Plenary, 11 Dec 2003

Meeting date: Thursday, December 11, 2003

Official Report 675KB pdf

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Public Services

Good morning. The first item of business is a debate on motion S2M-718, in the name of David McLetchie, on the reform of public services, and three amendments to the motion.

I do not dispute the fact that the Labour Government at Westminster and the Labour-Liberal Democrat Executive in Scotland have significantly increased spending on our public services and continue to do so. That is a matter of fact. This year, more than £7 billion is being spent on the national health service in Scotland, which is an increase of 30 per cent in cash terms and 18 per cent in real terms since 1999. Indeed, we spend almost 9 per cent of our gross domestic product—our annual national output—on health. That is the highest in the developed world according to the Organisation for Economic Co-operation and Development. There have also been significant increases in spending on education. For example, spending per secondary pupil has gone up by 13 per cent during the past four years.

I am happy to acknowledge those facts. I just wish that some of those in other parties who call constantly for more honest and reasonable debate in Scotland would acknowledge that significant and real year-on-year increases in expenditure were also a feature of the last Conservative Government, when health spending went up by 58 per cent and spending per secondary pupil went up by 27 per cent in real terms.

However, what matters is not who spent what, but the standards and level of service that are provided to the public. That was recognised in the Labour Party's 1997 election manifesto, which said that

"the level of public spending is no longer the best measure of the effectiveness of government."

How true.

I do not want to bury today's debate in a deluge of statistics. Suffice it to say that in a wealthy country such as Scotland, and measured against what we pay in taxes, we cannot and should not be satisfied with the length of time that patients have to wait to receive hospital treatment. We cannot be satisfied with the levels of attainment in many of our schools, and we should not tolerate the current levels of crime, especially violent crime, that plague far too many of our communities.

David McLetchie mentioned waiting times. Does he acknowledge that a maximum waiting time for in-patient treatment of nine months is a lot better than the maximum waiting time of 15 months that was achieved in the latter stages of the last Conservative Government?

The Executive can set targets in maxima, and I do not want to get bogged down in statistics, but it is undeniable that waiting lists are longer than they were four years ago and—to use the First Minister's favourite word—median waiting times are also longer, despite the additional expenditure of £1.7 billion on health over four years. That suggests to me that something is fundamentally wrong. There is certainly something wrong if the Minister for Health and Community Care buries his head in the sand and refuses to acknowledge what is plain for all to see.

What is happening is happening not because of any lack of political will on the part of members in the chamber; I have never doubted for one second that every party represented in the Parliament shares the objective of ensuring that everyone in Scotland is guaranteed access to high-quality public services. The debate is about how we achieve that.

We should have the courage to admit that the quality of public services is superior in many other western European countries. For example, in relation to health, waiting lists for hospital treatment in countries such as France and Germany are virtually unheard of. Cancer survival rates are better. The OECD ranked the United Kingdom bottom of a list of 11 countries on the care of stroke victims. We were the only country to be classified as having a high death rate from that cause. We all have an obligation to ask ourselves why we are not obtaining better results and what we can do to improve the situation.

The structures of our public services are overly centralised and we require reform that moves away from central control and direction. That view is shared by those at the highest levels; no less an authority than Kofi Annan, secretary general of the United Nations, is quoted in the latest Scottish Council Foundation document "The Fifth Wave" as saying:

"centrally planned systems don't work."

Unfortunately, our health service still contains too many features of such centrally planned systems with centralised targets, centrally directed funding and rigid national terms and conditions of employment. That means that the system can develop only as a result of the decisions and commands of politicians and bureaucrats, and it cannot respond adequately to patients' demands.

That is why resources are misallocated and the extra money that is going into the system is not delivering better results. The rigidities in the NHS also mean that it is less innovative than comparable systems. That was borne out by the Wanless report, which found that, in comparison with the United States, Canada, France and Australia, the UK NHS was the worst at introducing new technologies that could make a difference to people's lives. We must seek to change some of those features.

For many people, the ultimate justification of the current structure of the NHS is that it is fair. However, even that must now be questioned. Earlier this year, when he was Secretary of State for Health, Alan Milburn told NHS chief executives:

"In fifty years health inequalities have widened not narrowed. Too often even today the poorest services tend to be in the poorest communities."

He was right, even if he has now retired in despair. Those who defend the status quo on public services are defending a model of entrenched inequality. It is a two-tier system.

If we are to improve our health service, the extra spending must be accompanied by genuine decentralising reform to create a more flexible and diverse system that puts patients first. That is in line with the analysis in reports from two highly respected independent think-tanks—the King's Fund and the Scottish Council Foundation—both of which urge a move away from one-size-fits-all systems and a celebration of diversity and greater responsiveness to the needs of individual patients and communities. The First Minister and Mr Chisholm claim to follow the same principles, yet there has been no sign that they are prepared to take the steps that are necessary to change fundamentally the relationship between the patient and the NHS.

We will begin to create a truly patient-centred health service only when we start to give all patients genuine choice, and therefore greater control over the treatment that they receive, by giving them real purchasing power. Anything else means that no matter how much consultation is involved, the ultimate decision is still at the discretion of the medical authorities. At present, health boards may send patients to other parts of Scotland or the UK for treatment, but patients can go only where they are sent. Ironically, that was one of Labour's main criticisms of our system of general practitioner fundholding, in which patients had to follow the contract.

Accepting for the moment Mr McLetchie's proposition about choice, and given the consequent removal of resource from the public sector and the failure to build capacity, how will that help us to deal with inequalities in the public sector? That is something that the member criticised in relation to the current system.

Our proposals are about shortening queues and not jumping queues. We are talking about building capacity by doing what is done in many western European countries—by having a higher level of overall spending and a better balance of provision between the state-funded sector and the independent sector. That is a feature of health care systems in all the countries to which I have referred. We are almost alone in having a monopolistic state-funded system. If we want improvement for all, we will have to lever in additional resources. I will expand on that point later.

At the moment, choice is available only to those who can afford to pay twice: once through their taxes and again through direct payment or insurance for private treatment for themselves or their families. That is why we believe that choice should be extended to everyone through a patient's passport. A patient would still enter the health system through their GP and consultant; however, once diagnosed, they would be able to take the standard tariff funding for their treatment anywhere within the NHS. Such an approach would ensure that money followed the patient's choice and would lead to a truly national health service, not a regional one in which access is determined by one's postcode.

Although many patients would undoubtedly choose a local hospital for their treatment, others would exercise a choice that was based on a shorter waiting time or on acknowledged expertise in another institution. What matters is not the basis for patient decisions, but the fact that the choice is in their hands. The GP's role would be to advise on comparative waiting times, outcomes and locations and to act as a professional advocate for patients.

The patient's passport is a very important issue. Is the member saying that it would act as a passport out of the NHS for people who could afford it? Has he estimated the amount of money that would be siphoned off from the NHS to provide for it?

We would save money in the NHS and ensure that better provision was available to all by shortening queues and therefore lessening demand on the service. We would also lever more money into the health service overall, because people would pay to supplement the 60 per cent rebate on the standard tariff that they would receive from the service. Overall, our approach would improve investment and expand the range of providers and services. That is what we want to achieve.

Schools face similar problems to those that are faced by the health service, with a one-size-fits-all system that is justified largely on the grounds that it is fairer and more equal. The reality has been very different. There is an enormous gulf between the best and the worst performing schools and, overwhelmingly, it is the children in our most deprived communities who are trapped in poor schools.

The solutions to the problems of our schools are, in essence, the same as those for health. Parental choice must be at the heart of the system. In Scotland, choice exists currently only for those who can afford it: the small number who can afford—and are prepared—to pay twice. That is obviously true of those who pay their taxes and then pay for independent education on top. However, it is equally true of those who use the state system but can afford higher mortgages to buy houses in the catchment areas of the best schools. As a result, we have a system that entrenches inequality and denies educational opportunities to the least well-off.

The Tories propose to introduce an education voucher system. Is the member aware that in England, where there is more of a market situation, some children have to travel more than 11 miles to the nearest school with an available space?

If children have to travel to school—and their parents want them to—they should be free to do so. I find it difficult to understand why people in the Labour Party want to prescribe the schools that people should send their children to. It is quite illogical. The question whether to send their children to a particular school should be a matter for people's independent judgment. We should not tell them what to do.

We advocate a better schools passport, which would enable taxpayers' money to follow children to the schools of their parents' choice. That clarifies the role of the Government, which should be to act as the funder of education. However, the purchasing power would be transferred to parents. The passport would be equivalent in value to the current revenue cost of providing primary and secondary education, as well as a capital element that would allow popular schools to expand and new schools to be established.

Furthermore, a better schools passport would enable parents to send their children to any school—whether run by the council or by an independent educational trust—that was prepared to offer their child an education at a price equivalent to its value.

Will the member give way?

I am sorry; I really must finish.

Such a measure would help to develop a network of state-funded but independently managed schools and extend choice beyond what is on offer from our councils. In other words, we want a Jordanhill that is for all parents in Scotland, not just for a few who happen to be Scottish Executive ministers.

Whether or not members of other parties agree with our proposals, they should at least recognise that, despite all the extra spending, the current structures are not meeting the needs of our people, particularly the less well-off. In looking for improvements, we should remember that the current systems were shaped in the aftermath of the war and were designed to deal with a different world from the one that we face today. That was a world of rationing, lower expectations and lower life expectancy.

Will the member give way?

I am sorry; I am just winding up.

Times have changed and people are used to making—and expect to make—choices about all aspects of their lives. They are not content simply to accept their appointed lot—and rightly so. I believe that the same principle of choice should apply to our policy on public service delivery.

People expect this Parliament to debate and to come up with solutions to the big issues that we face. There is no bigger issue or responsibility than the state of our public services. This morning, we have kicked off a new and vigorous debate on the future provision of those services. [Applause.]

For that reason, I am pleased to move,

That the Parliament acknowledges the increased levels of spending on our public services, but notes that this has not been reflected in improved standards of service; recognises that fundamental reform is needed of public services in Scotland to achieve the standards of many other European countries and provide value for money for our taxpayers; calls, therefore, on the Scottish Executive to give patients genuine choice over the treatment they receive, establish foundation hospitals within the NHS in Scotland and promote the development of, and partnership with, the independent sector; calls on the Executive to expand choice and diversity in education by enabling taxpayers' money to follow children to the schools of their parents' choice and develop a network of state-funded but independently managed schools, and further calls on the Executive to enhance local accountability in respect of the provision of police services by the direct election of conveners of police boards.

The Tories might well be cheering—albeit in a rather muted way—but they certainly will not be cheering when the Scottish people get their chance to give their verdict on the ludicrous policies that have been set out this morning. Despite David McLetchie's moderate tones, which were a velvet glove to disguise an iron fist, he has given us a glimpse back into the dark, awful days of Thatcherism that we had to suffer for many years. Indeed, his proposals signal something worse than that, if that can be imagined, and confirm the Tories' lurch to the extreme right under Michael Howard, who gave us the poll tax and made millions more people unemployed.

There the Tories are, hurtling back through time to collect the debris of their old policies, patch them together and try to put a new label on them.

Will the member give way?

I will take an intervention in a while. I want to get into my stride.

It does not matter whether the Tories put a new label on those policies: they are the same old failed Tory policies that we have seen time and again.

Will the member give way?

Please let me get into my stride. I will be happy to take some interventions in a moment.

The Tories have been in opposition for six years, but they have not thought up a single new idea in that time. Let us be clear: the policies that we have heard about this morning are designed not to improve Scottish public services, but to dismantle them and to abolish the comprehensive system of provision that we have established. David McLetchie made that very clear in a speech that he gave earlier this year.

What is so wonderful about a system that has failed, by a significant margin, to meet the Executive's own target of ensuring that 80 per cent of children reach an appropriate standard of English reading, writing and arithmetic? What is so wonderful about a system that delivers such miserable results?

That is a complete misrepresentation of the position. Year on year, we are seeing an improvement in the attainment levels of all children in the five-to-14 age group. We are picking up from the disastrous legacy and low attainment levels that the Tories left us when they left office.

The difference between the Tories and us is that the Tories do not believe in community or society; instead, they believe in individuals and markets. As David McLetchie made clear last week, they reject the socially just society that we seek to create. Their vision is of a world in which the strong survive and the weak go to the wall. As we have seen time and again, the Tory party is a party of social exclusion and privilege; it is interested only in the few. The truth about the Tories is that they want to force people into the private sector by running down Scottish public service. That forms the background to their policies.

We, in the Executive parties, believe in investment in and reform of our public services, not in the status quo, but the Tories believe in cuts and competition in our public services. We believe in excellent services for all, but the Tories believe in good services for the few, at the expense of the many. That is why we comprehensively and fundamentally reject their philosophy.

Does the minister accept that the people who suffer most in the current comprehensive school system are those who cannot afford private education and cannot afford to buy a house in the catchment area of a good school, but are trapped in the catchment areas of poor schools? Why does he not accept that those are the people who suffer under his policies?

I will consider the Tory education proposals in some detail, and Malcolm Chisholm will pick up on the health matters in his closing speech. My colleagues will help to demolish the other arguments that the Tories have flung in during the debate.

Today, like last Thursday night, David McLetchie paid hardly any attention to education. Last week's speech was 26 pages long—he will be delighted to know that I read it in close detail—but less than two pages focused on, or were devoted to, education. It is easy to see why he said so little about education, both last Thursday and today—it is because his proposals for education are superficial, ill-considered, unprincipled and completely unworkable. They are dangerous and simplistic policies that will penalise pupils, parents and, particularly, the poor in our society.

The Tory policies would starve most of our schools of funds in the interests of only those who can travel or start their own school—that represents choice as a substitute for excellence throughout our education system. We should be clear that that is the Tories' policy intention; the policy is designed to mean choice for the few and chaos for the many. That is not an accident—the policy has been designed specifically to create a two-tier education system, in which only the few will benefit.

I do not disagree with a word of the minister's analysis of the Tories. However, does the minister accept that he, too, is culpable because he accepted with gusto one of the Tory policies—use of the private finance initiative and public-private partnership projects? That has left schools in East Lothian in a state of chaos as a result of a private contractor going into administration.

The SNP, if it had the chance, would cancel all the projects that we have commissioned and stop the building of new schools in Scotland. However, we want to see progress and we are happy with the progress that is being made.

The Tories' policy on education is a policy for the privileged elite who have social mobility, can travel and can exercise choice. There would be another system for those who were left behind—those who cannot exercise choice and who do not have social mobility. The policies are born from David McLetchie's view, which he has made clear, that he regards education not as a public good, but as a private privilege.

In the brave new Tory world, each parent would get a passport—a voucher by any other name, as has already been said. The voucher would have equal value throughout Scotland—

Will the minister take an intervention?

Let me finish the point, please.

Parents would take the voucher along to their local, or any other, school and demand to get in. The problem is that the answer may well be no, because the cost of education in that area is higher than the average cost in the rest of Scotland. In Shetland, Orkney, the Western Isles, most of the Highlands, most of Grampian, Argyll and Bute, the Borders, parts of Fife, the Angus glens and so on, the voucher would not buy people the education that they currently get. It is clearly not a policy for most of rural Scotland, where the average voucher value would not be sufficient.

Will the minister take an intervention?

Let me finish the argument.

It is also not a policy for much of urban Scotland, because the costs of many schools in our more deprived communities are also higher than average. The policy is designed not for most of rural Scotland or much of urban Scotland, but for the leafy suburbs, for the few and not for the many, and for those who can top up the value of the voucher.

Will the minister take an intervention?

Will the minister take an intervention?

Where will the money come from to fund those schools in the leafy suburbs, the ones that the Tories want to be better? It will be taken from the many and given to the few.

I give way to Lord James.

Is the minister aware that his Prime Minister, Mr Tony Blair, made this recommendation:

"Why shouldn't good schools expand or take over failing schools or form federations?"

By implication, the minister is condemning his own Prime Minister.

On the contrary, the Labour Party, both north and south of the border, is committed to improving standards for all our children. We have always had a very distinctive Scottish system and will continue to do so.

The second reason why parents might be met with a no when they turn up with their voucher at the local school is that the school might already be full. Those parents might happen to get there later than parents who are more mobile.

Most parents in Scotland want their children to go to the local school, but under the Tories' policy there would no longer be school catchment areas; there would be a free market for school places. That would lead to a free-for-all and, most likely, to chaos. Brian Monteith has said that the Tories have solved the problem of full schools. Each passport would have a capital element to it, as David McLetchie indicated, which would mean that parents could get together and build extensions to schools, or entirely new schools. Anyone with an ounce of common sense knows that that proposal is complete and utter nonsense. There would be such minor practical considerations as land supply, planning permission or the time scales that are required to develop new property. The capital element of the voucher would come from others in Scotland, who would provide the privileges for the few, as the Tories intend. The proposal is the kind of "simplistic tosh"—as Judith Gillespie put it—that characterises the Tories' plans.

Will the minister take an intervention?

You have about two minutes left, minister.

I will take a brief intervention.

The minister condemns vouchers, saying that they are intended only for the few. Does he also condemn the Labour members or their staff who use the parliamentary child care voucher system?

I expected better from Brian Monteith. I will treat his question with the contempt that it deserves.

The worst aspect of the Tory proposals is that, even if they worked for some, they would certainly not work for most people. If people could not exercise their choice for reasons of geography, transport or any other issue, what would happen? They would be left to rot, because a concept of failure and second best is at the heart of Tory policies and the Tory philosophy on education. The Tories do not care about the majority. Children would be left to rot in schools that had fewer teachers, higher class sizes and no improvement strategy and they would languish in those schools under a Government that was uncommitted to doing anything whatever to support improvement in those schools.

That is the philosophy that fundamentally divides the Tory party from the Executive parties. Whereas we will make improvements for all Scottish children, the Tories would turn their backs on the many in the interests of the few. That is why they have lost every election in Scotland over the past 25 years and it is why they will continue to lose elections in the future.

I move amendment S2M-718.3, to leave out from "acknowledges" to end and insert:

"supports the radical, demanding and relevant agenda set out in A Partnership for a Better Scotland including the delivery of excellent public services that put patients, pupils and victims first, ensure equality of access across urban and rural Scotland, devolve decision making to frontline staff, establish national standards on which local excellence can be built, backed by inspection, and share best practice and action to tackle and turn around poor performance."

There is a saying that a leopard never changes its spots, which is certainly true of the Tories this morning. Their answer to the crisis in the health service and failing standards in education is that the private sector will solve the problem.

The Tories say that the staffing crisis in the NHS, which is the root cause of so many of the service's problems, will somehow be solved if we take more staff away from the NHS to work privately, using—I presume—NHS facilities. Given the small number of private hospitals in Scotland, that policy is nothing short of total nonsense. Every pound that the Tories gave to the private sector would mean a pound lost to the NHS to try to build capacity to treat more patients and reduce waiting times. Under the Tories' proposals, we would have a shrinking, second-class NHS, which dealt only with life-threatening situations, and a burgeoning private sector for those who could afford to pay.

On education, the Tories want parents to be able to send their children to the school of their choice, but they do not explain what happens when that school is full. Must schools then cram children into overcrowded classrooms? Will unpopular schools simply close as the market dictates? Will parents have to build schools if they want their children to attend a local school?

Does the member acknowledge that, throughout Scotland, many popular schools are being closed by Labour councils, with the approval of the Executive? Does she agree that if parents had more power to choose their children's school, popular schools, such as Earnock High School, in Hamilton, would still be open and would not be being axed by Labour councils and the Labour Executive?

Mr McLetchie will not find me defending Labour councils in Scotland; however, neither will I accept the Tory policy that the survival of the fittest is the way forward and to hell with the rest.

This debate has more to do with the new regime under Michael Howard being determined to pull the Scottish Tories into line and have Tories speak with one right-wing voice across the UK. Michael Howard may, finally, have apologised for the poll tax but, as he was a minister in the Tory Governments of the 1980s and 1990s, he has a lot more to be sorry for. The people of Scotland will not forget the damage that the Tories did to our public services when they were in power. This debate shows their desire to privatise our public services and will act as a timely reminder to the Scottish public.

The real challenge in the debate is for the Labour-Lib Dem Executive. It is those parties' failure to provide adequate stewardship that has led to many of the problems that our public services face. They have happily continued with the Tory policy of PPP/PFI with great gusto, making Scotland the PFI capital of Europe—a legacy that will mortgage our nation's future for a generation. The £8 million overspend in Lothian because of the PFI at the Edinburgh royal infirmary is just one example of the major impact on patient care and the morale of staff. Hardly a day goes by without there being yet another problem at the Executive's flagship hospital.

Of course, with PFI, the risk is meant to be taken over by the private sector: that is what the private contractors are being paid their excess profits for. However, the Executive should try telling that to the pupils of the East Lothian schools that are asking the Scottish Qualifications Authority for special dispensation from the continuous assessment part of their courses because of the disruption caused over the past few months by the halt in works because Ballast plc, the PPP project contractor, has gone into administration.

Will Shona Robison tell us what the position would have been if the contract had been given to the public sector and the construction contractor that was building it had gone into liquidation? Would the position have been in the slightest degree different?

Of course it would, because profits would not have been put before pupils. Pupils must come before profits—that is what people will get under the SNP rather than the Labour-Lib Dem Executive. Firms are laying off staff and are demanding the return of desks in payment for unpaid bills. Can Robert Brown imagine that happening in the public sector? I do not think so.

The price and the risk of PPP have been laid out for all to see in East Lothian, and there is still no sign of a solution. When the minister is asked, he cannot tell us who owns the six secondary schools in East Lothian. So much for the private sector earning its excess profits by taking the risk; it is clear that it is parents and pupils who are taking the risk. The laissez-faire attitude of the Executive is staggering.

That is especially evident in health issues, on which the Minister for Health and Community Care appears to have no strategy. A piecemeal approach is being taken, with individual health boards centralising their services, which is leading to an increasingly fragmented health service. Health boards are saying that they cannot cope with the pressures that are being placed on them. The impact of the working time directive on junior doctors' hours is causing huge difficulties. Health boards are saying that they have no money to implement the changes, although the Executive has known about the impact of the working time directive for years. Somehow, little or no preparation has been undertaken to cope with the pressures.

Six minutes into Shona Robison's speech, we have had criticism of Labour Party policy and criticism of Tory party policy—flawed though it is, at least it is a policy. When are we going to hear about the SNP policy?

I will come on to a quote from Duncan McNeil himself, if he just holds his horses.

In Glasgow, we are being warned by hospital managers—in something akin to a softening-up process—that the number of hospitals in the city needs to be halved within three years to cope with drastic cuts in doctors' working hours. We are told that as many as 24 hospitals throughout Scotland face cuts as managers struggle to cope with the new laws as well as staff shortages and budget cuts. It is simply not good enough for the Minister for Health and Community Care to tell patients that bricks and mortar do not matter; they do matter when the lack of them means that patients have to travel huge distances to access a dwindling number of services.

Duncan McNeil hit the nail on the head when he said:

"It is crisis management right across Scotland".

I ask Duncan McNeil who is creating that crisis. The Minister for Health and Community Care is creating that crisis by his failure to intervene. It is time that the minister intervened.

Will Shona Robison take an intervention?

No, thank you.

Instead of allowing the butchering of our health service by a thousand local cuts, we need to have a moratorium on the acute services reviews that are taking place throughout Scotland in order to have a national debate on the future direction of our health service. That process cannot be allowed to take place through a muddle of local health board initiatives with no reference to each other. We need a national strategic plan for our health service to build the capacity in the NHS. I urge the Executive to begin that process today by telling us that there will be a moratorium and that it will work towards a national strategy, which we do not have at the moment.

I move amendment S2M-718.1, to leave out from "acknowledges" to end and insert:

"rejects the proposals by the Conservative Party to privatise our public services and deplores the continued use of PPP/PFI to fund our public services by the current Labour/Liberal Democrat Scottish Executive; believes that the developing crisis in the NHS will only be addressed by increasing the capacity of the NHS to treat more patients and reduce waiting times through effective policies to recruit and retain staff within the NHS in Scotland, and calls for a national debate on the way forward for the health service in Scotland."

I am pleased that the Tories have brought this necessary debate to the Parliament. However, I will not take any lectures on poverty and inequality from the party of Thatcher, Thatcher the milk snatcher. The Tory party's sudden alleged caring for the poor, which started with Michael Portillo's television appearance, makes me sick. We must value the public sector workers who work in our public services. Do we value them?

On a point of order, Presiding Officer. If a member is a member of a public sector union, should they not declare that as an interest at the start of their speech?

It should be mentioned.

I am proud to be a member of Unison. I was going to go on to describe not only my membership, but my union activities, including my participation in 60-odd days of strike action over the past two years.

If we do not value workers, we do not value public services. Today is a day of national action on behalf of nursery nurses, who have now been on strike for more than seven months. What value do we place on them? The Auditor General for Scotland found that Scottish Enterprise paid out £108 million in consultancy fees. If consultants, who are highly paid, are worth £108 million a year, our nursery nurses are worth at least £18,000 a year, and our hospital porters, our dinner workers in schools and our cleaners are worth a minimum wage of at least £7.50 an hour. They are the working poor.

Members always start jumping up and down about how we would pay for that £7.50 an hour—which is just £13,000 a year. At this point, I mention the £80 billion in tax that was evaded by the rich last year. I also mention the £5 billion that was spent on bombing innocent Iraqis and remind members of Gordon Brown's comment that the cost would be

"as much as it takes".

We can also look closer to home. There is now an increase in spending—only in the past three years and only because Labour stuck to the Tories' original spending plans—but where is the money going? After years of dismantling, selling off and destruction—the Tories' record speaks for itself—there is a lot of damage to be repaired. We do not hear the Tories mentioning the train crashes, BT or all the other failures of privatisation. There is a lot of damage to be repaired, but the Labour Party is hell-bent on further destruction and privatisation.

Where is the money going? Pharmaceutical company profits have soared through the roof. NHS Greater Glasgow's drugs budget rose 18 per cent in one year and 14 per cent in another. The money has also gone to PFI consortia, including the construction companies whose profits are three to 10 times greater under PFIs than under traditional building contracts. It is no wonder that the money is disappearing down a black hole; it is being siphoned off directly for the profits of private companies.

As indirect taxes go up for the majority of people and those on lower and middle incomes, as there is a constant honeymoon for the rich, and as public service spending is siphoned off for profit, hospital bed numbers are cut, staff numbers are cut and health boards and so on have to fund PFIs through their revenue budgets.

In the UK as a whole by 2007, £4.5 billion a year will have to be found just to service PFI. The experience at the ERI has shown that PFI will not guarantee even the electricity supply. It is time to end the sell-off and the rip-off—it is time to end privatisation.

I want now to concentrate on the NHS.

Will the member take an intervention?

I do not have time.

Four years ago, I moved a motion at Unison's national council expressing our members' concerns about acute service and maternity service reviews. It was clear then, as it is now, that, either through incompetence or by design, there has been an utter failure to consider, assess and plan according to overall national, as well as local, needs. There has been no assessment of the impact on neighbouring health board areas of hospital closures, accident and emergency service closures and maternity service closures, which have led to greater and greater distances between services. How many A and E units, maternity units and specialist services will there be in Scotland? Where is the national strategy?

The Executive amendment, which claims to ensure equality of access, is either utter fantasy or a downright lie. The facts speak for themselves. Lanarkshire NHS Board has called a meeting to ask how to consult on a consultation that will end in February. It is trying to convince us that moving from 15 doctors overnight in each of three hospitals to five doctors overnight in each of three hospitals is an improvement. I am sorry, but 15 take away 10 equals five. There is a move to have emergency surgery on only one site. I agree that if patients can be stabilised, they can wait until the next day, but if they cannot, those most in need of emergency surgery face the further high risk of transfer in an ambulance. What those patients need is emergency surgery, not a trip in an ambulance.

Shona Robison referred to working time regulations, consultant contracts and so on—1 April is shaping up to be groundhog day. Shortages of specialists, the working time regs and the consultant contract did not fall out of the sky. Why are we approaching this crisis?

In maternity services, women from poorer backgrounds, who are most likely to need consultant care, will sometimes have to travel hundreds of miles to get it. Those at the highest risk of prematurity and low birth-weight are precisely the people who will have no local access to consultant care. In this country we have the lowest birth-weights in Britain—what are we doing about that? We see unedifying battles over the least-worst scenarios—are mums' lives worth more than our babies'? That is absolutely disgraceful. We should set our sights on what is best, not on the least-worst option.

I do not expect all members to agree with everything that the Scottish Socialist Party proposes in its amendment. However, there must be recognition that the public are fundamentally at odds with the Executive and with health boards up and down the country. If there are no paediatricians, the answer is to shut hospitals. If there were no antibiotics, would the answer be to accept that we must do without them? Of course it would not.

The public are tired of the refrain that they do not understand and that they need educated. Health boards up and down the country are saying, "If only we can educate them hard enough, they will believe that 15 take away 10 doctors is not five, but 25." Do not be ridiculous. The public understand too well that reviews mean cuts—in maternity services, accident and emergency services and intensive care. No matter how many smoke-and-mirror routines health boards and the Executive use, reviews mean cuts.

I hope that across the parties there is honesty about what is really happening. If there is not, the biggest stain on the Parliament will be not the Holyrood building, but the NHS.

I move amendment S2M-718.2, to leave out from second "the" to end and insert:

"the crucial role played by low-paid public sector workers in delivering high quality services in often stressful situations; notes however, that they are poorly rewarded for their efforts; recognises that the time has come for radical reform of public services so that they can play a fuller role in eradicating poverty and social exclusion; believes, therefore, that the Scottish Executive should reverse the privatisation of public services involved in PFI and PPP and ensure that all public services are directing their main efforts into reducing the inequalities caused by poverty and discrimination, and further believes that the Executive should introduce a £7.50 an hour minimum pay level for all public sector workers in Scotland, call a moratorium on the centralisation of hospital services which reduces access to maternity, accident and emergency and other health services for those living in our most deprived and isolated communities and instigate a full, democratic and inclusive public debate to establish the real health needs of communities and the resources and measures required to meet those needs."

I am pleased to open for the Liberal Democrats.

Ensuring that the people of Scotland have equal access to decent public services throughout the country, wherever they live, is extremely high on the political agenda of members from the coalition parties. The best thing that I can say about the Conservative motion is that at least David McLetchie acknowledges that the coalition Government in Scotland is delivering record levels of funding for our public services.

Another constructive thing that I can say about the proposals is that they are radically different from anything that is on offer today from any other party that is represented in the Parliament. As Peter Peacock pointed out, David McLetchie's explanation of his proposals is simply a reworking of discredited Tory policies on health and education. It is clear to me that the Tories have still not learned that the Scottish electorate has rejected and will continue to reject any policy that is based on creating either a two-tier health service or a two-tier schools system.

Today the Conservative party has served a constructive purpose: it has reminded us exactly why the previous Conservative Government was so unpopular. The Tories failed to invest in our health service, our education system and our transport network. They privatised the railways, pushed up unemployment and stood by as Scotland's manufacturing industry collapsed. The policies that are before us today would create a two-tier NHS, in which the better-off would be subsidised by NHS money to go private while the poor waited in line.

The poorly thought-out nature of those proposals is demonstrated by their failure to address how Scotland's remote and rural communities can access decent health care and educational facilities. It is clear that the Tories like to pose as the party of rural Scotland when they think that they can get away with that. However, the proposals show that they have not given our rural communities a second thought. That is what happens when they try to graft failed Westminster policies on to the devolved Scotland.

Does Mike Rumbles agree that the Executive has created a two-tier health service and that the poor, who cannot pay to go private, have to wait longer than ever before for health treatment? Only those who can afford private health care, who pay taxes but also have to pay the full cost of private treatment, can access treatment quickly.

That is the myth that the Conservative party is generating. We are reducing waiting times and there is no two-tier service in Scotland, although that is precisely what the Conservatives' proposals are trying to achieve.

With all the money that would go to the private sector—I note that when I intervened earlier, David McLetchie was unable to tell me how much—the best doctors and nurses would leave NHS hospitals and the best teachers would leave our state schools, all for higher salaries elsewhere. That deliberate policy of siphoning off money from our NHS to the private sector would mean, in effect, a public subsidy to the better-off.

Will the member take an intervention?

In a moment.

I will say one thing for the Conservatives—they seem to have something of a collective brass neck. The so-called patient passport is simply a passport out of the national health service. I could not think of more divisive and disastrous policies for this country if I tried.

If the NHS provides care for terminally ill people in hospices that are run independently, is that siphoning money out of the NHS to the detriment of patients?

If, in the short term, we can use public money to reduce waiting lists and to address problems, that is fine. The Conservatives are trying to do something completely different—to siphon off public money to build up the private sector. That is quite wrong.

Will the member give way?

Not again.

It is quite instructive that these policies have been announced after the Tories south of the border adopted them. What happened to Scottish solutions for Scottish issues? There is no doubt in my mind that this new policy initiative is simply the Scottish Tories being told to implement English Tory policies.

In April last year, The Mirror revealed a taped conversation that took place at a meeting at the Conservative party conference, at which Liam Fox unveiled a four-phase strategy to undermine the NHS. We heard that described just now. Liam Fox said:

"The first phase is to persuade the public that the NHS isn't working".

It is.

In September the previous year, Iain Duncan Smith—does David McLetchie remember him?—said:

"In the private sector, it will cost more, so they (the patients that is) will have to top up with their own money or use some insurance scheme."

Some insurance scheme? Conservative policy now discriminates against the chronically sick, especially the elderly, who find it difficult to get health insurance. Has David McLetchie not noticed that?

There is no doubt that Tory policies in Westminster and Tory policies in Scotland are almost identical on so-called public service reform. The policies formerly applied only in England but now David McLetchie is backing them in Scotland.

The Tories' record on public services while in government was nothing short of catastrophic, although the public recollection of that record has faded somewhat in the past six years. I grant the Tories that this debate gives us an opportunity to remind the public what the Tories managed to do to our public services when they were last in charge of them. For instance, they introduced charges for eye and dental checks, which I am glad to say we are going to abolish in Scotland. Prescription charges rose from 20p when they came to power to £5.65 when they left. During the Tories' last five years, the proportion of GDP spent on schools fell. Let us not even go into their record on crime. Suffice it to say that they promised that there would be 5,000 extra police officers but cut the numbers by more than 400.

The reasons why the voters of Scotland comprehensively rejected the Conservatives in 1997, booting them out of every constituency in the country, have been resurrected this morning. It is ironic that, just as the party seems to be getting its internal act together after its desperation to get rid of Iain Duncan Smith, the Conservatives seem to have taken leave of their senses by adopting these uniquely divisive policies that are designed to subsidise the better-off at the expense of the poor. I am glad that, at last, the Tories have declared their hand in relation to how they want public services to operate in Scotland. I have every confidence that those policies will be seen as being divisive and disastrous for Scotland and I know that the Scottish people will consign them to the dustbin at the earliest opportunity.

It is my pleasure to contribute to this debate on the general theme of improving the provision of our public services. As David McLetchie has indicated, those services go to the heart of what the public in any civilised and responsible society is entitled to expect. Nowhere is that more relevant than in the obligation of Government to preside over a safe society in which the rule of law is both respected and enforced.

Few people, not even the Executive, would agree that we live in a safe Scotland in 2003. A crime is committed every 1.2 minutes and there is a violent attack every 32 minutes and a drugs-related death every day. Nearly a quarter of Scots do not feel safe when walking alone in their neighbourhoods after dark.

Depressingly—and contrary to what Mr Rumbles was saying—all serious crime is up since 1999 and, with the exception of fire-raising and vandalism, it is up dramatically since 1997. The EU average of crimes per 100 people is 5.9. In Scotland, it is 8.3, which is exceeded by Denmark, where it is 9.4, and England and Wales, where it is 9.8.

As I have previously demonstrated in this chamber, all the evidence from New York and, indeed, Middlesbrough confirms that crime levels fall in the face of neighbourhood policing. Despite the best efforts of a committed and courageous Scottish police force, we do not have neighbourhood policing. The first people to confirm that would be the police officers themselves. That is why my party is calling for an expanded neighbourhood policing presence. That will be the first step towards restoring the rule of law and respect for the rule of law, reassuring the law-abiding majority that they have a role to play and deterring the potential law-breakers from their pattern of crime.

Another vital component in the delivery of law enforcement is the combination of accountability and visibility, as Mr McLetchie's motion suggests.

According to the Executive's publication "Narrowing the Gap", published in 2002, only 22.6 per cent of the total number of Scottish police officers are available for patrol or to attend incidents at a given time and, disturbingly, only 4 per cent of duty time is allocated to foot patrol. That means that only 138 police officers are on foot patrol across Scotland at any one time.

That useful report also said that more than 80 per cent of people agree that an enhanced targeted and visible police presence would make people feel safer and would reduce crime. However, that is not happening and that failure is fuelling frustration, cynicism and disillusionment.

The current governance regime for the police force is provided by the Police (Scotland) Act 1967, which provides for a tripartite sharing of legal responsibility for policing by police authorities or joint boards, chief constables and the Scottish ministers. As we know, many of those boards straddle three or more local authority areas and, to most members of the public, the members of the board and the chairman are unknown and completely anonymous. There is a vacuum between the public, who know the kind of policing that they want, and the providers of that policing. That is why my party argues that police board conveners should be directly elected at the same time as we elect our councils.

Is it not the case that the Tory document "Localisation of the Police Service", which promises a fair deal for everyone on crime, proposes directly elected police authorities? How will another set of elections help to bring down crime?

I thank Dr Murray for her helpful intervention. That is the situation in England and Wales, where police board authorities contain people other than councillors. At least in Scotland we have an ex facie democratically elected structure. That is why we think that an improvement in the element of accountability could genuinely be achieved by making only the chairman the directly elected member.

Will the member give way?

I hope that Cathy Jamieson will forgive me, as I want to expand the point that Dr Murray has mentioned. The two elements are visibility and, importantly, accountability. All members would regard any attempt to politicise the police as regressive and profoundly undesirable. That is where a delicate balance has to be struck.

Directly elected police board conveners would have a public mandate, particularly on boards that are made up of councillors from other local authorities, and they would have the authority to drive forward neighbourhood policing plans and would be accountable to local people. Dr Murray and the minister might be interested to know that the position is not peculiar to the Scottish Conservatives. Her Majesty's Government's consultation paper "Policing: Building Safer Communities Together", which was published on 4 November, seeks views on wholly directly elected police boards south of the border.

When we seek to empower people in relation to health and education, it is logical and desirable that we ensure that they have the same influence in relation to procuring a safe society.

For 15 years, I have been involved in the public sector as an elected representative, mostly at the chalkface, where I have been constantly exhorted and have exhorted others to improve quality, set higher standards and ensure safety. When I first saw today's motion, I thought, "Great! The Tories have renewed themselves. They have a new agenda. They're caring for the less fortunate in society." Having listened to their speeches this morning, however, I now see that all that we have are the same old Tories pursuing the same old policy of improvements for the privileged few while those who are less well off are left out in the cold. The only difference is that the Tories have become better at disguising Thatcherite policies as universally beneficial.

The Tories' general approach is based on the assumption that if we compartmentalise services and consider each one in isolation, we will somehow improve people's lives. In reality, however, each service impacts on another and, in turn, they cumulatively impact on the communities that they serve. The concept of community is alien to the Tories, at least when it comes to policy making. The only ones that they seem to recognise are the business community, the professional community and the well-off who are able to choose.

If the Tories are indifferent to the concept of communities, why do we advocate a policy that will protect communities by allowing parents to choose to keep schools open in their communities instead of being the victims of a centralised educational approach that is denying them freedom and opportunity?

I am delighted that Miss Goldie has raised that, because it demonstrates precisely my point about putting buildings before quality of service and results: buildings do not of themselves deliver good-quality services or improvements to communities, and it is sometimes necessary to reduce the number of outlets for a service to ensure that quality is raised and maintained. If we enable parents to send their children to whatever schools they like, poorer families will lose out because, whatever the choices available, they can afford only the local schools. That is why the Labour-Liberal Democrat coalition is investing heavily in support for poorer areas and areas in which the need for support has been demonstrated.

Poorer parents cannot afford to drive five or 10 miles every morning like the people in the big houses up the road can, so, under the Tories' proposals, the wealthy would send their children to the best schools, which will become better off because of the increase in funding. Nobody in the Tories has demonstrated any recognition of the current funding system or suggested how it might be altered, and we now hear that they will raid the capital budgets as well as the revenue budgets. That is great. Having starved the public sector of capital investment for 20 years, the Tories will now raid the Executive's generosity in increasing those budgets for the first time in 20 years. The Executive has increased those budgets so that the poor have an opportunity to use better-quality buildings and see more police on the street working out of neighbourhood offices, as in the community policing initiative in Fife. The chief constable has demonstrated his commitment to that initiative by increasing investment in it, which is down to the increased money from the Executive that is available to him.

Where has Christine May been over the past 20 years or so? Even in Fife, new hospitals—which the Labour Party is now virtually intent on closing—courts and police stations were provided under the Tories.

The Tories may have provided the odd building here and there, but capital budgets provide for the improvement and maintenance of those facilities and—

Where are the new schools?

I will come to new schools in a moment, if Brian Monteith will wait.

The budgets for maintenance and improvement reduced over the years under the Tories, and I can get Phil Gallie the figures if he wants them.

I will consider hospitals for a moment. I understand that the Tories voted against foundation hospitals down south, and I am sure that, when Michael Howard went on his fishing trip with David McLetchie and Ted Brocklebank—neither of them are in the chamber, so I cannot check—in Pittenweem on Sunday, he took the opportunity to tell them that policies are now the same north and south of the border, but I do not see how that benefits the majority of the population. In the health service in Scotland, we are looking at the improvement that has come about because of the targeting of the key diseases and the consequential effect on acute services. That is difficult.

Tax cuts, particularly in council tax, reduce the amount of money that is available for police, education and primary care services, and I cannot see how that will benefit the poor. I am not saying that Executive policy is by any means perfect—I have complained in the past and will continue to complain about the multiplicity of targets, some of which conflict with one another. There is more work to be done on that, and I hope that, in his closing speech, the minister will accept that approaches such as the quality-of-life money, for which broad targets were set, and the partnership between social work services and the health service in community care for the elderly have worked extremely well. I want to see the Executive doing that kind of thing. By and large, we have huge investment—far beyond what we have had in the past 20 years—in our public services, and I want that to continue.

I support the Labour amendment.

When I was researching for today's debate, I tried to access the Scottish Tories' website, and up came the words, "This page cannot be displayed. Press refresh." Two thoughts occurred to me: "Is this personal or is the great Scottish public also being denied access to the tablets of Tory wisdom?" and "Is it worth pressing the refresh button?" It was probably not worth pressing refresh, and, so far, nothing said by the Tory or Labour members has changed my mind.

In 1997, Labour came into power. Before that, we had 18 years of Tory rule. That means that we have so far had 24 years of Tory and neo-Tory rule: a seamless transition from blue to the palest shade of undetectable pink. The current problems of delivery to the Scottish people are a shared unionist liability. The unionists are a coalition of the culpable.

The shortage of consultants and lack of access to all specialties—oncology, radiology, psychology and every other ology in the book—does not date from this year or last, but goes back for over a decade. It takes 12 years—

Will Christine Grahame give way?

Oh, if Duncan McNeil will let me get into my stride a little bit, I will be delighted to let him in.

Successive Westminster Governments have not recognised the status of nurses, which is key to the delivery of a caring and fair health service, where it matters: in the pay cheque. Let us not talk about percentage pay rises, because a 5 per cent pay rise for a fat cat is a damn sight more than a 5 per cent pay rise for a nurse. Forty per cent of our medical graduates leave and they do not come back to Scotland.

David McLetchie referred to purchasing power, which is, of course, privatisation. A two-tier service will disintegrate the national health service even more. We have fragmentation of professions and allied professionals. Contracting out of cleaning and catering has not improved delivery: we have dirtier hospitals and 40 per cent of our elderly people leaving hospitals are found to have a degree of malnutrition.

Given that Christine Grahame is convener of the Health Committee and given that the SNP health spokesperson made the same statement earlier, does she agree that one of the big problems leading to the shortage of consultants and doctors, which has a tremendous impact on the services that we can deliver, has been brought about by the European working time directive and the reduction of junior doctors' hours, which all parties supported?

No, I do not agree. It takes 12 years to train a consultant—they do not grow on trees—so we were already losing professionals way back in the time when we had the Tories and before Labour, as the neo-Tories, came into power and picked up half the Tories' blooming policies.

Hospitals that are built by PPP/PFI fail—the Edinburgh royal infirmary is a classic case—but Tories and neo-Tories hurtle us down the PPP/PFI brae without brakes.

Does Christine Grahame not agree that the problems with the Edinburgh royal infirmary are due to the bad way in which the contract was drawn up and the lack of specification? The contractors are only supplying what was asked for in the contract, and I think that the minister would agree on that point.

That is right, because it is cheap build and the contractors make their money on running the contract thereafter—we have been down that road with the private prisons. The money is in having the contract for 25 or 30 years down the line. Later on, the public sector owns the building when it is in a state of decay—if it is not already in such a state when it opens.

The NHS bill implodes, morale in the NHS declines and Labour continues with its neo-Tory solutions, which are all in-your-face and behind-your-back privatisation. The hypocrisy of Labour members lambasting Tory policies—when they grub around picking them up, dusting them down and relabelling them—is sweet. PFI becomes PPP, and foundation hospitals, which are Tony's totem, are also a Tory idea. Privatisation, like a rose by any other name, is privatisation.

Will Christine Grahame give way?

No. I ask Christine May to let me get on.

However, those policies are not a bitter pill for the unreconstructed neo-Tories who, appropriately, sit to my right.

I turn from the disciples to the prophets. The Tory solution is to throw more money at the private sector, which will, as it does now, use public facilities. The two-tier Tories promise passports for the privileged, the articulate and the determined—the very people who should stay to defend and use the failing health service and improve it for the less articulate and determined.

Jack the lad's solution is two bills, as if legislation alone will deliver nurses, consultants, general practitioners and dentists. What happened to dentists in Mike Rumbles's speech? He forgot about them. They are either not there, not in training or ready to retire.

Scotland—a self-sufficient land rich in food and fuel with a reducing population—is the sick man of Europe. Independence from the union cannot come soon enough for Scotland's pregnant women, elderly people and ill people so that its rich resources can be diverted from war, weapons and dripping roasts for the capitalist fat cats. Nye Bevan is turning in his grave—we should let him rest in peace.

I want to add a degree of seriousness to the debate. There is a debate to be had on how we develop and deliver policy for our public services and on whether the balance between the national and local levels is right. Are local authorities, health boards, education authorities and local policy makers responsive to local priorities or are they service deliverers on behalf of the Scottish Executive and the Parliament? We need continually to consider that balance. We must also bring in strategic regional planning, which has been debated this morning, without losing local character from schools and hospitals. I hope that the debate will address those challenges.

Most important, we must consider how we gear the scrutinising of policy in the Parliament and its committees so that we see better qualitative outcomes for people, such as better-educated children and healthier Scots, rather than quantitative outputs. The Finance Committee is beginning to examine that issue. It has only now come to light, through my questioning of the Minister for Finance and Public Services, that a delivery unit and a strategy unit exist, which are answerable to the permanent secretary in the Scottish Executive and which work on the issue. However, there is little public scrutiny of that work. The performance assessment framework in the health service has more than 100 quantitative output indicators. What public accountability is there in that?

I hope that next week's budget debate will address some of those issues but, to turn to the motion, the Conservative approach does not offer anything to that debate. In fact, the motion is based on deceit. The Conservatives offer passports for parents that they say would allow much greater choice in where people receive services, but that will be realistic only if there is sufficient capacity in the health and education services to offer that choice to everybody in Scotland. Such capacity can be brought about only by investment in the services, staff and buildings of a national health service.

The Conservatives sometimes mention investment. For example, their manifesto for the elections in May said that they would stick to the Executive's spending plans. When they are on a public platform, they deny that they wish to cut services, but the enterprise spokesman, Murdo Fraser, who is not in the chamber, talks about the Conservative party being a tax-cutting party and supports Iain Duncan Smith's proposal of a 20 per cent all-round cut in public services. It is almost hypocritical to say that we can cut taxes without cutting services.

Will the member take an intervention?

Not at the moment.

The passport for health would be only for elective procedures. The removal of people who use elective procedures, and therefore of the accompanying funding that boards receive, would bring into question the idea of a national health service and, at the same time, raise serious questions about the long-term future of consultant-led services, which are in doubt throughout Scotland. There are question marks over the consultant-led maternity services in the Borders general hospital in Melrose in my constituency. A passport system that raised difficulties for fragile local rural hospitals would raise long-term questions. In one fell swoop, the Conservatives would end the NHS and put local services at risk—not bad for a morning's work.

The member suggests that Murdo Fraser supports 20 per cent tax cuts. Can he produce—perhaps not today, but at any point—evidence that Iain Duncan Smith, Michael Howard or Murdo Fraser have said that they would make such cuts? The member says that tax cuts would have to be paid for by cuts in public services. Does he understand, or has he ever read about, the Laffer curve and the idea that cutting taxes can increase revenue, which many Governments have put into practice?

The Scottish and British people are reasonably sensible and they understand that we cannot get something for nothing, but every time the Conservatives are on a political platform in an election, that is what they offer the people of Scotland.

We must put into perspective some of the negativism that we have heard, particularly from the Tories and the SNP. Mr McLetchie said that choice is available only for those who can afford it, which is code for saying that quality is available only for those who can afford it. However, there are examples of truly outstanding work in comprehensive schools in the state system. The report of Her Majesty's Inspectorate of Education's inspection in April of Beeslack Community High School in Penicuik, which is in my constituency, states:

"The leadership provided by the headteacher and senior promoted staff was of very high quality and all staff worked together very effectively. The school was characterised by a strong, inclusive ethos and a very high degree of consistent, high quality practice across the whole range of its work."

I was honoured to be a guest at Beeslack's Christmas concert last night. Two pupils will be royal academicians.

We can have best-quality education and health services in the state sector, but we cannot tolerate the Conservatives' approach, which would reduce and almost end the national health service and our comprehensive education system.

At the outset of Jeremy Purvis's speech, he asked for balance and for the appropriate and fair allocation of resources throughout Scotland. We will have to watch the situation with vigilance in the years to come.

I am glad to speak in this brief debate, but before I set out my party's policy of reform of education, I will refer to the current state of affairs. The Scottish Executive has committed to increase spending on education and has kept that promise. Since Labour came to power in 1997, spending per secondary pupil is up by almost £1,000 a year and spending per primary pupil is up by £785 a year. I warmly welcome that increase of funding for the education system, but I must ask what Labour has achieved. If we compare 1999—when the Labour-Liberal Democrat coalition began—with 2003, we find that violence against school staff, permanent exclusions, temporary exclusions and truancy have gone up. On attainment, recently released figures show that Labour has failed to deliver its 1999 manifesto pledge that 80 per cent of children would reach the appropriate standard in reading, writing and arithmetic by the time that they leave primary school. Too many children are failing and being failed. For example, according to the Executive's figures, a majority of secondary pupils in Edinburgh and Glasgow cannot read or write properly.

I know only too well that the Executive genuinely wants to improve educational standards, but there is a basic problem with the system. That is why the Scottish Conservatives advocate radical reform, which is the only way in which to improve our education system.

I am in the middle of making a point.

We will establish the better schools passport, which will extend choice to all parents by allowing them to use the money that is spent on their children's education to access a wider and better range of schools.

Will the member give way on that point?

Let me continue. I will give way to Elaine Murray in a moment.

Through the better schools passport, we will end the constraints on parents and provide an incentive for all schools to achieve the highest standards. By extending access to schools in the area as well as to current independent and state schools, the better schools passport will provide a level of quality and diversity that is at present available only to a few. The policy will also allow good schools to expand by scrapping the present rule that prevents new capacity being created while any spare capacity remains.

Lord James Douglas-Hamilton may be aware that Dumfries and Galloway Council recently conducted a two-year consultation exercise on the issue in rural and urban areas. Parents and communities overwhelmingly wanted to retain the local comprehensive schools in their communities; they did not want to send their children to new schools, however well equipped they are. How does that equate with the Tories' suggestions?

Our policy is to support popular schools. If there is insufficient capacity in popular schools, it should be created.

The idea of the policy is to create opportunity for all by improving standards. If a school is failing, parents will put pressure on it to improve; if it does not, they will take their children to an alternative school.

Education authorities at local level will have a key role in intervening early in schools to find out whether management change is necessary, which will avoid the spectre of school buildings not being used. The fact is that popular schools can be kept open. The Executive is rubber-stamping the closure of Earnock High School in Hamilton. That is the kind of school that would be kept open under our policy.

I recommend to the Labour members who are present the wise words of Prime Minister Tony Blair. At the Labour Party conference, he said:

"In education, we need to move to the post-comprehensive era".

He went on to say that both education and the NHS

"require an end to the ‘one size fits all' mass production public service … Why shouldn't there be a range of schools for parents to choose from: from specialist schools to the new City Academies, to faith schools, to sixth forms and sixth form colleges offering excellent routes into university and skilled employment? Why shouldn't good schools expand or take over failing schools or form federations?"

I can well understand why Mr Mike Rumbles and members of his party might wish to dissociate themselves from Mr Tony Blair, but Mr Peacock is a supporter of the Labour Party. If Tony Blair is only too willing to espouse Conservative policy, why does the Executive not do so—if not now, perhaps in a few months' time? Surely the Labour members of the Executive will support their own Prime Minister.

Will the member give way?

No, I will not, because my time is almost used up.

The options in front of us are simple. We can settle for carrying on as we are doing, which would mean having huge inequalities in attainment throughout Scotland; settling for the fact that thousands of pupils leave school with no qualifications; denying most parents any real choice; and settling for the status quo. There is another option—we can give parents genuine choice in how best to educate their children in rural areas and throughout Scotland. [Interruption.]

Order.

The future of thousands of children in Scotland is at stake. We seek to replace uniformity with innovation and diversity. In reflecting the wishes of parents, we will produce higher standards and greater opportunity for all. We will do that by offering parents the better schools passport.

Members are not fooled by the Tories' new enlightened approach to debating. The Tories agree that public services have never been better funded, but flattery gets you nowhere. The Tories stop short of commending a Labour Government for its record levels of investment in our public services, but at least they are taking part in a debate, unlike the nats, whose silence shows that they are a bit policy light this morning.

It appears that the Tories' failure to commend us is not even due to a lack of political will; it is just that we do not embrace the private sector in the same way that they do, which is fair enough. The party that might be the party of low taxation—it is not sure about that—is implying that it can match Labour's record of investment and commitment to public services with less money. Jeremy Purvis was correct to point out that that cannot be done and that the public are not fooled.

The Tories' position is that improvement is to be achieved by the creation of choice and the decentralisation of structures such as those in the NHS. I believe that the passports that they talk about are a gimmick, which I predict they will drop before the next general election.

Let us examine that prospect of choice. The Tories talk about people having choice in where to have an operation or what school to send their children to, but the choice that they are really asking for is a choice between private and public services. It is clear that they want to give more prominence to the private sector. I do not think that they can help themselves, because they are much more comfortable with the private sector.

Let us consider an example. The standard cost of a hip replacement under BUPA is £8,000, whereas the cost in the NHS is £4,500. Even with a Tory voucher worth 60 per cent of that, there will still be a bill of £5,300 to pay. Perhaps the Tories' definition of choice is not the same as ours, because that scenario does not offer a real choice to those who do not have £5,000 to spend. One could say that the Tories are adopting a social exclusion policy. They have always been opposed to centralisation of our NHS and that is the position in which they are most comfortable.

I am impressed with the member's arithmetic, but has she ever heard of insurance—in particular, health insurance? In her calculation, should she not take account of the fact that someone might pay for their hip replacement through health insurance, which would mean that 60 per cent of the cost would be met by the NHS?

Mr Monteith should do some arithmetic of his own, because insurance policies cost money—people do not get them for nothing. It is interesting that the Tories have enlightened us on their position—they have told us that they intend to offer choice by adopting the American system.

The Tories claim that the number of deaths from stroke can be reduced by having more decentralisation, but they do not say how that can be done.

There is no doubt that the drive to reduce junior doctors' hours in line with the working time directive, to which Duncan McNeil referred, is action that the Tories should have taken when they were in power; they have left a Labour Government to implement the directive at the latest possible point.

In the 1990s, we had a policy of decentralisation, which was called the internal market. It set hospital against hospital and nurse against nurse. The elements of the health service failed to collaborate with each other. The policy was an unmitigated disaster, about which the Tories should express regret. They do not understand that, no matter how interesting their new policy is, they will not be able to shake off their past.

Will the member take an intervention?

No, I will not.

The Tories are not, and should not be, trusted on the NHS. Under the Tories, the connection between ill health and poverty was not recognised. As any health service manager can confirm, that was the phrase that dare not be mentioned.

The Tories have never understood what the Labour Government is trying to achieve with its social inclusion policies and its determination to eradicate poverty. For communities that have lived with the scourge of unemployment and constant low investment, the presentation of a choice between public and private services is meaningless; what they want is jobs, skills and real choice.

The role of the state in supporting the poorest in our communities is fundamental. There is a choice to be made, but it is about whether to properly fund public services with regular and constant investment and to provide equality of access or to provide a poorly funded mixture of public and private services. In my view, there is only one choice to make.

We need to have a mature debate on how to ensure that we constantly improve the quality of our public services. Labour members are not complacent about that. I, too, am concerned about the centralisation of our health service and I have arguments with my local health board about what it is doing. However, it is not just the politicians who should be involved in that debate—everyone should be involved, including the health service professionals who are pushing for choice.

I want to make a point about workers in the public sector. I have spent my adult life fighting for the rights of low-paid workers, particularly those in the national health service. I am pleased that a Labour-Liberal coalition is addressing that through "Agenda for Change". I know that some of those issues still need to be resolved, but for the first time we are promising a minimum wage and proper conditions of service. Without staff who feel that they are properly protected and looked after, we will not have a proper health service. We need to go further: we should give GPs commissioning powers to speed up the process of diagnosis, we should have more one-stop clinics in the NHS and everyone in the country should have a right to register with a dentist and to receive treatment.

I think that the Executive's crime agenda is the most revolutionary of any Government's to date. We are determined to say that it is unacceptable to have antisocial behaviour in our communities. Our work on that, for which we have cross-party support, is one of the most important things that the Parliament is doing and the reform of our court system is fundamental to the development of our public services.

I was glad to find that this morning's debate was a Scottish Conservative and Unionist Party debate on the reform of public services. The reason why I was so glad was that, when I read the motion—particularly when I reached the part that mentions foundation hospitals—I could easily have thought that it had been lodged by the Executive.

It is a bit rich—I use that word advisedly—for the Tories to lecture anyone on public services and even on public spending, given their appalling record not only on health, as Malcolm Chisholm has pointed out, but on education and, most important, local government, which was nearly destroyed by the last Tory Government. There are many people with long memories—and some with short memories—who are glad that the Tories are out of power.

When we remember what the Tories did when they were in government, we realise that they are once again showing their true colours in what they are proposing today. Mention has been made of foundation hospitals, although more by Tory members than by Labour members. Foundation hospitals are supposed to be the NHS and the independent sector working in partnership, but they are actually nothing more and nothing less than privatisation by the back door.

Let us also have a wee look at what would happen if the so-called patient's passport came to fruition. Pauline McNeill touched on that issue, but she would do well to think about the matter. Given that foundation hospitals, as pushed through by the Labour Government in Westminster, could come to fruition here in Scotland, perhaps Labour members could learn some lessons during today's debate. For example, let us look at the current prices for private operations. It costs £9,000 for a heart bypass, £5,000 for a hip replacement and £3,000 for a hysterectomy. Those are much more expensive than NHS prices.

"Choice, choice, choice" was the constant mantra during David McLetchie's speech, but let me tell him what choice would mean under his foundation hospitals or patient's passport scheme, or whatever label he wants to use. Basically, it would mean extending choice for only 5 per cent of Scotland's population—those would be the only people who could afford it. The other 95 per cent of Scotland's population could not afford it. That is what David McLetchie's foundation hospitals would mean.

I will try to impersonate David McLetchie just for a minute. Does the member accept that, although she argues that only 5 per cent would use the patient's passport to access private care, the other 95 per cent would be able to use it to access care throughout the NHS in the whole of Scotland rather than just in their health board area?

There would be 95 per cent who could not afford such care. What about the doctors who would perform the operations? Would they move over to the private sector? The Tories would do well to learn that lesson.

As Shona Robison highlighted in great detail, PFI/PPP and the privatisation and sell-off of our railways were imposed on the Scottish people and on the British people via Westminster when the Tories were in power. The Tories also seem to have forgotten about the fuel tax escalator, which caused all sorts of problems, particularly in the Highlands. All those policies were introduced by the Tories with absolutely disastrous consequences for Scotland. That is the legacy that the Tories have left behind for the people of Scotland.

Talking of legacies, I want to turn to the other unionist party. The Labour Party has taken on the Tory legacy and developed it with even more vigour. We have had more PFI/PPP and tuition fees. Thousands of council houses have been sold off and have been privatised by being transferred to the private sector.

Will the member give way?

I am sorry, but I have only a couple of minutes.

Labour members may crow about the extra money that was announced yesterday by their so-called masters in Westminster, but the public will ask what the Executive is doing with that money. Christine Grahame and others have highlighted the fact that the education system is failing our children, that our health service is crumbling and that homelessness is increasing. One in three children in Scotland lives in poverty. That is the legacy that Labour has delivered. Labour is supposed to be socialist, for goodness' sake.

"Socialism" is the word that Labour never mentions.

That is right. Wendy Alexander mentioned it once and I told her that it was her mantra. Bill Butler said that the Labour Party is not socialist, but I think that he needs to be taken back to the drawing board to learn.

As the Minister for Health and Community Care will sum up today's debate, I want to touch on the health service. Both Shona Robison and Carolyn Leckie mentioned the crisis in the health service, especially with the maternity services review. I ask the minister to think seriously about having a national debate on that subject. Not only in my area but the throughout the country, people are complaining about the flaws in the consultation process and the lack of consultation. I ask the minister to consider that seriously when he sums up.

A lot of people might say that the health service costs a lot of money, but let me just give the minister a wee fact. Gordon Brown announced yesterday an extra £800 million for the on-going war in Iraq and Afghanistan—in total, £6.3 billion has been spent on an illegal war. That should help to put in context the situation that we have in the health service today.

The motion suggests that choice and accountability are the two key ways of empowering people who use public services. No one doubts that the system of public services in Scotland needs radical reform. The welfare state of the 1940s cannot be expected to meet all the needs of the 21st century.

Public services in this country have been plagued by underfunding and inflexible state models of provision. People feel that their public services are failing, but the response by the centre has been an increasing centralisation of control. We have had endless targets and reams of strategies to the extent that, in education, it is difficult for good teachers to use their skills to determine the lesson plans and to set priorities for their pupils based on what their pupils need. Such concentration on central targets and central direction is not the solution.

I believe in mutual provision of services rather than provision of services through the market. Although many people agree that public ownership is the means by which public services should be provided, there is a big difference between that and state control with central direction of service provision.

The Tory solution concentrates on choice, but most of the time there is no choice in public services. People do not have a choice about which accident and emergency unit they attend—they want to go to their local one as quickly as possible. People want to send their kids to a local primary school. They want to go swimming at their local leisure centre. They want to go to the local library rather than travel halfway across town to go to the library for which they might have a passport. People want local services. Most of the time, there is no choice about services. People want to use the local one.

The member makes a good argument about why there should be choice, but what kind of choice would his party offer? At the moment, people are directed to services even if the local service is bad. There might be a good service a mile down the road, but if it happens to be over a county or health board boundary, people cannot go there. However, the Minister for Health and Community Care—who is not present at the moment—has said that he wants health boards to co-operate so that patients can move across boundaries. Will Mark Ballard join us in forcing the minister to go further?

The key is not to create an artificial choice but to decide who has power over the direction of services. The key is democracy and decentralisation rather than the creation of artificial choices between different library provisions over different county boundaries. The solution is not the Tory insistence that the market must always provide the best way. Real reform is about democracy and decentralisation, together with proper funding. That, rather than patient and pupil passports, is what we need.

Will the member take an intervention?

Sorry, I must move on.

To achieve that and to give people a real stake in the services that they own, we need a wider vision of public ownership and control. We need to explore new forms of mutual ownership. We need a revival of the mutual idea and a revival of co-operatives. The provision of public services can be expanded and enhanced not through greater state control, but through more co-operative options and new forms of social enterprise with innovative structures.

Does the member accept the principle of mutual ownership for Scottish Water?

The key is to have local control. We do not want big structures that are unresponsive to community needs. We need more local democracy and decentralisation. That cannot be achieved in any policy area by having a single body that covers the whole of Scotland with a board of stakeholders who are supposed to represent all the communities of Scotland. The question is most of all about scale.

The key for public services is to move away from a philosophy of consultation. Consultation is good in that it helps service providers to understand their users' needs, but we need to move away from that model to the model of participation. We need a genuine shift in power, control and ownership of public services. Ours is a very different agenda from Labour's agenda of foundation hospitals and public-private partnerships, which are about introducing market mechanisms and market forms of management.

Will the member give way?

Sorry, I have only a minute and a bit left.

Instead of that, we need a system of public ownership that really brings in the public. We need a new culture of empowered citizenship to support and build capacity in communities to allow them to play their full part in running public services. We need to support groups such as the Scottish Civic Forum in developing strategies to empower people. That is a long-term programme, which represents a sea change in the political culture of Scotland and a move away from state control towards citizen control and citizen power.

A new culture of participation in the public services is required. That will entail a big cultural change in the way in which public sector organisations work. We cannot simply bolt the slower and more organic ways in which communities work on to existing public services, which are designed not for communities to interact with, but for civil servants to run. There has to be a complete change in those organisations' relationships with the public.

We need support for and recognition of new mutualism and social enterprises to provide some of the structures. Most of all, we need a commitment to decentralise and democratise the provision of public services. That is a process, not a simple event, and the transition must be handled carefully. That strategy, rather than the Tories' efforts simply to shift public provision to the market, will lead to real reform of public services.

A number of members still wish to speak, so after Ken Macintosh has spoken I shall drop the time limit for speeches to three minutes, or perhaps two, to try to get everyone in.

A man walks into the doctor's with a duck on his head. That is an old line and a familiar way to start a joke. One describes an inherently implausible situation and creates a sense of dramatic tension, so that people are waiting for the punch line. That is how I feel when I hear the Tories talking about public services—I am waiting for the punch line. I do not believe that they are serious, so I wait for a joke.

I am not sure whether anyone can take the Tories seriously on public services reform. They had 18 years in power and their record shows that their approach to public services was not to reform them, but to sell them out, sell them short and sell them off. Their whole approach was driven by the dogma of market forces. If something could not be privatised, it had to be marketised. The application of market forces was the only way in which public services could be brought to heel.

I see little in the motion to persuade me that the Tories have moved on. The new buzzwords may be "patient passports" or "pupil passports", but the solution that the Tories are relying on is purchasing power and the belief that everything can be bought and sold. Their way of ensuring choice and efficiency is to harness that most powerful of motivations, greed. The result, of course, would be to turn patient against patient, school against school and rich against poor.

A couple of minutes ago, Pauline McNeill said that it was right that GPs should commission care. GPs are in the private sector and they are the basis of primary care as we know it—that is a case of buying in care. Does the member agree that Governments should set standards to purchase that care, whether from the public sector, the independent sector or profit-making and non-profit-making trusts? Can he expand his mind to answer that?

I agree that the Government should set standards, but I disagree with the idea that doctors, for example, are motivated only by their purchasing power or that purchasing power is the only way in which to make reform of the NHS work for the good of patients. I find it hard to believe that after all this time the Tories have failed to grasp that what really distinguishes the public sector is its values. The public sector ethos—or whatever one wants to call it—is what motivates public sector workers, which means that the profit motive will never be enough by itself to initiate reform.

I suppose that we should be grateful that the Tories have at least finally recognised the need for public services reform. Members have warmly welcomed their choice of subject for today's debate. After all, there is more joy in heaven over one sinner who repenteth—and, goodness knows, we know the Tories' sins well enough. However, for six years the Labour Party has been trying to introduce the power of consumer or personal choice; we have been trying to harness choice to the values of the public sector, not to discard one for the other.

If we are to be truly successful in reforming public services, we need to persuade people that our schools, our local government and our national health service are run in their interest—not just in their interest as members of society, but in their self-interest as individuals. An NHS that cannot deliver the operations that we need when we need them will not maintain the public's support, confidence and good will indefinitely, which is why the reform of public services is essential. Services such as the NHS are good for everyone, but they are particularly beneficial for the poor, the disadvantaged and the vulnerable, as they help to reduce inequality in our society and are a force for redistribution.

Mr McLetchie magnanimously acknowledged the increased spending that the Government and Executive have chosen to invest in the public services, as if the Tories agreed with any of those spending choices or as if they would not reverse them given half a chance. Even a cursory examination of the health passport scheme shows that the Tories' proposals would take billions of pounds out of our NHS to pay for those who can already afford private care. That is on top of the supposed tax cuts to which Jeremy Purvis and Pauline McNeill referred. All that adds up to a credibility gap and little that I have heard this morning has persuaded me that the Tories are bridging it.

The Tory motion states that none of that investment has made a difference in improving standards. It is right that investment by itself is not enough, but that investment, allied to reform, has made a difference—it is just blind prejudice to say otherwise. In my constituency, as around the whole of Scotland, we have more teachers, more classroom assistants, brand-new schools and a huge expansion in nursery provision, with places for all three and four-year-olds.

Parents and pupils can see the difference with their own eyes. Later this morning—I do not think that they are here yet—pupils are visiting from Mearns Castle High School and Crookfur Primary School, which are perfect examples of the achievements that pupils and comprehensive schools can make in our areas. When Labour came to power in 1997, around 10 per cent of young people in East Renfrewshire chose to go to private school. That figure is now down to 3 per cent. Families are choosing to opt into, not out of, well-run, comprehensive public services. That is not just because we are improving the fabric of our schools; it is because we are making the schools more accessible and more accountable to the families who use them.

That is what we have to do with our hospitals. We must continue with our huge programme of investment, but we have to make hospitals more responsive to the people who use them. We can do so through local systems of control and accountability. We will not do so with a policy based on the assumption that the people who choose to work in the public sector are solely self-interested and self-serving and need to be kept in check through the use of the profit motive.

The interests of providers and service users are not always the same, but neither are they in opposition. We share a common belief in making the public sector work for the benefit of all. We need investment, we need choice, we need to take the public services with us and we need to maintain a public sector ethos that will continue to serve us well. I urge members to reject the joke that is the Conservative motion.

I declare an interest. I am probably the only person in this place who has paid into the NHS since its inception in 1948. I am proud of the NHS and all that it has achieved. I am also saddened and sickened by the bitter cross-party fighting that I have witnessed this morning. Members should all think black burning shame of themselves. Instead of bickering viciously, we in this place should be seeking a 100 per cent cross-party consensus with the single aim of making the Scottish national health service a fine model for the whole of Europe. There should be a target of zero waiting time for all life-threatening illness and for all intolerable pain-related problems, such as those requiring hip replacements, which have been blandly mentioned.

I back our national health service 100 per cent. However, in 2002, when I was told that I required bilateral hip replacement and that I would have to wait a full year for it, I am sorry, but I took the easy option and opted out. I did so gladly, because pain is something that has to be experienced and tolerated to be believed. What worries me and makes me feel guilty is the fact that there are thousands of people who cannot do what I did and opt out and buy relief from intolerable pain.

Will the member give way?

Give me a second, please.

I had the operation at my own cost, without any insurance. That motivated me more than probably anything else to come into the political arena to see whether I could do anything to help senior citizens who suffer the unbearable pain of arthritis or who need health-giving treatment but cannot afford to adopt the approach that I took. The fact that I had been able to pay for that relief really bothered my conscience. It is unfair that some people cannot have such relief. I say honestly and sincerely that I felt and continue to feel guilty. If I can do anything to help any party to accelerate progress, my efforts will not have been in vain.

The pathetic mud slinging in the Parliament today is unacceptable to the Scottish electorate, who look to this place to produce some answers to the problems that face us. For example, ME costs the country millions of pounds every year, yet we do not contribute towards finding the cause of that problem. That is another little matter to which this place must attend.

I have been rereading Peter Ustinov's biography, "Dear Me", in which he writes that one of the greatest temptations that Alexander Solzhenitsyn faced when he was exiled to the west was the thought that he would be listened to. I will save the Tories from temptation, as listening to them is not on my agenda.

Will the member take an intervention?

No, because I have only three minutes for my speech.

Disintermediation is the Tory policy. As the Tories say, that means developing the private sector to bring more interests to bear on the public sector, such as shareholders, proprietors and other people who have to be paid off and whose interests must be taken account of in providing public services. That is hardly in the interests of the people who receive services.

As I have three minutes, there is no chance of interventions.

The Tories have hard questions to face as they sum up the debate, which I might encapsulate in the Colonsay-or-Corstorphine argument. If we are to have passports for teaching and health services, will the cost of providing a pupil place on Colonsay be the same as that in Corstorphine? It certainly will not be. Will the ambulance that goes to Colonsay, which is likely to be a helicopter, have the same funding as the ambulance that takes someone from Corstorphine? The Tories have fundamentally failed to link choice and value—two words that they use in their motion. Providing choice is fair enough, but it does not lead ineluctably to value.

I have a value—it is 48 guineas—because I was born before the national health service was established and I have the bill that my mother had to pay to bring me into this world. The debate continues about whether that was overpriced or underpriced but, be that as it may, there is little debate about the price of adopting the Tory philosophy.

The Tories talk much of queues. I am a mathematician—that is something of which members have heard a little lately. Is it not ironic that the mathematical theory that relates to the manipulation and management of queues is called the Monte Carlo theory? The Tories would make us subject to the dictates of the roulette wheel. Their proposals and ideas have been comprehensively rejected in the past and will be again at 5 o'clock.

We must now move to wind-up speeches. I have noted the members who were not called, to ensure that they are called the next time that they are on the list of members who wish to speak.

The real issue in the debate is whether, in the next 10 to 20 years, public services in Scotland and Britain will be public. I take nothing away from Mr Monteith, but the drive for privatisation of public services comes not from the Scottish Tories, but from organisations that represent transnational corporations, the World Trade Organisation and the International Monetary Fund, and from agreements such as the general agreement on trade in services.

That international process has opened up in the past 10 to 15 years because companies want access to big markets that involve billions of pounds. They want to open up public services to private capital. That process has taken place for years and across continents. We should be clear about the fact that every party in the Parliament, except the SSP, has signed up to that.

Will the member join me in congratulating the Scottish Executive on its liaison with the Department of Trade and Industry to ensure that public services were not offered up in the latest round of negotiations? I understand that the Government has no intention of offering up such services under GATS. I have been actively involved in GATS matters, as every member will know.

I hope that time is added to my speech because of that intervention. I remember that, in opposition, Labour opposed PFI and PPP. I say to the Tories that it is early days. In a few years, Labour might agree to the Tories' passports.

The debate is about whose version of private enterprise in public services is the right version to adopt and for parties to defend. Everything else in the debate is a technicality. Perhaps the Tories should be disqualified from debates on public services, given the destruction that they wreaked for 20 years. They propose passports for health services and for schools; next, they will suggest visas for universities and I have no doubt that the list will continue.

They are called scholarships.

I will come to that.

I remember when the national health service was genuinely national, before Thatcher. People could be referred anywhere in the country for treatment and expertise in whatever condition they had. However, good old Mrs Thatcher introduced the internal market, which put paid to such referrals. Now, people will not be able just to be referred—they will need a passport to cross the boundaries in the internal market.

The issue of choice is a red herring and a joke. Many members spoke about it. Why should anybody have to choose between a good hospital and a bad hospital? Why should anybody have to choose between a good school and a bad school? The point is that nobody should have to make such choices. We should put policies in place not to emphasise such choices, but to overcome them.

I am sorry; I have less time for my speech than speakers from all the other parties have. I might let the member intervene in a minute if I cover all my other points.

The Tories' health passport means top-up fees for the NHS. Their school passport means top-up fees for education through schools. That is all that passports will mean. They are no different from any other proposal from Westminster.

The Tories' ideas will not be accepted immediately, but the fact is that Labour has accepted PFI and PPP into the health service. Hundreds of thousands of NHS workers—the 40,000 who work for Sodexho, the 20,000 who work for Compass and the 10,000 who work for ISS—have average wages of £8,800, £9,000 and £10,000 as a result of the PFI and PPP policies. Where is their choice to have a hip operation that costs £8,000? We all know who will have the choice—it will not be the health service workers who do the mopping and cleaning and who look after people in hospital beds. We should reject PFI and PPP.

How can members look at themselves in the mirror when they defend PFI and PPP and the idea that the private sector should make three to 10 times more money out of us and our health service than it would make from investing in the stock exchange? The private sector is making those sorts of figures on those contracts.

Even more so, on the issues of democracy, transparency and open government, how on earth can the Tories defend PFI and PPP at the Edinburgh royal infirmary? People who are appalled at the level of service at the hospital cannot even get a look at the contract because of commercial confidentiality. It is an absolute disgrace that the community partnership cannot get access to the contract.

The SSP is campaigning to have every PFI and every PPP closed. We want public services to be funded with public money. Let us reverse the trend.

Let me begin by saying that it is good to be able to debate important issues that affect Scotland on their merits and not on how they fit into the interminable constitutional debate and argument of the separatists, whether they are of the red or the tartan variety.

To be quite frank, we have had today an excessive demonstration from the SNP of the total irrelevance of their policies on public services. I thought that they might have liked the idea of passports. In view of their constitutional desire to separate nation state from nation state, one could imagine that passports might be the sort of thing that would appeal to them.

In my newspapers today, I read a blast from the past. The now ennobled Michael Forsyth is calling for Scottish members of the Westminster Parliament to take over the role of members of the Scottish Parliament. It was a timely reminder of the context in which the work of the Parliament and the challenge of the Scottish Executive is set. As the Tories keep reminding us, we cannot escape responsibility for the problems of the present by invoking the spectres of the past. That is true, but it is equally true that one cannot undo in five year the damage that was done in the previous 20 years.

Let me be clear: the major problem in our schools, hospitals, youth services and transport system today is the legacy of long-term structural under-investment. There was under-investment in buildings and equipment and, above all, in staff. As the Tories acknowledged, those problems are being tackled by record levels of investment in our public services. Gradually and steadily we are renewing the facilities and buildings of our schools, hospitals and trains. Steadily, we are increasing support for the voluntary sector, the value of which was challenged and derided by Mrs Thatcher when she said that there was

"no such thing as society."

The botched privatisation of the railways was a stark example of how the market in so-called choice works in the public sector. That demonstrated all of the fallacies of the arguments that are being put forward today.

Will the member give way?

No, I will press on a bit.

What is the policy of the new Michael Howard Tories? It is not to improve the school curriculum, it is not to encourage more people into the science and engineering careers that the country needs, nor is it to reform arrangements for children with additional support needs so that they can reach their full potential. Their policy is not to deal with the major issues that are caused by the proper commitment to reduce junior doctors' hours, it is not to tackle hospital-acquired infections and it is not to improve our county's health. The policy of the new Michael Howard Tories is to have another reorganisation—another internal market with an external market tacked on.

David McLetchie says that we should lever in additional resources. I notice that he did not stay to hear other member's contributions to the debate. In fact, the Tories' passport policy is a mechanism to lever resources out of our public services. Patient passports and education vouchers will incur dead-weight costs from the people who have chosen private provision.

Is it not a scandal that pensioners have to sell their homes to buy the quality of care that they need in their later years?

Of course it is; that is why the Executive has made a commitment to provide free personal care, which will make a big difference in that respect.

The point is that vouchers are a subsidy for the few that are funded by the taxes of the many at the expense of the public sector. It is perfectly acceptable that private provision should be a choice that is available to people if they want to make that choice. That should not, however, be at the expense of the public sector.

Brian Monteith has appeared to be grossly indignant during the debate—he has been muttering "private insurance" throughout. It is understandable that private health insurance is taken up by quite a lot of people. Quite a lot of employers and even a number of unions provide such insurance. Indeed, it is possible to get private health insurance for dogs and cats these days.

For most of the elderly and disabled people who need the resources, private health insurance can be a chimera. Many more older people live in poverty than is the case among the rest of the population and many older people cannot afford private health insurance. Even if they could, such insurance is significantly more expensive for them, with costs of between £1,200 and £10,000 being quoted. Even Oliver Letwin, the Tory shadow chancellor, admitted recently about those policies:

"we need to get very much more detailed in how they … will work and what they will cost and what benefits they will bring".

I could not have put it better myself.

The Conservative policy fails all the tests that they have set. Despite what David McLetchie said, their policy would grossly widen health and education inequalities. It would like a leech suck money out of public services and reduce choice for the vast majority. At the same time, it would subsidise choice for the few. The Conservative policy would devastate our schools and hospitals; it would starve schools in the areas that are most deprived of resources and it would reduce opportunities for access to good quality health care. The policy is a blast from the past—it is a failed policy that would not work and it would have devastating consequences on our public services. I urge Parliament to show what it thinks of the Conservatives' new policies under Michael Howard by rejecting the motion that is before us.

I start by disagreeing whole-heartedly with Kenneth Macintosh, who suggested that there was some evidence that the Tories had repented and that the consequences of that should be welcomed. I fail to see the difference between the proposals that we heard about today and what the Tories did when they were in power. We are still talking about fundholding practices, albeit that they would be called by another name. We are still talking about the internal market, which is a passport to privatisation anyway. There is nothing new in what the Tories said. Their policies failed: they were rejected by the electorate and they will be rejected again in the future.

Will the member give way?

No, I want to develop my arguments. I might give way later.

On this occasion, I found myself in agreement with much of what Peter Peacock said. I agree with his analysis of the Tories' position on choice in education. Mr Peacock might find that difficult to believe. Does that stick in the craw a bit, minister?

The reality is that, apart from in urban Scotland, there is very little choice in education. One of the weaknesses of our education system is the big divide that is to be found in our major cities between the private, independent and public schools—whatever label we want to give them—and the schools that are provided by Government finance. The publicly funded schools suffer as a consequence.

I have no idea how the Tories envisage people being able to exercise choice in education or health simply by moving around the country. If mobility is a fundamental requirement in exercising choice, would the Tories provide additional funds to enable people to move around the country? Given what the Conservatives said earlier, I think that that is unlikely.

Will the member take an intervention now?

No, thank you.

Perhaps we are seeing a return to the Tories "on your bike" approach. Perhaps kids are going to be told to get out their bikes and cycle 11 miles—or perhaps a lot further than that in rural areas—to get to school.

To develop the point that was made by John Swinburne, I will be interested to hear how people who need double hip operations can get on their bikes. People in Grampian cannot get those services whereas in other parts of Scotland there is only a year's wait. The choices that the Tories presented today are the same kind of false choices that Mrs Thatcher presented while she was in power. It was not, "Would you like to buy your council house?" but "How would you like to buy your council house?" Today's debate is not, "Would you like to get some sort of private education?" it is "How would you like to buy your education?" It is not about whether people want to buy private health care insurance but about how they can buy it.

I was disappointed in one aspect of Peter Peacock's speech—he took a complacent attitude to the PFI and PPP failures in education. He said that he was happy with progress. Perhaps I could draw his attention to a report that was published this week, which suggested that 40 per cent of secondary 2 pupils have failed to reach level E in English reading, 49 per cent have fallen behind that target in English writing and 46 per cent have failed to reach the target in mathematics. Given that the target was only 80 per cent attainment, the target was not very high anyway. Is that the kind of progress with which Mr Peacock is happy?

There are now significant failures in the PFI/PPP process. The major contractor for Glasgow schools has gone belly-up—Amey plc has disappeared. I am disappointed by the attitude that the Liberal Democrats had to the situation in East Lothian. I thought that their laughter demeaned the position that the pupils in East Lothian will find themselves in when application has to be made to the SQA for relief from the difficulties that have arisen as a consequence of the potential lack of access to schools. We are dealing with serious matters. The only benefits that might come from PFI/PPP depend on competition and that competition does not exist—the marketplace cannot currently deliver it.

There are different interpretations of the levels of attainment in S1 and S2 throughout Scotland. Is the member seriously saying that those figures are being affected by the way in which the buildings in which the students work have been paid for? Does he not recognise that there is benefit in having buildings that match the talents and abilities of our young people?

I am sorry if I did not explain myself well—I was making two separate points. One was that the levels of attainment are not those which Peter Peacock set as his targets—it is a miserable failure that those targets have not been met. In addition, PFI/PPP will not achieve the delivery of proper education in proper facilities.

I agree with Carolyn Leckie that we need to have a debate about where we are going with our health service. We need to address the question of continued centralisation. Many members from all parties are concerned about the loss of local services. It is fine to drive up standards and it is great that we have royal colleges that are keen to do that but if, as a consequence, we cannot have services delivered locally, we need seriously to consider the situation. There are border issues, as David Davidson mentioned, but the privatisation approach will not address that. We need to have a national debate. I conclude on that point.

I thank the Conservatives for giving us the opportunity to expose their unfair, uncosted and unworkable policies on health, education and crime, although it turns out that they had little to say about the latter, except on there being a directly elected element to police boards. At that point, I agreed for once with Shona Robison when she said that they were acting under orders from Michael Howard because all members of police boards in Scotland, unlike in England, are already elected as councillors.

The Conservatives had a little more to say about education, but it was still "simplistic tosh" as Judith Gillespie said the other day. It was not thought through and David McLetchie had no answer when Rhona Brankin asked him about people not having the right to send their child to their local school. We believe in increasing choice in schools, we believe in appropriate choice between schools and, most of all, we believe in raising standards in all schools.

James Douglas-Hamilton asked what we had achieved since 1999. We have free school places for all our three and four-year-olds; we have classroom assistants in all our schools; we have smaller class sizes; we have more young people sitting exams and getting qualifications; we have more young people getting better grades; we have more young people going to university; and we have year-on-year improvements in literacy and numeracy standards from the disastrous legacy of the most recent Conservative Government.

As always, there was complete distortion today of what we are saying and doing: for example, in relation to the independent health sector, which we are prepared to use on an equitable basis; in relation to centralisation, which I will describe in a moment; and most of all according to the terms of today's motion, in relation to what we are saying and doing about choice.

Let us be clear about the dividing lines: we believe in choice for all, but the Conservatives believe in choice for those who can afford to pay. The people whom they will support in the independent sector would still have to pay thousands of pounds out of their pockets. Choice is illustrated for us in the action that we took in setting up the national waiting times database so that patients can choose, if they wish, to go to a different hospital in Scotland where there is a shorter waiting time.

However, there is a second dividing line because patients want choice, but they want more than that. That is why they want to influence directly the nature of the care and services that they receive. That is why we place such emphasis on learning from the experience of patients and on involving them in redesigning specific services.

I was pleased to speak to patients and clinicians at the launch of the managed clinical network for stroke and coronary heart disease in Glasgow. Clinicians and patients there are making decisions at the front line. That is also an example of better links across traditional boundaries. That work will be carried forward next year as we set up community health partnerships to bring a new focus to local decision making and delivery.

It is a great pity that David McLetchie was not at the launch of the managed clinical network for stroke and coronary heart disease in Glasgow. Once again, he was running down everything that the health service does. I tell him that the chair of the national advisory committee on stroke said recently that Scotland is currently doing more for stroke services than any other country in the world except Norway, through the stroke strategy, the extra investment in the stroke strategy, the stroke managed clinical networks, the stroke standards that are being developed by NHS Quality Improvement Scotland and because of the national stroke audit.

I take the minister back to the point about patients having choice through the waiting times database. Will that choice exist from the day that patients are diagnosed as having a condition that needs further treatment instead of their having an arbitrary six or nine-month wait?

Once again, the Conservatives show a complete lack of knowledge about what is happening. I mentioned the waiting times database—that information is available in GP surgeries. GPs and patients can access that information together today and that gives them choice.

The Conservative motion calls for the setting up of foundation hospitals. I say to the Conservatives that we have our own reform agenda in Scotland and that we do not take lectures from London, as they do from their party leader. We support a single health system that breaks down traditional barriers rather than a centralised one. We support patient journeys that are integrated across traditional boundaries and we support decision making at the front line, as is happening in managed clinical networks and which will happen in community health partnerships.

The key to change is to give health care teams support to solve old problems in new ways. We support, value and empower staff—a point on which I agree with Carolyn Leckie. That is precisely what the centre for change and innovation has been doing for the past year. It has undertaken 10 major programmes of work with front-line staff to secure practical changes and to improve waiting times and care of patients with specific illnesses.

The SNP asked about recruitment and retention of staff. In the latest year, there have been 572 doctors and 956 extra nurses employed, which is almost unprecedented in the past decade or two in the health service. The SNP talked about a national strategy—Sandra White talked particularly about maternity services. We have a national maternity strategy, which we outlined in a white paper. There will be another detailed piece of work on the back of that.

The SNP asked for a debate. In The Herald on Monday, I said that I supported a public debate on the important issues of service reorganisation; it must be a serious debate that has at its heart clinical safety and quality of care, as well as local access wherever that is consistent with those principles.

Will the member take an intervention?

I have only one minute left.

On reorganisation and the health service more generally, we heard the typical unbalanced approach from the SNP. Christine Grahame was even laughing at herself by the end of her speech as she talked about dirty hospitals, but she did not talk about the new national standards on clean hospitals or about many other things that are driving up standards of care. Shona Robison once again ran down the new Edinburgh royal infirmary. I do not have time to read out the letter about that in The Scotsman today, but I hope that she has time to do so later.

Both the SNP and the SSP showed their usual ideological opposition to PPP. That opposition would slow down modernisation of our health infrastructure and that is not what patients want. It is not all PPP—total capital investment in health by the traditional route will be £400 million by 2005-06, which is more than double that in 1997-98 and includes £87 million for the new Beatson oncology centre.

Across the board, we support a focus on patients, pupils and victims first. We support equal access rather than access based on ability to pay. We support national standards and inspections as a framework that underpins the devolution of decision making to front-line staff, and we support sharing of best practice and action to tackle poor performance.

We do not support the abolition of comprehensive health and education systems, as advocated by David McLetchie, and we do not advocate patient passports to penalise the poor. The clearest choices relate to health. We advocate a modern NHS, whereas the Tories advocate the end of the NHS. We advocate equal access, whereas the Tories advocate access that is dependent on ability to pay. We advocate choice for all, whereas the Tories advocate choice for those who can afford to pay for it. I know what the people of Scotland support and what they will continue to support.

I am pleased to take part in this debate; it has been thoroughly useful.

Today has been an important day in the life of this young Parliament. In time, it will be seen as the day that confirmed that the Conservative party is the true Opposition party in Parliament. Many members know that Labour and Liberal Democrat members will privately welcome the fact that we are the true Opposition party.

It is a pity that we did not have this debate last week, when the SNP had the chance to debate public services. Yet again, the SNP decided to discuss constitutional matters. Have we been graced by the presence of the leader or the deputy leader of the SNP to show the significance of public services to that party? I do not see them.

Will the member give way?

No. I want to carry on and make progress. I have only 10 minutes.

I am no Nostradamus, but I can tell that today is the beginning of a new future. David McLetchie has laid before Parliament a different approach and has offered the Scottish people a choice. I accept that things will take time, but we will see whether the Scottish people warm to our proposals and vote for them. It is important to give an alternative view of how public services can be delivered to the Scottish people.

As Robert Brown explained, the SNP offers more of the same, but with a different passport, which is meaningless because it must be stamped by Frankfurt and Brussels at every juncture. It would have no value whatsoever.

Would the patient passport as designed by the Conservative party—which would take people out of the national health service—hit at the poor and the poorest people in Scotland, who cannot afford private health care?

That was a singularly inept intervention that was not pertinent to the point that I am making. However, I will come in due course to the issue that Mike Rumbles raises.

I am no Nostradamus or Mystic Meg. However, even before the amendments were lodged, it was fairly easy to predict the line of attack that the other parties would take on the Conservatives' motion. First, they would challenge the motives of Conservative MSPs and politicians and our commitment to public services. Of course, that is the low moral ground; it involves scaremongering but not challenging with real debate. My family—my sons, my father and sister—all went to the same local state school. There are teachers and further education lecturers in the Conservative party. Lord James Douglas-Hamilton's four sons were born in the Western general hospital, using the NHS. The Conservative party is full of members who are committed to public services. We do not challenge members' motives when they say that they want better public services. All we say is that we want better public services, too.

After our motives, the next line of attack would surely be to say that nothing is wrong, that more money is being made available and that things are getting better. Many members have explained how things are getting worse, so I do not need to do so. We have acknowledged that more money has been spent and we have also said that, when we were in power, we spent more money, too.

However, from that period, we have identified that simply spending more money does not bring the necessary results that the public not only want but deserve. If anybody doubts that, I will give some examples. The Minister for Health and Community Care holds a Lothian seat. In the NHS in Lothian, the median wait for orthopaedic surgery has increased by 43.7 per cent and the median wait for outpatient appointments with a dermatology consultant has increased by 28 per cent. The median wait for outpatient appointments with an ear, nose and throat specialist has increased and vacancies for qualified radiographers have increased. Nursing and midwife staff vacancies have also increased.

Given that the member's facts are absolutely correct, how will the situation improve if doctors are taken out of the NHS and go into the private sector? Would waiting times increase under the Conservatives' proposals?

The answer is no. I will explain why that is so as I proceed.

Members doubt our motives and challenge the unchallengeable fact that things have been getting worse in many ways. However, the next line of attack is that the Conservatives will privatise public services. Many people have echoed that point, which is more scaremongering. Are we talking about the private health service that we know and love, in which GP surgeries are private professional practices that are contracted by the NHS and in which GPs build their own surgeries to provide services to the NHS? Are we talking about an NHS that provides a voucher in everything but name to private opticians for provision of spectacles? Many services are already provided by private contractors throughout the NHS. There is no question of privatising something that is already provided by many private practitioners. Therefore, the argument does not stack up.

The next argument was also predictable—that our proposals would be divisive and that the Conservatives are somehow scary people who offer extreme policies. Strangely enough, such policies have been adopted in Sweden, where there are education vouchers, and in Denmark and the Netherlands, where communities can deliver local schools. I say to Mr Rumbles that I am talking about rural and urban communities.

I want to finish what I am saying.

Such policies have been adopted in Alabama and in Florida, where education vouchers are so popular that campaigns are springing up in states throughout the United States to introduce education vouchers. In Chicago, the school system allows parents to choose schools without catchment areas and in New Zealand, local communities run schools. Such places are not populated by scary and extreme politicians, but by people who are looking to deliver public services that meet people's aspirations.

Under the Tory's education voucher system, which is designed to introduce a free market, how would education vouchers work for pupils for whom there are significant extra costs as a result of their special educational needs or additional support needs? Costs for them would be much higher. Would such pupils be given two or three vouchers?

We would not abolish records of needs, but we would protect such children so that money reached them. Records of needs should not be taken away from many of the most vulnerable children in our society.

Finally, the next line of attack that one could see coming was that our policies are not Scottish. It is clear that we have a separate education system and that the process of coming up with policies—

The member may not go to the toilet.

In developing our policies for higher education and education in general, it is clear that we have taken account of the separate nature of Scottish education. In explaining our justice policies, Annabel Goldie explained that we acknowledge the differences in how the justice system in Scotland is run. We take account of such matters and our policies are tailored, thought up and delivered for Scotland.

If I move on, Presiding Officer—

You have five seconds.

A lot more than five seconds.

The Conservatives have a vision in which patients choose the treatment and the hospital that they want, where pupils can access the type of education that is best suited to their talents and where the people of Scotland can—through accountable police conveners—deliver the policing policies that they desire.

I believe that that is far more worthy than the policies currently offered by the Executive and I believe that our policies will in time gain the support of the Scottish people.