Interview: Alex Neil MSP

Scotland's new Health Secretary, Alex Neil is reflecting on how he and his family have benefited "enormously" from the National Health Service over the years as he contrasts the treatment his son has received on both sides of the Atlantic.

"When we went to the States when we were relocating out there, way back in the early '80s, my son, who was a baby at that time, took ill with violent sickness. We took him to casualty in Nashua, New Hampshire and the first question I was asked was, 'Have you got your credit card?' Quite frankly, until I answered that question positively they weren't interested in looking at my son.

"Compare that to many years later when he was at death’s door from septicaemia and it was the National Health Service that saved his life. So I contrast those two services and, my God, are we lucky to have the National Health Service."

Neil, who was previously Cabinet Secretary for Infrastructure and Capital Investment, took over the health brief from Deputy First Minister Nicola Sturgeon in September. In an interview with this magazine, Sturgeon stated that the five years she spent as Health Secretary will "always count as one of the most special things I have done in life".

Neil agrees that the health portfolio is "very special".

"I think the thing about health is everybody is a stakeholder in the health service. Indeed, babies yet to be born are stakeholders in the health service and therefore it matters to everybody in Scotland."

Neil has been a strident and articulate defender of SNP Scottish Government policy during its administration, earning him the moniker 'Minister for Newsnight' during his time on the backbenches. Interviews frequently describe him as "straight-talking", and, less charmingly, as a "bruiser". But is this a fair assessment of his style?

"Straight talking, definitely! Bruiser?" he pauses, "I think is how some people would like to paint me, but I think over the last few years when I've had responsibility for initially, housing and communities and, latterly, infrastructure and capital investment, I think it is fair to say that while I robustly defend and promote the Government's position, what I'm really interested in is policy reform."

In his first few weeks, Neil has made a commitment to go 'back to the floor' to meet with frontline staff in an effort to learn more from those directly involved about the health service he is now in charge of.

"The first thing that strikes you is the level of dedication and total commitment of the staff - whether you are talking to porters, ambulance drivers, consultants, nurses, doctors, everybody. It is just a total commitment to the NHS and to the concept of the NHS."

While he admits there is "frustration" about pay freezes, he says the dedicated staff are also full of good ideas about how to improve services.

"They want to participate. They want to be in a position to influence the innovative approaches and they themselves are coming up with many good ideas about what can be improved, what can be done better and so on."

Neil speaks with pride about what they are already achieving. Last week he attended an event to highlight the work of the Scottish Patient Safety Programme, which aims to steadily improve the safety of hospital care right across the country. The programme has attracted plaudits from across the globe and in particular, Neil says he was struck by the supportive comments of Professor Don Berwick, CEO of the Institute for Healthcare Improvement who was also due to help President Obama with his healthcare reforms before the Senate intervened. 

"When asked about how do we compare to the rest of the UK, his reply was that Scotland, in terms of the Patient Safety Programme, is the best in the world. Not just the best in the UK or Europe, the best in the world," boasts Neil.

Visitors have been coming from all over the world to see for themselves, including representatives from Denmark, which Neil says has since "cloned" the Scottish programme for itself:

"So you cannot get a higher compliment than that. I think that says it all about how successful it has been."

In times of financial crisis such work takes on greater significance, not less, he explains, as he says the patient safety work is a "very good example of prevention being better than cure" and a "top priority". The Government is now looking to roll the programme out more widely and set more ambitious targets for the next three years to further reduce incidents of unnecessary harm to patients, with Neil adding:

"To make Scotland the safest health service in the world - that's the ambition."

Recently, however, First Minister Alex Salmond was forced to defend opposition claims that Scotland's NHS is in "crisis" after Auditor General Caroline Gardner placed the finances of the NHS on an "amber warning", arguing instead that the Scottish Government has protected the spending of health boards and the revenue budget of the NHS in real terms.

Neil also holds no truck with such criticism from his opponents.

"Well, first of all, in the election last year no other party gave a commitment that they would protect the health budget so it is a bit rich for people who were going to raid the health budget for other purposes to criticise us when we have protected the health budget," he says bluntly.

"The second thing is you have to look at and compare what these opposition parties have been doing down south. The £20bn cuts in the English health service were initiated by Andy Burnham, the Labour Health Secretary. They are being implemented by the Tory Liberal coalition. So their agenda in the health service they are in charge of south of the border has been an agenda of cuts. Ours has been an agenda of financial protection and investment for the health service. So I'm not in any way going to entertain any lessons from any of the three unionist parties about money and investment in the health service because their track record has been extremely poor."

Coming to the role from a business background, Neil is understandably keen to ensure that the NHS is run as efficiently as it can be.

"I've no doubt at all that there are areas of the health service where we can do things better. For example, I think we can make even more savings in terms of improving the management of the drugs budget. Already we've made substantial savings of, I think, £30m a year. I think there is more that can be done there. I think some of the non-labour costs - the health service, for example, in Scotland spends £68m a year on energy costs. I think there is maybe scope through our eco-hospitals programme to reduce that budget. We spend £150m a year on travel, I think there is maybe scope to tighten up some aspects of that. The use of teleconferencing, for example, could reduce the travel bill."

Telehealth and telecare is another area where Neil is keen to work with others to ensure Scotland is exploiting its "intellectual leadership" for the benefit of the NHS and the nation.

"I think we are generally regarded as a world leader on telehealth and telecare," says Neil, giving examples of "phenomenal" 3D imaging work being undertaken at the Golden Jubilee Hospital and an electronic pen in use by community nurses in the Western Isles that he says reduces the amount of time they have to spend in administration by 50 per cent.

"What happens is they've got this pen that has a memory and a chip in it. So when they go out to visit the person in the home and they are writing their notes, the pen is automatically updating the computer as they are doing that...We intend to roll that out across Scotland and that will reduce very substantially the amount of time the community nurses need to spend in administration."

However, as our population ages and demand on the NHS increases, the Scottish Government has been clear that wider reforms are also required. Neil used his speech to the SNP conference in Perth last month to pledge to end the "bureaucratic battle" between local authorities and the health boards as he restated the Government's commitment to integrating health and social care.

"The first thing I did when I became Health Secretary was reinforce the message that Nicola had given to both the local authorities and the health boards that this is a very, very high priority."

The Scottish Government is currently progressing legislation to aid this integration, however, Neil stresses that areas should not wait for the legislation to start getting organised. Some, such as West Lothian and Highland are already "well ahead", he says. Others, which he tactfully declines to name, not so. "So our message is to everybody: step on the accelerator. We want this done and dusted ASAP."

And yet, bringing about such a significant change will be no mean feat and Independent MSP Margo Macdonald recently expressed concern in the chamber that those working at ground level on the integration of health and social care services are under great stress. Conversely, Neil insists that integration will, ideally, lessen the strain on staff.

"I think there can be nothing more stressful for a hospital manager or a staff nurse having to wrangle with the social work department about delayed discharge of a patient who no longer needs to be in hospital but isn't ready to be discharged from hospital, even though they are medically ready to be discharged, because the support package isn't up and running in their home or their community.

"Similarly, by the way, there will be frustration on the social work side. It is not one-way traffic.

"So what this whole project, I think, will do is take a lot of the frustration out of the system because it will put an end, once and for all, to the financial and bureaucratic wrangle about who picks up the tab for people who are ready to leave hospital but need community care assessment and [a] package."

The ageing population, budget cuts imposed by Westminster, the detrimental effect these are having on health inequalities, poverty and deprivation in Scotland, and the increasing costs of medicines, treatments and technologies are all huge challenges that must continue to be faced in Scotland, Neil says, and will command his attention as Health Secretary.

However, he is determined that in contrast to the reforms south of the border, Scotland's NHS will stay true to its founding principles and "continue to grow and prosper as part of the public sector in Scotland."

"The NHS will remain free at the point of use. That is a fundamental principle. What's happening south of the border is the Americanisation of the health service in England.

"And that is just not going to happen in Scotland," he states finally.