Subordinate Legislation
Official Feed and Food Controls (Scotland) Regulations 2009 (SSI 2009/446)
Good morning. I welcome everyone to the fourth meeting in 2010 of the Health and Sport Committee. I remind witnesses, people in the public gallery and committee members to switch off their mobile phones and other electronic equipment.
We have received no apologies.
The first agenda item is consideration of a negative Scottish statutory instrument. Members have copies of the regulations, along with a cover note setting out their purpose and any comments for the committee's attention from the Subordinate Legislation Committee. The regulations revoke and re-enact, with changes, the Official Feed and Food Controls (Scotland) Regulations 2007, and apply to Scotland only.
Do members have any comments on the regulations?
No.
Are members content not to make any recommendations to Parliament on the regulations?
Members indicated agreement.
National Health Service (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2010 (SSI 2010/1)
Agenda item 2 is an evidence session on a negative instrument that amends the National Health Service (Charges for Drugs and Appliances) (Scotland) Regulations 2008 to decrease the charges for drugs, medicines and appliances from £4 to £3 from 1 April 2010. Members have a copy of the regulations, along with a cover note setting out their purpose, and comments made by the Subordinate Legislation Committee.
I welcome to the meeting the Minister for Public Health and Sport, Shona Robison MSP, to give evidence on the regulations. She is accompanied by Tom Wallace, policy manager of community pharmacy and primary care infrastructure, Deirdre Watt, team leader in community pharmacy and primary care infrastructure, and Dr Catriona Hayes, statistician in health analytical services.
A motion to annul the instrument has been lodged and will be debated after the evidence session. Once the debate has started, the minister's officials will not be able to participate; they can participate only in the evidence session prior to the debate on the motion.
I invite members to ask questions.
In the recent parliamentary debate about prescription charges, I and some of my colleagues raised the issue of cancer patients and suggested that perhaps we should rebalance how prescription charges are phased out to allow cancer patients to get free prescriptions immediately. Has the minister had time to reflect on that since the debate? If not, will she consider it in future? We have heard from Citizens Advice Scotland and others that people who are in that situation have quite a lot of financial issues, and giving them free prescriptions would make a big difference to them.
That was discussed at length in the debate a couple of weeks ago. In a year, no one will pay anything, so along with everyone else cancer patients will get their prescriptions free.
When we were looking at how to implement the policy, we decided that the fairest approach would be to abolish charges for everyone, because if we selected particular groups for exemption, we would just create more anomalies in the system. Therefore, after fairly lengthy discussions and debates within Government, we decided that the fairest approach would be to abolish prescription charges for everyone.
Rhoda Grant highlighted cancer patients. I could point to many other people who are currently not exempt, such as those who have multiple sclerosis, Parkinson's disease, glaucoma, chronic obstructive pulmonary disease, rheumatoid arthritis or cystic fibrosis, who would say that they should also be exempt and should not have to wait until next year.
We wanted to avoid having a debate among people with different conditions, so we felt that the best and fairest way was to abolish the charges at a point at which everyone would be treated fairly and equitably. That was our position during the recent debate, and it is still our position.
Is it true that, under the current prescription charging regime, some patients are still receiving medication that costs less than the prescription charge that they have to pay?
Can you explain?
The ingredient cost of a prescription is a certain sum of money, and people who pay prescription charges pay the prescription charge. Is it not a fact that some patients are paying more in prescription charges than the cost of what they are getting?
I understand what you mean, and I understand that that is the case. I do not have any figures to show how many people fall into that category. The point is that no distinction should be made on the basis of ability to pay. The issue is that people who are ill should not have to pay a tax on ill health. The principle of abolition is therefore sound.
To go back to Rhoda Grant's point to some extent, we needed to front-load the process of moving towards complete abolition to help those who have chronic conditions. That is why we made the deep 50 per cent cut in the price of prepayment certificates. We recognised that front-loading the process would help those who have chronic conditions as we move towards abolition.
What is the average cost of a prescription?
Dr Catriona Hayes (Scottish Government Health Finance Directorate):
The overall average cost is approximately £11. It might be slightly more than that, but that is the approximate cost.
You have given an average, but I imagine that some prescription drugs cost a fortune compared with others. What is the highest figure, if the average is £11?
And what is the lowest?
I do not have the figures with me, but there is huge variation between drugs that are now relatively cheap, because they have been around for a long time and are produced generically, and drugs that are particularly specialised and new. The gulf is huge. We can send that information, if the committee is interested.
An average figure is sort of useful, but we are all aware that the cost of particular treatments probably comes to thousands of pounds. There are often public arguments about the cost of some drugs.
My apologies for arriving late, minister—it was very rude of me.
This question might have been asked already, in which case I apologise. I heard the tail end of what you just said, and previously I have heard you articulate the broad principles of why your Government wants to end up with free prescriptions. Has the context of the very changed economic circumstances caused you to pause to reflect? Did you take any other considerations into account? The very changed financial circumstances in which we now find ourselves have certainly caused me and my party to consider a range of expenditure commitments. Have they caused you to pause and reflect on the proposed measure, or are you of the view that the policy is unaffected by them?
The economic backdrop is of course a consideration for the Government in determining how to proceed across the board, but we firmly believe that the policy is the right one to pursue, that it helps with the management of people who have long-term conditions and that it assists self-management, alongside other policies. We would not pursue a policy that we did not believe was affordable. We believe that this policy is affordable within public resources, even in the tight financial climate, albeit that it requires significant resources. So far, the policy has been within the budget that has been set aside for it. You are absolutely right that it is a matter of choice, and the economic backdrop is indeed difficult. However, we still believe that it is the right thing to do. People should not be penalised because they happen to fall ill.
The other question is, what is the alternative to what we are doing? Is it to continue with a very out-of-date system? The list of exempt conditions was drawn up a long time ago. If you do not believe that what we are doing is right, what is the alternative? Do we leave things as they are? Do we extend the list of exempt conditions? If so, who is in and who is out? When you start to unpick that, it is quite sobering, because there are hundreds of chronic conditions, and exempting some and not others is not acceptable to us—it would not be fair or based on equity. If all chronic conditions were exempted, only a very small number of people—those without a chronic condition—would pay. Rather than trying to ensure that all chronic conditions were included, we judged our approach to be the cleanest and most effective way of applying this fair policy. If you do not accept that, you have to answer the question, what is the alternative to what we are doing?
I understand that Mary Scanlon wishes to debate the motion, so we now move to the debate on motion S3M-5461. I remind members that officials cannot take part.
In moving the motion, I do not wish to repeat all the points that were made in the recent debate on prescription charges. However, it is worth putting some issues on the record.
As Ross Finnie said, there is no doubt about the financial challenges that the NHS, and indeed every other public service in Scotland, faces. Those challenges will be debated at stage 3 of the Budget (Scotland) Bill this afternoon, and during the passage of every other budget bill for at least another decade.
In these difficult times, it is even more important to look at every pound that is spent, examine whether that is the best use of the limited resource and look at the opportunity cost of allocating money to reduce prescription charges. I noted during the minister's discussion with Ross Finnie that 50 per cent of people in Scotland are already exempt from prescription charges. The 50 per cent who receive free prescriptions account for more than 90 per cent of all prescriptions that are handed out.
The question that we face today is, against a background of efficiency savings and cuts in the health service, should the Government be reducing from £4 to £3 the cost of prescriptions for those who can afford to pay? Every penny spent has an opportunity cost. In a recent debate, the Conservatives suggested that the money could be used to fund a universal health visiting service to ensure that every child under five gets the vital health and development checks that this committee has recommended.
Even with the prescription charges in place, the cost to the taxpayer of prescribed items has risen from £580 million at the start of this Parliament to more than £1 billion now.
Already, 10 per cent of the population of Scotland are on antidepressants, despite the Government target to reduce antidepressant prescribing. Antibiotic prescribing also continues to rise, despite the link with hospital-acquired infections. Last year, I mentioned the 7 per cent increase in antibiotic prescribing in Wales, where prescription charges have been abolished, compared with the 1 per cent increase in England for the same period.
The Government estimates that the increase in prescriptions would be 1 per cent in the first year, and then another 1 per cent, 2 per cent and 5 per cent on abolition. We do not have up-to-date figures for what is happening in Scotland in our briefings. In Wales, the increase in prescriptions was 5 per cent in the first years, and then 4 per cent and 6 per cent on final abolition. That is well above the Scottish Government's estimates. For the Welsh equivalent of this year's reduction from £4 to £3, the increase in prescriptions was 5.44 per cent, compared with the Government's estimate of 1 per cent. Has the minister reviewed any of the estimates since prescription charges were reduced and how the cost to the taxpayer has changed?
I, and a couple of my colleagues, raised the issue of wastage last year. Has anything been done to address that?
In the unlikely event of my winning the vote today, I ask the Government constantly to review prescribing practices to ensure that prescriptions are given only when appropriate and when there is nothing better to address the condition. The example that I give, which I make no apology for repeating, is mental health. I know that it is easy to hand out antidepressants to get a patient out of the surgery, but, in the long term, psychiatry, psychology, counselling and other talking therapies might be the preferred and appropriate approach to treating the person's condition.
I move,
That the Health and Sport Committee recommends that nothing further be done under the National Health Service (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2010 (SSI 2010/1).
I will ask other members to raise points and then allow the minister to answer them. I will then allow Mary Scanlon to wind up.
Mary Scanlon has made some very good points. Certainly, probably too many antidepressants and antibiotics are being prescribed. However, I part company with her on how to reduce that number through prescription charges. The logic behind the position is that those who do not need antidepressants will not collect their prescription, but the patient is often not the best person to make that judgment. If too many antibiotics and antidepressants are being prescribed, the remedy is to tackle those who are writing the prescriptions by counselling them and educating them so that they do not prescribe so many of those medications. I am not so concerned about the proposal's effect on the chronic sick, because they can already get a season ticket that adjusts the price so that the cost is not huge.
From my time in general practice, I know that the people who are hardest hit by prescription charges are those who are on a limited income and who are not entitled to free prescriptions who suddenly need three or four medicines to cope with an episode of acute illness. Such people will often ask the chemist, "Which of these are the most important, because I can't afford all of them?" I was often told, "I can't get my medicine until pay day." When people need to wait for two or three days before they can buy a prescription that they need urgently, they can place a bigger burden not only on society in general but on the health service, because they might then need more expensive treatment.
A course of penicillin for an infection—I checked this the other day—costs the NHS £1.27. Charging people £4 for that means that we are profiteering from people's illness by charging more than the private sector would charge.
Finally, what is the logic of confining charges only to medicines? An equally applicable case could be made for charging people for visiting their doctor. That would cut down on the number of prescriptions that are dispensed, because people would not go to the doctor so often. If we charged people for going into hospital for an operation, we might have fewer operations and thereby save the health service money. Once we accept the principle of charging at point of need, we open up a whole Pandora's box of charges that could be levied. I believe that that is the wrong way to go. For those reasons, I oppose Mary Scanlon's motion.
Before taking part in this discussion, it might be advisable that I declare an interest—this is not in my register of interests, but I mention it for the sake of fairness and equity—by clarifying that I am a holder of an exemption certificate. That is probably a fair declaration to make in the context of this debate.
This year more than previously, I am concerned about the changed economic circumstances, which I raised with the minister earlier. In response to Ian McKee's closing argument, I point out that the regulations deal specifically with charges for drugs, and there is no suggestion—certainly from me, although I will not go into what others might suggest—of introducing charges for operations or for visiting general practitioners. Not everything that one gets from the NHS at the point of need is free—people are required to pay for dressings and all sorts of things—so we should confine our consideration to prescription charges.
As I indicated to the minister, our concern arises from the current economic climate. I accept that the cohort of people whom the minister identified includes certain persons who have long-term conditions, but that cohort also includes people who are perfectly able to pay for their prescriptions, even in the present economic circumstances.
The minister invited me to consider what the alternatives are. Having been a member of the previous Government, I am aware that whether an illness is designated in the list of long-term conditions can almost depend on which adviser one speaks to. Some advisers are more able to give an answer; others seem to produce a list that gets ever longer. However, given the present financial circumstances, I think that an alternative option would be to increase that list in a way that is consonant with its being an interim measure.
I am not content, considering the priorities for the health service as a whole, and given that not everything in the health service is free, that the proposed policy is a sensible allocation of resource in these circumstances. Therefore, for different reasons, I support Mary Scanlon's motion to annul.
I hear what Ross Finnie says, but given that—as Rhoda Grant mentioned earlier—cancer is an issue of life-threatening urgency, the Government has been remiss in not addressing that policy area. The minister mentioned other diseases that are serious, chronic, and long term, many of which are potentially life threatening, but the urgency of cancer is such that people cannot wait. The illness, as we see when we visit our friends, relatives and constituents, eats up people's resources quickly and acutely, which is why we are most concerned that the Government has not addressed that point.
It is fine to say that all people with long-term conditions might have to wait until next year, but what will they do in the meantime? For the past three or four years, nothing has been done about the issue. The policy area is hugely divisive: we would all love to have universal benefits such as free school meals and free bus passes—which we already have to some extent—but, as Ross Finnie rightly points out, the issue is whether we can continue to afford such things.
Like every other MSP in the room—apart from the minister—I earn £57,631 a year. I feel that it is ignominious that I am entitled to free prescriptions—I get them because I am over 60—when people who are suffering from cancer are not. Those people need help in so many ways, for example with their travel expenses and their medication. I visited a Maggie's Centre only a fortnight ago, and I was so impressed with the work that is done there. It is so wrong that we are not addressing the needs of cancer patients.
I have great sympathy with the point that Helen Eadie and Rhoda Grant have made. However, the recent debate in Parliament brought to my attention the British Medical Association's paper on the subject, which makes clear that although the BMA has every sympathy with the proposal to single out cancer patients, as has happened down south, it believes that that is extremely unfair, and that such a system produces winners and losers. The BMA's view—which happens to be the Government's position—is that the fairest way forward is to abolish prescription charges, because otherwise there would be a lot of losers.
I do not always quote the BMA, but in this instance I will rely on its view, as it considers, on behalf of its many members and the many patients whom they deal with, that that is the way forward. We would love to abolish all charges immediately, economic weather permitting, but—to use an awful expression that I have said I would never use—the direction of travel towards abolishing prescription charges is just fairer, although I have huge sympathy for people with cancer.
In Northern Ireland, an important project on cancer patients and access to benefits was undertaken that turned out to be important in changing the benefits system there. It found that people who had cancer were getting benefits, but that they were disallowed from claiming those benefits once they were in remission. The rules on that were changed as a result. That issue needs to be addressed in Scotland. It would be useful if some charities in this country examined the Northern Ireland project and the way in which it was used to increase the benefit supply to cancer patients in particular.
Does anyone else want to comment?
I apologise for being late and missing the beginning of the debate. I do not know whether the issues that I want to raise have been covered.
There is no doubt that the fairest system is one with no prescription charges at all: it is simple and easy. I thought that such a system would mean that we would get rid of the entire bureaucracy around those who have to apply for exemptions, but we now know, of course, that we will not get rid of that bureaucracy, because anyone who wishes to be in the minor ailments scheme will have to continue to apply for exemption. The same exemptions will apply and there will be the same unfair boundaries that existed before. We will not get rid of the bureaucracy, and all the costs and paraphernalia around it will be retained in 2011. That important issue has not been fully addressed. It is clear that there will be unfairnesses wherever the boundaries are drawn, but we will simply swap one set of unfairnesses for another in 2011. Admittedly, the situation will be less onerous, but there will nevertheless be unfairnesses.
The fact that cancer was the subject of a manifesto commitment makes it different. The Labour Party has pursued that in debates, and we still think that it is appropriate to do so. I accept what Christine Grahame said in a personal capacity about the emphasis on benefits, ensuring that people are given the proper advice, and how that is undoubtedly helping, but there are, nevertheless, individuals with cancer who need treatments for other conditions and who find things difficult.
I support the idea that we need to change the system. The previous system was out of date, unfair and contained appalling anomalies; for example, extremely wealthy people who had conditions such as an underactive thyroid received all their treatments free. That approach has no logic, and I do not really understand the original basis for it. It was probably taken because substantial numbers of people with underactive thyroids went mad before the health service came in and the consequences of that were significant. I do not think that anyone around this table would say that the previous system was fair or that it is not extremely difficult to try to apply an approach to one set of long-term conditions but not to another. That is very tough. We can guess what constitutes a long-term condition, but there will always be a boundary. It seems to me that, if we were going to have a system of prescription charges, we would need to look abroad to the systems that are based entirely on income.
I have considerable sympathy with the point that Ross Finnie made—I am sure that Mary Scanlon made the same point and I missed it. In the current climate, in which resources will be very constrained, people who are better off must make an additional small contribution. That issue will need to be revisited.
In the present situation, the Government wishes to pursue a continuing reduction of prescription charges to their abolition. I will certainly not oppose that; that is the Government's decision, based on its budget. However, we will watch closely, as we have repeatedly said in debates. We will ask serious questions about decisions on resources the first time a patient does not receive a cancer drug from a health board on financial grounds.
The costs of medicines have been restrained in the past two years compared with their costs in the previous decade, because procurement has become much better and the savings on procurement have been substantial, which has prevented the drugs bill from going up. However, that is temporary and we cannot increase the number of generic prescriptions, the figure for which is already 90 per cent. Howat and Crerar made it clear that there are very few further savings to be made in that respect. Future savings on the drugs bill will be small. New drugs are coming out that will be horrendously expensive. The question how the country will be able to afford those drugs needs to be seriously addressed as we go beyond 2011, when budgets that are continuing to increase at the moment will start to reduce for the first time.
The minister may address points that have been raised in the debate before Mary Scanlon sums up.
There is quite a lot to deal with.
It is two weeks since we fully debated prescription charges in Parliament. I welcome the opportunity to explore the issues again.
Obviously, we are discussing the penultimate step towards abolishing prescription charges for all patients in Scotland. Mary Scanlon has suggested that only those who can afford to pay will benefit. I have no doubt that the removal of the tax will be of most benefit to the sickest and the poorest people—the people to whom the vast majority of medication is currently dispensed. For example, we estimate that 600,000 adults in families with incomes that are less than £16,000 who must currently pay charges will benefit when they collect prescriptions.
Mary Scanlon said during the debate that there were anomalies in the previous system. I agree. However, she and the rest of the committee need to be clear that there are anomalies in the current system and that we can get rid of them only by abolishing charges for all. Mary Scanlon seems to be saying that because of the opportunity cost, there should no further change to the system. She seems to be arguing that every penny that we are spending on the policy should go towards something else, which means, de facto, that there should be no change to the current system. People with multiple sclerosis, Parkinson's disease, asthma, glaucoma, COPD, dementia and so on would continue to pay for their prescriptions and the anomalies in the system would continue. We do not believe that that would be right.
Abolition will also ensure that all patients can follow their GP's clinical judgment and guidance—Ian McKee made that point—and collect all the medication that is required. They will not have to make the choices that some have had to make.
"There is no doubt that the reduction will lead to better compliance."—[Official Report, Health and Sport Committee, 18 March 2009; c 1682.]
Those are Mary Scanlon's words. I have no doubt that she is right and I welcome that position. We, too, believe that the investment will lead to further compliance and improve patients' health.
As I said to Rhoda Grant in evidence, our policy approach does not single out individual conditions but has already ensured that all patients, regardless of their health condition, are benefiting. That includes the 190,000 people—100,000 more than previously—who own prescription prepayment certificates. All those people are likely to have long-term conditions.
A number of questions were raised: I will try to respond to them all. Mary Scanlon asked about the evidence so far. Overall, our assumptions included a 2 per cent increase in non-exempt scripts—that is, PPCs and paid scripts—in 2008-09. The actual figures showed that the 2 per cent assumption was robust, but I say to Mary Scanlon that we do monitor the system and keep it under review. Of course, issues such as prudent prescribing are crucial. They always have been and are no less so now.
I want to touch on the issue of cancer patients again. Helen Eadie said that cancer patients will have to wait for another year, but of course they waited for eight years up to 2007 with no change whatever to the prescription charges that they had to pay. When we came into government, we decided that that was wrong and that we should therefore begin to abolish prescription charges. I have explained the reasons why we chose to proceed as we did instead of selecting people with certain conditions. People with cancer and other conditions are already saving a huge amount of money through prepayment certificates. A patient who bought an annual PPC in the past year will save nearly £61 compared with pre-policy prices. That is money that cancer patients are saving now that they did not save before 2007.
Richard Simpson's point that he will raise the issue every time a cancer drug is not given by a health board is disingenuous, given that the matter was of as much concern under the previous Administration, although there was no proposal to abolish prescription charges. That is why Nicola Sturgeon, the Cabinet Secretary for Health and Wellbeing, took the action that she did to make the process around decisions on drugs much more transparent. I believe that we now have a good system through the Scottish Medicines Consortium, and that we have safeguards and transparency in the system that did not exist before 2007. It is disingenuous to try to link the two issues.
Ross Finnie mentioned affordability, which I have touched on. The judgment is this: two thirds of the prescription items that are not exempt are for long-term conditions, so if we accept that changes have to be made—Ross Finnie acknowledged that the present system is not right—we must ask what system we should introduce. A system that is fair and which exempts everyone who has a long-term condition will not cost very much less than full abolition. We have been over and over the figures, and I assure the committee that that is the case.
I should say that prescribed dressings will be free as well—I think that Ross Finnie mentioned that.
I hope that I have managed to address the points that were made. The abolition of prescription charges is a point of principle, but it will have practical effect. We believe that it will help people who have chronic conditions to manage their conditions. It will also help to ensure that people comply with requirements to take medication, which we know has been not happening because of cost. Abolition is a fairer way of proceeding than picking and choosing certain conditions on the basis that they are somehow more important than others. I hope that this time next year I will again be before the committee to complete the final stage of the abolition of prescription charges. I oppose the motion in the name of Mary Scanlon.
There are no rumours of a reshuffle, to the best of my knowledge. I am sure that you will be here next year. You have my assurance—you know what it is worth.
I think that I have discombobulated the minister.
I think that the minister was in a better position before you said that.
Mary Scanlon will wind up.
I thank all colleagues for their comments.
The minister mentioned that last year the number of prescriptions increased by 159,000 following the reduction in charges. Other more appropriate and more effective solutions should not be shelved, given that charges are being reduced. That is the main context of my motion. I mentioned the 7 per cent increase in prescribing of antibiotics in Wales, when the increase in England over the same period was only 1 per cent.
When I spoke to my motion, I could have gone on for 10 or 20 minutes—[Interruption.]
There has just been a groan to my right.
I appreciate that. We recently had a parliamentary debate on the subject, in which many of the issues were raised, so I did not think that it would be appropriate to repeat what had already been said—I say that in case anyone criticises me for missing anything out. I am sure that colleagues understand.
I appreciate the difficulties to do with conditions that do not result in exemption from prescription charges—that was very much an issue in the parliamentary debate.
Ian McKee and I got off to a bad start on prescription charges last year. It has been slightly better this year, although it was never suggested that patients should be charged for an operation or to visit a GP, so I say to him, with the greatest respect, that I feel that it was inappropriate to include those points in today's debate, as they are not related to it.
Spending on the national health service has only ever reduced in one year. I apologise to Helen Eadie for saying so, but that happened under a Labour Government in the 1970s, following instructions from the International Monetary Fund, so I will take no lessons from anyone, given that spending on the NHS increased over all the years during which the Conservatives were in government.
I thank Ross Finnie for his measured and considered remarks. I also thank him for taking into account the realities of the current economic situation, to which I will return.
The issue with cancer patients is not about them queueing up at pharmacies for over-the-counter drugs. It is, rather, as Richard Simpson said, about their being denied drugs that have been recommended by oncologists in acute hospitals. It was the initial denial of such drugs to Michael Gray that led to a petition being submitted to the Parliament two years ago.
Last year I met the support group for oesophageal cancer, which is concerned about lack of recognition and the failure to give people surgery. Today I have tried to point out that, when money is spent on one issue, it is lost to another.
I thank my Labour colleagues, Rhoda Grant and Helen Eadie, for their contributions. Government ministers have argued that scrapping prescription charges will abolish bureaucracy, but we know that it will not. The minor ailments scheme is excellent, although Richard Simpson was right to acknowledge that a bureaucracy will still be needed to determine who is on benefits and eligible for the scheme.
It is unfortunate that the minister came to today's meeting with a prepared speech and did not address many of the issues that I raised in my short opening speech. I did not say that those who can afford to pay prescription charges will benefit, as the minister suggested in her prepared speech, and I did not mention compliance, which is important but has been debated. The minister did not acknowledge at all the serious economic climate that we face and the huge debt that this country has to pay. She did not address the review of wastage, about which I asked. I also asked whether there would be a review of appropriate prescribing and used the example of mental health patients, for whom antidepressants are not always the best or most appropriate solution. Given that the minister did not address many of the issues that I raised, I will press the motion in my name.
Before I put the question on the motion, I invite the minister to address a couple of the issues that have been raised.
Mary Scanlon and Richard Simpson mentioned the minor ailments scheme. We have been utterly clear about the issue from the beginning, as Richard Simpson knows from the two parliamentary questions that were answered in August and September 2008, which clearly laid the policy intention out. I am sure that he will have reflected on that. At a meeting of the committee last year, he said:
"The minister has a number of questions to answer, the first of which is on the minor ailments service. She will know that I have asked about that in parliamentary questions. The response has been that the service is not to be extended when free prescriptions are extended to all patients."—[Official Report, Health and Sport Committee, 18 March 2009; c 1688.]
In reply, I made our policy intention clear. As Richard Simpson's words demonstrate, he knows what the policy intention is. The minor ailments service is a service for people who are already exempt, the purpose of which is to prevent those who are high users of prescription and over-the-counter medicines from going to their GPs.
On a point of order, convener. The minister is supposed to be addressing the issues that Mary Scanlon raised.
I confirm that Mary Scanlon raised the issue of the minor ailments scheme. However, the minister was tending to address Richard Simpson's points. It is Mary Scanlon's motion, so the minister should address the points that Mary made. I will allow Mary Scanlon to respond in conclusion. I invite the minister to respond to the other issues that the member raised.
Mary Scanlon picked up especially on Richard Simpson's argument that a bureaucracy would be left in place around the minor ailments service, which is a good service that prevents people from going to their GP. That is why we will continue with the service. That has been made clear all along, as Richard Simpson and Mary Scanlon both know.
I will respond to Mary Scanlon's other points. I made it clear that we keep every bit of information under constant review. We receive regular monitoring reports on the impact of the policy. Mary Scanlon is absolutely right that prudent prescribing is critical—it always has been. A lot of effort has gone into this, and we have had no indications from GPs or health boards that the policy is having an adverse impact on either GP consultations or health boards' ability to manage their budgets. I reassure Mary Scanlon that we are scrutinising every aspect of the policy and will continue to do so as we move towards the abolition of charges.
I thought that, when I wound up the debate, it was the end of the debate and the motion would go to a vote. I do not wish to continue the debate, as we have a huge amount of business to get through. However, Richard Simpson has a point. No one has said that the minor ailments scheme is not a good service. I feel that, the longer we go on about this, the more the minister is misrepresenting what has been said. It is an absolutely excellent, first-class service and no MSP would say that it is not. Therefore, the minister should not say to me or my Labour colleagues that we are attempting to criticise the service. Nevertheless, Richard Simpson has a point. Pharmacies must decide who is eligible, and not everyone is eligible for the minor ailments scheme.
I have heard a repetition of what was said before. Yes, there is constant review—that is easy to say—but I still have not heard that wastage or mental health are being addressed. Therefore, I would like to end the debate, if I may suggest that.
Absolutely. I just thought that, as some points that you raised in your summing up had not been addressed, it was only fair to allow the minister to come back in and then to allow you to respond to what she said. I take it that you are pressing your motion, Mary.
Yes.
The question is, that motion S3M-5461 be agreed to. Are we agreed?
No.
There will be a division.
For
Ross Finnie (West of Scotland) (LD)Mary Scanlon (Highlands and Islands) (Con)
Against
Helen Eadie (Dunfermline East) (Lab)Christine Grahame (South of Scotland) (SNP)Rhoda Grant (Highlands and Islands) (Lab) Michael Matheson (Falkirk West) (SNP) Ian McKee (Lothians) (SNP) Dr Richard Simpson (Mid Scotland and Fife) (Lab)
The result of the division is: For 2, Against 6, Abstentions 0.
Motion disagreed to.
I thank the minister and her team, and I suspend the meeting briefly for a change of witnesses.
Meeting suspended.
On resuming—
Public Appointments and Public Bodies etc (Scotland) Act 2003 (Amendment of Specified Authorities) Order 2010 (Draft)
We move to item 4 on the agenda, which is subordinate legislation. This is an oral evidence session on an instrument that is subject to affirmative procedure—the draft Public Appointments and Public Bodies etc (Scotland) Act 2003 (Amendment of Specified Authorities) Order 2010. The order will amend schedule 2 to the Public Appointments and Public Bodies etc (Scotland) Act 2003, which lists the specified authorities to which the code of practice that is published by the Commissioner for Public Appointments in Scotland applies. Members have a copy of the draft instrument, along with a paper that sets out the comments of the Subordinate Legislation Committee. I welcome the Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, who will give evidence on the draft instrument. She is accompanied by John Swift, the head of the health public appointments unit, and by Gillian Russell, the divisional solicitor for the health and community care division. I welcome you both.
A motion that the committee recommends that the order be approved has been lodged. As with the previous item, the motion may be debated following an evidence-taking session. If there is a debate, the cabinet secretary's officials will not be able to participate.
If members have no questions, and no one wishes to debate the motion, I ask the cabinet secretary to move the motion.
Motion moved,
That the Health and Sport Committee recommends that the draft Public Appointments and Public Bodies etc. (Scotland) Act 2003 (Amendment of Specified Authorities) Order 2010 be approved.—[Nicola Sturgeon.]
Motion agreed to.
Health Board Elections (Scotland) Amendment Regulations 2010 (Draft)
The next item is an oral evidence session on the draft Health Board Elections (Scotland) Amendment Regulations 2010. They amend the Health Board Elections (Scotland) Amendment Regulations 2009, which set out the arrangements for pilot health board elections. Members will have received a copy of the draft regulations along with a paper setting out comments from the Subordinate Legislation Committee.
The Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, is still with us to give evidence on the draft regulations. She is accompanied by Robert Kirkwood, business planning executive, and by Gillian Russell, divisional solicitor in the health and community care division of the Scottish Government. A motion that the committee recommends that the regulations be approved has been lodged and will be debated following the evidence session. Once the debate has started, the officials cannot participate.
I invite questions from members.
I have more of a comment than a question, convener. I raised and pursued this issue during the passage of the Health Boards (Membership and Elections) (Scotland) Bill, and I am bound to say that I think that the instrument clarifies perfectly adequately the points that were highlighted by the committee, raised in the various debates and responded to by the cabinet secretary.
Indeed, I am slightly puzzled as to why a secondary question now appears to have arisen. I never thought that there was any doubt that if a person with a residence qualification applied to be included on the electoral register and, having been accepted, was granted the right to vote as is required under the legislation, the person who had to decide the constituency in which they exercised that vote was the person on whom the right had been conferred. I cannot understand why the Subordinate Legislation Committee suggests that it could be inferred that an electoral registrar might have such a right, and I do not share that committee's confusion on the matter; I am quite clear that it is the elector who must make that decision if they are not to fall foul of the principal legislation.
Secondly, as the cabinet secretary pointed out during the passage of the primary legislation, the act makes it quite clear that a person will not be able to vote twice. I interpret that to mean that anyone who tried to do so would be breaking the law, which is why it does not surprise me that it was suggested that an offence be introduced in that respect.
I am quite clear, Presiding Officer—
Presiding Officer!
You are going up the chain, convener. It is happening to everyone.
I am quite clear that the amendment regulations will do what they set out to do, which is to clarify issues that were raised during stage 2 of the Health Boards (Membership and Elections) (Scotland) Bill. At that time, the cabinet secretary committed to providing clarification so, on this occasion, I find myself wholly supporting the regulations. It is perfectly legitimate for the Subordinate Legislation Committee to raise such issues—after all, that is its job—but I do not believe that those concerns cause any problems for agreeing the regulations.
Those comments were more points for debate, but they are nevertheless on the record.
Motion moved,
That the Health and Sport Committee recommends that the draft Health Board Elections (Scotland) Amendment Regulations 2010 be approved.—[Nicola Sturgeon.]
Motion agreed to.
That was short and sweet. I suspend for five minutes.
Meeting suspended.
On resuming—