Jackie Baillie (Dumbarton) (Lab): It will come as no surprise to members that this morning I will concentrate on health spending; however, I do so as a former member of the Finance Committee, where, I am pleased to note, consensus appears to have broken out in my absence.

First, though, I must correct certain scurrilous remarks that Derek Brownlee made. My contribution to the Labour group's night out was indeed very minor when compared with the guest appearances of John Swinney and Nicola Sturgeon and, of course, our very own James Kelly, who—with physical enhancements—appeared as Big Eck.

Let me be serious for a minute. Before I turn to the 2010-11 budget, I will briefly consider the budget for this financial year. Many members will be familiar with Audit Scotland's report "Overview of the NHS in Scotland's performance 2008/09", which makes it clear that NHS boards are having to make more than £175 million in recurring savings and £25 million in non-recurring savings. In other words, they will have to make £200 million of savings simply to break even this year. By any stretch of the imagination, that is a substantial amount of money. The report goes on to say:

"This presents a significant challenge for many NHS bodies, and their auditors have stated that it will be difficult for some to achieve the required level of savings without any negative impact on the services they provide."

So front-line services will be affected.

Although I welcome the Scottish Government's commitment to protect front-line services next year, any such commitment needs to be real. Frankly, if it is unable to protect such services this financial year, one is left to question whether its prospects of doing so next year are realistic. The Government also has to spell out what it means by "front-line services". Do they include clinical staff such as nurses and doctors? What about cleaners and porters, who also do vital jobs? Does the Government accept that reducing staff has a direct impact on services?

The Finance Committee concluded worryingly that there is little evidence that front-line services are being protected and said that the budget document contains no analysis of the definition that was provided by Mr Swinney, and no indication of how it had been applied and services prioritised. That view was supported by other subject committees, which emphasised the difficulty of ensuring that—and tracking whether—this prioritisation of front-line services happens at all.

Let me illustrate that with what we know is going on in NHS Greater Glasgow and Clyde, which has still to produce its cost savings plan for 2010-11. However, its 2009-10 plan describes the cost savings challenge that it faces in order to secure a balanced financial outturn and identifies £55 million of savings that it will have to make simply to break even. Its list of cost savings includes several service redesigns that have no supporting data that demonstrate that they are real efficiency gains. It includes traditional mechanisms such as vacancy management, which is short term and not a recurring efficiency, and cuts in discretionary spending. Again, none of those provides analysis of the impact on front-line services. When we take a closer look, no less than 15 of the 20 proposed savings are identified as having staffing implications. In a labour-intensive service, it is difficult to see how such savings will not impact on front-line services.

We in the Labour Party highlighted the lack of transparency over NHS savings last year. It is disturbing to see that that lack of rigour continues. Little output information has been provided to validate efficiency gains. Service reductions are referred to as "efficiency savings", and savings are being used to balance the books, not for reinvestment. I have to say that 2010-11 looks like being a very tough year for health boards, too.

I have listened to some of the contributions and, despite best wishes for Christmas and the new year, the SNP still has its single transferable excuse, which is to blame someone else—in this case, it is Westminster. Unfortunately, the facts in respect of health services do not bear that out. The SNP is responsible for giving health its worst budget since devolution, as is clear whether we look at it in cash terms or in real terms. We need to go back to the days of Michael Forsyth to match how bad the current allocation is. This year, the real-terms increase has been 0.9 per cent in the health line alone, if capital acceleration is included. However, if that is taken out of the health line, the increase reaches an all-time low of 0.1 per cent. Last year, the NHS got 2.5 per cent, and we can see evidence that it struggled.

We need to compare that with the NHS in England receiving a 6.7 per cent increase year on year for the same period.

Derek Brownlee: I am not challenging the figures that Jackie Baillie has used, but is one of the issues not that the per capita spend on health in England is still lower than it is in Scotland, so Barnett consequentials will always be lower until we reach parity on the per capita spending?

Jackie Baillie: It is true that the per capita spend in Scotland continues to be higher, although the gap is narrowing, but we have not delivered the outcomes that we would expect from that increased health spending, and there is a lack of the transparency that would enable us to understand why that is the case.

Of course, Mr Swinney might seek to contradict me, but he might be less willing to contradict the British Medical Association, the Royal College of Nursing or Unison. The BMA said recently that there has been a reduction in front-line staff. The head-count increase that has been so lauded by the Cabinet Secretary for Health and Wellbeing actually masks a cut in the number of medical posts. Figures show that the number of nurses dropped by 2.1 per cent and the number of consultants by 0.2 per cent, and that there was a staggering 13 per cent drop in accident and emergency specialists.

The Deputy Presiding Officer: The member will have to conclude, I am afraid.

Jackie Baillie: That is not a record to be proud of. I ask the cabinet secretary to reflect further on the needs of the NHS.

Official Report Thursday 17 December 2009 - Budget Process 2010-11