view on this? I take your point that it
:08:08. > :08:12.is complicated and you spent a long time looking at it. When the amount
:08:13. > :08:14.of money that you pay to the pharmacist for handling the
:08:15. > :08:19.prescription is ten times higher than the value of the drug that the
:08:20. > :08:24.pharmacist is giving out, this is what we pay you for. There has to be
:08:25. > :08:28.a better way than this? Jackson Carlaw, what about the general
:08:29. > :08:35.benefit to health by improving access to medication? We are always
:08:36. > :08:45.talking about prevention better than cure? We have got our own policy on
:08:46. > :08:50.prescrenion. -- prevention. Bear in mind, 80% of those prescribed
:08:51. > :09:00.prescriptions previously received them free of charge. Those under 16,
:09:01. > :09:05.pregnant women, older people, they all receive prescriptions free of
:09:06. > :09:11.charge. I'm on ?60,000. Shona is on ?100,000. The First Minister is on
:09:12. > :09:13.?140,000. The idea that we are receiving free prescriptions when,
:09:14. > :09:24.as I say, the contribution we could make by paying for those
:09:25. > :09:28.prescriptions - and I don't agree with Jackie - ?65,000 raised from
:09:29. > :09:31.prescriptions is a meaningful contribution to providing medication
:09:32. > :09:35.for those people being denied it because we are told there is not
:09:36. > :09:39.enough money. Jackie Baillie, didn't you want this to be reviewed,
:09:40. > :09:44.thinking there might be better things to do with the money? This is
:09:45. > :09:49.the bigger question before us. We know we are facing severe cuts to
:09:50. > :09:53.public services. The NHS is something everybody on this panel
:09:54. > :09:58.wants to protect. There is a reality here. In order to protect it, we
:09:59. > :10:02.need to be able to identify how we pay for the NHS going forward. Have
:10:03. > :10:06.you changed your mind on this? We have been on a journey, we recognise
:10:07. > :10:10.that free prescriptions is something that is popular with the public. I
:10:11. > :10:15.would want to test to make sure that it is actually doing what it says on
:10:16. > :10:20.the tin, which is it is improving health. But is this wider debate
:10:21. > :10:24.that there will be cuts comes down the line from the UK Government, the
:10:25. > :10:29.Scottish Government have up till now been a conveyor belt for Tory
:10:30. > :10:33.austerity. What we need to decide is as you move forward, we all say we
:10:34. > :10:37.will protect the NHS, but who is actually coming forward with
:10:38. > :10:40.proposals that raise the revenue that will do it? And with respect, I
:10:41. > :10:45.think it is only the Scottish Labour Party that are talking about the
:10:46. > :10:50.kind of taxation proposals that will fund the NHS going forward, none of
:10:51. > :10:51.the others are. I'm sure the other panellists are going to disagree.
:10:52. > :10:54.Let's take another question. This time from David Webster from
:10:55. > :10:56.the Royal College of GPs. Hi, David, what would
:10:57. > :10:58.you like to ask? The Royal College of GPs has
:10:59. > :11:00.shown how we will be How do the panel propose to deal
:11:01. > :11:17.with the GP workforce in Scotland? Christine Jardine? I think I have
:11:18. > :11:23.already said - we would want to increase the GP share, the primary
:11:24. > :11:30.healthcare share, of the NHS budget because we are facing what is a
:11:31. > :11:39.crisis. We would be more than 720 GPs short. We would have mental
:11:40. > :11:43.healthcare professionals in a GP's clinic, nurse practitioners, but we
:11:44. > :11:46.have to retrain other medical professionals, we have to encourage
:11:47. > :11:50.medical students to become general practitioners and to do that, we
:11:51. > :11:54.have to change the culture, we have to empower them to use their skills,
:11:55. > :11:58.the way they want to use them. And to do what they went into the
:11:59. > :12:02.medical professional to do, which is to care for people. Too often now,
:12:03. > :12:06.they feel like they are business managers and they are looking over
:12:07. > :12:11.accounts and spread sheets, rather than thinking about medicine. Do
:12:12. > :12:22.away with the targets and just allow medical professionals to be medical
:12:23. > :12:25.professionals. And I must admit, the SNP Government's workplace planning
:12:26. > :12:28.was so bad that they did not see this crisis coming. They should have
:12:29. > :12:32.been planning for the last nine years to when we got to this
:12:33. > :12:36.situation. Many of these GPs are retiring. And that should have been
:12:37. > :12:41.dealt with much sooner than it is now. Shona Robison, why wasn't there
:12:42. > :12:50.better planning by the Scottish Government for this crisis? There
:12:51. > :12:54.has been workforce planning. The number of GPs has increased but it
:12:55. > :12:57.hasn't kept up with demand. There are a number of reasons for that.
:12:58. > :13:04.Christine touched on an important one. Nicola Sturgeon cut the number
:13:05. > :13:07.of training places... We need more young doctors to choose general
:13:08. > :13:11.practice, there are a range of reasons why they are not. We have of
:13:12. > :13:16.course increased the number of training places from 300 to 400.
:13:17. > :13:23.Nicola Sturgeon cut them. One at a time. Getting rid of the bureaucracy
:13:24. > :13:31.that GPs complained about, investing ?20 million this year in additional
:13:32. > :13:36.workforce pressure measures to reduce that pressure on the workload
:13:37. > :13:42.of GPs and over the next three years, ?100 million extra to help to
:13:43. > :13:47.develop some of the recruitment and retention programmes and a new
:13:48. > :13:50.contract from next year which out of everything will probably be the most
:13:51. > :13:54.important thing because we know that we need to have a multidisciplinary
:13:55. > :13:58.team. It can't all be on the heads of GPs. That is what GPs have said
:13:59. > :14:03.they want. We are working with the BMA to develop that new contract. So
:14:04. > :14:07.a lot of work is going on. If we get that right, I believe we will be
:14:08. > :14:10.able to have a model of primary care here in Scotland that will be very
:14:11. > :14:14.appealing, not just for young doctors here, but perhaps from
:14:15. > :14:20.elsewhere as well. Jackie Baillie, you can't lay this at the door to
:14:21. > :14:28.have the Scottish Government, it's a UK-wide problem?
:14:29. > :14:34.Health is devolved and it's up to the Scottish Rothmans declined to
:14:35. > :14:38.read. I want to thank David for his question because we are told that
:14:39. > :14:42.about ?100 million is stripped out of GP services under the SNP, they
:14:43. > :14:46.have presided over GP crisis which has left surgery is struggling. A
:14:47. > :14:52.third of them cannot fill vacancies easily. The nature of is changing.
:14:53. > :14:57.What we need to do is make sure we recruit and retain GPs. Let me
:14:58. > :15:02.correct Shona, the reason we don't have enough GPs now is that in 2011,
:15:03. > :15:06.Nicola Sturgeon as health minister took a decision to cut the number of
:15:07. > :15:11.GB training places, to cut the number of nursing places. -- GP
:15:12. > :15:15.training. The RCN and BMA at the time warned that this was entirely
:15:16. > :15:19.the wrong thing to do. We are now reaping the whirlwind of that
:15:20. > :15:24.decision. What we would do is not just recruit and retain more GPs, we
:15:25. > :15:28.would encourage the provision of nurse practitioners which I have
:15:29. > :15:30.seen work really well in GP surgeries, supporting GPs and making
:15:31. > :15:34.sure that patients are seen by the right person at the right time. We
:15:35. > :15:40.would extend the role of pharmacies as well. They have a part to play in
:15:41. > :15:43.this. We would look at the Krugman tossed specialist nurses for
:15:44. > :15:46.diabetes, asthma and so on. -- at the recruitment of specialist
:15:47. > :15:55.nurses. One thing we want to do which is not new is that we want to
:15:56. > :15:57.make sure that if you go to your GP surgery, you have an appointment
:15:58. > :16:01.with a health professional within 48 hours. The reason we want to do that
:16:02. > :16:03.is to drive the change we see in primary care because that is the
:16:04. > :16:07.first port of call for many people. If we get primary care right, we
:16:08. > :16:12.stop people ending up either in out-of-hours services or at the
:16:13. > :16:19.front door of A We need to resource primary care adequately to
:16:20. > :16:22.make the NHS work more effectively. What would be Scottish Conservatives
:16:23. > :16:29.do today with a crisis which a mock if you respecting it at lumps out of
:16:30. > :16:33.the SNP on a partisan basis, I'm not going to do with. The public tummy
:16:34. > :16:36.that the one thing they are fed up with is when political parties use
:16:37. > :16:39.the NHS as a football and start kicking each other with it. The
:16:40. > :16:43.reality is, the public and professionals know there is a huge
:16:44. > :16:49.challenge facing the NHS. What they want is a strategic plan agreed on a
:16:50. > :16:53.nonpartisan, all-party basis. Of course, the nature of the work of
:16:54. > :16:57.GPs has changed. People are living longer. The cohort of patients they
:16:58. > :17:01.have is becoming increasingly elderly. Yes, we need to see far
:17:02. > :17:04.more investment being moved from secondary care into primary care.
:17:05. > :17:09.Also making use of pharmacies as well to try to relieve the pressure
:17:10. > :17:13.at that end from GPs. To make their multidisciplinary in terms of the
:17:14. > :17:17.people that work there. To have other, allied health professionals
:17:18. > :17:28.in partnership with GPs. To create an environment which ensures people
:17:29. > :17:30.want to work within GP practice in Scotland and not leave to become GPs
:17:31. > :17:33.elsewhere. I've got to say when Jackie talks about raising money for
:17:34. > :17:36.the NHS, we have a lot of people who are about to retire from practice
:17:37. > :17:39.and a lot of consultancies vacant in secondary care in hospitals. What
:17:40. > :17:42.Jackie will do is say, come to Scotland where the vacancies exist
:17:43. > :17:45.and we will charge you for more tax than anywhere else in the UK for
:17:46. > :17:49.doing the same job. I don't think they will come and we need to work
:17:50. > :17:52.on a much greater cross-party basis to come up with a strategic plan,
:17:53. > :17:57.working with whoever is the government to make sure we succeed.
:17:58. > :18:02.You need to explain what cuts you are going to make, Jackson. Your
:18:03. > :18:06.proposals raise not a single penny more. We know that cuts to come are
:18:07. > :18:11.really quite severe. How would you continue to fund the NHS? Absolute
:18:12. > :18:15.nonsense, the government's own figures estimate that over the
:18:16. > :18:19.lifetime of this Parliament, I think about ?400 million per year will
:18:20. > :18:22.come in additional consequential to the Scottish health service as a
:18:23. > :18:29.result of increased spending down south. We have promised a triple
:18:30. > :18:30.lock, inflation, to present or the health consequential. We have
:18:31. > :18:36.promised a total minimum spend ?14.25 billion by 2020. It is
:18:37. > :18:40.current E ?13 billion. There is no cut coming in health spending.
:18:41. > :18:43.There's been no cut. It's how we use the money. If we use it to plaster
:18:44. > :18:46.over the cracks, we will get nowhere. We have to come up with a
:18:47. > :18:52.plan that everyone, including all the professionals here, can work
:18:53. > :18:56.with the politicians on. Let's hear from some doctors, Dr Alan McDevitt
:18:57. > :19:00.is chair of the Scottish General practitioners committee. What do you
:19:01. > :19:02.make of what the panel has said? I welcome the recognition of the
:19:03. > :19:05.problems we have around general practice and the shortage of GPs we
:19:06. > :19:09.will have for quite some time to come. It is essential the whole
:19:10. > :19:14.country and patients make valuable use of the time GPs have. We only
:19:15. > :19:17.have so much time we must make it is -- must make sure it is for when
:19:18. > :19:21.patients need us most and other professionals must join in to help
:19:22. > :19:25.services there. But I'm absolutely clear it's got to be cross-party
:19:26. > :19:29.support. We can't afford to be a football. It's too important a
:19:30. > :19:32.matter to leave to party politics in this. I absolutely welcomed the
:19:33. > :19:35.moves to work together to make sure the future we are trying to build
:19:36. > :19:39.for general practice in Scotland will attract young doctors here and
:19:40. > :19:42.to make sure the patients continue to have service in all of the
:19:43. > :19:46.communities around Scotland. It's got to be a good place to be a GP
:19:47. > :19:51.and young doctors have to want to be GPs in future. Any other thoughts on
:19:52. > :19:56.why the crisis has arisen? The gentleman there. I'm a hospital
:19:57. > :19:59.consultant and we have a similar problem in hospital consultancies.
:20:00. > :20:02.It is not unique to general practice. Part of the problem is the
:20:03. > :20:07.uncertainty in Scotland. We have five medical schools and the
:20:08. > :20:12.Professor of the College in Glasgow made it quite clear that we lose the
:20:13. > :20:15.production of one medical school per year for Scotland. We have five
:20:16. > :20:20.schools but actually, there are a sufficient numbers of young doctors
:20:21. > :20:24.leaving immediately, either because they are domiciled in the south or
:20:25. > :20:27.they are discarded and dissolution. The problem we have is filling posts
:20:28. > :20:32.not just in general practice but right across the whole service.
:20:33. > :20:36.Every six months, my department sits down and only within days before the
:20:37. > :20:39.beginning of a six-month period, do we know which doctors are going to
:20:40. > :20:42.be working in the department. There are times when we are waiting on
:20:43. > :20:46.people getting work permit because they have flown in from overseas.
:20:47. > :20:52.You can't run the health service when you can't predict the staffing.
:20:53. > :20:55.Thereafter 50% of leave for consultant posts vacant in Scotland.
:20:56. > :20:59.We have a serious crisis. Throwing money at it will not solve the
:21:00. > :21:05.problem. We have to consider concentrating the workforce we have,
:21:06. > :21:09.perhaps in fewer centres. The public may have to accept the fact we can't
:21:10. > :21:13.have a hospital at the end of every street because we frankly cannot
:21:14. > :21:17.staff them that the present time. Shona Robison, that might not be
:21:18. > :21:21.popular with the public. Is it a good idea? The National clinical
:21:22. > :21:24.strategy we have developed sets out right from community health services
:21:25. > :21:29.to the most specialist services that you might need once-in-a-lifetime, a
:21:30. > :21:34.procedure that we would want to arrange. We have elective centres,
:21:35. > :21:38.and Nicola Sturgeon confirmed today ?200 million will be spent on
:21:39. > :21:41.another five Golden Jubilee elected centres across the whole of Scotland
:21:42. > :21:45.which will help us deal with some of the capacity issues of the future.
:21:46. > :21:50.But one of the most important things we are going to do is a new graduate
:21:51. > :21:59.entry medical school which will have a focus on primary care and which
:22:00. > :22:06.will tie the graduate fees being paid to services in the NHS. I think
:22:07. > :22:10.that will be a very good way of securing Scottish grown doctors here
:22:11. > :22:13.in the NHS in Scotland. I think there are also good signs around
:22:14. > :22:17.junior doctor fill rates, partly perhaps because we don't have the
:22:18. > :22:21.problems with the junior doctor dispute because of the imposed
:22:22. > :22:28.contract down south. We have a different model here. We have not
:22:29. > :22:33.done that. I think we will see some interest from elsewhere in the UK
:22:34. > :22:37.and beyond for junior doctor posts here. And consultants as well, very
:22:38. > :22:42.important, we are looking at how we can perhaps recruit them on Arroyo
:22:43. > :22:45.-- on a more regional bases so consultants have the opportunity as
:22:46. > :22:50.was working in district and rural General hospitals, to also work in a
:22:51. > :22:53.teaching hospital. There's been some success in doing that, making posts
:22:54. > :22:54.more attractive. We need to do all of that and more.
:22:55. > :22:57.Let's move onto another question, this time from Allan Sutherland.
:22:58. > :23:04.Hello, Allan, tell us what your question is for the politicians.
:23:05. > :23:11.I've just the Scottish budget is ?13 billion per year. I thought it was
:23:12. > :23:15.?12 billion. I have read that ?1 billion of that is spent on created
:23:16. > :23:23.illnesses. Things like eating or drinking too much and smoking, etc.
:23:24. > :23:25.What are your proposals for preventing that? What programmes do
:23:26. > :23:30.you think could be put in place to prevent and try to save some of that
:23:31. > :23:31.?1 billion, which is another ?1 billion that was mentioned that
:23:32. > :23:40.could be spent elsewhere? Jackie Baillie? It's a fascinating
:23:41. > :23:45.question because I think this is about prevention being better than
:23:46. > :23:48.cure. We know, and it is a staggering statistic, something like
:23:49. > :23:56.2% of the population cost 50% of the NHS budget. We know who these 2%
:23:57. > :24:02.are. They are some of the poorest people in our society. They may be
:24:03. > :24:05.smoke, drink, eat too much, and they don't have access to the kind of
:24:06. > :24:08.lifestyle that many others do. But at the heart of this for me is not
:24:09. > :24:14.just about doing something about smoking, maybe about alcohol or
:24:15. > :24:19.diet. It is actually about inequality. We know that if you have
:24:20. > :24:24.wealth inequality, you have health inequality. At the heart of this for
:24:25. > :24:27.us is about making sure that we close the educational attainment gap
:24:28. > :24:32.so that our young people get the best possible start in life, that we
:24:33. > :24:36.actually pay decent wages for jobs. We would introduce, as we have done,
:24:37. > :24:39.the living wage, not just across the public sector but in the private
:24:40. > :24:45.sector, too. If you start to tackle the causes of poverty, and give
:24:46. > :24:48.people the opportunity themselves to do things differently, that is how
:24:49. > :24:55.you make the long-term shift. Interestingly enough, NHS Scotland,
:24:56. > :25:01.which is an agency that works for Shona Robison's Department, they
:25:02. > :25:04.came to the Finance committee and said, "The one thing you could do is
:25:05. > :25:09.raise taxes to solve poverty, to tackle inequality, and that would
:25:10. > :25:15.make the fundamental difference to spending in the NHS". Shona Robison?
:25:16. > :25:19.They also said that delivering the living wage was a key component of
:25:20. > :25:22.tackling health inequalities of course, it would be the low paid
:25:23. > :25:26.would be most hit by Jackie Baillie and Labour's tax proposals. The
:25:27. > :25:33.porters and the cleaners working in the NHS will have to Peifer George
:25:34. > :25:37.Osborne's austerities. But we have a ?13 billion health budget, which
:25:38. > :25:42.will rise by at least ?1.6 billion over the next parliamentary session.
:25:43. > :25:46.It is what we do with that resource which is really important. We need
:25:47. > :25:48.to shift more of the spending into community health services. The
:25:49. > :25:54.concept of the community health harbour that Alan and his colleagues
:25:55. > :25:57.are developing is very important because we can have community
:25:58. > :26:00.services that don't just treat illness but you can imagine a
:26:01. > :26:05.situation with third sector organisations involved in those
:26:06. > :26:09.hubs, that could be GPs and other elf professionals signposting people
:26:10. > :26:13.into services, like maybe walking groups or mental health
:26:14. > :26:17.organisations. Really pulling together all of those organisations
:26:18. > :26:20.and services into a genuine community health service. I think
:26:21. > :26:23.that is a very exciting possibility and something that could be
:26:24. > :26:28.delivered through the new contract. I will come to the other panellists
:26:29. > :26:32.but let's hear from the audience. In Scotland, two out of three people
:26:33. > :26:35.are overweight or obese so it is a pretty big problem. The gentleman in
:26:36. > :26:39.the middle, what would you like to say? Orange rabbit I would like to
:26:40. > :26:48.hear the panel are suing the Citizen request and that was asked. -- I
:26:49. > :26:51.would like to hear the panel answering a question that was asked,
:26:52. > :26:53.that was all very trusting but it did not answer the question that was
:26:54. > :26:57.asked. This lady here? Yet another taxes to be paid by the people, the
:26:58. > :27:02.sugar tax. This is related to this question. Like nicotine and
:27:03. > :27:05.cigarettes, is harmful but it is also very addictive. Instead of
:27:06. > :27:10.taxing the companies that make and sell harmful products for profit,
:27:11. > :27:16.our government finds it in their power yet again to tax the people.
:27:17. > :27:21.Thus creating a revenue stream. My question is... Why not attack the
:27:22. > :27:27.companies that are making the foods in the supply? If they are not
:27:28. > :27:33.there, people can't have them. That is a fair point. It is UK Government
:27:34. > :27:38.policy, obviously. This gentleman? I'd like to take Jackie Baillie to
:27:39. > :27:43.task on what you just said. She said 2% of the Scottish population
:27:44. > :27:47.account for 50% of the spend? If the Scottish population is 5 million
:27:48. > :27:52.people and 2% of that is 100,000 people, and we have a budget of ?13
:27:53. > :28:42.billion, ?6.5 billion is spent on 100,000 people?
:28:43. > :28:45.billion, ?6.5 billion is spent on person. But I can't believe that and
:28:46. > :28:49.believe me, I will go away and check. The lady in the middle.
:28:50. > :30:07.believe me, I will go away and need to really invest in the
:30:08. > :30:09.preventative agenda. Scottish Conservatives believe 14 Health
:30:10. > :30:13.Boards have 14 different approaches to what we might call health
:30:14. > :30:16.visiting. There needs to be a national health visiting service
:30:17. > :30:20.which is GP attached, not just for the first 12 months of a child's
:30:21. > :30:29.life, but for the first seven years. We would like to create an
:30:30. > :30:32.additional 500 health visitors, that's 1,000 additional health
:30:33. > :30:35.visitors, who will work with young families because many of these
:30:36. > :30:39.problems are established in those early years. If we can invest at
:30:40. > :30:43.that level early on, maybe we can head off some of the problems that
:30:44. > :30:50.will occur in later life. Let me say, we would concentrate some of
:30:51. > :30:53.that resource in areas of high health inequality. We recognise the
:30:54. > :30:58.incidents of these conditions is higher in those areas. Before I come
:30:59. > :31:01.back to Christine Jardine, a gentleman here with his hand up?
:31:02. > :31:04.Jackson talks about personal responsibility. I would argue it is
:31:05. > :31:12.very difficult when you are struggling to make ends meet to
:31:13. > :31:15.decide to go out for a run or cook a healthy meal. Personal
:31:16. > :31:18.responsibility hasn't worked for however many years. You have to
:31:19. > :31:24.encourage it. But to do that, you have to tackle the root causes. What
:31:25. > :31:30.would the Liberal Democrats do to prevent lifestyle illnesses?
:31:31. > :31:36.Prevention is the key word. The gentleman here, the lady who
:31:37. > :31:41.mentioned diabetes all raise very good points, but it comes back to
:31:42. > :31:47.prevention. We have had some successes with the smoking ban. It
:31:48. > :31:51.has been highly effective in preventing related cancers.
:31:52. > :31:59.Unfortunately, minimum unit pricing hasn't had a chance yet to make an
:32:00. > :32:02.effect and Jim Hume, his Private Bill, is another example of what we
:32:03. > :32:07.can do. What we would like to do is ringfence what the other lady
:32:08. > :32:11.mentioned, the sugar tax. There will be consequentials for the spending
:32:12. > :32:15.of the sugar tax. We would like to ringfence that to encourage people
:32:16. > :32:20.and to invest in sport and activities to overcome some of these
:32:21. > :32:25.problems which do exist in Scotland. The big thing is inequality. We have
:32:26. > :32:31.to get round that. One of the things we would do is invest more in
:32:32. > :32:37.primary care and empower the GPs to prescribe things which were really
:32:38. > :32:41.social measures, like if they are working in an area of deprivation,
:32:42. > :32:45.where there is a problem with the housing, they could recommend that
:32:46. > :32:49.someone has insulation in their house and that would be paid for by
:32:50. > :32:53.the Government. They could recommend that they have an exercise regime or
:32:54. > :33:00.a gym membership and encourage people to do things. Public health
:33:01. > :33:03.has to have more investment in education and in measures like the
:33:04. > :33:11.smoking ban over the next few years if we are to make any progress at
:33:12. > :33:15.all. It is only by doing that - and it also affects mental health. It
:33:16. > :33:19.all comes back to investing in primary care and fighting to
:33:20. > :33:26.overcome these inequalities. I would like to move on to mental health.
:33:27. > :33:30.Allan, what is your response? I have struggled for ten years to lose a
:33:31. > :33:35.stone and I can't do it, but I did give up smoking 20 years ago and I
:33:36. > :33:40.don't drink a lot. What is disappointing to me is, this thing
:33:41. > :33:45.about inequality and poverty. It is an issue. I did some research on
:33:46. > :33:50.this, and one of the richest countries in the world is Japan.
:33:51. > :33:54.Their obesity rate is 3%. One of the poorest countries in Ghana, the
:33:55. > :33:58.other is Nigeria, their obesity rate is 3%. Scotland's is one of the
:33:59. > :34:01.highest in the world, so it is not just a question of where you are
:34:02. > :34:05.coming from, people have choices. A lot of the people you are talking
:34:06. > :34:07.about don't know the choices and your point about education,
:34:08. > :34:11.everybody has talked about education, that is one thing. You
:34:12. > :34:16.can't walk into a petrol station or a shop these days without running a
:34:17. > :34:20.gauntlet of sweeties, there are things like that... There needs to
:34:21. > :34:24.be an all-round approach. One more hand in the front? All of the things
:34:25. > :34:29.that have been spoke about have come back to young people and how they
:34:30. > :34:37.are growing up in Scotland and then going on to jobs. A lot of the
:34:38. > :34:41.recent decisions made by Parliament focus on young people. You were
:34:42. > :34:48.talking about the living wage being increased to the over 25s, the
:34:49. > :34:51.cutting of housing benefits for under 25s, so these young people are
:34:52. > :34:55.getting added pressures and you expect them to be GPs and be
:34:56. > :35:00.consultants, when no-one is giving them the original support at the
:35:01. > :35:06.start. You talk about early education and intervention, so up to
:35:07. > :35:12.the ages of 12, then we have the group from 12 to 25 which seem to be
:35:13. > :35:15.ignored, so they are having to work harder, work longer and you expect
:35:16. > :35:18.them to take care of their own health. Their mental health then
:35:19. > :35:30.becomes a big problem because how can they look after their mental
:35:31. > :35:37.health, their physical health? OK. Thank you.
:35:38. > :35:38.Now, Erin Lowe has a question on a subject that many of our
:35:39. > :35:40.Hello, Erin, what would you like to ask?
:35:41. > :35:48.Why is mental health still treated as secondary to physical health?
:35:49. > :35:56.Shona Robison? If I can respond to both of your points? First, the
:35:57. > :36:02.living wage, the Scottish living wage that we talk about is not just
:36:03. > :36:07.for the over 25s, it is for everybody, the UK Government's new
:36:08. > :36:12.minimum wage is the one that you are referring to. We think that is
:36:13. > :36:15.wrong. There shouldn't be a discrimination against young people.
:36:16. > :36:22.The issue of mental health is very, very important. We do believe that
:36:23. > :36:26.we need to build on the investment that we have already made in mental
:36:27. > :36:31.health so over the next five years, we want to invest another ?150
:36:32. > :36:35.million in mental health. Some of that will focus on children and
:36:36. > :36:40.adolescence mental health services. We have expanded the workforce.
:36:41. > :36:43.There is more to be done. Do you accept Erin's point that it is still
:36:44. > :36:48.treated as secondary to physical health? Well, it shouldn't be and we
:36:49. > :36:51.certainly want to make sure that there is an increasing share of
:36:52. > :36:55.resource to mental health to make sure that when people need access to
:36:56. > :37:00.mental health services they get it. That will be at different levels.
:37:01. > :37:04.For some people, they will require a service of psychologists and
:37:05. > :37:11.psychiatry. For many people, what they need is more of a counselling
:37:12. > :37:16.service, and we think through link workers attached to GP practices we
:37:17. > :37:19.could get a service that is more readily available so when someone
:37:20. > :37:23.needs help, they get help. We will be laying out plans at how we will
:37:24. > :37:29.deliver that, particularly for young people. I know my daughter's turning
:37:30. > :37:36.13 and I see among a lot of people her age that sometimes they need
:37:37. > :37:40.additional help. It might not be at the level of a psychiatrist, but
:37:41. > :37:43.they need help. We can provide a better offer to young people growing
:37:44. > :37:47.up here in Scotland working with the schools. Christine Jardine, do you
:37:48. > :37:53.accept that mental health is treated as secondary to physical health?
:37:54. > :37:56.Sadly, it is. I think the lady who raised it is right. That is
:37:57. > :38:00.something we have to change. What we would want to do to answer both
:38:01. > :38:06.questions because they both make very good points is we would want to
:38:07. > :38:10.double the share of the budget for children Children and Young People
:38:11. > :38:15.for mental healthcare there. Shona says the Government is aware of
:38:16. > :38:19.this. For the last four years, the share of the health budget has been
:38:20. > :38:25.reduced by the Scottish Government. You mentioned the ?150 million, but
:38:26. > :38:27.the actuality is that your strategy, your last strategy ended in December
:38:28. > :38:31.and you don't have another one yet, so we don't know how the money is
:38:32. > :38:37.going to be allocated and where it is going to be spent. What we would
:38:38. > :38:42.do is place mental health services at the forefront by when we expand
:38:43. > :38:45.and invest in GP practices, not just link health professionals to them,
:38:46. > :38:48.have a mental health professional there, because one of the biggest
:38:49. > :38:53.problems with mental health issues is the stigma that is attached to
:38:54. > :38:57.them. We have to normalise it. We have to make it so that it is like
:38:58. > :39:01.going to the dentist or going for an eye test, you go to your GP and
:39:02. > :39:08.there is a counsellor there or a mental health professional so you
:39:09. > :39:12.don't feel any stigma. It takes three or four visits sometimes
:39:13. > :39:20.before a patient opens up and admits the problem is stress or depression.
:39:21. > :39:25.Depression costs 670,000 working days in Scotland a year. It is a
:39:26. > :39:28.massive issue. You say you are putting young people at the
:39:29. > :39:32.forefront of the strategy. At the moment, some young people have had
:39:33. > :39:40.to wait a year to see a mental health professional. That is
:39:41. > :39:46.ridiculous. If you live in Dingwall you have to travel to Dundee to see
:39:47. > :40:01.a mental health professional. There are no beds. OK. Alright. The woman
:40:02. > :40:08.over there? I want to talk about the issue of force treatment in mental
:40:09. > :40:13.health. Without human rights, you get stigma. We have no human rights.
:40:14. > :40:20.We do not have the right to refuse medication. When MSPs go back, when
:40:21. > :40:26.they are re-elected, you will be working on the mental health review
:40:27. > :40:29.because you won't listen to the UN. They have forced a review because
:40:30. > :40:33.the UN want you to ban forced treatment because it is against
:40:34. > :40:37.human rights. Thanks for that point. I would like to stick to the
:40:38. > :40:41.original question. Thank you for the point. I will go back to Jackie
:40:42. > :40:45.Baillie on the original question. Can I go back to Erin's question?
:40:46. > :40:50.You are right, there would be a national outcry if we were talking
:40:51. > :40:56.about the waiting times that we are for mental health, for children and
:40:57. > :41:01.young people, because I very much welcome the SNP's introduction of a
:41:02. > :41:05.waiting time target for mental health services, an 18-week referral
:41:06. > :41:09.to treatment. They have not met it once. It is pointless having targets
:41:10. > :41:14.unless you resource those targets to enable people to meet them. The fact
:41:15. > :41:18.that they have not met it once and performance is getting worse, not
:41:19. > :41:22.better, and there are 8,000 young people who have waited longer than
:41:23. > :41:27.the 18 weeks. Christine is right, some as much as a year, to access a
:41:28. > :41:31.key service. What we would do is it needs to start at school. We need to
:41:32. > :41:37.make sure there are enough educational psychologists at school
:41:38. > :41:39.helping young people there. We would recruit more community psychiatric
:41:40. > :41:44.nurses and mental health professionals and key to this is
:41:45. > :41:48.better access to talking therapies. They have been shown to work. We
:41:49. > :41:53.need more people trained to actually provide that kind of service. At the
:41:54. > :41:58.end of the day, it comes back to, you know, the fact that we are going
:41:59. > :42:05.to be facing enormous cuts to services. I don't want mental
:42:06. > :42:08.health, which some would describe as a Cinderella service in the NHS, to
:42:09. > :42:12.get worse as a result of those cuts, which is why these people here need
:42:13. > :42:18.to explain how they are going to invest in the NHS when they are not
:42:19. > :42:25.raising the money to do so. There will be an increase of ?1.6 billion
:42:26. > :42:29.over the next Parliament session, in addition to the ?13 billion already
:42:30. > :42:34.there. That is a lot of money. What is important is how that money is
:42:35. > :42:40.spent. Where I do agree is that we need to spend a higher proportion of
:42:41. > :42:44.that resource in primary and community care services, including
:42:45. > :42:49.mental health services, so that is a commitment from the SNP. Shona
:42:50. > :42:56.Robison made a big deal out of the budget this year. Let me tell you,
:42:57. > :43:02.despite the uplift, somewhere like Greater Glasgow and Clyde Health
:43:03. > :43:13.Board is having to cut ?69 million from its budget. OK. Let me bring
:43:14. > :43:18.in... Let me bring in Jackson Carlaw. How would you... I will try
:43:19. > :43:22.not to interrupt while I'm being interrupted! To come back to the
:43:23. > :43:26.original question, why did it happen? It happened because mental
:43:27. > :43:31.health has been widely misunderstood across the general public and there
:43:32. > :43:36.hasn't been enough champions for it. The real progress over the last five
:43:37. > :43:39.years has been a far, far greater wider public understanding of what
:43:40. > :43:43.mental health condition are. People realise that conditions like obesity
:43:44. > :43:47.and alcoholism and drugs and depression are very often
:43:48. > :43:50.underpinned by mental health issues. So, yes, the real challenge, the
:43:51. > :43:54.great challenge for this next Scottish Parliament is to bring the
:43:55. > :43:59.treatment of mental health on a parity with the treatment of
:44:00. > :44:05.physical health. There is a usual bit of partisanship here, we will
:44:06. > :44:07.commit tomorrow to an additional ?300 million investment in mental
:44:08. > :44:12.health. I don't think we are unique in this. All of the parties are
:44:13. > :44:17.committed to making that change in mental health in the next
:44:18. > :44:20.Parliament. I agree. That may mean we need a mental health professional
:44:21. > :44:23.in each GP practice. But that is all part of the whole remodelling and
:44:24. > :44:27.reshaping of our Health Service which has to be part of an
:44:28. > :44:29.all-party, non-partisan, wider agreement if it is going to be
:44:30. > :44:41.long-term and sustainable. I'd like to bring in Rory O'Connor
:44:42. > :44:44.who is a professor of psychology at Gartnavel Royal Hospital. What have
:44:45. > :44:48.you heard? I'm dying to see the focus on mental health is welcome we
:44:49. > :44:50.know amongst middle-aged men in Scotland in particular, it is the
:44:51. > :44:54.single biggest killer of young and middle-aged men. We need to do
:44:55. > :44:57.something about this. Scotland has led the way in the last 1015 years,
:44:58. > :45:02.we have seen a marked reduction in suicide but we need to do so much
:45:03. > :45:06.more. My concern is we are too complacent. Rates have come down but
:45:07. > :45:10.they are still much higher than England. I'm looking for reassurance
:45:11. > :45:13.from all of you that mental health, public health, suicide prevention is
:45:14. > :45:16.not just about mental health but about broader public and social
:45:17. > :45:22.health. What are you going to do about that? The lady at the back as
:45:23. > :45:25.well wanted to make a point. The issue is coming from everybody who
:45:26. > :45:29.is speaking seems to come back to the issue of sustainability, which
:45:30. > :45:32.Jackson mentioned at the end. The fact that the issues we are facing
:45:33. > :45:36.in Scotland, whether that is down to a poor health record or inequality,
:45:37. > :45:41.is never going to quite match, however much we managed to raise the
:45:42. > :45:45.budget over the coming years. How we set priorities has been part of the
:45:46. > :45:49.discussion and a lot of the focus has been on primary care and public
:45:50. > :45:52.health and prevention and early intervention, community nursing and
:45:53. > :45:57.general practice. But a lot of the targets that are still set out, how
:45:58. > :46:01.we measure is excess in the NHS, are still focused on hospitals. I would
:46:02. > :46:05.be interested to hear from the panel how they might address how they set
:46:06. > :46:08.a measure of success with the transformation agenda they are
:46:09. > :46:12.setting up this evening. I would like to take one more point from the
:46:13. > :46:16.young woman at the end. It was just a point, a lot of the panellists
:46:17. > :46:20.have touched on extending the resources and putting investment in.
:46:21. > :46:24.There are tools in lots of communities that are massively
:46:25. > :46:28.underused, like community workers and youth workers. They are already
:46:29. > :46:32.engaging with so many young people in our communities. It does not
:46:33. > :46:36.always necessary have to create new jobs. If you can create better links
:46:37. > :46:39.with community practitioners and youth workers, not just in schools
:46:40. > :46:42.but in the wider community, because a lot of young people won't engage
:46:43. > :46:46.in school, you can start to tackle the problems early. That may been
:46:47. > :46:49.signposting, no one is saying youth workers can fix everything but
:46:50. > :46:52.making those links and improving services at the starting point for
:46:53. > :46:55.young people can have an influential effect in everything that follows.
:46:56. > :46:58.Thank you, lots of heads nodding. Given that life expectancy
:46:59. > :47:07.in Scotland varies hugely according to class, what are your plans
:47:08. > :47:20.to tackle the root causes Jackson Carlaw? I have partly
:47:21. > :47:24.answered that and I think tackling health inequalities start to the
:47:25. > :47:26.point of bird. At the moment, we don't have a national health
:47:27. > :47:31.visiting service and we offer a service in the first 12 months of
:47:32. > :47:36.life. Many of the indications of problems that will actually go on to
:47:37. > :47:39.create the much deeper inequalities that will be suffered can be seen at
:47:40. > :47:45.the age of three and through to the age of seven. We need to invest in
:47:46. > :47:51.that early years span of life, birth to the age of seven. That is why I
:47:52. > :47:53.talk about a national GP attached health visiting service, with
:47:54. > :47:58.particular concentration of those additional 1000 health visitors in
:47:59. > :48:03.the areas where those health inequalities are most acute. I know
:48:04. > :48:06.there's a debate about the economy and about inequality generally, but
:48:07. > :48:11.in terms of what we do specifically in health, that is where I would
:48:12. > :48:16.like to see it focused. We need to tackle Thomas still, the great
:48:17. > :48:19.problems we have got in Scotland -- tackle, still. I'm afraid we suffer
:48:20. > :48:24.them more acutely than other parts of the UK in terms of obesity and
:48:25. > :48:26.the various addictions that exist, the problems that manifest
:48:27. > :48:32.themselves and waste the opportunity of so many people's lives. That is
:48:33. > :48:36.where the priority has to be. It has to be investing in a major step
:48:37. > :48:41.change in that preventative agenda, now at the early years the stage in
:48:42. > :48:44.life. Jackie Baillie, a man in affluent East Dunbartonshire can
:48:45. > :48:47.expect to live more than seven years longer than someone from Glasgow
:48:48. > :48:52.city, for example. What would Scottish Labour do to tackle that?
:48:53. > :48:55.Firstly, it is a scandal we have such a disparity in Scotland but
:48:56. > :48:59.it's also a scandal that the mortality rate, the life expectancy
:49:00. > :49:03.rate in Scotland is the worst of any of the four countries of the UK. We
:49:04. > :49:08.absolutely need to do something about that. But I think it is, when
:49:09. > :49:12.we are talking about health inequality, rooted in the wider
:49:13. > :49:17.debate about wealth inequality. If people have good jobs and a good
:49:18. > :49:22.education, if they are able to earn, they make different life choices.
:49:23. > :49:26.You know, rather than struggling with the day-to-day challenge of
:49:27. > :49:31.just living in their community. We need to absolutely invest in that.
:49:32. > :49:35.That is educational attainment, the living wage, improving people's
:49:36. > :49:39.prospects to work in high skilled jobs in the industries of the
:49:40. > :49:43.future. It is absolutely tied to the wider debate about the economy. But
:49:44. > :49:48.let me just say to the young woman there, that talked about community
:49:49. > :49:52.workers and youth workers, I used to work in a community setting. I used
:49:53. > :49:55.to look at particularly some of the women in those communities who were
:49:56. > :49:59.the backbone of those communities and were influential in getting
:50:00. > :50:07.change. But you can't get that these days. The government have cut local
:50:08. > :50:12.government by ?1.4 billion. I don't know when I last saw a youth worker
:50:13. > :50:16.or a community worker engaged in doing that kind of really valuable
:50:17. > :50:20.work of community development in certainly the areas that I
:50:21. > :50:25.represent. That is as a result of the cuts, substantial cuts to local
:50:26. > :50:27.government budgets and local government services. Christine
:50:28. > :50:32.Jardine, what with the Liberal Democrats do to tackle the root
:50:33. > :50:35.causes of health inequality? I think the root causes of health inequality
:50:36. > :50:41.are much wider than help itself. It is, as you say, a social problem. If
:50:42. > :50:44.you live in certain places, you will have a longer life expectancy than
:50:45. > :50:52.someone who lives less than a mile away. That is not acceptable. Things
:50:53. > :50:55.like a penny on tax for education to ensure better education, we need
:50:56. > :51:02.more affordable rented housing. We need a fairer, wealthy -- a fairer
:51:03. > :51:05.welfare system. We need 18-25 -year-olds to get housing benefit.
:51:06. > :51:09.We need all these things but when it comes to health, we need to do what
:51:10. > :51:14.I said earlier, to broaden the scope of practice is to look at
:51:15. > :51:17.encouraging people, to prescribe to them for an exercise class,
:51:18. > :51:21.encourage them, point them in the direction, as has already been said,
:51:22. > :51:23.of walking groups, and ring fence the consequential from spending in
:51:24. > :51:31.England from the sugar tax to ensure that we invest in activities for
:51:32. > :51:34.young people. Girls very often give up sport at school. Make sure there
:51:35. > :51:38.are other activities for them to take part in. Invest in sporting
:51:39. > :51:43.clubs. It is the wider issue and we have to tackle it through more than
:51:44. > :51:48.just health. Shona Robison, the SNP government has had nine years. Have
:51:49. > :51:51.you even made a dent in this? Life expectancy is improving but it is
:51:52. > :51:55.not improving as quickly for those who were living in the most deprived
:51:56. > :52:00.communities. That is a challenge. I think where there is agreement is
:52:01. > :52:04.that it can't just be for the health service alone to tackle. It has to
:52:05. > :52:10.be across government, so the attainment challenge, for example,
:52:11. > :52:14.?750 million that the First Minister has said will be invested in getting
:52:15. > :52:18.opportunities and creating educational opportunities early in
:52:19. > :52:23.life, so kids can have the best chance in life, but you know, there
:52:24. > :52:26.are other factors which impinge on people's life chances, for example,
:52:27. > :52:31.some of the welfare changes the UK Government has brought in have
:52:32. > :52:35.devastated some families' incomes. That pulled the rug out from under
:52:36. > :52:36.many families. We have to look at not just what we can do
:52:37. > :53:04.determinants of health and the importance of government improving
:53:05. > :53:07.the overall experience of people right across the population. I'm
:53:08. > :53:11.delighted we've also talked a lot about mental health. I want to see
:53:12. > :53:15.more than just talking in the next Parliament. What I want to ask is,
:53:16. > :53:19.we have also heard a fair bit from most of you about the agreement
:53:20. > :55:08.amongst you about how health should be run. How will
:55:09. > :55:12.amongst you about how health should the talking down of our NHS. That is
:55:13. > :55:15.so unfair. It strays into that territory, demotivated staff and
:55:16. > :55:18.politicians have to be very careful that when they are talking about and
:55:19. > :55:23.debating the NHS, that they don't get into the territory of constantly
:55:24. > :55:29.talking down... You need to stop using the staff as a human shield.
:55:30. > :55:32.We have hard-working staff and you need to resolve them. I'm going to
:55:33. > :55:37.have to bring in the other two. Christine Jardine, it sounds very
:55:38. > :55:41.much like a political football! I take the gentleman's point but I
:55:42. > :55:46.will also say that no one has talked down the NHS staff and nobody would
:55:47. > :55:50.do that. Like Jackie, as a liberal, I'm proud of what Beveridge did and
:55:51. > :55:55.what our staff do every single day. I take the gentleman's point and how
:55:56. > :55:58.do we get away from it? Looking for transformational change in the way
:55:59. > :56:02.the health service is run. What we would do is talk to the Royal
:56:03. > :56:06.colleges. Rather than announce it in conference speeches, that we are
:56:07. > :56:09.going to have five centres that the Royal colleges knew nothing about, I
:56:10. > :56:13.would make sure that they were consulted, that we took their
:56:14. > :56:17.advice. After all, they are the people who know what is needed.
:56:18. > :56:22.Politicians only enact what is needed. The doctors need to tell us.
:56:23. > :56:26.The professionals need to tell the politicians first. Jackson Carlaw?
:56:27. > :56:30.We call it a national health service across the UK but in fact, it is now
:56:31. > :56:35.four different health services who have gone their way since
:56:36. > :56:37.devolution. In Scotland, all of the political parties are committed to a
:56:38. > :56:41.National Health Service free at the point of need and delivery. It is
:56:42. > :56:44.not the same thing as saying we will never criticise the management
:56:45. > :56:47.decisions, day-to-day, that the government of the day take. It is
:56:48. > :56:54.about saying we need to agree and work together on a cross-party basis
:56:55. > :56:57.as to how we said your -- secure the long-term future scholar's NHS in
:56:58. > :57:01.the public sector model we want and value. How do we stop that breaking
:57:02. > :57:04.down in this election? You say you're not going to vote for parties
:57:05. > :57:10.that do it. Briefly before we go, what do you make of that? A lot of
:57:11. > :57:14.it sounded like football to me, I have to say! Thanks very much your
:57:15. > :57:15.contribution. All that remains is to thank
:57:16. > :57:20.the panel, the studio audience and of course,
:57:21. > :57:23.you at home for watching. We'll have another special
:57:24. > :57:25.debate next Tuesday, this time on the subject of energy
:57:26. > :57:28.and the environment. If you'd like the chance to be in
:57:29. > :57:31.the audience, then you can apply through BBC Scotland's Election 2016
:57:32. > :57:40.online page.