Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, March 9, 2022

Official Report 1247KB pdf

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Portfolio Question Time

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Health and Social Care

The next item of business is portfolio question time, and the first portfolio is health and social care. If a member wishes to request a supplementary question, they should press their request-to-speak button or indicate that in the chat function by entering the letter R during the relevant question.

Question 1 was not lodged.

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General Practice Closures (NHS Tayside)

To ask the Scottish Government what discussions it has had with NHS Tayside in light of reports of the closure of general practitioner practices. (S6O-00823)

The Scottish Government is aware that the Friockheim and Ryehill practices in NHS Tayside will hand back their GP contracts later this year. NHS Tayside is working with the respective health and social care partnerships to consider how best to ensure that general medical services continue to be provided to patients who are registered with the practices once the contracts have been handed back.

I wrote, with Councillor Richard McCready, to the cabinet secretary on 15 February about the need to address local people’s concerns about the Ryehill health centre, but I have yet to receive a response. Some 5,300 patients are being thrown into limbo. Can the cabinet secretary give clarity on what will happen next? Where will people get care and when will they know that?

The closure flies in the face of the announcement that the cabinet secretary made in Dundee, just two months ago, about expanding GP provision. What new strategy can the cabinet secretary put in place to tackle declining access to services? What he has done so far is clearly not working.

On Michael Marra’s specific point, I will of course look into the issue about the correspondence that he and the local councillor sent to me—I have also had correspondence on the matter from Councillor Bill Campbell—and I will get an official response to him.

The member was absolutely right to ask me about the next steps. If he wishes, after question time I will send him details of who best to contact in the health and social care partnership. In essence, that partnership, alongside the health board, will assess the various options; they are having active discussions with neighbouring general practices to ascertain whether they can take on more patients. They will also see whether any practice has the desire or intention to take over the Ryehill practice. The same goes for the Friockheim practice, which I also mentioned.

When a decision is made on how best to deliver local general medical services, patients will be informed directly.

On the more general point, I can elaborate on that with more detail, but given the time constraints I will just say that this Scottish National Party Government has an excellent record of investing in our GP services, which is probably why we have more GPs per 100,000 people than anywhere else in the UK. In Scotland, we have 95 GPs per 100,000; the number in England is 78 and in Wales it is 76. We will continue to invest in GP services.

On the more specific issue, I am always happy to continue discussions with the member and will ensure that he gets details of the health and social care partnership that is taking the matter forward.

On the staffing crisis in NHS Tayside, the British Medical Association in Scotland is highly concerned about consultant vacancies in that health board. A freedom of information response shows that vacancies are significantly higher than the figure that the Scottish Government released.

Despite months of promises to recruit, there has been no improvement. When will the Scottish Government release accurate data and an analysis of the extent of the problem in Tayside? How does it intend to address the serious lapses in workforce planning?

Let me make a few points. First, under this Government we have record staffing levels, and the number of medical and dental consultants has increased considerably.

I met the NHS Tayside chief executive and chair a number of weeks ago and we discussed consultant vacancies, particularly in oncology. We have set up a short-life working group on that.

On our future plans, we will publish our national workforce strategy later this week.

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Essure Sterilisation Devices

To ask the Scottish Government whether it will meet with the Life after Essure UK and Ireland support group to discuss its concerns about a lack of awareness and understanding of the reported damaging physical and mental health impacts of Essure sterilisation devices. (S6O-00824)

Yes, I will be happy to meet members of the Life after Essure support group; I am in the process of making arrangements.

I very much welcome the minister’s positive response to me. I hope that the meeting takes place as soon as possible.

A key issue that the women have raised with me is the lack of knowledge on the ground among their general practitioners. They recently met the Northern Ireland Minister of Health; following that meeting, every GP in Northern Ireland has been sent a fact sheet and information about the crippling impact of Essure devices on women’s physical and mental health.

The sooner such information can be passed to our GPs, the better. Is the minister prepared to consider the issue and see whether we can accelerate getting that information out to GPs across the country, so that women can get support?

The member is absolutely correct. It is vital that there is a consistent approach and a clear treatment pathway for any woman who is experiencing complications as a result of a device. Once I have met the affected women, the Scottish Government will consider whether any further action is needed on our part or by the national health service in Scotland. That will potentially include writing to GPs or seeking alternative means of ensuring that there is increased awareness in places where women are going to seek help with devices.

Although Essure devices were withdrawn from the United Kingdom market in 2017, it is estimated that up to 2,000 women were implanted with devices. Can the minister advise members which of Scotland’s health boards implanted devices, and whether the Scottish Government has considered the merits of writing to the relevant individual GPs to raise awareness of the device’s crippling long-term side effects, given how busy the GP workload is?

Once I have met the women who are affected, we will consider all options for ensuring that the appropriate people are informed about the concerns that are being raised. I can give the member the assurance that about 700, rather than 2,000, women in Scotland were implanted with the device before it was withdrawn from the market in September 2017. I can write to her with details on which health boards were using the device.

I am keen to raise awareness of the issue across the board, and I am keen that women are able to seek support and get an appropriate response from GPs when they do so. That last point is important—we have seen that issue arise time and again in relation to women’s health, and it is one of the reasons why we are introducing the role of patient safety commissioner. We are very keen that women—indeed, all patients—are heard when concerns are raised about the safety of devices, and that appropriate action is taken.

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Dialysis Units (Location)

To ask the Scottish Government how decisions are made regarding the location of dialysis units. (S6O-00825)

It is the responsibility of national health service boards, working with their local partners, to plan service delivery and treatment in accordance with the needs of patients who are undergoing dialysis in their particular area. The location of renal services and associated satellite dialysis units are identified on the basis of needs assessments of patients and where they live, which are carried out by individual health boards. The Scottish Government funds the Scottish renal registry, which assists services to carry out audits in order to support improvements in service delivery and planning.

Last Friday, I visited the recently opened dialysis unit in Rothesay on the Isle of Bute. I pay tribute to my constituent Hamish Kirk, who worked tirelessly with others to ensure that the unit was set up, following a donation. Sadly, Hamish died last month, having benefited from the new unit for only a matter of weeks.

Does the cabinet secretary agree that it is important that health and social care partnerships work with local groups and individuals to ensure that units such as the one on Bute can be established?

I join Jenni Minto in paying tribute to her constituent, Hamish Kirk. I send my sympathies to his loved ones and friends, and to the local community.

I agree whole-heartedly with what Ms Minto said. The local partnership with Bute Kidney Patients Support Group is an excellent example of the NHS board, the local health and care partnership and local community groups working closely together. It is important that people who are undergoing dialysis can access care as close to home as possible, which is why we continue to fund satellite units. I pay tribute once again not only to Jenni Minto’s constituent, but to the great work that Bute Kidney Patients Support Group has done.

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Transvaginal Mesh Case Record Review

To ask the Scottish Government whether it will provide an update on the transvaginal mesh case record review, led by Professor Alison Britton, and the anticipated timescale for its completion. (S6O-00826)

The review was established in February 2021 to look into women’s concerns about the accuracy of their case records. Since then, Professor Britton has met everyone who wishes to take part, and the panel is now starting to consider each woman’s medical records, alongside their concerns. A number of factors, including Covid-19, have meant that the review has taken longer than we initially thought that it would, but we expect it to conclude later this year. I hope that it will be a beneficial process for all who are involved in it.

In response to written questions that I submitted on the review in September last year, the Cabinet Secretary for Health and Social Care informed me that the commissioned contractor, Clinco, would

“request ... appropriate case records from Health Boards.”—[Written Answers, 18 October 2021; S6W-03321]

At that point, data-sharing agreements had been reached with some health boards for access to patient records, and the cabinet secretary said that he expected agreements to be in place for “all relevant Boards” in the near future.

We are now almost six months on. Can the minister please confirm whether all data-sharing agreements are now agreed, and whether every health board has made available all the required and requested patient information? If not, can she advise what might be holding up that process?

Given that the information being shared is so sensitive, we have worked really hard to ensure that there is a robust process in place for transferring patient records to the panel for review. That has taken some time to finalise, but I am sure that we all agree that it is vital that patients’ private information is kept safe and secure. I am pleased to report that all those issues now appear to be resolved and that records are being received from the health boards as requested, and I am grateful to the panel and particularly to the women taking part for their forbearance.

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Alcohol Harm (Disadvantaged Communities)

To ask the Scottish Government what support it is providing to people at risk of alcohol harm in the most disadvantaged communities. (S6O-00827)

There is a stark social gradient to alcohol harms: alcohol-specific death rates in the most deprived areas are 4.3 times higher than those in the least deprived areas, and people in the most deprived areas are seven times more likely to be admitted to hospital with alcohol-related conditions than those in the least deprived areas.

We take a whole-population approach to reducing alcohol consumption and risk of alcohol-related harms to drive reductions of alcohol harm in our most deprived communities. We are taking action to improve the conditions that drive alcohol harms, reduce poverty and inequalities, provide good quality affordable housing and enable the best start in life for our children.

This is an area that the minister and I have a particular interest in and are particularly keen to make progress on. The minister mentioned that the alcohol-related death rate in the most deprived areas in Scotland is 4.3 times higher than in the least deprived areas. The minister will be aware of the report on alcohol-problem management in deep-end practices serving the most deprived populations in Scotland, which was launched today by Scottish Health Action on Alcohol Problems, and she will be aware that it shows the value and effectiveness of the primary care alcohol nurse outreach service in reducing alcohol harms. Will the minister say whether the Scottish Government would encourage all deep-end practices to adopt a similar model?

First, I commend Joe FitzPatrick for his work in this area as a minister and as a back-bench MSP. I know that it is an area that he cares deeply about and will continue to work hard on. I assure Mr FitzPatrick that the Scottish Government will carefully consider the findings of the report that was published today, which highlights the need for more research into the effectiveness of those services.

We support person-centred approaches such as those that are provided by primary care alcohol nurse outreach services in deep-end practices for alcohol treatment. That is set out in our national strategies: the Scottish Government’s “Mental Health Strategy 2017-27” and “Rights, Respect and Recovery”, the national alcohol and drug strategy.

Scottish Health Action on Alcohol Problems recently highlighted the so-called multiple disadvantages faced by black and minority ethnic people who are struggling with alcohol harm, whereby culture and other issues add to the barriers to people seeking treatment. What is the Scottish Government doing to ensure that everyone in our society can access the support that they need?

That is a key question that I am deeply interested in resolving. We have talked about the work of the deep-end practices on tackling alcohol-related harm, but they are also doing incredible work in tackling inequalities and reaching the people in our society who often find it hard to access healthcare. There is a range of work going on across the board, and I expect that the deep-end practice work will feature strongly in what Mr Choudhury describes, which is intersectionality, with different inequalities coming together and making life very difficult for people who experience that.

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Women’s Health Plan

To ask the Scottish Government, in light of international women’s day, whether it will provide an update on its action to improve health and reduce inequalities for women in Scotland, as outlined in the women’s health plan. (S6O-00828)

Implementation of the women’s health plan is under way. In October last year we launched the NHS Inform menopause information platform, which is the first stage in the development of a comprehensive women’s health information platform. Work is also under way to develop information and resources for girls and women on starting periods, managing symptoms, choosing contraception and planning for pregnancy, which will all be added to the platform.

In spring this year, we will publish an implementation plan setting out in more detail how the actions will be implemented. Our first progress report will be published in autumn this year.

One of my constituents recently contacted me to say that her endometriosis pain had resulted in her permanently closing her hair salon in Doune. She welcomes the women’s health plan and its specific focus on endometriosis research and reductions in diagnosis time. Can the minister please give an update on the work being done to improve the lives of endometriosis sufferers across Scotland in particular?

Endometriosis is a high priority for the Government, and we have a range of work under way to improve the experience for women. We are working with NHS Inform to update its endometriosis pages with accurate, up-to-date information and a lived experience video. We aim to provide additional resources to school-age children, teachers, parents and carers, working with the national resource for relationships, sexual health and parenthood—RSHP. We funded Endometriosis UK with £15,000 to raise awareness and to support those who are waiting for a diagnosis.

The centre for sustainable delivery has developed an endometriosis care pathway to individualise treatment, to improve earlier intervention and to streamline referrals to secondary and tertiary care. We will deliver more opportunities for training on endometriosis for healthcare professionals. We are also developing networks to co-ordinate endometriosis care, helping to provide equitable access to support and care for women right across Scotland.

We know that endometriosis symptoms can start in puberty, and it is a horrible thing for young people to go through. Menstrual wellbeing education was made compulsory in England in 2020 and in Wales at the end of 2021. Scotland is the only place in Great Britain where it is not currently mandatory. Will the minister commit to introducing compulsory menstrual wellbeing education in Scottish schools?

Ms Hamilton will be aware that very little in the education curriculum in Scotland is mandatory. We tend not to work that way; we tend to work with local authorities to ensure that there is a broad-ranging curriculum and that children can access a broad range of education.

As I alluded to in my previous answer, however, we have worked on resources for RSHP, and those additional resources are available to school-age children, teachers, parents and carers to utilise to improve levels of awareness. That is a vital area for improving our work on endometriosis.

Pertinent to the women’s health plan being a success is the proper functioning of maternity wards across the country. The minister will be aware that there was a failure of telephone systems at Crosshouse hospital in East Ayrshire over the weekend, with reports that that affected the line to the maternity unit. Will the minister update the Parliament on what was described by the health board as a “major incident”, and will she set out how the Government has responded?

Before you answer, minister, I appreciate that that was a bit wide of the original question. It was really supposed to be a supplementary to the question that is in the Business Bulletin. However, if the minister wishes to say a few words in response, that is fine.

I am more than happy to get an update to the member. The reports that I heard over the weekend and on Monday about that incident were that there was an extremely rapid response to it. It was a strong test of the mutual aid systems that are in place, at a time when the national health service is under the greatest pressure that it has ever endured. The initial reports were that there was really good support from the health boards around the area where that critical failure was experienced.

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Children’s Mental Health Services (Waiting Times)

To ask the Scottish Government whether it will provide an update on the progress it is making to reduce waiting times for children’s mental health services. (S6O-00829)

The Scottish Government has provided record-breaking levels of investment, including our £120 million mental health recovery and renewal fund. As part of that work, we have made an additional £40 million available to improve child and adolescent mental health services, with £4.25 million of that amount specifically dedicated to clearing waiting list backlogs by March 2023. We are working closely with all the national health service boards, particularly those with the most significant performance challenges, to develop and implement detailed local improvement plans that will deliver the CAMHS specification, clear backlogs and meet targets.

Alternative pathways that provide early interventions for children and young people’s mental health at an early stage can prevent mental health issues from becoming more serious and reaching crisis point. What steps is the Scottish Government taking to address the difficulties currently faced by children and families wishing to access alternative mental health services and to ensure that mental health care can be stepped up or down between tiers 2 and 3 without the child’s place on any waiting list being lost?

We are committed to improving access to community mental health and wellbeing support for our children and young people, and their families and carers. In this financial year, we have provided local authorities with an additional £15 million to fund over 230 new and enhanced support services for children and young people. The funding gives local partnerships the flexibility to implement services on the basis of local priorities, with a focus on prevention and early intervention, and as an alternative for those for whom CAMHS is not suitable.

Local authorities have advised us that nearly 18,000 children and young people accessed community-based services between July and December last year, with more than 800 referrals to those services being made by health professionals, which is, as I am sure everyone would agree, encouraging to note.

There are three supplementaries. I intend to take all three. The first is from Craig Hoy.

Amid soaring CAMHS waiting times, Public Health Scotland figures show that antidepressant medication was prescribed to 20,825 children aged up to 19 in 2019-20. That is an increase of more than 80 per cent in a decade and a trebling in relation to those aged 10 to 14. What assessment is the Government undertaking to look into the root cause of that increase and to ensure that young people are not being put on pills when they should be setting out on more positive or preventative pathways?

Before the minister responds, I wish to stress to members that supplementaries are supposed to be supplemental to the question in the Business Bulletin. I just want to make that point again.

The minister could perhaps answer briefly, in so far as the supplementary relates to the question that is in the Business Bulletin.

I think we all have to be careful about how we describe these situations because we do not want to stigmatise these young folk. Beyond that, I think that we have to trust our clinicians, who will do everything that is right and proper to ensure that people are treated well.

I am more than happy to have a discussion with Mr Hoy about these issues outwith the chamber, but I would plead with everyone in the chamber to be very careful about their use of language when it comes to the prescription of drugs.

Three hundred and ninety-two young people were waiting over two years for mental health care. One young person in NHS Grampian was waiting for 2,534 days—that is six years and 11 months—for their care to begin. We get endless promises from this Government, but the waits seem to be never ending. By when can young people expect a decent and timely mental health service?

I agree with Mr Rennie that some of those waits are completely and utterly unacceptable. That is why we are making the investment that we are in clearing backlogs and waiting lists.

Beyond that—and I am sure that Mr Rennie will agree with this, because we have had conversations about it—the best way of dealing with it is to try to prevent folk from having to use acute services in the first place by getting the community investment and preventative spend right.

Our ambition, as I laid out earlier in my answer to Stephanie Callaghan, is to clear backlogs by March 2023.

As members in the chamber will understand, the Government’s efforts are targeted in the main at those health boards with backlogs that existed prior to the pandemic and have been exacerbated by it. We will continue to do that.

I will squeeze in a brief supplementary from Jackie Baillie and I hope that the response will be brief.

The latest CAMHS workforce data shows that there were 190 whole-time equivalent vacancies at the end of 2021, which is double the 2019 vacancy rate. Does the minister accept that CAMHS waiting times will not be reduced if the Government does not get serious about tackling workforce planning? Can he say how many more CAMHS staff there will be, and when?

We are in the process of workforce expansion and there will be vacancies that we need to fill to ensure that we reach an expanded level. We have provided sufficient funding for a minimum of 320 additional CAMHS staff over the next five years. For the first time ever, the Government, with the agreement of a number of health boards, has been recruiting on a national basis to ensure that we can get new workers into our CAMH services across the country. That is so that we can ensure that we get the recruitment right.

That concludes portfolio questions on health and social care. I will allow a short pause before we move on to the next portfolio, so that front-bench teams can change seats.