27/10/2016 Scotland 2016

Demands on our hospitals are ever increasing and costs

So why's the Government failing to shift the balance

Audit Scotland's annual review of the financial performance of the

NHS found that funding isn't keeping pace

We'll hear from Health Secretary Shona Robison.

Saturday's election may be won by the Pirate Party, who are kicking

And we get a preview of the exhibition which hopes

to transform the way we think about Iraq.

Nobody doubts there've been some improvements to the health service

Indeed, today's report highlights the record levels

of funding and staffing, and how patients are waiting

But the problem is that the NHS is continually chasing its tail.

It's failing to keep pace with ever increasing demand -

mainly because we're all living longer.

Now, the way to break that circle is to shift the balance towards more

But the report says it's just not happening.

In a moment I'll be asking the Health Secretary why.

James has a blocked artery in his right leg and has been waiting

months to be seen by a specialist. He is not alone. Today's report says

the health service has failed to eat most of its key waiting time

targets. That is 12 weeks since my GP referred me. I have heard

nothing. On Monday I decided to call the appointment office. They

informed me that it would be at least 30 weeks before I could maybe

hear something because of a shortage of consultants. Nobody doubts that

reducing the weight for people like James is important that the auditor

general says meeting ambitious waiting time targets is preventing

the Scottish Government is shifting towards more patients being treated

in the community rather than in hospital. The consensus about the

vision within Scotland and internationally, it seems to be the

right way forward. What we find in the report is that there is not

enough big deal for who we get there from where we are now in terms of

understanding how much money is required, both for investment and

longer term financing, which staff are required, how we invest capital

budgets and make sure we develop the services we need. It is those were

just planning that would help make a reality. It physically been here

before. It wasn't 2005 that a long-term vision was published for

the NHS in Scotland calling for just that shift. Today's report also

highlights the problem of an ageing workforce. Half of crazy nurses are

over 50, so are one third of GPs. Replacing them when they retire is

another challenge. Well I'm joined now

from our Dundee studio by the Health Secretary Shona

Robison. We have known about this need to

rebalance the health system for more than one decade. You have been in

Government for nine years, why has more not happened? A lot has

happened. We have seen the integration of health and social

care, that has been the biggest reform in decades, bringing those

two institutions together with single budgets, planning services at

a local level, making sure that they can invest in services and

importantly get people more quickly so we can tackle things like delayed

discharge. But Audit Scotland does recognise some of the achievements

of the past decade that then goes on to challenge as to up the pace of

shifting the balance of care. The First Minister made a major

announcement on that at SNP conference which was the investment

of ?500 million over this parliamentary session into primary

and community health services. Primary care is going to be where

the new models of care are going to keep people out of hospital, and

importantly make sure that people can stay in their own home with

those local health services supporting them for as long as

possible. But your past record does not give us much hope. The report

today sees the balance which in hospital and community-based care

has not shifted in the last five years. You have not made any

progress at all. We have through the integration of health and social

care. That has been a big reform. But over the course of this

Parliament is the 500 million shift in funding to primary care will see

for the first time over half of the health budget being spent on primary

and community health services. That is a big shift. That will mean

changes. The National clinical strategy which has been supported by

health professionals the length and breadth of Scotland lays out how

that is going to happen. There will be specialist centres, elective

centres, which will do some of the hip and knee operations that people

will need more of an ageing population. It will mean some pain

-- it will mean some changes to acute services. We hope this will

get support from across the other parties and of course leads to take

the public with us on some of these changes as well but that National

clinical strategy is the way forward. Audit Scotland accept that

and support that. We agree that we need to bring together all of these

things into a delivery plan. We have said that by the end of this year we

were way out in detail the milestones, the finance, and of

course the workforce plans. But despite how you allocate the money,

you essentially face a choice, I don't reduce spending on acute care

and shift resources more into the community, or you maintain acute

services and somehow find an extra pot of money from elsewhere, so what

is the strategy you are adopting? Their health budget will increase

overall sort by 2021 it will go up by 14.2 billion, an extra ?500

million above inflation over this parliamentary term, that means that

the health budget will grow by another ?2 billion, however demand

is also growing and we need to make sure that a bigger proportion of

that money goes to primary care and community health services. And we

will need to release money from acute services. The National

clinical strategy lays out how that will be done. We need to of course

make sure that people still get a good service whether it primary care

or in the acute sector, that change will be required. We will have to

drive that change forward. One way forward is the ambitious waiting

time targets, it is mentioned in the report today. The problem is that

there is no money left over to make those big changes. Of course Harry

Burns has been appointed, he was the previous Chief Medical Officer, very

well respected, to lead a review of the targets, because it is important

that we measure what is important, so outcomes for patients need to be

the focus of our targets. I think we accept it is time to look at all of

that, not just in health but in here as well. Does this mean you will

abandon some of the targets? I am not going to prejudge what Harry

Burns comes up with. He will consult widely, health professionals,

patient groups, the public, to make sure we are measuring the right

things, that we can measure the outcomes for patients, rather than

just the inputs. Let us let Harry Burns get on with that job. It is

important that people get access to speedy diagnosis and treatment for

cancer, for example, we are investing another ?100 million over

the next five years to make sure people get quicker diagnosis and

treatment of cancer. We need to make sure that people still get access to

quick diagnosis and treatment, particularly where we want to

improve survival rates. Cancer is a very important area that people will

expect to get quick diagnosis and treatment end. One of the ways you

could reduce the pressure is on the health service is by tackling bed

blocking. You said last year that you wanted to eradicate bed

blocking, why had he failed to do that? Delayed discharge has reduced.

Audit Scotland recognise that. They have not produced quickly enough. I

want to eradicate it and they have the ambition to eradicate it but it

has been quite challenging, but if I could point out if you look at the

health and care partnerships that are now responsible for planning

bills services that will get people out of hospital, some of them have

performed very well, reducing delays to series or less. You have reduced

locking by 2% per year, if you continue with that we will never get

there. We need to up the rates. All of the partnerships are performing

as the best 25% are, doing what they are doing, we read reduce the lead

discharge by half overnight so we are working with partnerships that

have got more to do to tackle delays. We know what works. The

partnerships that have eradicated delays effectively have done the

things that we nor work. We want all partnerships to do that and we will

work with them to make sure that they do that. How will you move more

health care into the community and social care generally when you are

cutting budgets of local councils? We have already invested ?250

million in this financial year, that is quarter of ?1 billion, that will

continue throughout this Parliament, invested in social care, and the

reason we did that, and that was quite controversial because it meant

that half of the money going to the health budget was then transferred

through their health and care partnerships through integration

into social care, but we felt that was the right thing to do because we

know that without social care packages we cannot keep people at

home and importantly we cannot tackle delayed discharge. That is a

big investment. That'll make a big difference in making sure that we

have the package is there to get people out of hospital when they are

ready to go home. That is a big investment and we will see the

benefits from it. Thank you. You may have noticed there's been

a revolt against the political From Trump in America,

Ukip and Momentum here in the UK, But perhaps the most radical

is to be found in Iceland. The Pirate Party favours direct

democracy, complete Government transparency,

and the decriminalisation of drugs. And polls ahead of the upcoming

general election there suggest it could head up a new

Coalition Government. Joining me from Reykjavik

is Ingo Sigfusson from The Icelandic Where has this party coming from and

who is appealing to? The art appealing by and large to younger

people but they seem to be appealing to pretty much every portion of

society to some extent. The roots of this party can be traced back to the

results of the financial collapse in Iceland in 2008. We saw the

Government collapse in early 2009. Several new parties were started at

that time, many of them appealing to grassroots and direct democracy, and

many people who formed to Dave's Pirate Party began their political

involvement at the time and they have three parliamentarians already.

That is one of the unknowns about this election, although they are

doing quite well in the polls, we know because they have a lot of

followers among young people that young people tend to be the group

that does not come out to vote so that the something that we will be

following closely on Saturday. There is a scepticism about the

political elites all across Europe. Visit the case in Iceland that a lot

of people think they're politicians are corrupt? That is entirely true.

Because of ice and's size, politics, business, everything is intertwined.

There are only 330,000 of us. Everyone tends to know everyone. We

saw the established political parties quite happily involved in

the fears that led up to the financial crash of 2008. Many feel

that those parties have not really faced up and apologised to the

extent that they should have. This spring we had the Panama Papers

which showed us that the new crop of established party politicians were

perhaps not quite as transparent, and they were certainly not going by

the same rules that applied to the rest of us, and that re-affirmed

people's belief that politics, traditional politics, was corrupt

and we needed to change yet again. Is it more a movement or a political

party? Its leader says it has no ambitions

to be Prime Minister. The person you are probably referring to, the

best-known, although the route the jobs. They are a movement. They want

to implement the policies. They want an online system where people login

to vote on legislation. They do not look or act like politicians. Many

of the policies that they are advocating, some of them have been

picked up by other parties, but they are quite unusual.

What do they say about the economy? Iceland has recovered to a large

extent since the financial crash in 2008 but is there no business in the

business community about what would happen if Pirate Party did well.

I don't think there is real nervousness. One reason is because

even if they get 19-22% of the vote that they might get, they would have

to go into coalition. The four parties in government have agreed

they would try to form a coalition got the necessary votes. Even if the

Pirates were as radical as some people think they are, and they

probably aren't, even if they where they would have to compromise

because their coalition partners may not share their views on everything

or be as radical. I don't think the Pirates will take up the country and

run everything into the ground. We have had unusual parties run parts

of the country. We had a comedian run for mayor in Reykjavik a few

years ago as a lark but he won. He did not do any better but not any

worse than the previous incumbent. The headlines from Iraq just today

are full of the bloody battle for Mosul and a human rights prize

for two Yazidi women who escaped sexual slavery at the hands

of so-called Islamic State. The latest instalment

of misery in what seems to be A new exhibition of pictures aims

to show a different side Probably not what you think about

when you hear the word Iraq. These images by the photographer Mohammed

Kelenchy appear in an exhibition in Glasgow.

Iraq is a civilisation, whatever you think of art and history. Iraq is

the country of the cradle of civilisation and now all that people

in Scotland know about Isis and Sunni and Shia and Christian and

Israelis. Iraq is not like that. These pictures are reflecting what

we are. Not like the bloody pictures that are present in the media about

us. It is really reflecting our culture. It is not what we're seeing

in the media now. There are as many reasons for being

here as there are Iraqis in Scotland.

I came as a Ph.D. Student, sponsored by the Iraqi government. When I came

it was not like this part during these three years it has been upside

down. No escape and phone calls are a

lifeline to home. -- now Skype and phone calls. But

although that contact keeps you close, it also remains you how far

away you are. You want to be between them. You

want to share all these memories with them but you cannot go there.

For now, memories and by pictures on a wall and hopes that they will give

us a new image of Iraq. I love Scotland. It is my second

home and you know how Scottish people are extremely kind people and

it is good for them to know what I am as an Iraqi living in Scotland.

If it is indifferent faith, different cultures, food, education.

That is what we're trying to candour of the image of what the media put

for us for many years. Now, joining me to discuss the day's

big stories are the journalist Dominic Hinde and the former

Scottish Labour adviser Simon Pia. Less document the NHS first. The

audit report out today and there seems to be a consensus on boats

moving from hospital-based care into care in the community.

But progress has been slow. I think this is a problem for the SNP. They

have had one of the longest most extended honeymoons in politics and

I think they are in a difficult position no because with the

prospect of IndyRef2, people are going to ask them what they are

actually like at running something. It is mounting up with education

problems and the NHS and it cannot wash their hands and blame

Westminster or previous Labour administrations because they're been

in power for over a decade. A lot of the blame rests with the First

Minister Nicola Sturgeon. The SNP are very conservative fiscal --

fiscally and you need more money. Labour, to their credit, were honest

enough in the recent elections for Holyrood said a penny on tax to pay

for public services. It didn't do them much good in the polls but that

is where the problem lies. Sean Robertson is not admitting that.

It was under a Labour government in 2005 merger had the care report

warning about all the changes. That was part of Labour's manifesto

in 2011, care in the community. The Scottish Government is not

supporting health boards and councils who would be providing the

care once people were discharged. This charge still is one of the big

problems. So you are saying put up tax to do

that? I think the whole of society is in

denial about this. We want low tax lake in the US but good public

services late in the Nordic countries and you've got to bite the

bullet and see how for this? The SNP wanted because they are political

carrots and so were Labour but they have got their act together.

-- political coward 's. Underneath all of it is this need to

shift responsibility from hospital-based care to community

care. There is an understanding in the NHS

in Scotland, I have spoken to managers in recent weeks, and there

is an appetite for things to happen. But the government haven't budgeted

enough money to make them run the right way because she cannot run the

health service on a running budget and reform it.

Do you think the NHS is fit for purpose? There is ever-increasing

demands and the cost of drugs is rocketing and there is an ageing

society. It is still admired throughout the

world but there is political coward mess. We all love the NHS but a

political party should see this as an NHS tax we are going to put up.

These are cuts, not savings. The previous Administration said the

same thing. The responsibility lies with them and they have got to get

their act together. It is not only Audit Scotland who have criticised

them. Last year, the Association of medical colleges and faculties were

also damning. They have been warned time and again and there is no

action. I think the NHS makes up 40% of

Scottish Government spending. Can it be allowed to go up any higher?

I think it depends how important you think health care is. When you think

that we have the most advanced health care system in history in

terms of technology. You pay your national insurance and get health

for life, it is a brilliant system. If people want to pay money for it

to does not necessarily a bad thing. Do you think the whole culture of

the way we talk about health is something that needs to change?

Maybe there is too much focus on waiting time targets.

I would maybe say that. But there is also the culture of managerialism.

Even get it at the BBC, too many managers rather than new front line

journalists. I was really struck by the management culture 20 years ago

when I did work in the NHS. Let us turn to our almost daily

wrecks and discussion. -- Brexit. David Mandel has been speaking about

what it will mean. They will not be a special deal for

the city or for the car industry. There will be issues in relation to

financial services around part sporting, so specific issues around

specific industries but it is wrong to characterise that some areas of

the country will get a special deal. It doesn't look like we will get a

special deal. I think the Scottish Government knew

that. Nicola Sturgeon said she had a series of points you want to be mad

but she knew that they would be met the cause of the nature of the

Westminster attitude to what Brexit could be. Also David Mandel doesn't

have an idea himself. He didn't really say anything and that doesn't

Titian. How can you meet demands when you don't know yourself?

There is a backlash on the way, isn't there?

Yes, I think it is moving that way. The way they mishandled the 2014

referendum and Westminster antagonised a lot of the Scottish

population. I think the Tories misread Scotland and there is

trouble ahead. David Mandel was squirming habits today. He is

speaking about no special treatment for Scotland but deferential status.

What can they give Scotland that will satisfy Nicola Sturgeon?

Independence. You never know. If you have some parts in the single

market and other parts of the country not in single market, that's

unlikely to work. It is an almost impossible

situation. You could end up something like China and Hong Kong.

That separate Scotland even more than independence.

What will Nicola Sturgeon do next? I think she is in a very difficult

position but she is being well served by the Tories. The confusion

and Westminster just helped by time and helps women over and say, look

at them. What sort of deal did government do with Nissan? If they

are prepared to do a special deal with the Japanese car manufacturer

but not Scotland or Northern Ireland, what does that say? She can

throw that back at them. The government are being cagey about

what sort of deal or nod and a wink was given.

Thank you both very much. Laura MacIver will be

here on Monday night, usual time. It's seen two of its top figures

quit in as many months. Tonight, new disclosures

about problems at the heart of the independent child

sexual abuse inquiry. Also tonight, the first British TV

interview with the man who created the image of Donald Trump

with the book The Art of the Deal and who is now doing everything

in his power to stop him getting