12/04/2016 Scotland 2016

The countdown to the Holyrood election continues and tonight, for

From prescription charges to GP shortages, we have an invited studio

audience champing at the bit to ask senior politicians the questions

about health policy that really matter to them.

For the Liberal Democrats, we have Christine Jardine.

Jackson Carlaw for the Conservatives.

Hello and welcome to this special debate on health.

Let's get straight into questions from the audience, the first of

Hello, Lynne, what would you like to ask the panel?

Prescription charges should be means-tested, do you agree?

Good question to start off with. Shona Robison, what do you think,

shouldn't people who can afford to pay for prescriptions? No, we think

prescription charges were a tax on ill-health. When I sat on the Health

Committee we looked at this in a lot of detail. It was a very unfair

system. You had some people with chronic conditions, who were exempt,

many others who weren't exempt. Cancer patients had to pay for their

drugs as well, if they weren't exempt in other categories. That was

wrong. We looked at a system of whether you could make everybody

with a chronic condition exempt, but were then left with so few people

that the administration costs of operating a system for a small

number of people didn't make any sense. The decision was made,

rightly, to abolish prescription charges. It is a very important part

of keeping people well, particularly people who have long-term conditions

and require those medications to keep them well. So we will certainly

maintain free prescriptions going forward. Jackson Carlaw, an

important part of keeping people well? This is a difficult policy

that the Scottish Conservatives have decided to embrace, which is to

reintroduce prescription charges. I want to explain why. I don't know

how many watched last night the news and there

how many watched last night the news paracetamol. We are living in a

golden age of new pharmaceutical breakthroughs for diseases which

many of you have put into tins and now we are seeing new drugs coming

forward for them. They can improve the quality of

life. While others are They can improve the quality of

prescriptions and that was not if you had one item to pay for, but

perhaps several. We recognised that it's a tax on ill-health. We would

keep prescriptions free. I have to take issue with Jackson. He is

introducing a hidden tax here. The issue of specialist drugs is

something that is dealt with separately. The amount he would save

on prescription charges wouldn't begin to touch some of the costs of

these specialist drugs. And therefore I think whilst the

approval process for the muscular dystrophy drug that was talked

about, I was have severe issues with, I do think he's mixing two

things up and that is unhelpful to the debate. Christine Jardine, where

do the Lib Dems stand on prescription charges? We wouldn't

reintroduce them because it is a Conservative "stealth tax." They are

talking about it to bring Scotland into line with policy in London.

Where they are introducing the "stealth tax," it would be ?8 per

item. It would also be extremely costly to look at a complicated way

of either means-testing, or working to salaries, and that money would be

much better spent investing in the services which are currently

underfunded and vital. Mental health - we would like to double the budget

of mental healthcare for children and young people. We would like to

increase the budget for primary healthcare. We won't be able to do

that if we have a costly system of working out who should and who

shouldn't pay prescription charges. We are where we are, and we

shouldn't take on the extra expense of trying to revert it this quickly.

Lynne, what is your view on this? Yes, they all have their own points.

How can you sanction a GP prescribing paracetamol when you can

buy it for 23 pence in a shop? Many people possibly have an issue with

that. The answer to that is to invest in public health education,

so the people are aware that it is the first port of call, and it

should be the pharmacist and trust people, who as Jackson says, not to

abuse the system, to buy their drugs when they can and to leave the

prescriptions for those who might need them more. Shona Robison, what

is your response? It is important to recognise that for some people who

are prescribed paracetamol, they are prescribed it in doses that you

can't get over the counter because they are using it for chronic pain

conditions. It is not as straightforward as going in and

getting a packet of paracetamol, these are in quite high doses that

you would not be able to get over the counter because of conditions

like chronic pain. That is an important element of this. Anyone

else from the audience have a view on this? I take your point that it

is complicated and you spent a long time looking at it. When the amount

of money that you pay to the pharmacist for handling the

prescription is ten times higher than the value of the drug that the

pharmacist is giving out, this is what we pay you for. There has to be

a better way than this? Jackson Carlaw, what about the general

benefit to health by improving access to medication? We are always

talking about prevention better than cure? We have got our own policy on

prescrenion. -- prevention. Bear in mind, 80% of those prescribed

prescriptions previously received them free of charge. Those under 16,

pregnant women, older people, they all receive prescriptions free of

charge. I'm on ?60,000. Shona is on ?100,000. The First Minister is on

?140,000. The idea that we are receiving free prescriptions when,

as I say, the contribution we could make by paying for those

prescriptions - and I don't agree with Jackie - ?65,000 raised from

prescriptions is a meaningful contribution to providing medication

for those people being denied it because we are told there is not

enough money. Jackie Baillie, didn't you want this to be reviewed,

thinking there might be better things to do with the money? This is

the bigger question before us. We know we are facing severe cuts to

public services. The NHS is something everybody on this panel

wants to protect. There is a reality here. In order to protect it, we

need to be able to identify how we pay for the NHS going forward. Have

you changed your mind on this? We have been on a journey, we recognise

that free prescriptions is something that is popular with the public. I

would want to test to make sure that it is actually doing what it says on

the tin, which is it is improving health. But is this wider debate

that there will be cuts comes down the line from the UK Government, the

Scottish Government have up till now been a conveyor belt for Tory

austerity. What we need to decide is as you move forward, we all say we

will protect the NHS, but who is actually coming forward with

proposals that raise the revenue that will do it? And with respect, I

think it is only the Scottish Labour Party that are talking about the

kind of taxation proposals that will fund the NHS going forward, none of

the others are. I'm sure the other panellists are going to disagree.

Let's take another question. This time from David Webster from

the Royal College of GPs. Hi, David, what would

you like to ask? The Royal College of GPs has

shown how we will be How do the panel propose to deal

with the GP workforce in Scotland? Christine Jardine? I think I have

already said - we would want to increase the GP share, the primary

healthcare share, of the NHS budget because we are facing what is a

crisis. We would be more than 720 GPs short. We would have mental

healthcare professionals in a GP's clinic, nurse practitioners, but we

have to retrain other medical professionals, we have to encourage

medical students to become general practitioners and to do that, we

have to change the culture, we have to empower them to use their skills,

the way they want to use them. And to do what they went into the

medical professional to do, which is to care for people. Too often now,

they feel like they are business managers and they are looking over

accounts and spread sheets, rather than thinking about medicine. Do

away with the targets and just allow medical professionals to be medical

professionals. And I must admit, the SNP Government's workplace planning

was so bad that they did not see this crisis coming. They should have

been planning for the last nine years to when we got to this

situation. Many of these GPs are retiring. And that should have been

dealt with much sooner than it is now. Shona Robison, why wasn't there

better planning by the Scottish Government for this crisis? There

has been workforce planning. The number of GPs has increased but it

hasn't kept up with demand. There are a number of reasons for that.

Christine touched on an important one. Nicola Sturgeon cut the number

of training places... We need more young doctors to choose general

practice, there are a range of reasons why they are not. We have of

course increased the number of training places from 300 to 400.

Nicola Sturgeon cut them. One at a time. Getting rid of the bureaucracy

that GPs complained about, investing ?20 million this year in additional

workforce pressure measures to reduce that pressure on the workload

of GPs and over the next three years, ?100 million extra to help to

develop some of the recruitment and retention programmes and a new

contract from next year which out of everything will probably be the most

important thing because we know that we need to have a multidisciplinary

team. It can't all be on the heads of GPs. That is what GPs have said

they want. We are working with the BMA to develop that new contract. So

a lot of work is going on. If we get that right, I believe we will be

able to have a model of primary care here in Scotland that will be very

appealing, not just for young doctors here, but perhaps from

elsewhere as well. Jackie Baillie, you can't lay this at the door to

have the Scottish Government, it's a UK-wide problem?

Health is devolved and it's up to the Scottish Rothmans declined to

read. I want to thank David for his question because we are told that

about ?100 million is stripped out of GP services under the SNP, they

have presided over GP crisis which has left surgery is struggling. A

third of them cannot fill vacancies easily. The nature of is changing.

What we need to do is make sure we recruit and retain GPs. Let me

correct Shona, the reason we don't have enough GPs now is that in 2011,

Nicola Sturgeon as health minister took a decision to cut the number of

GB training places, to cut the number of nursing places. -- GP

training. The RCN and BMA at the time warned that this was entirely

the wrong thing to do. We are now reaping the whirlwind of that

decision. What we would do is not just recruit and retain more GPs, we

would encourage the provision of nurse practitioners which I have

seen work really well in GP surgeries, supporting GPs and making

sure that patients are seen by the right person at the right time. We

would extend the role of pharmacies as well. They have a part to play in

this. We would look at the Krugman tossed specialist nurses for

diabetes, asthma and so on. -- at the recruitment of specialist

nurses. One thing we want to do which is not new is that we want to

make sure that if you go to your GP surgery, you have an appointment

with a health professional within 48 hours. The reason we want to do that

is to drive the change we see in primary care because that is the

first port of call for many people. If we get primary care right, we

stop people ending up either in out-of-hours services or at the

front door of A We need to resource primary care adequately to

make the NHS work more effectively. What would be Scottish Conservatives

do today with a crisis which a mock if you respecting it at lumps out of

the SNP on a partisan basis, I'm not going to do with. The public tummy

that the one thing they are fed up with is when political parties use

the NHS as a football and start kicking each other with it. The

reality is, the public and professionals know there is a huge

challenge facing the NHS. What they want is a strategic plan agreed on a

nonpartisan, all-party basis. Of course, the nature of the work of

GPs has changed. People are living longer. The cohort of patients they

have is becoming increasingly elderly. Yes, we need to see far

more investment being moved from secondary care into primary care.

Also making use of pharmacies as well to try to relieve the pressure

at that end from GPs. To make their multidisciplinary in terms of the

people that work there. To have other, allied health professionals

in partnership with GPs. To create an environment which ensures people

want to work within GP practice in Scotland and not leave to become GPs

elsewhere. I've got to say when Jackie talks about raising money for

the NHS, we have a lot of people who are about to retire from practice

and a lot of consultancies vacant in secondary care in hospitals. What

Jackie will do is say, come to Scotland where the vacancies exist

and we will charge you for more tax than anywhere else in the UK for

doing the same job. I don't think they will come and we need to work

on a much greater cross-party basis to come up with a strategic plan,

working with whoever is the government to make sure we succeed.

You need to explain what cuts you are going to make, Jackson. Your

proposals raise not a single penny more. We know that cuts to come are

really quite severe. How would you continue to fund the NHS? Absolute

nonsense, the government's own figures estimate that over the

lifetime of this Parliament, I think about ?400 million per year will

come in additional consequential to the Scottish health service as a

result of increased spending down south. We have promised a triple

lock, inflation, to present or the health consequential. We have

promised a total minimum spend ?14.25 billion by 2020. It is

current E ?13 billion. There is no cut coming in health spending.

There's been no cut. It's how we use the money. If we use it to plaster

over the cracks, we will get nowhere. We have to come up with a

plan that everyone, including all the professionals here, can work

with the politicians on. Let's hear from some doctors, Dr Alan McDevitt

is chair of the Scottish General practitioners committee. What do you

make of what the panel has said? I welcome the recognition of the

problems we have around general practice and the shortage of GPs we

will have for quite some time to come. It is essential the whole

country and patients make valuable use of the time GPs have. We only

have so much time we must make it is -- must make sure it is for when

patients need us most and other professionals must join in to help

services there. But I'm absolutely clear it's got to be cross-party

support. We can't afford to be a football. It's too important a

matter to leave to party politics in this. I absolutely welcomed the

moves to work together to make sure the future we are trying to build

for general practice in Scotland will attract young doctors here and

to make sure the patients continue to have service in all of the

communities around Scotland. It's got to be a good place to be a GP

and young doctors have to want to be GPs in future. Any other thoughts on

why the crisis has arisen? The gentleman there. I'm a hospital

consultant and we have a similar problem in hospital consultancies.

It is not unique to general practice. Part of the problem is the

uncertainty in Scotland. We have five medical schools and the

Professor of the College in Glasgow made it quite clear that we lose the

production of one medical school per year for Scotland. We have five

schools but actually, there are a sufficient numbers of young doctors

leaving immediately, either because they are domiciled in the south or

they are discarded and dissolution. The problem we have is filling posts

not just in general practice but right across the whole service.

Every six months, my department sits down and only within days before the

beginning of a six-month period, do we know which doctors are going to

be working in the department. There are times when we are waiting on

people getting work permit because they have flown in from overseas.

You can't run the health service when you can't predict the staffing.

Thereafter 50% of leave for consultant posts vacant in Scotland.

We have a serious crisis. Throwing money at it will not solve the

problem. We have to consider concentrating the workforce we have,

perhaps in fewer centres. The public may have to accept the fact we can't

have a hospital at the end of every street because we frankly cannot

staff them that the present time. Shona Robison, that might not be

popular with the public. Is it a good idea? The National clinical

strategy we have developed sets out right from community health services

to the most specialist services that you might need once-in-a-lifetime, a

procedure that we would want to arrange. We have elective centres,

and Nicola Sturgeon confirmed today ?200 million will be spent on

another five Golden Jubilee elected centres across the whole of Scotland

which will help us deal with some of the capacity issues of the future.

But one of the most important things we are going to do is a new graduate

entry medical school which will have a focus on primary care and which

will tie the graduate fees being paid to services in the NHS. I think

that will be a very good way of securing Scottish grown doctors here

in the NHS in Scotland. I think there are also good signs around

junior doctor fill rates, partly perhaps because we don't have the

problems with the junior doctor dispute because of the imposed

contract down south. We have a different model here. We have not

done that. I think we will see some interest from elsewhere in the UK

and beyond for junior doctor posts here. And consultants as well, very

important, we are looking at how we can perhaps recruit them on Arroyo

-- on a more regional bases so consultants have the opportunity as

was working in district and rural General hospitals, to also work in a

teaching hospital. There's been some success in doing that, making posts

more attractive. We need to do all of that and more.

Let's move onto another question, this time from Allan Sutherland.

Hello, Allan, tell us what your question is for the politicians.

I've just the Scottish budget is ?13 billion per year. I thought it was

?12 billion. I have read that ?1 billion of that is spent on created

illnesses. Things like eating or drinking too much and smoking, etc.

What are your proposals for preventing that? What programmes do

you think could be put in place to prevent and try to save some of that

?1 billion, which is another ?1 billion that was mentioned that

could be spent elsewhere? Jackie Baillie? It's a fascinating

question because I think this is about prevention being better than

cure. We know, and it is a staggering statistic, something like

2% of the population cost 50% of the NHS budget. We know who these 2%

are. They are some of the poorest people in our society. They may be

smoke, drink, eat too much, and they don't have access to the kind of

lifestyle that many others do. But at the heart of this for me is not

just about doing something about smoking, maybe about alcohol or

diet. It is actually about inequality. We know that if you have

wealth inequality, you have health inequality. At the heart of this for

us is about making sure that we close the educational attainment gap

so that our young people get the best possible start in life, that we

actually pay decent wages for jobs. We would introduce, as we have done,

the living wage, not just across the public sector but in the private

sector, too. If you start to tackle the causes of poverty, and give

people the opportunity themselves to do things differently, that is how

you make the long-term shift. Interestingly enough, NHS Scotland,

which is an agency that works for Shona Robison's Department, they

came to the Finance committee and said, "The one thing you could do is

raise taxes to solve poverty, to tackle inequality, and that would

make the fundamental difference to spending in the NHS". Shona Robison?

They also said that delivering the living wage was a key component of

tackling health inequalities of course, it would be the low paid

would be most hit by Jackie Baillie and Labour's tax proposals. The

porters and the cleaners working in the NHS will have to Peifer George

Osborne's austerities. But we have a ?13 billion health budget, which

will rise by at least ?1.6 billion over the next parliamentary session.

It is what we do with that resource which is really important. We need

to shift more of the spending into community health services. The

concept of the community health harbour that Alan and his colleagues

are developing is very important because we can have community

services that don't just treat illness but you can imagine a

situation with third sector organisations involved in those

hubs, that could be GPs and other elf professionals signposting people

into services, like maybe walking groups or mental health

organisations. Really pulling together all of those organisations

and services into a genuine community health service. I think

that is a very exciting possibility and something that could be

delivered through the new contract. I will come to the other panellists

but let's hear from the audience. In Scotland, two out of three people

are overweight or obese so it is a pretty big problem. The gentleman in

the middle, what would you like to say? Orange rabbit I would like to

hear the panel are suing the Citizen request and that was asked. -- I

would like to hear the panel answering a question that was asked,

that was all very trusting but it did not answer the question that was

asked. This lady here? Yet another taxes to be paid by the people, the

sugar tax. This is related to this question. Like nicotine and

cigarettes, is harmful but it is also very addictive. Instead of

taxing the companies that make and sell harmful products for profit,

our government finds it in their power yet again to tax the people.

Thus creating a revenue stream. My question is... Why not attack the

companies that are making the foods in the supply? If they are not

there, people can't have them. That is a fair point. It is UK Government

policy, obviously. This gentleman? I'd like to take Jackie Baillie to

task on what you just said. She said 2% of the Scottish population

account for 50% of the spend? If the Scottish population is 5 million

people and 2% of that is 100,000 people, and we have a budget of ?13

billion, ?6.5 billion is spent on 100,000 people?

billion, ?6.5 billion is spent on person. But I can't believe that and

believe me, I will go away and check. The lady in the middle.

believe me, I will go away and need to really invest in the

preventative agenda. Scottish Conservatives believe 14 Health

Boards have 14 different approaches to what we might call health

visiting. There needs to be a national health visiting service

which is GP attached, not just for the first 12 months of a child's

life, but for the first seven years. We would like to create an

additional 500 health visitors, that's 1,000 additional health

visitors, who will work with young families because many of these

problems are established in those early years. If we can invest at

that level early on, maybe we can head off some of the problems that

will occur in later life. Let me say, we would concentrate some of

that resource in areas of high health inequality. We recognise the

incidents of these conditions is higher in those areas. Before I come

back to Christine Jardine, a gentleman here with his hand up?

Jackson talks about personal responsibility. I would argue it is

very difficult when you are struggling to make ends meet to

decide to go out for a run or cook a healthy meal. Personal

responsibility hasn't worked for however many years. You have to

encourage it. But to do that, you have to tackle the root causes. What

would the Liberal Democrats do to prevent lifestyle illnesses?

Prevention is the key word. The gentleman here, the lady who

mentioned diabetes all raise very good points, but it comes back to

prevention. We have had some successes with the smoking ban. It

has been highly effective in preventing related cancers.

Unfortunately, minimum unit pricing hasn't had a chance yet to make an

effect and Jim Hume, his Private Bill, is another example of what we

can do. What we would like to do is ringfence what the other lady

mentioned, the sugar tax. There will be consequentials for the spending

of the sugar tax. We would like to ringfence that to encourage people

and to invest in sport and activities to overcome some of these

problems which do exist in Scotland. The big thing is inequality. We have

to get round that. One of the things we would do is invest more in

primary care and empower the GPs to prescribe things which were really

social measures, like if they are working in an area of deprivation,

where there is a problem with the housing, they could recommend that

someone has insulation in their house and that would be paid for by

the Government. They could recommend that they have an exercise regime or

a gym membership and encourage people to do things. Public health

has to have more investment in education and in measures like the

smoking ban over the next few years if we are to make any progress at

all. It is only by doing that - and it also affects mental health. It

all comes back to investing in primary care and fighting to

overcome these inequalities. I would like to move on to mental health.

Allan, what is your response? I have struggled for ten years to lose a

stone and I can't do it, but I did give up smoking 20 years ago and I

don't drink a lot. What is disappointing to me is, this thing

about inequality and poverty. It is an issue. I did some research on

this, and one of the richest countries in the world is Japan.

Their obesity rate is 3%. One of the poorest countries in Ghana, the

other is Nigeria, their obesity rate is 3%. Scotland's is one of the

highest in the world, so it is not just a question of where you are

coming from, people have choices. A lot of the people you are talking

about don't know the choices and your point about education,

everybody has talked about education, that is one thing. You

can't walk into a petrol station or a shop these days without running a

gauntlet of sweeties, there are things like that... There needs to

be an all-round approach. One more hand in the front? All of the things

that have been spoke about have come back to young people and how they

are growing up in Scotland and then going on to jobs. A lot of the

recent decisions made by Parliament focus on young people. You were

talking about the living wage being increased to the over 25s, the

cutting of housing benefits for under 25s, so these young people are

getting added pressures and you expect them to be GPs and be

consultants, when no-one is giving them the original support at the

start. You talk about early education and intervention, so up to

the ages of 12, then we have the group from 12 to 25 which seem to be

ignored, so they are having to work harder, work longer and you expect

them to take care of their own health. Their mental health then

becomes a big problem because how can they look after their mental

health, their physical health? OK. Thank you.

Now, Erin Lowe has a question on a subject that many of our

Hello, Erin, what would you like to ask?

Why is mental health still treated as secondary to physical health?

Shona Robison? If I can respond to both of your points? First, the

living wage, the Scottish living wage that we talk about is not just

for the over 25s, it is for everybody, the UK Government's new

minimum wage is the one that you are referring to. We think that is

wrong. There shouldn't be a discrimination against young people.

The issue of mental health is very, very important. We do believe that

we need to build on the investment that we have already made in mental

health so over the next five years, we want to invest another ?150

million in mental health. Some of that will focus on children and

adolescence mental health services. We have expanded the workforce.

There is more to be done. Do you accept Erin's point that it is still

treated as secondary to physical health? Well, it shouldn't be and we

certainly want to make sure that there is an increasing share of

resource to mental health to make sure that when people need access to

mental health services they get it. That will be at different levels.

For some people, they will require a service of psychologists and

psychiatry. For many people, what they need is more of a counselling

service, and we think through link workers attached to GP practices we

could get a service that is more readily available so when someone

needs help, they get help. We will be laying out plans at how we will

deliver that, particularly for young people. I know my daughter's turning

13 and I see among a lot of people her age that sometimes they need

additional help. It might not be at the level of a psychiatrist, but

they need help. We can provide a better offer to young people growing

up here in Scotland working with the schools. Christine Jardine, do you

accept that mental health is treated as secondary to physical health?

Sadly, it is. I think the lady who raised it is right. That is

something we have to change. What we would want to do to answer both

questions because they both make very good points is we would want to

double the share of the budget for children Children and Young People

for mental healthcare there. Shona says the Government is aware of

this. For the last four years, the share of the health budget has been

reduced by the Scottish Government. You mentioned the ?150 million, but

the actuality is that your strategy, your last strategy ended in December

and you don't have another one yet, so we don't know how the money is

going to be allocated and where it is going to be spent. What we would

do is place mental health services at the forefront by when we expand

and invest in GP practices, not just link health professionals to them,

have a mental health professional there, because one of the biggest

problems with mental health issues is the stigma that is attached to

them. We have to normalise it. We have to make it so that it is like

going to the dentist or going for an eye test, you go to your GP and

there is a counsellor there or a mental health professional so you

don't feel any stigma. It takes three or four visits sometimes

before a patient opens up and admits the problem is stress or depression.

Depression costs 670,000 working days in Scotland a year. It is a

massive issue. You say you are putting young people at the

forefront of the strategy. At the moment, some young people have had

to wait a year to see a mental health professional. That is

ridiculous. If you live in Dingwall you have to travel to Dundee to see

a mental health professional. There are no beds. OK. Alright. The woman

over there? I want to talk about the issue of force treatment in mental

health. Without human rights, you get stigma. We have no human rights.

We do not have the right to refuse medication. When MSPs go back, when

they are re-elected, you will be working on the mental health review

because you won't listen to the UN. They have forced a review because

the UN want you to ban forced treatment because it is against

human rights. Thanks for that point. I would like to stick to the

original question. Thank you for the point. I will go back to Jackie

Baillie on the original question. Can I go back to Erin's question?

You are right, there would be a national outcry if we were talking

about the waiting times that we are for mental health, for children and

young people, because I very much welcome the SNP's introduction of a

waiting time target for mental health services, an 18-week referral

to treatment. They have not met it once. It is pointless having targets

unless you resource those targets to enable people to meet them. The fact

that they have not met it once and performance is getting worse, not

better, and there are 8,000 young people who have waited longer than

the 18 weeks. Christine is right, some as much as a year, to access a

key service. What we would do is it needs to start at school. We need to

make sure there are enough educational psychologists at school

helping young people there. We would recruit more community psychiatric

nurses and mental health professionals and key to this is

better access to talking therapies. They have been shown to work. We

need more people trained to actually provide that kind of service. At the

end of the day, it comes back to, you know, the fact that we are going

to be facing enormous cuts to services. I don't want mental

health, which some would describe as a Cinderella service in the NHS, to

get worse as a result of those cuts, which is why these people here need

to explain how they are going to invest in the NHS when they are not

raising the money to do so. There will be an increase of ?1.6 billion

over the next Parliament session, in addition to the ?13 billion already

there. That is a lot of money. What is important is how that money is

spent. Where I do agree is that we need to spend a higher proportion of

that resource in primary and community care services, including

mental health services, so that is a commitment from the SNP. Shona

Robison made a big deal out of the budget this year. Let me tell you,

despite the uplift, somewhere like Greater Glasgow and Clyde Health

Board is having to cut ?69 million from its budget. OK. Let me bring

in... Let me bring in Jackson Carlaw. How would you... I will try

not to interrupt while I'm being interrupted! To come back to the

original question, why did it happen? It happened because mental

health has been widely misunderstood across the general public and there

hasn't been enough champions for it. The real progress over the last five

years has been a far, far greater wider public understanding of what

mental health condition are. People realise that conditions like obesity

and alcoholism and drugs and depression are very often

underpinned by mental health issues. So, yes, the real challenge, the

great challenge for this next Scottish Parliament is to bring the

treatment of mental health on a parity with the treatment of

physical health. There is a usual bit of partisanship here, we will

commit tomorrow to an additional ?300 million investment in mental

health. I don't think we are unique in this. All of the parties are

committed to making that change in mental health in the next

Parliament. I agree. That may mean we need a mental health professional

in each GP practice. But that is all part of the whole remodelling and

reshaping of our Health Service which has to be part of an

all-party, non-partisan, wider agreement if it is going to be

long-term and sustainable. I'd like to bring in Rory O'Connor

who is a professor of psychology at Gartnavel Royal Hospital. What have

you heard? I'm dying to see the focus on mental health is welcome we

know amongst middle-aged men in Scotland in particular, it is the

single biggest killer of young and middle-aged men. We need to do

something about this. Scotland has led the way in the last 1015 years,

we have seen a marked reduction in suicide but we need to do so much

more. My concern is we are too complacent. Rates have come down but

they are still much higher than England. I'm looking for reassurance

from all of you that mental health, public health, suicide prevention is

not just about mental health but about broader public and social

health. What are you going to do about that? The lady at the back as

well wanted to make a point. The issue is coming from everybody who

is speaking seems to come back to the issue of sustainability, which

Jackson mentioned at the end. The fact that the issues we are facing

in Scotland, whether that is down to a poor health record or inequality,

is never going to quite match, however much we managed to raise the

budget over the coming years. How we set priorities has been part of the

discussion and a lot of the focus has been on primary care and public

health and prevention and early intervention, community nursing and

general practice. But a lot of the targets that are still set out, how

we measure is excess in the NHS, are still focused on hospitals. I would

be interested to hear from the panel how they might address how they set

a measure of success with the transformation agenda they are

setting up this evening. I would like to take one more point from the

young woman at the end. It was just a point, a lot of the panellists

have touched on extending the resources and putting investment in.

There are tools in lots of communities that are massively

underused, like community workers and youth workers. They are already

engaging with so many young people in our communities. It does not

always necessary have to create new jobs. If you can create better links

with community practitioners and youth workers, not just in schools

but in the wider community, because a lot of young people won't engage

in school, you can start to tackle the problems early. That may been

signposting, no one is saying youth workers can fix everything but

making those links and improving services at the starting point for

young people can have an influential effect in everything that follows.

Thank you, lots of heads nodding. Given that life expectancy

in Scotland varies hugely according to class, what are your plans

to tackle the root causes Jackson Carlaw? I have partly

answered that and I think tackling health inequalities start to the

point of bird. At the moment, we don't have a national health

visiting service and we offer a service in the first 12 months of

life. Many of the indications of problems that will actually go on to

create the much deeper inequalities that will be suffered can be seen at

the age of three and through to the age of seven. We need to invest in

that early years span of life, birth to the age of seven. That is why I

talk about a national GP attached health visiting service, with

particular concentration of those additional 1000 health visitors in

the areas where those health inequalities are most acute. I know

there's a debate about the economy and about inequality generally, but

in terms of what we do specifically in health, that is where I would

like to see it focused. We need to tackle Thomas still, the great

problems we have got in Scotland -- tackle, still. I'm afraid we suffer

them more acutely than other parts of the UK in terms of obesity and

the various addictions that exist, the problems that manifest

themselves and waste the opportunity of so many people's lives. That is

where the priority has to be. It has to be investing in a major step

change in that preventative agenda, now at the early years the stage in

life. Jackie Baillie, a man in affluent East Dunbartonshire can

expect to live more than seven years longer than someone from Glasgow

city, for example. What would Scottish Labour do to tackle that?

Firstly, it is a scandal we have such a disparity in Scotland but

it's also a scandal that the mortality rate, the life expectancy

rate in Scotland is the worst of any of the four countries of the UK. We

absolutely need to do something about that. But I think it is, when

we are talking about health inequality, rooted in the wider

debate about wealth inequality. If people have good jobs and a good

education, if they are able to earn, they make different life choices.

You know, rather than struggling with the day-to-day challenge of

just living in their community. We need to absolutely invest in that.

That is educational attainment, the living wage, improving people's

prospects to work in high skilled jobs in the industries of the

future. It is absolutely tied to the wider debate about the economy. But

let me just say to the young woman there, that talked about community

workers and youth workers, I used to work in a community setting. I used

to look at particularly some of the women in those communities who were

the backbone of those communities and were influential in getting

change. But you can't get that these days. The government have cut local

government by ?1.4 billion. I don't know when I last saw a youth worker

or a community worker engaged in doing that kind of really valuable

work of community development in certainly the areas that I

represent. That is as a result of the cuts, substantial cuts to local

government budgets and local government services. Christine

Jardine, what with the Liberal Democrats do to tackle the root

causes of health inequality? I think the root causes of health inequality

are much wider than help itself. It is, as you say, a social problem. If

you live in certain places, you will have a longer life expectancy than

someone who lives less than a mile away. That is not acceptable. Things

like a penny on tax for education to ensure better education, we need

more affordable rented housing. We need a fairer, wealthy -- a fairer

welfare system. We need 18-25 -year-olds to get housing benefit.

We need all these things but when it comes to health, we need to do what

I said earlier, to broaden the scope of practice is to look at

encouraging people, to prescribe to them for an exercise class,

encourage them, point them in the direction, as has already been said,

of walking groups, and ring fence the consequential from spending in

England from the sugar tax to ensure that we invest in activities for

young people. Girls very often give up sport at school. Make sure there

are other activities for them to take part in. Invest in sporting

clubs. It is the wider issue and we have to tackle it through more than

just health. Shona Robison, the SNP government has had nine years. Have

you even made a dent in this? Life expectancy is improving but it is

not improving as quickly for those who were living in the most deprived

communities. That is a challenge. I think where there is agreement is

that it can't just be for the health service alone to tackle. It has to

be across government, so the attainment challenge, for example,

?750 million that the First Minister has said will be invested in getting

opportunities and creating educational opportunities early in

life, so kids can have the best chance in life, but you know, there

are other factors which impinge on people's life chances, for example,

some of the welfare changes the UK Government has brought in have

devastated some families' incomes. That pulled the rug out from under

many families. We have to look at not just what we can do

determinants of health and the importance of government improving

the overall experience of people right across the population. I'm

delighted we've also talked a lot about mental health. I want to see

more than just talking in the next Parliament. What I want to ask is,

we have also heard a fair bit from most of you about the agreement

amongst you about how health should be run. How will

amongst you about how health should the talking down of our NHS. That is

so unfair. It strays into that territory, demotivated staff and

politicians have to be very careful that when they are talking about and

debating the NHS, that they don't get into the territory of constantly

talking down... You need to stop using the staff as a human shield.

We have hard-working staff and you need to resolve them. I'm going to

have to bring in the other two. Christine Jardine, it sounds very

much like a political football! I take the gentleman's point but I

will also say that no one has talked down the NHS staff and nobody would

do that. Like Jackie, as a liberal, I'm proud of what Beveridge did and

what our staff do every single day. I take the gentleman's point and how

do we get away from it? Looking for transformational change in the way

the health service is run. What we would do is talk to the Royal

colleges. Rather than announce it in conference speeches, that we are

going to have five centres that the Royal colleges knew nothing about, I

would make sure that they were consulted, that we took their

advice. After all, they are the people who know what is needed.

Politicians only enact what is needed. The doctors need to tell us.

The professionals need to tell the politicians first. Jackson Carlaw?

We call it a national health service across the UK but in fact, it is now

four different health services who have gone their way since

devolution. In Scotland, all of the political parties are committed to a

National Health Service free at the point of need and delivery. It is

not the same thing as saying we will never criticise the management

decisions, day-to-day, that the government of the day take. It is

about saying we need to agree and work together on a cross-party basis

as to how we said your -- secure the long-term future scholar's NHS in

the public sector model we want and value. How do we stop that breaking

down in this election? You say you're not going to vote for parties

that do it. Briefly before we go, what do you make of that? A lot of

it sounded like football to me, I have to say! Thanks very much your

contribution. All that remains is to thank

the panel, the studio audience and of course,

you at home for watching. We'll have another special

debate next Tuesday, this time on the subject of energy

and the environment. If you'd like the chance to be in

the audience, then you can apply through BBC Scotland's Election 2016

online page.