:00:00. > :00:00.Demands on our hospitals are ever increasing and costs
:00:00. > :00:11.So why's the Government failing to shift the balance
:00:12. > :00:35.Audit Scotland's annual review of the financial performance of the
:00:36. > :00:36.NHS found that funding isn't keeping pace
:00:37. > :00:44.We'll hear from Health Secretary Shona Robison.
:00:45. > :00:52.Saturday's election may be won by the Pirate Party, who are kicking
:00:53. > :00:57.And we get a preview of the exhibition which hopes
:00:58. > :01:07.to transform the way we think about Iraq.
:01:08. > :01:09.Nobody doubts there've been some improvements to the health service
:01:10. > :01:16.Indeed, today's report highlights the record levels
:01:17. > :01:18.of funding and staffing, and how patients are waiting
:01:19. > :01:26.But the problem is that the NHS is continually chasing its tail.
:01:27. > :01:29.It's failing to keep pace with ever increasing demand -
:01:30. > :01:31.mainly because we're all living longer.
:01:32. > :01:34.Now, the way to break that circle is to shift the balance towards more
:01:35. > :01:43.But the report says it's just not happening.
:01:44. > :01:49.In a moment I'll be asking the Health Secretary why.
:01:50. > :01:55.James has a blocked artery in his right leg and has been waiting
:01:56. > :02:00.months to be seen by a specialist. He is not alone. Today's report says
:02:01. > :02:03.the health service has failed to eat most of its key waiting time
:02:04. > :02:13.targets. That is 12 weeks since my GP referred me. I have heard
:02:14. > :02:18.nothing. On Monday I decided to call the appointment office. They
:02:19. > :02:28.informed me that it would be at least 30 weeks before I could maybe
:02:29. > :02:31.hear something because of a shortage of consultants. Nobody doubts that
:02:32. > :02:35.reducing the weight for people like James is important that the auditor
:02:36. > :02:38.general says meeting ambitious waiting time targets is preventing
:02:39. > :02:41.the Scottish Government is shifting towards more patients being treated
:02:42. > :02:49.in the community rather than in hospital. The consensus about the
:02:50. > :02:53.vision within Scotland and internationally, it seems to be the
:02:54. > :02:57.right way forward. What we find in the report is that there is not
:02:58. > :03:01.enough big deal for who we get there from where we are now in terms of
:03:02. > :03:06.understanding how much money is required, both for investment and
:03:07. > :03:09.longer term financing, which staff are required, how we invest capital
:03:10. > :03:13.budgets and make sure we develop the services we need. It is those were
:03:14. > :03:20.just planning that would help make a reality. It physically been here
:03:21. > :03:24.before. It wasn't 2005 that a long-term vision was published for
:03:25. > :03:29.the NHS in Scotland calling for just that shift. Today's report also
:03:30. > :03:39.highlights the problem of an ageing workforce. Half of crazy nurses are
:03:40. > :03:40.over 50, so are one third of GPs. Replacing them when they retire is
:03:41. > :03:43.another challenge. Well I'm joined now
:03:44. > :03:45.from our Dundee studio by the Health Secretary Shona
:03:46. > :03:52.Robison. We have known about this need to
:03:53. > :03:57.rebalance the health system for more than one decade. You have been in
:03:58. > :04:01.Government for nine years, why has more not happened? A lot has
:04:02. > :04:04.happened. We have seen the integration of health and social
:04:05. > :04:07.care, that has been the biggest reform in decades, bringing those
:04:08. > :04:12.two institutions together with single budgets, planning services at
:04:13. > :04:21.a local level, making sure that they can invest in services and
:04:22. > :04:26.importantly get people more quickly so we can tackle things like delayed
:04:27. > :04:31.discharge. But Audit Scotland does recognise some of the achievements
:04:32. > :04:35.of the past decade that then goes on to challenge as to up the pace of
:04:36. > :04:38.shifting the balance of care. The First Minister made a major
:04:39. > :04:42.announcement on that at SNP conference which was the investment
:04:43. > :04:45.of ?500 million over this parliamentary session into primary
:04:46. > :04:51.and community health services. Primary care is going to be where
:04:52. > :04:54.the new models of care are going to keep people out of hospital, and
:04:55. > :04:57.importantly make sure that people can stay in their own home with
:04:58. > :05:01.those local health services supporting them for as long as
:05:02. > :05:06.possible. But your past record does not give us much hope. The report
:05:07. > :05:09.today sees the balance which in hospital and community-based care
:05:10. > :05:15.has not shifted in the last five years. You have not made any
:05:16. > :05:19.progress at all. We have through the integration of health and social
:05:20. > :05:22.care. That has been a big reform. But over the course of this
:05:23. > :05:26.Parliament is the 500 million shift in funding to primary care will see
:05:27. > :05:31.for the first time over half of the health budget being spent on primary
:05:32. > :05:35.and community health services. That is a big shift. That will mean
:05:36. > :05:39.changes. The National clinical strategy which has been supported by
:05:40. > :05:44.health professionals the length and breadth of Scotland lays out how
:05:45. > :05:48.that is going to happen. There will be specialist centres, elective
:05:49. > :05:50.centres, which will do some of the hip and knee operations that people
:05:51. > :05:56.will need more of an ageing population. It will mean some pain
:05:57. > :06:02.-- it will mean some changes to acute services. We hope this will
:06:03. > :06:06.get support from across the other parties and of course leads to take
:06:07. > :06:10.the public with us on some of these changes as well but that National
:06:11. > :06:15.clinical strategy is the way forward. Audit Scotland accept that
:06:16. > :06:18.and support that. We agree that we need to bring together all of these
:06:19. > :06:23.things into a delivery plan. We have said that by the end of this year we
:06:24. > :06:26.were way out in detail the milestones, the finance, and of
:06:27. > :06:31.course the workforce plans. But despite how you allocate the money,
:06:32. > :06:36.you essentially face a choice, I don't reduce spending on acute care
:06:37. > :06:41.and shift resources more into the community, or you maintain acute
:06:42. > :06:46.services and somehow find an extra pot of money from elsewhere, so what
:06:47. > :06:53.is the strategy you are adopting? Their health budget will increase
:06:54. > :06:59.overall sort by 2021 it will go up by 14.2 billion, an extra ?500
:07:00. > :07:04.million above inflation over this parliamentary term, that means that
:07:05. > :07:07.the health budget will grow by another ?2 billion, however demand
:07:08. > :07:13.is also growing and we need to make sure that a bigger proportion of
:07:14. > :07:17.that money goes to primary care and community health services. And we
:07:18. > :07:20.will need to release money from acute services. The National
:07:21. > :07:24.clinical strategy lays out how that will be done. We need to of course
:07:25. > :07:27.make sure that people still get a good service whether it primary care
:07:28. > :07:34.or in the acute sector, that change will be required. We will have to
:07:35. > :07:38.drive that change forward. One way forward is the ambitious waiting
:07:39. > :07:43.time targets, it is mentioned in the report today. The problem is that
:07:44. > :07:51.there is no money left over to make those big changes. Of course Harry
:07:52. > :07:55.Burns has been appointed, he was the previous Chief Medical Officer, very
:07:56. > :08:00.well respected, to lead a review of the targets, because it is important
:08:01. > :08:04.that we measure what is important, so outcomes for patients need to be
:08:05. > :08:09.the focus of our targets. I think we accept it is time to look at all of
:08:10. > :08:14.that, not just in health but in here as well. Does this mean you will
:08:15. > :08:19.abandon some of the targets? I am not going to prejudge what Harry
:08:20. > :08:23.Burns comes up with. He will consult widely, health professionals,
:08:24. > :08:27.patient groups, the public, to make sure we are measuring the right
:08:28. > :08:32.things, that we can measure the outcomes for patients, rather than
:08:33. > :08:37.just the inputs. Let us let Harry Burns get on with that job. It is
:08:38. > :08:42.important that people get access to speedy diagnosis and treatment for
:08:43. > :08:46.cancer, for example, we are investing another ?100 million over
:08:47. > :08:50.the next five years to make sure people get quicker diagnosis and
:08:51. > :08:55.treatment of cancer. We need to make sure that people still get access to
:08:56. > :08:59.quick diagnosis and treatment, particularly where we want to
:09:00. > :09:04.improve survival rates. Cancer is a very important area that people will
:09:05. > :09:08.expect to get quick diagnosis and treatment end. One of the ways you
:09:09. > :09:12.could reduce the pressure is on the health service is by tackling bed
:09:13. > :09:15.blocking. You said last year that you wanted to eradicate bed
:09:16. > :09:23.blocking, why had he failed to do that? Delayed discharge has reduced.
:09:24. > :09:27.Audit Scotland recognise that. They have not produced quickly enough. I
:09:28. > :09:31.want to eradicate it and they have the ambition to eradicate it but it
:09:32. > :09:34.has been quite challenging, but if I could point out if you look at the
:09:35. > :09:38.health and care partnerships that are now responsible for planning
:09:39. > :09:43.bills services that will get people out of hospital, some of them have
:09:44. > :09:54.performed very well, reducing delays to series or less. You have reduced
:09:55. > :09:59.locking by 2% per year, if you continue with that we will never get
:10:00. > :10:04.there. We need to up the rates. All of the partnerships are performing
:10:05. > :10:11.as the best 25% are, doing what they are doing, we read reduce the lead
:10:12. > :10:15.discharge by half overnight so we are working with partnerships that
:10:16. > :10:20.have got more to do to tackle delays. We know what works. The
:10:21. > :10:24.partnerships that have eradicated delays effectively have done the
:10:25. > :10:27.things that we nor work. We want all partnerships to do that and we will
:10:28. > :10:33.work with them to make sure that they do that. How will you move more
:10:34. > :10:38.health care into the community and social care generally when you are
:10:39. > :10:46.cutting budgets of local councils? We have already invested ?250
:10:47. > :10:50.million in this financial year, that is quarter of ?1 billion, that will
:10:51. > :10:55.continue throughout this Parliament, invested in social care, and the
:10:56. > :10:57.reason we did that, and that was quite controversial because it meant
:10:58. > :11:03.that half of the money going to the health budget was then transferred
:11:04. > :11:06.through their health and care partnerships through integration
:11:07. > :11:10.into social care, but we felt that was the right thing to do because we
:11:11. > :11:13.know that without social care packages we cannot keep people at
:11:14. > :11:17.home and importantly we cannot tackle delayed discharge. That is a
:11:18. > :11:21.big investment. That'll make a big difference in making sure that we
:11:22. > :11:26.have the package is there to get people out of hospital when they are
:11:27. > :11:27.ready to go home. That is a big investment and we will see the
:11:28. > :11:31.benefits from it. Thank you. You may have noticed there's been
:11:32. > :11:33.a revolt against the political From Trump in America,
:11:34. > :11:37.Ukip and Momentum here in the UK, But perhaps the most radical
:11:38. > :11:44.is to be found in Iceland. The Pirate Party favours direct
:11:45. > :11:47.democracy, complete Government transparency,
:11:48. > :11:51.and the decriminalisation of drugs. And polls ahead of the upcoming
:11:52. > :11:53.general election there suggest it could head up a new
:11:54. > :11:59.Coalition Government. Joining me from Reykjavik
:12:00. > :12:13.is Ingo Sigfusson from The Icelandic Where has this party coming from and
:12:14. > :12:18.who is appealing to? The art appealing by and large to younger
:12:19. > :12:21.people but they seem to be appealing to pretty much every portion of
:12:22. > :12:28.society to some extent. The roots of this party can be traced back to the
:12:29. > :12:33.results of the financial collapse in Iceland in 2008. We saw the
:12:34. > :12:39.Government collapse in early 2009. Several new parties were started at
:12:40. > :12:44.that time, many of them appealing to grassroots and direct democracy, and
:12:45. > :12:49.many people who formed to Dave's Pirate Party began their political
:12:50. > :12:55.involvement at the time and they have three parliamentarians already.
:12:56. > :12:58.That is one of the unknowns about this election, although they are
:12:59. > :13:01.doing quite well in the polls, we know because they have a lot of
:13:02. > :13:05.followers among young people that young people tend to be the group
:13:06. > :13:09.that does not come out to vote so that the something that we will be
:13:10. > :13:15.following closely on Saturday. There is a scepticism about the
:13:16. > :13:18.political elites all across Europe. Visit the case in Iceland that a lot
:13:19. > :13:27.of people think they're politicians are corrupt? That is entirely true.
:13:28. > :13:32.Because of ice and's size, politics, business, everything is intertwined.
:13:33. > :13:38.There are only 330,000 of us. Everyone tends to know everyone. We
:13:39. > :13:41.saw the established political parties quite happily involved in
:13:42. > :13:45.the fears that led up to the financial crash of 2008. Many feel
:13:46. > :13:51.that those parties have not really faced up and apologised to the
:13:52. > :13:56.extent that they should have. This spring we had the Panama Papers
:13:57. > :14:04.which showed us that the new crop of established party politicians were
:14:05. > :14:07.perhaps not quite as transparent, and they were certainly not going by
:14:08. > :14:13.the same rules that applied to the rest of us, and that re-affirmed
:14:14. > :14:14.people's belief that politics, traditional politics, was corrupt
:14:15. > :14:29.and we needed to change yet again. Is it more a movement or a political
:14:30. > :14:37.party? Its leader says it has no ambitions
:14:38. > :14:43.to be Prime Minister. The person you are probably referring to, the
:14:44. > :14:57.best-known, although the route the jobs. They are a movement. They want
:14:58. > :15:04.to implement the policies. They want an online system where people login
:15:05. > :15:14.to vote on legislation. They do not look or act like politicians. Many
:15:15. > :15:19.of the policies that they are advocating, some of them have been
:15:20. > :15:25.picked up by other parties, but they are quite unusual.
:15:26. > :15:29.What do they say about the economy? Iceland has recovered to a large
:15:30. > :15:34.extent since the financial crash in 2008 but is there no business in the
:15:35. > :15:40.business community about what would happen if Pirate Party did well.
:15:41. > :15:47.I don't think there is real nervousness. One reason is because
:15:48. > :15:59.even if they get 19-22% of the vote that they might get, they would have
:16:00. > :16:03.to go into coalition. The four parties in government have agreed
:16:04. > :16:09.they would try to form a coalition got the necessary votes. Even if the
:16:10. > :16:12.Pirates were as radical as some people think they are, and they
:16:13. > :16:18.probably aren't, even if they where they would have to compromise
:16:19. > :16:25.because their coalition partners may not share their views on everything
:16:26. > :16:29.or be as radical. I don't think the Pirates will take up the country and
:16:30. > :16:35.run everything into the ground. We have had unusual parties run parts
:16:36. > :16:43.of the country. We had a comedian run for mayor in Reykjavik a few
:16:44. > :16:47.years ago as a lark but he won. He did not do any better but not any
:16:48. > :16:50.worse than the previous incumbent. The headlines from Iraq just today
:16:51. > :16:53.are full of the bloody battle for Mosul and a human rights prize
:16:54. > :16:56.for two Yazidi women who escaped sexual slavery at the hands
:16:57. > :17:00.of so-called Islamic State. The latest instalment
:17:01. > :17:04.of misery in what seems to be A new exhibition of pictures aims
:17:05. > :17:28.to show a different side Probably not what you think about
:17:29. > :17:36.when you hear the word Iraq. These images by the photographer Mohammed
:17:37. > :17:43.Kelenchy appear in an exhibition in Glasgow.
:17:44. > :17:50.Iraq is a civilisation, whatever you think of art and history. Iraq is
:17:51. > :17:59.the country of the cradle of civilisation and now all that people
:18:00. > :18:05.in Scotland know about Isis and Sunni and Shia and Christian and
:18:06. > :18:13.Israelis. Iraq is not like that. These pictures are reflecting what
:18:14. > :18:19.we are. Not like the bloody pictures that are present in the media about
:18:20. > :18:26.us. It is really reflecting our culture. It is not what we're seeing
:18:27. > :18:30.in the media now. There are as many reasons for being
:18:31. > :18:38.here as there are Iraqis in Scotland.
:18:39. > :18:42.I came as a Ph.D. Student, sponsored by the Iraqi government. When I came
:18:43. > :18:48.it was not like this part during these three years it has been upside
:18:49. > :18:57.down. No escape and phone calls are a
:18:58. > :19:06.lifeline to home. -- now Skype and phone calls. But
:19:07. > :19:09.although that contact keeps you close, it also remains you how far
:19:10. > :19:13.away you are. You want to be between them. You
:19:14. > :19:20.want to share all these memories with them but you cannot go there.
:19:21. > :19:25.For now, memories and by pictures on a wall and hopes that they will give
:19:26. > :19:30.us a new image of Iraq. I love Scotland. It is my second
:19:31. > :19:35.home and you know how Scottish people are extremely kind people and
:19:36. > :19:44.it is good for them to know what I am as an Iraqi living in Scotland.
:19:45. > :19:49.If it is indifferent faith, different cultures, food, education.
:19:50. > :19:55.That is what we're trying to candour of the image of what the media put
:19:56. > :19:57.for us for many years. Now, joining me to discuss the day's
:19:58. > :19:59.big stories are the journalist Dominic Hinde and the former
:20:00. > :20:11.Scottish Labour adviser Simon Pia. Less document the NHS first. The
:20:12. > :20:17.audit report out today and there seems to be a consensus on boats
:20:18. > :20:21.moving from hospital-based care into care in the community.
:20:22. > :20:28.But progress has been slow. I think this is a problem for the SNP. They
:20:29. > :20:33.have had one of the longest most extended honeymoons in politics and
:20:34. > :20:37.I think they are in a difficult position no because with the
:20:38. > :20:42.prospect of IndyRef2, people are going to ask them what they are
:20:43. > :20:47.actually like at running something. It is mounting up with education
:20:48. > :20:50.problems and the NHS and it cannot wash their hands and blame
:20:51. > :20:56.Westminster or previous Labour administrations because they're been
:20:57. > :21:04.in power for over a decade. A lot of the blame rests with the First
:21:05. > :21:13.Minister Nicola Sturgeon. The SNP are very conservative fiscal --
:21:14. > :21:20.fiscally and you need more money. Labour, to their credit, were honest
:21:21. > :21:25.enough in the recent elections for Holyrood said a penny on tax to pay
:21:26. > :21:30.for public services. It didn't do them much good in the polls but that
:21:31. > :21:37.is where the problem lies. Sean Robertson is not admitting that.
:21:38. > :21:45.It was under a Labour government in 2005 merger had the care report
:21:46. > :21:53.warning about all the changes. That was part of Labour's manifesto
:21:54. > :21:55.in 2011, care in the community. The Scottish Government is not
:21:56. > :22:01.supporting health boards and councils who would be providing the
:22:02. > :22:06.care once people were discharged. This charge still is one of the big
:22:07. > :22:09.problems. So you are saying put up tax to do
:22:10. > :22:16.that? I think the whole of society is in
:22:17. > :22:19.denial about this. We want low tax lake in the US but good public
:22:20. > :22:24.services late in the Nordic countries and you've got to bite the
:22:25. > :22:28.bullet and see how for this? The SNP wanted because they are political
:22:29. > :22:38.carrots and so were Labour but they have got their act together.
:22:39. > :22:43.-- political coward 's. Underneath all of it is this need to
:22:44. > :22:45.shift responsibility from hospital-based care to community
:22:46. > :22:49.care. There is an understanding in the NHS
:22:50. > :22:56.in Scotland, I have spoken to managers in recent weeks, and there
:22:57. > :22:59.is an appetite for things to happen. But the government haven't budgeted
:23:00. > :23:04.enough money to make them run the right way because she cannot run the
:23:05. > :23:11.health service on a running budget and reform it.
:23:12. > :23:14.Do you think the NHS is fit for purpose? There is ever-increasing
:23:15. > :23:20.demands and the cost of drugs is rocketing and there is an ageing
:23:21. > :23:27.society. It is still admired throughout the
:23:28. > :23:33.world but there is political coward mess. We all love the NHS but a
:23:34. > :23:49.political party should see this as an NHS tax we are going to put up.
:23:50. > :23:52.These are cuts, not savings. The previous Administration said the
:23:53. > :23:58.same thing. The responsibility lies with them and they have got to get
:23:59. > :24:06.their act together. It is not only Audit Scotland who have criticised
:24:07. > :24:10.them. Last year, the Association of medical colleges and faculties were
:24:11. > :24:13.also damning. They have been warned time and again and there is no
:24:14. > :24:18.action. I think the NHS makes up 40% of
:24:19. > :24:26.Scottish Government spending. Can it be allowed to go up any higher?
:24:27. > :24:32.I think it depends how important you think health care is. When you think
:24:33. > :24:37.that we have the most advanced health care system in history in
:24:38. > :24:42.terms of technology. You pay your national insurance and get health
:24:43. > :24:46.for life, it is a brilliant system. If people want to pay money for it
:24:47. > :24:53.to does not necessarily a bad thing. Do you think the whole culture of
:24:54. > :24:55.the way we talk about health is something that needs to change?
:24:56. > :25:00.Maybe there is too much focus on waiting time targets.
:25:01. > :25:10.I would maybe say that. But there is also the culture of managerialism.
:25:11. > :25:21.Even get it at the BBC, too many managers rather than new front line
:25:22. > :25:26.journalists. I was really struck by the management culture 20 years ago
:25:27. > :25:38.when I did work in the NHS. Let us turn to our almost daily
:25:39. > :25:46.wrecks and discussion. -- Brexit. David Mandel has been speaking about
:25:47. > :25:53.what it will mean. They will not be a special deal for
:25:54. > :25:57.the city or for the car industry. There will be issues in relation to
:25:58. > :26:06.financial services around part sporting, so specific issues around
:26:07. > :26:10.specific industries but it is wrong to characterise that some areas of
:26:11. > :26:16.the country will get a special deal. It doesn't look like we will get a
:26:17. > :26:22.special deal. I think the Scottish Government knew
:26:23. > :26:25.that. Nicola Sturgeon said she had a series of points you want to be mad
:26:26. > :26:30.but she knew that they would be met the cause of the nature of the
:26:31. > :26:37.Westminster attitude to what Brexit could be. Also David Mandel doesn't
:26:38. > :26:41.have an idea himself. He didn't really say anything and that doesn't
:26:42. > :26:47.Titian. How can you meet demands when you don't know yourself?
:26:48. > :26:52.There is a backlash on the way, isn't there?
:26:53. > :26:59.Yes, I think it is moving that way. The way they mishandled the 2014
:27:00. > :27:09.referendum and Westminster antagonised a lot of the Scottish
:27:10. > :27:13.population. I think the Tories misread Scotland and there is
:27:14. > :27:19.trouble ahead. David Mandel was squirming habits today. He is
:27:20. > :27:26.speaking about no special treatment for Scotland but deferential status.
:27:27. > :27:38.What can they give Scotland that will satisfy Nicola Sturgeon?
:27:39. > :27:41.Independence. You never know. If you have some parts in the single
:27:42. > :27:48.market and other parts of the country not in single market, that's
:27:49. > :27:52.unlikely to work. It is an almost impossible
:27:53. > :27:57.situation. You could end up something like China and Hong Kong.
:27:58. > :28:06.That separate Scotland even more than independence.
:28:07. > :28:11.What will Nicola Sturgeon do next? I think she is in a very difficult
:28:12. > :28:17.position but she is being well served by the Tories. The confusion
:28:18. > :28:26.and Westminster just helped by time and helps women over and say, look
:28:27. > :28:31.at them. What sort of deal did government do with Nissan? If they
:28:32. > :28:34.are prepared to do a special deal with the Japanese car manufacturer
:28:35. > :28:40.but not Scotland or Northern Ireland, what does that say? She can
:28:41. > :28:43.throw that back at them. The government are being cagey about
:28:44. > :28:44.what sort of deal or nod and a wink was given.
:28:45. > :28:47.Thank you both very much. Laura MacIver will be
:28:48. > :28:52.here on Monday night, usual time. It's seen two of its top figures
:28:53. > :29:45.quit in as many months. Tonight, new disclosures
:29:46. > :29:48.about problems at the heart of the independent child
:29:49. > :29:53.sexual abuse inquiry. Also tonight, the first British TV
:29:54. > :29:56.interview with the man who created the image of Donald Trump
:29:57. > :30:00.with the book The Art of the Deal and who is now doing everything
:30:01. > :30:04.in his power to stop him getting